Originally Posted by Deb C

Your absolutely correct. The doctor shortage and fewer students being able to afford the extraordinarily expensive price of becoming a doctor, is a festering problem in this country. It appears that we would rather penalize doctors and keep future doctors tied to debt, than take money out of the greedy hands of the insurance industry.

When people start complaining about doctor pay, they need to realize the expense of their education, overhead costs of insurance, paying off student loans, and the emotional toll of being responsible for the lives and well being of human beings. This country needs to stop punishing doctors and teachers, while they so loyally bow to the greed of the giant corporations.

It seems that the insurance companies will do well under ACA.
There should be better way to reach consenus on approach.

- in a cacophony of hysteria - worth a read.

I've highlighted the part about Maternity Care and Mental Illness (funny how those go together ) which really goes to the heart of the societal aspect of the "better plans" under the ACA. I also further highlighted a sub-paragraph in that section that what is really happening here is making the individual market consistent with the employer-based insurance requirements. I believe this give much greater resonance to this issue than what is usually discussed (i.e. "bro, my insurance is going up and I'm a guy who doesn't need maternity care!")

And then, of course, I highlighted the piece about how the insurers' profiteering is being very limited by the Medical Loss Ratio that a lot of people around here conveniently forget when they start getting hysterical about the mean old insurers. I'm thinking that this is eventually going to put a lot of insurers out of business and start opening the door to.... psss, best not to mention it. Shhhh.

Also, I highlighted a piece on subsidies for deductions that even I had never heard about! Very cool!

And, of course, I highlighted the last paragraph that should be obvious to anyone who is really interested in reality instead of flogging their favorite magic pony to poop a golden nugget.

I Just Lost My Insurance Because of Obamacare. What Do I Do?
A step-by-step guide to replacing your health insurance

Insurance companies have cancelled policies for several million Americans, causing widespread confusion and anxiety. Here’s an attempt to explain what’s happening and why—and what you can do if you’ve received one of those letters.

I JUST GOT A LETTER FROM MY INSURANCE COMPANY, CANCELLING MY HEALTH POLICY. WTF?

Sorry to hear that. It’s pretty scary. Most likely it’s a by-product of the Affordable Care Act—you know, “Obamacare.” You can get a new plan, but you may not find one just like your current policy. The price might be different, too.

I THOUGHT PRESIDENT OBAMA SAID I COULD KEEP MY PLAN IF I LIKE IT. I’M PISSED OFF.

That’s fair. The vast majority of Americans get their health insurance from large employers or from government programs like Medicare and Medicaid. Not much is changing for them. But the law is reorganizing the “non-group” market. That’s for people who buy insurance on their own, directly from insurers. It’s a small portion of the population, but it’s a big country so that’s still a lot of people—probably a few million. It sounds like you’re one of them.

BUT WHY DISTURB INSURANCE FOR PEOPLE LIKE ME?

Because the non-group market is pretty messed up. It’s probably the source of most health insurance horror stories you’ve heard.

or one thing, insurers don’t like to cover people who might actually get really sick and run up big medical bills. When you apply, they check your medical history and records. If insurers find evidence of pre-existing medical conditions—or something about you, like your age, makes you a likely candidate for illness—they won’t offer you a regular policy at a normal price. They might charge you higher premiums. They might refuse to cover services related to pre-existing conditions. Or they might deny you coverage altogether. This is called “medical underwriting.”

In the past, if you got sick, insurance companies would frequently scour your records all over again, just to see if they could find something—anything—that was an early sign of illness. If they found one, they’d refuse to cover your bills and you’d be stuck with tens or even hundreds of thousands of dollars of medical bills. That was called “rescission.” Pretty much everybody thought that was awful. It was a big scandal. Obamacare prohibited that practice.

The other big problem with the non-group market is that insurers frequently sell policies that have really big gaps in coverage. The worst of these are so-called “mini-med” plans. You pay some absurdly low monthly fee—$25 or maybe $50—so it sounds like a great deal. But the benefit might consist of covering just a few doctor visits, or maybe a few hundred dollars a year. Then you’re on your own.

Even more generous policies on the non-group market frequently leave out key services. They might not include rehabilitative services or mental health or maternity. They might have huge deductibles, like over $10,000 for one person. They might have no limit on how much you could pay out of your own pocket. People usually don’t know about this when they buy the policy, because insurance is pretty confusing. They only find out after they’ve gotten in an accident or developed some ailment—and discover the huge bills.

SO WHAT DOES OBAMACARE DO ABOUT THIS?

It puts an end to medical underwriting. Insurers have to sell policies to anybody willing to pay the premiums. And they can’t charge people more, or hold back benefits, to people with pre-existing conditions. They can charge older people more than younger people, but the rates can’t vary by more than a factor of three. (Today, insurers will typically charge older people as much as five times what they’d charge a younger person.) The only other variable insurers can use in pricing is smoking: If you’re a tobacco user, they can charge you more.

The other big change is on the benefits side. The law sets a broad standard for how much coverage all policies must provide. At a minimum, they must provide an “actuarial value” of 60, which is like saying the policy must cover 60 percent of the typical person’s medical expenses. There’s a limit on out-of-pocket expenses: If you have an Obamacare policy, and over the course of a year you end up spending more than $6,350 in co-payments, deductibles and so on, the policy must pick up additional charges completely, as long as they are part of your covered services. (For a family, the out-of-pocket maximum is twice that—$12,700.)

The law also establishes a set of “essential health benefits” that all policies must cover. The standard is a little complicated to explain, but it’s more or less like the requirements now in place for most small business policies—with specific guarantees of prescriptions, mental health, rehabilitative services, and maternity, among other things.

Insurers who scrapped their old plans did so either because state regulators ordered them to do so—or because the insurers decided, for business reasons, to start anew rather than modify existing plans to meet Obamacare guidelines.

MATERNITY AND MENTAL HEALTH, HUH? WHAT IF I DON’T NEED THEM?

This has been a subject of debate lately. Some people would argue it’s wrong to make you pay for services you don’t think you will need. Others would argue that’s the whole point of insurance—to get you paying for a menu of services, only some of which you might need. For example, most insurance policies cover cancer. You might never get cancer, but most people want to insure against the risk of it. Why not mental illness and other services the law requires that insurance include?

Maternity and pediatric services are a bit different, since only women actually use maternity care and only people with children need pediatric care. Some would say men shouldn’t have to pay for maternity and that people shouldn’t pay for pediatric services if they don’t have or expect to have kids. Advocates for including these would argue that they are an investment in the public good that pays in the long run, that men are equally responsible for parenthood even if they don’t physically carry babies, and that getting born XY rather than XX is precisely the sort of random event for which insurance is supposed to pay. Also, for what it’s worth, lots of people don’t plan to have kids but end up with kids anyway.

Do keep in mind that, for better or for worse, employer policies operate by the same principles. Employees pay the same premiums, regardless of gender or medical condition. And while employees sometimes have choices over benefits, particularly at really large companies, they don’t typically get to choose whether to include stuff like mental health and maternity.

SO WHAT KIND OF OPTIONS WILL I HAVE?

Each state has its own marketplace, with its own insurers and multiple plan options. By law, the benefits fall into different categories—bronze, silver, gold, and platinum. Bronze plans are the least generous: For the typical person, they’d cover about 60 percent of medical expenses. Platinum plans are the most generous: They’d cover about 90 percent of medical expenses. People under 30 have the option of enrolling in special catastrophic-only plans, which are pretty similar to the bronze plans but structured a bit differently and sometimes cheaper. See this FamiliesUSA guide to the metal levels if you want more specific information.

The plans are available to anybody, regardless of pre-existing condition. They must cover each of the essential health benefits, with the out-of-pocket limit I mentioned previously. But every plan will structure its benefits differently. You'll want to pay close attention to the co-payments and deductibles, which are the costs you pay out-of-pocket when you go to the doctor, pick up a prescription, and so forth. Those costs can get pretty high. You might be surprised—and in some cases surprised unpleasantly—to learn how threadbare even some of the new Obamacare policies can be.

Before you make any decisions, a little background reading might not be a bad idea. Consumer Reports has a good interactive guide to Obamacare. The Kaiser Family Foundation has more resources for people who want to learn about the new law. HealthInsurance 101 is another useful resource.

HOW DO I LEARN ABOUT MY OPTIONS AND PICK ONE?

The primary method of enrollment is supposed to be online. The federal government is running websites for 36 of the state marketplaces, while 14 states plus the District of Columbia are running their own. If you just go to healthcare.gov, it will direct you to the proper site. If you want help from a human being, you can use a toll-free number or visit a “navigator” in person. Navigators are people the federal government and state trained to help people enroll. You can also try enrolling via an insurance broker or insurance company, as people have traditionally done, or by printing out the paper application (from healthcare.gov) and mailing it.

SOUNDS GREAT. BUT I HEARD THE WEBSITES AREN’T WORKING.

This has been a huge problem. Most of the state-run sites are working pretty well right now, after some early glitches. The best seem to be in California, Connecticut, Kentucky, and New York. But the federal site, healthcare.gov, barely worked for the first few weeks. Performance appears to have improved a great deal in just the last few weeks. More and more people are using it successfully. But some still run into errors.

President Obama has said that most people will be able to use the federal sites by the beginning of December, in time to arrange coverage for January. But if the site can't handle the expected rush of traffic, the federal government is going to have to rely more heavily on alternative methods of enrollment—or come up with some other contingency plans, so that nobody goes uninsured at the beginning of the year. They’ll probably think of something, but it might be pretty cumbersome for everybody involved—state officials, insurers, doctors and hospitals and pharmacies, and, of course, people like you. This is another good reason to be angry.

WHEN I GO ON THE WEBSITES, I’LL FIND THESE NEW PLANS WITH THESE NEW BENEFITS, AVAILABLE TO EVERYBODY. SUPER. BUT WHAT ARE THEY GOING TO COST ME?

Good question. The requirement that insurers sell to everybody and the requirement that all plans include comprehensive coverage will tend to make insurance more expensive in most states. Think of this way: We’re telling the insurers they must cover sick people they wouldn’t cover before and include benefits they wouldn’t include before. That means they’re going to spend more money. In response, they’re going to raise premiums.

How those prices compare to your current policies will depend on what you have now and where you live. In states like New York, which already had many of these regulations, the prices will tend to come down. But most states don't have such regulations on the books already. In those places, the premiums will tend to go up.

I KNEW IT: OBAMACARE IS GOING TO MAKE ME PAY MORE FOR MY INSURANCE, RIGHT?

Not so fast. The law is changing a bunch of other things, too. It’s introduced a bunch of “payment reforms” into Medicare that will encourage doctors, hospitals, and drug and device makers to be more efficient and lower their prices. Many experts believe the industry is already responding and that those responses are one reason health care costs aren’t rising as fast as they have in the past. You might not notice these savings, because they are the equivalent of premium increases you’ll never see. But they appear to be real. And they are supposed to get bigger over time.

The law also has something called the “medical-loss ratio.” It’s basically a limit on how much money insurance companies can divert to profits and overhead. Or, to put it another way, it’s a requirement that insurers spend most of their money on actual medical services for beneficiaries. This is basically a check on insurance company profiteering and, to the pleasant surprise of many experts who were skeptical of it, it seems to be having some effect. The provision went into effect not long after the Affordable Care Act became law and, already, several million Americans have gotten rebate checks because of it.

BUT I HEARD PREMIUMS WERE DOUBLING OR MORE IN SOME CASES, EVEN WITH THOSE CHANGES.

Again, you’re hearing only part of the story. The law also has subsidies, in the form of tax credits. And these are very special tax credits. You don’t have to wait until the end of the year to file for them. You get them right upfront, when you buy your insurance policy through one of the marketplaces. It’s basically like a discount on the sticker prices and for some people the discount will be huge—like thousands of dollars a year, almost as much as the insurance itself. For several million people, the price of the cheapest available policy will be absolutely nothing. The plan will be free. Of course, those are the bronze plans that don’t offer much coverage and those people might want to pay a little more to get better insurance. Also, remember that not everybody gets those tax credits.

SO WILL I GET ONE OF THOSE DISCOUNTS?

It depends entirely on your income. The subsidies are largest for people whose incomes are at or just above the poverty line, which is about $11,000 for an individual and $24,000 for a family of four. The higher your income, the less money you get. Once your income becomes higher than 400 percent of the poverty line, which is roughly $46,000 for an individual and $94,000 for a family of four, you are no longer eligible for subsidies. You’d have to pay the full insurance premium.

To see what kind of subsidy you would probably get, try out the Kaiser Foundation's "subsidy calculator." It will tell you how much you'd have to pay for the second-cheapest silver plan in your area, as well as the cheapest bronze plan. It's not an official estimate. And the actual premiums will be different if you decide to choose a different insurance plan.

By the way, the law has a second set of subsidies that haven’t gotten much attention. These are “cost-sharing subsidies.” They reduce the deductibles, co-payments, and so on, so that you don't have to pay so much every time you go to the doctor, fill a prescription, or need more intensive care. These subsidies are structured in the same way—the higher your income, the lower the subsidy—only they stop altogether at just 250 percent of the poverty, which is about $29,000 for an individual and $59,000 for a family of four.

WHAT IF MY INCOME IS REALLY LOW. THEN WHAT?

The original idea was that anybody with an income below 133 percent of the poverty line, or about $15,000 for an individual and $31,000 for a family of four, wouldn’t even bother with private insurance. They’d enroll in Medicaid, the same program that already insures tens of millions of low-income Americans. But the Supreme Court disrupted that plan. The states run their own Medicaid programs and, thanks to the Court’s July 2012 ruling on the Affordable Care Act, the states have a lot more leeway to reject the Medicaid expansion. About half have done just that.

If you live in one of those states and your income is above the poverty line, you can still qualify for the subsidies that will help you buy private insurance in the new marketplaces. But if your income is below the poverty line, then you may not qualify for Medicaid. It will depend on what guidelines your state had in place before.

If you’re wondering which states have expanded Medicaid to all low-income people and which ones haven’t, just look at a political map. Most of the blue states—the ones in which voters supported Obama in the last election—have expanded their Medicaid programs. Most of the red states have not. But there are some exceptions.

I HEARD SOME PEOPLE WON’T BE ABLE TO SEE THEIR DOCTORS ANYMORE. WHAT’S THAT ALL ABOUT?

Insurers are trying to keep premiums low, in order to grab all those new customers in the marketplaces. One way to do that is to limit beneficiaries to a network of doctors and hospitals that will accept lower reimbursement. The idea isn't new: Insurers did a lot of this in the 1990s, when managed care—you know, HMOs—first became popular. Consumers didn't like it so insurers backed off just a bit, but now they're pushing the approach again. They figure that people will generally shop on price, even if it means sticking within narrow networks, and there's a lot of marketing evidence to suggest they are correct.

The problem is that some people want wider access, might be willing to be pay for it, but aren't going to find plans within their means that provide it. (Nobody is going to stop these people from seeing their favorite doctor or hospital, but the out-of-pocket charges will be more than many and possibly most can pay.) Plans are supposed to pick networks that provide quality care, not just cheap care. And Obamacare actually requires all plans to have "adequate" networks. But that doesn't mean plans will always include the doctors or hospitals people want. If you have a favorite provider or hospital, you'll want to check whether they belong to plans available to you—or whether you'd pay more to use them.

I HEARD THE PRESIDENT TOLD INSURERS NOT TO CANCEL PLANS. SO I CAN KEEP MY CURRENT POLICY AFTER ALL?

That depends. The president told insurers they had the option to renew existing plans, even those expiring sometime in calendar 2014, for one more year. And he told state regulators they had the option to allow plans to take that step. But notice the key word in both sentences: "Option." It's entirely at the discretion of the insurers and the state authorities. Some plans, like Florida Blue, have announced they will be offering customers the right to renew expiring policies. But the state insurance commissioner of Washington has already said he's sticking with the original policy: In his state, insurers can't renew plans expiring after December unless those plans qualify for the law's original "grandfather" clause. (That clause allowed plans in place as of March, 2010, to remain in effect indefinitely.)

WHAT IF I DECIDE NOT TO GET INSURANCE?

The law includes an individual mandate. If you have access to affordable coverage and decline to get it, you'll have to pay a financial penalty. In 2014, it's either 1 percent of your household income or a flat fee of $95 per adult and $47.50 per child, up to $285 for a family. You would pay whichever is sum is greater. The penalty increases in 2015 and 2016. The law does inculde some exemptions, so you can always check to see if you qualify for one.

SO IS OBAMACARE A GOOD DEAL FOR ME?

Only you can answer that. Partly it will depend on your circumstances. What's your income and health status? Where do you live? What kind of insurance do you have now? But partly it will depend on what you value. The government is establishing a new set of standards for health insurance and those standards are forcing many people, like you, to change your arrangements. Do you care about the protections the new law gives you? If those protections cost you more money—and for some people they will—are they worth it?

You might also have an opinion about the law's underlying philosophy. One way to think of Obamacare is as an attempt to spread the financial burden of illness across a more diverse group of people, so that they healthy will subsidize the sick and the wealthy will subsidize the poor. It's more or less the way employer insurance already functions. Do you think that's the right thing to do? The law pays for its new protections with some new revenues, like a new tax on the wealthiest Americans, and with some reductions in what Medicare pays providers and insurance companies. Do those bother you? Do they seem like a worthwhile tradeoff for making coverage more stable and widely available?

One parting note: Don't simply compare Obamacare coverage to the insurance you have now. America's health care system has been in flux for a long time. Even if the Affordable Care Act had never become law, you could have run into problems down the road—because your insurance had become unaffordable, because you needed new coverage and couldn't get it, or because your benefits didn't meet your needs once you got sick. Maybe you will like your options under Obamacare. Maybe you won't. Either way, make sure you think through what the future without those options might really be like.

Hopefully, this more level-headed approach to this issue will catch on and we can move past the "OMG, someone somewhere is going to pay more and the world will come to an end tomorrow!!!! AAAAGGGGHHHH!!!!!" Or, the even more 'useful' screech of "We didn't get single payer and I'm going to hold my breath and turn really blue until we do! So there, you mean meanies!!!!" Or the really insightful "LIar, liar, I have no idea what I'm talking about but you are a liar. Liar!!!!!" And my very favorit -"I'm gong to say something that will make me look like a dumbfuck and then I'm going to try to convince you all that I didn't really say it or that it really didn't mean what it meant because you are a mean meanie for pointing out that it meant what I meant"

It's all good from an entertainment point of view, but really, is that why you are here?

Originally Posted by stilltim

Where are you getting this information? Between having a father who is a physician, having worked in the healthcare industry and having a son who was born with a congenital heart defect that has required frequent care and multiple surgeries, I have talked to more doctors than I care to count. Your information is completely at odds with what I'm hearing from them.

Malpractice insurance is ridiculously high for doctors these days. Some professions in the healthcare industry have been pretty much eliminated because it's no too expensive to insure them. For example, that's why you don't see many emergency medical helicopters. It's too expensive to insure the pilots.

You are correct. Our son will graduate with a debt of about $300,000. Most doctors have grueling and demanding schedules that are unfortunately expected in their fields. My primary puts in untold hours with patients, hospital visits, and that never ending paper work. There is a growing burn out rate because of the demands of health care.

There's a lot of myths and misconceptions about doctors. It's just plain easier to blame the profession, or use as an example a few greedy docs, than it is to hold the rotten system accountable.

http://politicalticker.blogs.cnn.com...obamacare-ads/

Conservative group continues to pile money into anti-Obamacare ads

(CNN) - Conservative advocacy group Americans for Prosperity's anti-Obamacare efforts have now topped $7.6 million in spending over the last few weeks with Thursday's announcement of a new $1.7 million ad buy.

According to a release, the ad buy marks the group's third wave of TV, radio and web ads going after the Affordable Care Act, better known as Obamacare. As the ads have done in the past, the new round will applaud lawmakers who've opposed the law and blast those who've supported it.

Most recently, AFP launched an even larger buy late last month of $2 million that went after vulnerable Democratic Senators Kay Hagan of North Carolina and Mary Landrieu of Louisiana.

This time, Republican Reps. Joe Heck of Nevada and Dan Benishek of Michigan will be getting praise while Democratic Reps. Ann Kirkpatrick of Arizona and Nick Rahall of West Virginia will be getting criticism.

Both Kirkpatrick and Rahall face challenging reelection bids in next year's midterms.

Check the latest ad from the Crotch Brothers -

http://www.youtube.com/watch?v=4PRM_...ature=youtu.be

Not about politics, poll numbers, election, boo-hoo, it's about real people

It's about people losing their health insurance, their doctors, whaaaaa, obamacare just doesn't work..

Have you heard that before? And you thought you derived all that from your own thinking....
.... silly sheeple.

Ask yourselves why two of the richest men in the world making billions in energy production would give a rat's ass about you little people that this actress is trying so hard to connect with on such an empathetic level??? If you haven't, then keep baaing.

It would be funny all the vitriol against Obamacare here from those professing it as an evil corporate plot when that vitriol is just sheeple baaing the Crouch Brothers' propaganda like Pavlov dogs. It would be funny except in is actually very very sad.

Here's a good profile of the Crotch Brothers; sheeple should know their masters -

http://obamacarefacts.com/koch-broth...-obamacare.php

The Koch Brothers and ObamaCare: and Other Koch Brothers Facts

Originally Posted by The Rani

Let it be. It will all fall apart soon enough....

"I'm way ahead o' ya, Sister!" !x9


Prince

PS:

"Le Marché" n'est pas un marché!
Mon Dieu! Les Incompétents! !

It looks like McAuliffe is not backing down on his promise to do the ACA Medicaid Expansion in Virginia -

http://hamptonroads.com/2013/11/mcau...nding-medicaid

McAuliffe signals no retreat on expanding Medicaid

That's going to be a big check in the win column with an estimated 400,000 more people getting coverage!

That's another 400,000 the ACA has brought single payer to while we're still waiting for the whiners here to bag their first.

__________________________________________________ _______________

By the way, here's somebody who has set up the big scoreboard on all of this -

http://obamacaresignups.net/

I've asked them to add a column that would track how many have been signed up to single payer by the insatiable whiners on this and other forums . They said you all have to bag your first one and then they'll consider it. Let me know when any of your whining efforts result in gving someone health care coverage.

Originally Posted by princeofcats67

"I'm way ahead o' ya, Sister!" !x9


Prince

PS:

"Le Marché" n'est pas un marché!
Mon Dieu! Les Incompétents! !

Just imagine if they had me guest on all the mass news media channels?

No more magic ponies and horseshit for you all to transfixed by any more. What would you do with all that free time and independent thinking?

Boggles the mind.

Originally Posted by The Rani

At no time did I say that anyone making less than $11K per year would be "forced" to pay anything.
I said that they would NOT pay $2K per year, the average rate offered when I plugged that number into the system on the website.
If you weren't such a dumbfuck and/or douchebag liar, you would stop making posts to the contrary.

Yes, dear, and are you going to post your alarm that the sun will be setting in the West today or that you've discovered with alarm that there are anatomical differences between males and females?

Oh, and did you contacted Madonna to let her know of your recent discovery that she should have given it up years ago?

You slippery fish are the most fun when you're desperate.

Now if we can just get a couple of your toadies to sing in harmony!

Originally Posted by The Rani

At no time did I say that anyone making less than $11K per year would be "forced" to pay anything.
I said that they would NOT pay $2K per year, the average rate offered when I plugged that number into the system on the website.
If you weren't such a dumbfuck and/or douchebag liar, you would stop making posts to the contrary.

I saw it. And that you saw and acknowledged that there were tax rebates as well.

Again, this issue goes under the radar.

" An insurance card is of little value if you cannot find physicians who will accept it."

Low payment rates for exchange plans threaten adequacy of provider networks

Insurers will be paying physicians less through their exchange plans than they do through their existing commercial plans. If the rates turn out to be typically 30 or 40 percent less, as this article suggests, they will have problems maintaining adequate provider networks. An insurance card is of little value if you cannot find physicians who will accept it.As we said from the start, those designing health care reform were making a terrible mistake when they decided to make health insurance premiums affordable while largely ignoring health care costs.

Look what they did:

* They assigned very low actuarial values to the plans that most individuals will select, leaving 30 to 40 percent of health care costs to be paid by the patient, though some will receive inadequate subsidies.


* They designed plans with very high deductibles, causing the large percentage of patients who need less care to receive virtually no sickness or injury benefits from their plans.


* They reduced the size of their provider networks which will reduce spending by making care less accessible, especially specialized care.

* Now it appears that they will be reducing provider payments to levels that will be rejected by many physicians. Although employer-sponsored plans are moving in the same direction, it is likely that many physicians will limit their practices to these plans and cash-paying patients, while avoiding patients in the exchange plans and the chronically-underfunded Medicaid program.

* As part of the SGR fix, legislators are considering not allowing any inflationary increases in the Medicare program for the next ten years - keeping the payment rates flat. If so, physicians are apt to leave the Medicare program as payment rates approach that of Medicaid.


As we approach $3 trillion in health care spending, this is criminal! For that kind of spending, everyone could have high quality health care. Instead, we get a system that perpetuates disparities in health care while creating financial burdens for precisely those individuals who most need health care.


The entire health care system will not collapse, but this experiment will perform so miserably that most will consider it to be a failure. We don’t need to go back to the drawing boards. We merely need to enact a system that we already know will achieve our goals - an improved Medicare for all.

Originally Posted by Deb C

Again, this issue goes under the radar.

" An insurance card is of little value if you cannot find physicians who will accept it."

Low payment rates for exchange plans threaten adequacy of provider networks

You can't have it both ways. Either rates have to continue going up, or reimbursement must be controlled. Considering how bad the imbalance is in the US in comparison to other nations, I'm voting for tightening the screws.

We may have to pay-down student loans or push hard for MDs to join clinical practices, but something has to give here. Medical care can't be 20% of the entire economy ... at least not at this point in time.

Originally Posted by Marx & Lennon

You can't have it both ways. Either rates have to continue going up, or reimbursement must be controlled. Considering how bad the imbalance is in the US in comparison to other nations, I'm voting for tightening the screws.

We may have to pay-down student loans or push hard for MDs to join clinical practices, but something has to give here. Medical care can't be 20% of the entire economy ... at least not at this point in time.

Or we could go with the GOP approach and just let those 40 million die. That at least appeals to thier Nihilist wing.

Originally Posted by Deb C

You are correct. Our son will graduate with a debt of about $300,000. Most doctors have grueling and demanding schedules that are unfortunately expected in their fields. My primary puts in untold hours with patients, hospital visits, and that never ending paper work. There is a growing burn out rate because of the demands of health care.

There's a lot of myths and misconceptions about doctors. It's just plain easier to blame the profession, or use as an example a few greedy docs, than it is to hold the rotten system accountable.

Exactly. But, I do want to reiterate my point here that the cost has a lot to do with the fact that we've done away with the small, entrepreneurial doctor's practices that were the backbone of the industry just a few decades ago.

When my wife and I got married, some of my family came with us to Taiwan to celebrate with my wife's family. As it happened, one of us got sick and we stopped at a pharmacy... which actually turned out to be also a doctor's office. It was a full service shop where the doctor was also the proprietor. My dad looked around with much interest, commenting "This is the way the profession used to be when I started out 40 some years ago." Total cost of the cold and flu medicine for that stop was just a dollar or so.

On another visit to the in-laws, I got deathly ill and had to be taken to the emergency room. Total cost of that visit? $25... for an ER visit! That's a tenth or less of what the same visit would cost here. And yes, I know, the cost of living in Taiwan is less than it is here. But, it's not one-tenth of what it is here. It's more like half. So, call it more like $50 dollars after the cost of living adjustment.

How do they do it so cheap?

First of all, they don't have the kind of industry regulation we do. Nor do they have the rampant malpractice litigation that we have. So, they doctors have fewer costs.

Second, it was a cash only business. You pay for the service or you don't get it. There's no such thing as insurance. The result was that the doctor's HAD to keep rates affordable to practically everyone.... or they wouldn't have any business. In other words, unlike us, they were still subject to the law of supply and demand.

Another anecdote: my mother in-law came to visit when my daughter was born. She looked at the half dozen nurses milling about the nurses' station and said "No wonder your healthcare is so expensive. Look at all those people doing nothing!" Well, the reality is more likely that the nurses were:

a) filling out loads of paperwork on every patient to make sure they could cover themselves in the case of a lawsuit... and to make sure some government busybody can't claim they didn't follow regulations.

b) monitoring all sorts of electronics to make sure that they jump as soon as the patient requests anything or as soon as any reading is a little suspicious. This part actually does improve quality of care a little bit. But, its purpose is really to keep ambulance chasers from claiming that they were being negligent.

But either way, the having all those nurses sitting there costs a lot. Costs are being inflated by litigation and over-regulation enormously.

Originally Posted by stilltim

Exactly. But, I do want to reiterate my point here that the cost has a lot to do with the fact that we've done away with the small, entrepreneurial doctor's practices that were the backbone of the industry just a few decades ago.

When my wife and I got married, some of my family came with us to Taiwan to celebrate with my wife's family. As it happened, one of us got sick and we stopped at a pharmacy... which actually turned out to be also a doctor's office. It was a full service shop where the doctor was also the proprietor. My dad looked around with much interest, commenting "This is the way the profession used to be when I started out 40 some years ago." Total cost of the cold and flu medicine for that stop was just a dollar or so.

On another visit to the in-laws, I got deathly ill and had to be taken to the emergency room. Total cost of that visit? $25... for an ER visit! That's a tenth or less of what the same visit would cost here. And yes, I know, the cost of living in Taiwan is less than it is here. But, it's not one-tenth of what it is here. It's more like half. So, call it more like $50 dollars after the cost of living adjustment.

How do they do it so cheap?

First of all, they don't have the kind of industry regulation we do. Nor do they have the rampant malpractice litigation that we have. So, they doctors have fewer costs.

Second, it was a cash only business. You pay for the service or you don't get it. There's no such thing as insurance. The result was that the doctor's HAD to keep rates affordable to practically everyone.... or they wouldn't have any business. In other words, unlike us, they were still subject to the law of supply and demand.

Another anecdote: my mother in-law came to visit when my daughter was born. She looked at the half dozen nurses milling about the nurses' station and said "No wonder your healthcare is so expensive. Look at all those people doing nothing!" Well, the reality is more likely that the nurses were:

a) filling out loads of paperwork on every patient to make sure they could cover themselves in the case of a lawsuit... and to make sure some government busybody can't claim they didn't follow regulations.

b) monitoring all sorts of electronics to make sure that they jump as soon as the patient requests anything or as soon as any reading is a little suspicious. This part actually does improve quality of care a little bit. But, its purpose is really to keep ambulance chasers from claiming that they were being negligent.

But either way, the having all those nurses sitting there costs a lot. Costs are being inflated by litigation and over-regulation enormously.

You're discussing a model that hasn't been in use in the US for decades, and never will again. No, it's not the lawyers making the changes mandatory. Though the desire to sue for malpractice is out of control in some states, the payouts aren't. Per capita payouts peak at less than $40, and bottom-out under $4. Average is about $15, which makes the national bill for malpractice less than $5 Billion. Healthcare is 17% of our economy, or roughly $4 Trillion. The 0.13% spent on lawsuits isn't much in the grand scheme of things.

What is important is the insurance companies. They want everything itemized and categorized. It's bean counting, and part of the roughly 40% overhead added to the cost of getting well. $1.6 Trillion; that's your cost adder.

One of the cost considerations that hasn't gotten a lot of attention is how the American consumer bears the brunt of rewarding the R&D that results in miracle drugs, medical devices, and other miracle technology (I'm old enough to remember when "CAT scan" meant something very very different).

The companies that develop these miracles want to make a return of investment - they argue that for every miracle they developed, the had a 1000 losers and each of the losers cost as much to do the R&D as the one winner and they need to make a profit in order to keep the miracle train working. Others might call this obscene profiteering. If your dying of cancer and there's a miracle pill you don't really give a shit which one it is, and you want desperately for you single payer, insurer or your family to pay whatever it takes.

In the majority of countries with single payer or something close to it, they can negotiate the price down. The companies are mostly okay with that because they got the US consumer who will foot the bill (to either provide the R&D incentive, obscene profits, or the gottahaveit demand - pick your poison). Moreover, since the docs and hospitals get a percentage on the costly new miracles, they don't spend a lot of time trying to figure out how to keep the expense down for American consumers; they like performing miracles, getting their ratings up and making enough money to retire by 40!

So how do you deal with this? You could go with the big F.U. to the corporate evil ones, but if they're right about that resulting in no R&D incentive say bye-bye to cures for cancer, heart disease, diabetes, autism, Alzheimers, etc. etc. And don't give me the whole hippie-hippie shake about preventative living style (have I mentioned I don't do magic pony land?), people want cures they have not preaching for what they might get. (Note - I think we're okay on the erectile dysfunction front so at least we should screw the suits on that - no pun intended).

Then there's the death panels approach that decides who and who doesn't get these miracles: less demand (but more bodies), less pricey. That whole death panel thing doesn't sit well, however, with people even though Rani may have recently embraced it.

Maybe the alternative is big govt should pay these R&D companies off? Thoughts?

Originally Posted by The Rani

Yep. There are many layers to this disaster that people haven't even considered yet.

Funny how people talk about the need to control health care cost out of one side of their mouths and scream out the other side that everyone needs the Mayo Clinic on their policy .

I guess some people were born to bitch.

Originally Posted by The Rani

At no time did I say that anyone making less than $11K per year would be "forced" to pay anything.
I said that they would NOT pay $2K per year, the average rate offered when I plugged that number into the system on the website.
At least I see that you've stopped making posts to the contrary.

You said the website told you this and in your typical WTF implied the whole ACA would fall like a deck of cards with such ridiculousness. The point isn't you recognizing the obvious of the inability to pay - that would be no more reason for you to post an alarm than you telling us the sun will set in the West today. The point is your ridiculous assertion that anyone or thing would force such a payment. You know that, but you are a slippery fish that doesn't like to look foolish. No one likes to look foolish; it's just how long you spend trying to cover it up that tends to suggest other ailments may be involved.

Originally Posted by Deb C

Again, this issue goes under the radar.

" An insurance card is of little value if you cannot find physicians who will accept it."

Low payment rates for exchange plans threaten adequacy of provider networks

This is a looming problem. Just going to Medicare for all may not be a sloution either since many physicians are already baning Medicare patients. The system in France looks attractive as a model, but I don't see Congress agreeing to anything. This will require a bottom up push from the voters.

Originally Posted by playwrite

Maybe the alternative is big govt should pay these R&D companies off? Thoughts?

More .1% nonsense



The NIH has always been the primary engine of medical research in America, we just have a back-asswards system of awarding patent monopolies to private interests who play a tangential role to the actual research. This also leads us to a system where only certain types of treatments and diseases are profitable, and it's definitely one of the major reasons why America lags behind in Celiac research, detection, and diagnosis. 2/3 of the research I follow for my condition is coming from Australia, Ireland, Sweden, Italy, and other countries whose researchers and medical professionals have an incentive to minimize costs and illness, rather than an incentive to turn sick people in to life-long customers.

The private sector doesn't really do with pure science very well, so most of the basic knowledge that creates treatments originates with the NIH and university graduate programs. We definitely make sure to look out for those poor owners of the "too big to fail" businesses, though!

http://www.economist.com/news/scienc...d-bad-medicine

Originally Posted by playwrite

One of the cost considerations that hasn't gotten a lot of attention is how the American consumer bears the brunt of rewarding the R&D that results in miracle drugs, medical devices, and other miracle technology (I'm old enough to remember when "CAT scan" meant something very very different).

The companies that develop these miracles want to make a return of investment - they argue that for every miracle they developed, the had a 1000 losers and each of the losers cost as much to do the R&D as the one winner and they need to make a profit in order to keep the miracle train working. Others might call this obscene profiteering. If your dying of cancer and there's a miracle pill you don't really give a shit which one it is, and you want desperately for you single payer, insurer or your family to pay whatever it takes...

Maybe the alternative is big govt should pay these R&D companies off? Thoughts?

There is a new drug for a rare blood cancer that will keep the cancer in remission more or less permanently. It's called Imbruvica, and costs $130,000 a year. Nothing more to say about that, except that it and many others are there because they work as maintenance drugs,. They were designed that way on purpose. Most are expensive, albeit not quite that expensive. High five figures seems to be the annual target.

Originally Posted by radind

This is a looming problem. Just going to Medicare for all may not be a sloution either since many physicians are already baning Medicare patients. The system in France looks attractive as a model, but I don't see Congress agreeing to anything. This will require a bottom up push from the voters.

Doctors limit Medicare patients, because they make more from others, not because they make too little to survive. Think about it. We have the most expensive healthcare system on earth, and one of the few cost managment systems is just s-o-o-o mean to the providers that they can't take it any more. Yeah, right.

Originally Posted by Marx & Lennon

There is a new drug for a rare blood cancer that will keep the cancer in remission more or less permanently. It's called Imbruvica, and costs $130,000 a year. Nothing more to say about that, except that many others are there because they work as maintenance drugs, and were designed that way on purpose. Most are expensive, albeit not quite that expensive - high five figures, annually.

"Imbruvica was approved based on a clinical trial testing it in 111 patients whose cancer had recurred after at least one prior therapy. The cancer shrank in about 49 percent of patients and disappeared in 17 percent. These responses lasted a median of 17.5 months. It is not yet clear if the drug prolongs lives.

Side effects included diarrhea, infections and bleeding or bruising and decreases in platelets and infection-fighting white blood cells."

http://www.nytimes.com/2013/11/14/bu...oval.html?_r=0

What a deal!!!

Imbruvica is the first FDA-approved drug to make use of Bruton's tyrosine kinase, a chemical discovered by researchers... in Sweden. In 1993.

Originally Posted by JohnMc82

"Imbruvica was approved based on a clinical trial testing it in 111 patients whose cancer had recurred after at least one prior therapy. The cancer shrank in about 49 percent of patients and disappeared in 17 percent. These responses lasted a median of 17.5 months. It is not yet clear if the drug prolongs lives.

Side effects included diarrhea, infections and bleeding or bruising and decreases in platelets and infection-fighting white blood cells."

http://www.nytimes.com/2013/11/14/bu...oval.html?_r=0

What a deal!!!

Pharma says: "You have to get the money while you can." Now, go and play in the street.

Originally Posted by JohnMc82

More .1% nonsense



The NIH has always been the primary engine of medical research in America, we just have a back-asswards system of awarding patent monopolies to private interests who play a tangential role to the actual research. This also leads us to a system where only certain types of treatments and diseases are profitable, and it's definitely one of the major reasons why America lags behind in Celiac research, detection, and diagnosis. 2/3 of the research I follow for my condition is coming from Australia, Ireland, Sweden, Italy, and other countries whose researchers and medical professionals have an incentive to minimize costs and illness, rather than an incentive to turn sick people in to life-long customers.

The private sector doesn't really do with pure science very well, so most of the basic knowledge that creates treatments originates with the NIH and university graduate programs. We definitely make sure to look out for those poor owners of the "too big to fail" businesses, though!

http://www.economist.com/news/scienc...d-bad-medicine

Dude, your chart for the US is NIH and possible a comparison to other countries' central govt spending on biomedical (but likely, particularly for China, its all those other countries biomedical R&D spending). NIH's research budget is big but not in relation to what all the drug companies, biotech firms and the myriad of medical devices and technology firms spend. Moreover, this is like comparing US test scores of 330 million people to the test scores of Singapore's 3 million people; you're comparing a % change in NIH spending where that change alone may be as big as some of those other countries' entire expenditure in the area. I don't know, but if you're going to put this kind of horseshti up there, you should.

Moreover, who are you to say that it is the pure basic "R" in R&D that drives the high cost of drugs and technology in health care???? You're going to have to do a lot more than this to even begin to frame a discussion let alone convince anyone.

I don't know why you want to live in Debs' magic pony land where it is just the evil insurers (who will now have to spend 80/85% of their total revenue on actual health expenses or give premium rebates) driving health costs, but you shouldn't have any illusions that is what you are doing.

Originally Posted by playwrite

NIH's research budget is big but not in relation to what all the drug companies, biotech firms and the myriad of medical devices and technology firms spend.

You're right - relative to other countries, research in America is relatively privatized. It still relies heavily on publicly funded research, but they do get huge tax breaks and a great argument for patent monopolies. Two things "the market" does poorly: utilities, and pure research. Medicine is both, so if we want a functional system, we have to get rid of all the middle-men who use that defense to justify their accumulation of wealth.

you're comparing a % change in NIH spending where that change alone may be as big as some of those other countries' entire expenditure in the area. I don't know, but if you're going to put this kind of horseshti up there, you should.

It still undermines your theory that America is doing things right when it comes to promoting research. The bigger aggregate costs get, and the more the government gets squeezed out, the less we're going to see of new developments and treatments. The most popular new drugs are of questionable safety and efficacy, but they're selling like hotcakes.

I don't know why you want to live in Debs' magic pony land where it is just the evil insurers (who will now have to spend 80/85% of their total revenue on actual health expenses or give premium rebates) driving health costs, but you shouldn't have any illusions that is what you are doing.

Didn't we just go over the fact that the MLR rule change is only going to affect about .1% of what we spend on healthcare each year? $2 billion is nice, but it's not even peanuts on the scale we're looking at. It doesn't get to be a trump card for every problem in the system, and no, you can't just wave off the ridiculous incentives created by investors in the other .1% who can only see the world in terms of personal profit & loss.