The Affordable Care Act is Coming Home to Roost

[JuanGuzman]

You've got me cornered. I can not find a single link that proves 50 million people were uninsured before Obamacare was passed.

 

Here it is:

The United States Census Bureau annually reports statistics on the uninsured. The current Census Bureau report states that the number of Americans living uninsured declined to 48.6 million in 2011 from 49.9 million in 2010. In in 2009 there were 50.7 million people in the US (16.7% of the population) who were without health insurance. link: http://www.census.gov/newsroom/releases/archives/income_wealth/cb11-157.html

Edited December 16, 2013 by JuanGuzman

[DC Tom]

First things first, I should note that the best part of Obamacare is the fact that those 40-50 million people with out health insurance will get health insurance. That being said I believe ACA or Obamacare will have result in more efficient health spending then what was the status quo. Here a couple ways:

1. The "Community Rating" which prohibits insurers from varying rates based on health status or claims history will mean reduced administrative costs as insurers stop devoting administrative dollars yp investigating peoples health history or gaming insurance contracts so that they include only healthy people in their risk pool. I think this has already been seen in reduced premiums and rebates for consumers.. from the June 2013 Kaiser study: the study focused on actual experience under the Affordable Care Act as it affected individual market consumers (those buying insurance on their own). The study found that the Medical Loss Ratio provision of the Act had saved this group of consumers $1.2 billion in 2011 and $2.1 billion in 2012, reducing their 2012 costs by 7.5%.
    
    
    
   
2. Expansion of medicaid benfits to more people. Medicaid has been the most cost efficient insurer over the last decade.. performed better .
    
   
3. Buying workhorse/brand name pharmaceutical drugs and using bulk buying to negotiate discounts, yes that means lower profits for pharmaceutical firms but lower costs health insurance.
    
    
    
   
4. Moving away from fee-for-service to bundled payments.. bundled payments allow insurers to negotiate for one episode of care instead of doctors doing unesscessary treatments in the old fee for service model. I'm interested to see how this works for medicare but its expective to incentivize better care ass doctors and hospitals are rewarded for good treatment and lower re-admission rates ect. Most studies expect bundled payments to deliver better service for less cost. I think the RAND corporations expects savings of at least 5.4 per cent over a 10 year period
    
    
   
5. penalties for cadillac plans... basically one of the ways employer delivered health insurance was encouraged in the U.S. is due to favourable tax treatment for health benefits, it would be treated differently than income and not tax so employers/employees were incentivized to take health insurance instead of income. The problem is that for really high income earners it makes sense to increase your health insurance benefits, rather be taxed at the highest rate.. you get these cadillac plants with small or nonexistent co-pays, deductibles, or caps that encourage the overuse of medical care, driving the cost up for the uninsured or those on other plans. The nex tax limiting cadillac plans is a good thing for spending efficiency.
    
    
   
6. More people having access to preventative care, for instance heart diseases, diabetes, blood pressure etc. all develop over time. If those people who are now insured due to Obamacare start having regular check-ups, preventative care such as early diagnosis of diabetes can lower life time health spending.
    
    
    
   
7. Section 3025 of the Affordable Care Act added section 1886(q) to the Social Security Act establishing the Hospital Readmissions Reduction Program, which requires CMS to reduce payments to IPPS hospitals with excess readmissions, effective for discharges beginning on October 1, 2012.
   
8. (Edit) one more creating... online health exchanges is a good thing. One stop shop to compare prices allows for more competition (assuming the tech issues get solved)
   

Last but not least I believe Conservatives talking point on this is "DEATH PANELS" .. .but I think that

 

The establishment of indpendant advisory panels that limit "government spending" on treatments with low effectiveness and/or patients who aren’t going to live much longer is a good thing. Remember this only for government tax payer supported insurers programs. For me its such a contradiction that conservatives hate low-income people getting insured by goverment but then go around screaming bloody murder/DEATHPANELS when the government actually tries to spend more efficiently on treatment.

 

It just makes a lot of sense of panels to evaluate what treatments are working and what are just a waste of money. Then they relay that information to doctors and hospitals

 

None of those are measures of efficiency, merely cost-cutting measures.

 

Do you know what "efficiency" means?

[B-Man]

A Win for Religious Liberty in New York

 

A judge in the Eastern District of New York has ruled in favor of religious liberty in Roman Catholic Archdiocese of New York v. Sebelius – the archdiocese and other Catholic entities involved in the suit do not have to comply with the Obama administration’s abortion-drug, contraception, female sterilization mandate.

 

Read the ruling here.

 

 

Obamacare’s Biggest Problem: Human Nature

 

 

 

 

Mass. Health-Care Exchange Scraps Enrollment System, Is Looking for Alternatives

 

 

 

 

Re: A Win for Religious Liberty in New York

 

The key element in Judge Cogan’s finding was his specific rejection of the administration’s minimalistic approach to religious liberty. This is yet another instance in which courts have rejected (unfortunately not unanimously) the administration’s narrow and unhistorical view of religious liberty — see the Supreme Court’s decision in the Hosanna Tabor case, and numerous lower-court rulings on the HHS mandate.

 

Judge Cogan rightly found that the HHS mandate improperly requires church agencies to perform acts that are directly contrary to their Catholic faith — by forcing them to affirmatively endorse and facilitate access to abortion, contraception, and sterilization, under penalty of ruinous fines. This is a very important point, and one that should be axiomatic to anyone who believes in ordered liberty. If religious freedom means anything, it means that the government can’t force people to do things that they believe God has forbidden. For people of faith, there is a hierarchy of authority, and it is deeply unjust for the government to try to arrogate to itself the ultimate authority over people’s consciences.

 

Pope Francis has made this point forcefully, saying:

"A healthy pluralism, one which genuinely respects differences and values them as such, does not entail privatizing religions in an attempt to reduce them to the quiet obscurity of the individual’s conscience or to relegate them to the enclosed precincts of churches, synagogues or mosques. This would represent, in effect, a new form of discrimination and authoritarianism."

[GG]

 

 

None of those are measures of efficiency, merely cost-cutting measures.

 

Do you know what "efficiency" means?

 

They are not even cost cutting measures, but are marketing bullet points.

[JuanGuzman]

None of those are measures of efficiency, merely cost-cutting measures.

 

Do you know what "efficiency" means?

 

Starting to question your intelligence if you don't think the ACA measures i listed are efficient.

Getting the same drugs for less money = efficient

promoting competition through online exchanges = efficient

reducing hospital re-admissions through incentives for better treatment = efficient

reducing the number of cadillac plans that inefficiently use health resources = efficient

Access Preventative Care that lowers life time spending health and improves outcomes = Efficient

reducing administrative fees = Efficient

 

ect the list goes on.... cutting costs and maintaining or in this case improving service is a textbook definition of improved efficiency.

 

Anyway, it's clear most people have made up their mind in this room. (at least those commentating). I doubt I can convince anyone support Affordable Care Act, and I don't think I'll be convinced by anyone that ACA is worse than the status quo.

 

The awesome thing is we are going to have the next half decade to see who was right and who was wrong. I look forward to it

Edited December 17, 2013 by JuanGuzman

[boyst]

You know it is a bad when Howard Stern calls this a major failure. A huge !@#$up. Stern is a liberal douche and hit it on the head calling it a disaster and saying howdisappointed he was because the system needs revamping . He said this is nothing but a failure and a reflection of this administration.

 

And for the record. I trust Stern far more then most people and won't even mention him in the same sentence as a few folks here. He is a smart man.

[DC Tom]

Starting to question your intelligence if you don't think the ACA measures i listed are efficient.

Getting the same drugs for less money = efficient

promoting competition through online exchanges = efficient

reducing hospital re-admissions through incentives for better treatment = efficient

reducing the number of cadillac plans that inefficiently use health resources = efficient

Access Preventative Care that lowers life time spending health and improves outcomes = Efficient

reducing administrative fees = Efficient

 

ect the list goes on.... cutting costs and maintaining or in this case improving service is a textbook definition of improved efficiency.

 

Anyway, it's clear most people have made up their mind in this room. (at least those commentating). I doubt I can convince anyone support Affordable Care Act, and I don't think I'll be convinced by anyone that ACA is worse than the status quo.

 

The awesome thing is we are going to have the next half decade to see who was right and who was wrong. I look forward to it

 

Textbook definition? What textbook are you reading? It's clearly not one that defines "efficiency." You clearly don't know what that word means - e.g. a high-premium, low-deductible "Cadillac plan" risk pool should use health care resources very efficiently, given that it's evening out health care costs across a risk pool and collecting up front the vast majority of the monies needed to cover health care costs. In fact, to argue that's inefficient is to argue that the very principle behind socialized medicine - amortizing costs over a large population, and eliminating individual exposure to the fiscal risk of health care costs - is inefficient. Which kind-of makes you a pinhead, doesn't it?

 

Do you have a textbook definition for "commentating" as well?

[JuanGuzman]

Wrong the whole point on Cadillac plans is that it causes people to over consume e.g., too much health care because of favourable tax treatments. Since one good is being taxed (income) and another isn't health care. High income earners over invest in it,

[IDBillzFan]

Wrong the whole point on Cadillac plans is that it causes people to over consume e.g., too much health care because of favourable tax treatments. Since one good is being taxed (income) and another isn't health care. High income earners over invest in it,

 

By 'over consume' and 'too much health care,' you probably mean things like forcing men to buy coverage for their own maternity care, right?

[DC Tom]

Wrong the whole point on Cadillac plans is that it causes people to over consume e.g., too much health care because of favourable tax treatments. Since one good is being taxed (income) and another isn't health care. High income earners over invest in it,

 

Which is not a measure of efficiency.

 

And, again, is the same argument you could make for socialized medicine.

 

By 'over consume' and 'too much health care,' you probably mean things like forcing men to buy coverage for their own maternity care, right?

 

Just like by "high income earners," he means union members.

[OCinBuffalo]

here I was warming up to crush each bullet....

 

but GG/Tom already took care of it. There's not a single piece of data the power point presentation above that isn't massaged. It's the literal equivalent of "cheese food". You guys know where the "Medicare administrative costs are 4%, private insurance are 20%" comes from?

 

The West Wing. Yes, TV show "data". And, it's 4%, not 2%, and there's a reason WHY.

 

Once again: The Formula for all "Interesting" Liberal Tropes(interesting today, holy writ tomorrow):

= compare apples to oranges, cherry pick the data, and run to the media, who on cue, goes banannas.

 

Look, this all comes down to entirely different business models. EDIT: and for the CPAs here? A balance sheet comparison ends this argument immediately. Or, 3 words: Chart of Accounts. Pretending any real comparison can be made is patently retarded.

 

Meanwhile, I'm looking at an MDS 2.0 form right now. For the rest of you, go here, and try to say the word: "efficient" to yourself while you read, without laughing. http://www.cms.gov/M...MDSAllforms.pdf

 

There are excatly 134 points of stupidity on that form, and I have already proven every single one of them, in production software(EDIT: well...some of them are dodgy, about 20, but, the rest are solid. The dodgy ones are so because of the kludginess of the MDS. You could interpret things different ways, and try to get over, but only on ~20. Notice: I'm talking about "interpretation" on something that is supposed to be a standard: think gymastics judges, vs. the 1st down chains. How do you want to get paid?). This approach is so flawed, that is it useless as both a quality assurance instrument, AND a reimbursement instrument.

 

Why in the hell we decided to combine two things that have little to do with each other when it comes to business process? Who the F knows? I've never gotten anything approaching a non-trivial, educated answer on this. Now, they are coming up with the 3rd version of this idiocy. http://www.cms.gov/M.../MDS30Draft.pdf

 

Which contains the following gem:

Surprisingly, going to the resident is often more efficient. Using the resident as the primary information source is not only time well spent, it can actually be faster.

Raise your hand if talking to the customer, about the customer's needs, working better than not talking to them, is in any way "surprising" to you.

 

Efficient. And you guys wonder why I get pissed. This is version #3! Do you have any idea how many billions of iterations we've already gone through with v1-2....to find out only NOW, that talking to the customer...."surpisingly" is "time well spent" because it's "faster"?

 

 

This is why I laugh so hard when tools like Waddle Waddle Guzman attempt to tell me I'm the ideologue. I've got the real facts, as I posted above, and I literally have a hand in physically creating the data, every day, that shows how stupid this is.

 

Now you can see for yourself. I'm not going to give you the answers: that would ruin the fun. Read through this stuff and tell me what you see, and hey...for all I know, one of you may come up with stupidity point #135, which would be even more fun.

Edited December 17, 2013 by OCinBuffalo

[keepthefaith]

Wrong the whole point on Cadillac plans is that it causes people to over consume e.g., too much health care because of favourable tax treatments. Since one good is being taxed (income) and another isn't health care. High income earners over invest in it,

 

WTF planet are you on? Favorable tax treatment? Why should anyone be taxed on a health insurance policy? A better case could be made that individuals should be able to deduct their health insurance cost. The majority of people in the US get their health insurance through their employer and the employers more often than not pay for most of those premiums. The employers take the cost of providing that benefit as an expense. Better plans cost more. Many who have better plans are not high income earners. They simply work in organizations that have chosen or negotiated to provide more complete plans. Taxing better plans is going to be wildly unpopular and was simply put into place to raise money to fund subsidies and reduce what the government feels are inequities in coverage. It's redistribution 101 and won't save anyone a dime. It will however increases people's tax bill and/or cause some to buy less expensive plans with less coverage. Neither of those things are good.

[DC Tom]

here I was warming up to crush each bullet....

 

but GG/Tom already took care of it. There's not a single piece of data the power point presentation above that isn't massaged. It's the literal equivalent of "cheese food". You guys know where the "Medicare administrative costs are 4%, private insurance are 20%" comes from?

 

Who cares? That's not even the graphic he included. That was actually a meaningless, empty bar chart comparing the growth rate of total expenses between the two programs...

 

...without any reference to outcomes, which you would think would be necessary to measure efficiency.

[OCinBuffalo]

Who cares? That's not even the graphic he included. That was actually a meaningless, empty bar chart comparing the growth rate of total expenses between the two programs...

 

...without any reference to outcomes, which you would think would be necessary to measure efficiency.

What? I'm just going after the boiler plate 4% vs. 20% argument, that Juan didn't even get right. That argument is predicated on the assumption that you never run into somebody like me.

 

Bad assumption. I now have access to terrabytes of data. All of which says the same thing:

 

The government's administration of Medicare is anything but efficient, and via things like the MDS, I have PROVEN that they in fact hurt quality, or, make it near impossible to assure quality. There's nothing about how Medicare is run that even approaches proper methodolgy. And, what's worse? The times when other industry approaches have been tried?

 

They take what works off the factory floor, and expect it to work in health care. See here: http://ceur-ws.org/Vol-820/Demo4.pdf It's college professors and everything! Woooooo! FAIL!

 

Read the abatract, and the first few paras. Bad problem definition = solution is hopeless. I give them credit(their grade? C-), because they recognize they have to adjust. But, then they fail to see the real problems. And, try handing this paper to a 200 lb CNA/Radiology Tech on her smoke break. These guys have never been on a project in the real world.

 

Same story: "intellectuals" coming from everywhere but real enterprise projects, struggling, because they have no experience in real enterprise project work. Whereas you and I realize instantly that scheduling is irrelevant when creating the core, and...

 

Tell me: how do "varying levels of granularity" standards(I'm sure you have at least one) work at the Navy? hehehe...Suffer!

 

The entire paper is defeated by 2 words: unplanned work. Oh yes, "reschedule"? What if work is done, that was never scheduled to begin with? Simple: lady comes sees doctor and doc realizes she needs a whole other set of treatments, etc. Unplanned work FAIL. This happens all the time, so trying to set up a "patient with P dx/condition needs Q service via R schedule" baseline and, doing your analysis on that, means your going to get 162 unique experiences today, and nothing to work with.

 

The data looks like somebody puked on the screen, is all over the place, and they wonder why they can't do "efficient"?

 

My standard is clear as a bell, and always consistent. F schedule, because my system is not patient-centered . Nor should any health care system be patient-centered. You can't compare patient to patient, so you have no chance of setting efficiency standards using anything to do with them(you just make it up as you go = MDS = gymnastics judges). This is how things like the MDS get invented. This is how costs get out of control, this is how the government makes all of it worse. Show me one patient, and you've seen: 1 patient. There is practically no commonality between one to the next.

 

Legos are indispensible. That's what we have: lots and lots of Legos.

 

These professors are the closest people in the world to where we are at, and they fail miserably(wanna see their analytics results?). This is my "competition".

 

Well, there's these guys, and...Juan Guzman.

Edited December 17, 2013 by OCinBuffalo

[Alaska Darin]

Wrong the whole point on Cadillac plans is that it causes people to over consume e.g., too much health care because of favourable tax treatments. Since one good is being taxed (income) and another isn't health care. High income earners over invest in it,

The best way out of a hole is to put down the shovel. It's like there's nothing you liberal apologists won't believe if it's accompanied by a color chart.

[TheMadCap]

Wrong the whole point on Cadillac plans is that it causes people to over consume e.g., too much health care because of favourable tax treatments. Since one good is being taxed (income) and another isn't health care. High income earners over invest in it,

 

BS. My "Cadillac Plan" has a deductible of 1500 bucks and then it only covers 80%. I don't get anything for free, in fact, this plan has prevented many of my co workers from automatically running to the doctor for a sniffle. Not all "Cadillac Plans" are the same, and it doesn't mean you pay nothing. I about 5200 bucks per year for mine, and that does not include the other 20% I pay for other services.

 

I should also mention that I am a transplant patient, so I do have quite a bit of personal experience with all types of health insurance, both good and bad. In 2015 when my plan gets cancelled because my employer cannot afford to splurge out an extra 40% off the top for the same coverage, our cost WILL go up, and our coverage WILL go down. It is ridiculous and beyond comprehension that anyone would argue it would not. It HAS to, it's designed to do that. This is why that law is ****...

[DC Tom]

Wrong the whole point on Cadillac plans is that it causes people to over consume e.g., too much health care because of favourable tax treatments. Since one good is being taxed (income) and another isn't health care. High income earners over invest in it,

 

And by the way - the "Cadillac plans" are defined not by the coverage they provide, but by the premiums paid. In other words, the definition is directly tied only to the cost of insurance, and not at all to the amount of coverage provided.

[Alaska Darin]

And by the way - the "Cadillac plans" are defined not by the coverage they provide, but by the premiums paid. In other words, the definition is directly tied only to the cost of insurance, and not at all to the amount of coverage provided.

That's "Efficiency", right?

[Nanker]

That's "Efficiency", right?

Absolutely, like the increase in people covered by Medicaid. They government buys TV and radio ads to promote this free healthcare coverage and lo and behold, folks sign up! Free insurance is infinitely more efficient for the end user, and the % of people "insured" miraculously goes up. It's like nirvana for liberals.

[IDBillzFan]

Absolutely, like the increase in people covered by Medicaid. They government buys TV and radio ads to promote this free healthcare coverage and lo and behold, folks sign up! Free insurance is infinitely more efficient for the end user, and the % of people "insured" miraculously goes up. It's like nirvana for liberals.

 

By the time you factor in the true efficiency of how every dollar of welfare adds $1.50 into the economy, is it any wonder the progressive ideology is all the rage these past few years?