What's Good About the ACA (Obamacare)?

[Doc]

Rationing is perfectly fine, just as long as elected officials are doing it, and not stockholders. Because we all know our elected officials only have our best interest at heart and are masters at saving money.

 

Seriously though, I'd love to see the rationing chart. And I'd like to know who gets sued and who has to pay the damages.

[dayman]

Here's an article that talks about the long term pay shift I'm talking about:

 

http://news.harvard.edu/gazette/story/2012/07/moving-beyond-health-cares-fee-for-service/

 

The AQC predates, but is similar to, the Pioneer Accountable Care Organization contracts that Medicare began this year through the Affordable Care Act, an initiative in which Medicare will reward groups of providers based on improved outcomes and lower health care spending.

 

The researchers looked at the first two years of data from the AQC and found that the program has, in fact, succeeded in lowering total medical spending while simultaneously improving quality of care.

 

On average, groups in the AQC spent 3.3 percent less than fee-for-service groups in the second year, the study showed. Provider groups that entered AQC from a traditional fee-for-service contract model achieved even greater spending reductions of 9.9 percent in year two, up from 6.3 percent in the first year. Compared with those groups, groups that entered from contracts that were already similar to the AQC achieved fewer savings in both years. The researchers also found that the improvements in quality of chronic care management, adult preventive care, and pediatric care associated with the AQC grew in the second year.

 

“Moving away from fee-for-service models is high on the agenda of those looking to establish a fiscally sustainable, efficient health care system,” said Michael Chernew, professor of health care policy at Harvard Medical School (HMS) and senior author on the study. “It is likely that this type of new payment model will grow rapidly in coming years in the nation as a whole, and particularly in Massachusetts. By analyzing this program, we’re studying the future before it gets here.”

[birdog1960]

 

Seriously though, I'd love to see the rationing chart. And I'd like to know who gets sued and who has to pay the damages.

current law provides protection to insurance companies for refusing to pay for care on the basis that they aren't refusing actual care. guess who gets caught holding the short straw in this instance. i don't know of a successful malpractice case for refusing care against an insurance company. do you?

[dayman]

And here's a video that talks about the challenges of moving away from fee for service and why it takes a while:

 

http://www.youtube.com/watch?v=d_FcdP6JfTY

[Doc]

current law provides protection to insurance companies for refusing to pay for care on the basis that they aren't refusing actual care. guess who gets caught holding the short straw in this instance. i don't know of a successful malpractice case for refusing care against an insurance company. do you?

I already knew the answer. So as a doctor, you're expected to ration care based on what the pols say, but the pols won't be subject to litigation. Yeah, that should be a real great !@#$ing system!

And here's a video that talks about the challenges of moving away from fee for service and why it takes a while:

 

youtube.com/watch?v=d_FcdP6JfTY

I've got the solution. I agree with ditching fee-for-service. So instead of paying the insurance company an monthly premium, you pay them only if your outcomes are good. Sign me up!

[3rdnlng]

Look just be to clear here, the shift in payment procedures is still experimental and what I'm saying is the ACA includes Medicare in the game to a substantial degree. The gov't (being such a large spender in the messy public-private hybrid we've had and will continue to have) is one of the primary parties people blame for the explosion of costs. What Medicare does, how Medicare pays, the providers structure around the private payers eventually follow. So in that manner, provisions in the ACA for new Medicare payment schemes look to lead the way (on the large scale necessary) to spur along the change.

 

The change itself is organic. The ACA did not invent this, nor would this have not occurred without it. The ACA responded to the need for it and got on board with the push towards it.

 

10 years..IDK..that's a number I've heard kicked around. The point is to move substantially away from the fee-for-service oriented healthcare system (read: high costs) we have now is not overnight. It will take time. It will take time to bring down costs. And there are things the ACA brings along that will aid that effort.

 

So when I say 10 years I'm not saying 10 years for the ACA to work. I'm saying 10 years for our system to really be departed from the current pay structures that contribute substantially the explosion of costs.

 

10 years. Sort of like what I keep hearing everytime I bring up drilling in ANWR.

[birdog1960]

I already knew the answer. So as a doctor, you're expected to ration care based on what the pols say, but the pols won't be subject to litigation. Yeah, that should be a real great !@#$ing system!

 

if it's considered standard of care on a national basis i believe it will be much easier to defend. maybe i'm delusional but i think those standards will be evidence based and aimed at providing the best care to the most people. if that's not the goal then i can understand opposition.

[dayman]

if it's considered standard of care on a national basis i believe it will be much easier to defend. maybe i'm delusional but i think those standards will be evidence based and aimed at providing the best care to the most people. if that's not the goal then i can understand opposition.

 

 

Some decision making will ultimately be needed but I'm telling you guys "it's the pay structure stupid!" (best James Carville voice)

 

That's the largest change the American system needs.

[DC Tom]

Some decision making will ultimately be needed but I'm telling you guys "it's the pay structure stupid!" (best James Carville voice)

 

That's the largest change the American system needs.

 

When the ACA bankrupts the insurance industry, that'll change very quickly.

[birdog1960]

Some decision making will ultimately be needed but I'm telling you guys "it's the pay structure stupid!" (best James Carville voice)

 

That's the largest change the American system needs.

i agree. that will help the providers to do the right thing. stop the incentive to do more and more. but patient demand and expectations need to be controlled as well. people need to bear at least a significant part of the huge costs of extraordinary care so that they at least consider that not doing it is a reasonable option. i think we're talking about the same thing: basic care for everone. out of pocket costs for elective tests and procedures and payment reform away from fee for service.

[ieatcrayonz]

And here's a video that talks about the challenges of moving away from fee for service and why it takes a while:

 

youtube.com/watch?v=d_FcdP6JfTY

I didn't click your video but the preview screen shot gave it all away. Some dork with a gray beard has all the answers. What a surprise.

[birdog1960]

I didn't click your video but the preview screen shot gave it all away. Some dork with a gray beard has all the answers. What a surprise.

yeah. i'd stay away from doctors who look dorky and have gray beards as well. go for the ones that look like they spend most of their time in singles bars.

[Juror#8]

Serious question, because my knowledge on the subject is limited to second hand info (I haven't read the bill) but how will the additional 30 million be insured? Is that number accountable to those added to medicaid?

 

 

So it's not all bad.

 

You know where your bread is buttered.

[ieatcrayonz]

yeah. i'd stay away from doctors who look dorky and have gray beards as well. go for the ones that look like they spend most of their time in singles bars.

It's not so much that as it is the professorial commie types. They could be doctors or lawyers or accountants, or climatologists, or Peter Orszag. They can be spotted a mile away. They are different than hippy commies. I don't think they really like hippy commies but they need them to ramp up the overall commie numbers. Hippy commies are real easy to spot but so are these professor types if you take your time.

 

The professor commies never really use any excuses when their crappy plans fail. They don't re-examine their plan or their basic premise, they just come up with an alternative crappy plan. It is a must that they speak in terms that seem smart and highfalutin but mean nothing and that their solution be vague so that they can have excuses ready for later so that crappy plan part 3 can sell. They must smile a lot and talk down to people so it is easy to believe that they hold some secret knowledge that nobody else could possibly understand. This helps them sell crappy plans to people that have real problems and are unable or unwilling to come up with their own solution. The best plan for a professor commies is one that sounds awesome, has no basis in reality and works crappy. It has to sound awesome to sell. It has to have no basis in reality so that when it doesn't work, they can find someone to blame and say that if only reality were altered the plan would have worked. It has to work crappy so they can have a phase 2, 3 and 412.

 

Most times these dorks actually become the phony characters they were playing as a role. That is why I can tell exactly the load of crap they were spewing without even having to click. Invest a little time yourself because in the long run you will save time.

[birdog1960]

You know where your bread is buttered.

he's been notably absent from the discussion since then. don't think he got the red meat he was looking for.

[Doc]

yeah. i'd stay away from doctors who look dorky and have gray beards as well. go for the ones that look like they spend most of their time in singles bars.

Those guys weren't doctors.

[Rob's House]

he's been notably absent from the discussion since then. don't think he got the red meat he was looking for.

No, just letting it play out. I'm more curious on this issue than trying to make a point. It sounds like an imminent disaster but I guess I'm looking for some way to rationalize it so I can believe it might be okay. So far I can't say my biggest concerns have been addressed.

 

Some things I just disagree with: Young people being forced to disproportionately compensate for the cost of old people. It sounds good rhetorically (the how "we" treat our old people bit) but I'm already concerned about my daughter having to pay for the retirement of old people, now she'll have to pay for their health care also. I'm also troubled by the way we're essentially abolishing insurance. When I was a kid my parents paid for check-ups and dental appointments out of pocket, and the prices weren't so absurd as they are today. Insurance was in case you got sick or injured. Now we're essentially socializing medicine incrmentally. Insurance is now just your health care payment plan. That's consistent with the forced coverage of pre-existing conditions. It sounds noble, but that's not what insurance is, that's what collectivism is. They're not the same.

 

On the more fundamental issues, I still don't see a great deal of value here. A good portion of this alleged 30 million newly insured are hypothetical based on a temporary medicaid inclusion that is at the discretion of the state as to whether it should cover them. If this is so desireable why didn't we just expand medicaid? That way you cover the people who can't afford insurance without infringing upon the rights of others. Plus, due to the temporary nature of it, this is essentially a request of the states to allow the government to pass the buck to them. If that's a desirable outcome why not let the states handle the issue on their own? I'm also of the understanding, and I'm hoping those in the industry can shed more light on this, that doctors make far less treating those on Medicaid despite the cost of treatment being held constant - more on this later.

 

So this basically leaves us with the mandate which I see little value in. I get the "freeloader" argument, but it doesn't hold water. Prevention of "freeloading" does little to address the harm this bill purports to cure, that is provide access to health care for those who can't afford it. It actually does nothing to address this. And while I don't have the numbers, I'm of the understanding that the cost of services rendered by those uninsured who are subject to the mandate is relatively negligible.

 

So the only new money pumped into the system is from those not currently insured, who will not be on Medicaid. In the meantime, Dr.'s compensation per visit will drop, more people will have more access to non-essential health care treatment, and "insurance" companies have their premiums capped.

 

Here's where it all falls apart. You have more people consuming more health care services without a corresponding increase in money coming in, a decrease in doctor compensation (which necessarily results in a decrease in the supply of doctors/supply of health care services), and a cap on prices. How can this work?

 

Less Supply + More Demand = Higher Prices

 

If you have higher prices, how do you not have higher premiums? And if you don't have higher premiums how do the insurance companies stay in business? What keeps the whole system from collapsing?

 

Please, I really want someone to explain this in a way that makes sense because so far, including in this thread, no one has.

Edited July 20, 2012 by Rob's House

[DC Tom]

Here's where it all falls apart. You have more people consuming more health care services without a corresponding increase in money coming in, a decrease in doctor compensation (which necessarily results in a decrease in the supply of doctors/supply of health care services), and a cap on prices. How can this work?

 

Less Supply + More Demand = Higher Prices

 

If you have higher prices, how do you not have higher premiums? And if you don't have higher premiums how do the insurance companies stay in business? What keeps the whole system from collapsing?

 

Please, I really want someone to explain this in a way that makes sense because so far, including in this thread, no one has.

 

Or, as I keep saying, "Not based in any sort of economic reality." All the "good ideas" in the world don't make this law any better when it's fiscally completely unworkable...which is why so many people like the individual components, but hate the bill.

[birdog1960]

Those guys weren't doctors.

thus the "as well"

[birdog1960]

No, just letting it play out. I'm more curious on this issue than trying to make a point. It sounds like an imminent disaster but I guess I'm looking for some way to rationalize it so I can believe it might be okay. So far I can't say my biggest concerns have been addressed.

 

Some things I just disagree with: Young people being forced to disproportionately compensate for the cost of old people. It sounds good rhetorically (the how "we" treat our old people bit) but I'm already concerned about my daughter having to pay for the retirement of old people, now she'll have to pay for their health care also. I'm also troubled by the way we're essentially abolishing insurance. When I was a kid my parents paid for check-ups and dental appointments out of pocket, and the prices weren't so absurd as they are today. Insurance was in case you got sick or injured. Now we're essentially socializing medicine incrmentally. Insurance is now just your health care payment plan. That's consistent with the forced coverage of pre-existing conditions. It sounds noble, but that's not what insurance is, that's what collectivism is. They're not the same.

 

On the more fundamental issues, I still don't see a great deal of value here. A good portion of this alleged 30 million newly insured are hypothetical based on a temporary medicaid inclusion that is at the discretion of the state as to whether it should cover them. If this is so desireable why didn't we just expand medicaid? That way you cover the people who can't afford insurance without infringing upon the rights of others. Plus, due to the temporary nature of it, this is essentially a request of the states to allow the government to pass the buck to them. If that's a desirable outcome why not let the states handle the issue on their own? I'm also of the understanding, and I'm hoping those in the industry can shed more light on this, that doctors make far less treating those on Medicaid despite the cost of treatment being held constant - more on this later.

 

So this basically leaves us with the mandate which I see little value in. I get the "freeloader" argument, but it doesn't hold water. Prevention of "freeloading" does little to address the harm this bill purports to cure, that is provide access to health care for those who can't afford it. It actually does nothing to address this. And while I don't have the numbers, I'm of the understanding that the cost of services rendered by those uninsured who are subject to the mandate is relatively negligible.

 

So the only new money pumped into the system is from those not currently insured, who will not be on Medicaid. In the meantime, Dr.'s compensation per visit will drop, more people will have more access to non-essential health care treatment, and "insurance" companies have their premiums capped.

 

Here's where it all falls apart. You have more people consuming more health care services without a corresponding increase in money coming in, a decrease in doctor compensation (which necessarily results in a decrease in the supply of doctors/supply of health care services), and a cap on prices. How can this work?

 

Less Supply + More Demand = Higher Prices

 

If you have higher prices, how do you not have higher premiums? And if you don't have higher premiums how do the insurance companies stay in business? What keeps the whole system from collapsing?

 

Please, I really want someone to explain this in a way that makes sense because so far, including in this thread, no one has.

there's a big problem with your math at the end. medical care hasn't been based on the free enterprise system, supply and demand, since medicare was enacted. doc's who see a majority of medicare and medicaid patients have had their prices set for years - my entire career. yes, demand will increase but prices for the govt payers are determined by the govt and have been for decades. even in negotiations with private insurers, individual, independent doctors are prohibited by law from joining together to negotiate prices. the insurers have had the upper hand for years. so many of us are accustomed to it and have adapted. guess how...we work longer hours and see more patients or we accept lower pay. and that's what's likely to happen here. and by design, i believe, the bill will begin the boulder rolling downhill towards an alternative to the current model of private insurance. on that, we agree.