The Affordable Care Act II - Because Mr. Obama Loves You All

[B-Man]

Oregon poised to abandon its failed ObamaCare exchange

The Hill [Washington, DC], by Elise Viebeck

 

Original Article

 

Oregon is set to become the first state to drop its ObamaCare exchange and transition into the system managed by the federal government.

 

 

 

.

[Dante]

Looks like the pathological liar just keeps on keepin on. Seems like that lofty 8 million sign ups are probably another tall tale.

 

http://news.investor...counted-for.htm

Edited April 25, 2014 by Dante

[OCinBuffalo]

We accomplish appropriate time with the Doctor, meaning no rushing (except for sme providers who are just here to collect a check) by subsidizing the Dept of Internal Medicine revenues from specialties, and the lucrative surgical department. General Internal Medicine has been a mney loser for decades here, meaning provider fail to cover their salary and benefits for the fiscal year- we have a annual primary care support agreement in place, to make sure our Internist can see patients, do research and teach of needed.... I think that is why you will see more providers shut down stand alone practices for internal med, and come to large centers where they can earn a good salary, and not have to see a pateint every 10 minutes for 20 in a 4 hour clinic session. My last annual exam was 45 minutes- I needed 20, but they were thorough and my MD had a student in tow. Where I see the most time wasted in primary care is poor triage of the original call from the patient- complex cases put into a 20 minutes spot, routine stuff put into a 40 minute spot- alot of our issues is having non-medical staff laying out the schedule of and otherwise efficeint provider. I also think the advent of EMR has done more to occupy MD time than the ACA and its reimbursements... they spend alot of time typing, less time caring... kind of ironic consirding how EMR where desimged to be more efficeint.

 

 

 

Jesus, why do you continue to post in this thread, you're making everybody dumber by having to read this tripe- those components of an insurance plan you cited have been in place for decades, the ACA didn't all of the sudden create those utilization tactics of managed care... it simple doubled down on an innefficeint, wasteful convolued mess. Any reform plan including 3rd party insurance as its mainstay will be expensive, messy and cost more... but the ACA didn't create the problem in the first place.

I think a review of the history of RVU use, the governance over their levels and what changes might be coming soon might clarify your thinking here. this article does a very good job: http://www.nejm.org/...56/NEJMp1310583

 

"ideally, physicians work would be reimbursed on the basis of patient outcomes that use effective clinical risk assessment"

 

"natural reform of RVU_based systems is limited by the secretive, proprietary and specialty based nature of the AMA's RVU committee which functionally sets RVU levels".

 

from the outset, 1 RVU in 1 specialty was to be of equal value to an RVU in any other. Many would argue that even before the bastardization of the entire concept, the calculus valued specialists. I can't recall the number of diabetes office visits that originally equalled a single bypass surgery but i believe it approached a weeks worth. from a population based health perspective this is absurd. Then the secret little committee which is overwhelmingly specialty weighted decide to add on a conversion factor to rvu's which is a multiplier that is invariably higher for specialists than for primary care.

 

and the results? well, firstly we have the desired ratio (at least as found in most of the rest of the more cost and outcomes efficient nations in the world) of specialists to primary care reversed. This necessarily leads to time constraints and shorter patient visits since primary care is the front line. It also leads to very expensive care as people with scalpels and xray machines and those administrating them like to use them as profit centers.

 

we also have about 50% of all physicians employed, although I can't find any figures that substantiate your claim that those are majority primary care. personal experience tells me differently. And then we get claims like yours that primary care is subsidized and lucky to be so. nothing could be further from the truth. we're relatively undervalued and the corrupt system of setting RVU levels is to blame. Importantly, those responsible are not government officials.

My F'ing my. Look what happens when you bring up RVU: you get 2 big posts. The same clowns who brought you RVU...CMS.... who can't get any of these smaller things right, historically, consistently, should have a crack at defining bigger things, or the entire thing?

 

Perhaps I have erred in bringing up Meaningful Use? As in: the devil you know(RVU) vs. the devil neither of these guys knows yet(Meaningful Use)? Boy, these guys are right there with the why/how of RVU, aren't they? (Meaningful Use Aside: "I have one word, just one word I want to say to you:"...Minutes. Somebody take note of the fact that I said "minutes" to birdog and B-large...for later. Why? Because the howling and wailing will be funny as hell...later.)

 

Ok, back to it:

 

1. I am fully aware of the Rob Peter to Pay Paul approach in health care. It is pervasive in every sector of the vertical. Decades of forcing some business lines to pay for others is why your margins always suck. You are forced into the loser lines for lots of reasons, largely government regulation. Thus you can't ever get ahead of the game/grow via operational budget, and not capital. Which in turn, is the biggest reason why you tend to have awful IT/EMR/whatever the F some clown pretending to be me wants to call the next thing, that only meets 3-40% of your requirements, and only actually records 60% of what you do. You never have the $ on hand to get better, and I'm talking real get better, not paying $20k in maintenance fees and collecting your annual EMR version upgrade. (BTW, we've solved this problem completely.)

 

2. "Patient outcomes based on effective clinical risk assessment"? Wrong. Assclown wrong. You both know what an EMR is. Therefore, you both also know that bastardizing CMR tactics for health care has failed(many of the same reasons deploying workflow in health care has failed). You don't know why that is true. That is fine. It's my job to know why. You don't care why. You do care about getting the outcomes you want, and you ain't.

 

Clinical risk assessment? What the F are we? Insurance adjusters or line managers? Birdog: you run the shop, AND, you give the care. Who manages 90% of your risk? You? Or the lady who runs the front of the shop? Hint: Not you. Who is responsible for the quality of the care being dispensed? Not front lady. More on this later, but do you see the disconnect between EMR = CRM yet? Do you understand that they base everything they do on CMR, when they aren't basing it on the old paper forms, though?

 

3. You think this post is long? Start me on "scheduling" some time. "Scheduling" is retarded in health care, as I can prove that 70% of your man/day is unplanned work....so....scheduling the unplanned in the conventional sense is absurd. "Scheduling" is a direct result of failure to understand CRM, and then, failure to adjust CRM for health care, and then apply that adjusted thing properly. People who say the word "workflow" but don't know what it means, has also been an huge contributor to the "Scheduling" debacle. Workflow, first properly understood via practical experience with it, then properly adjusted for health care, is the answer to your 20 min/40 min problem. (Solved the F out of this one)

 

4. "Patient outcomes based on effective clinical risk assessment" = How about we stop mushing words that don't belong together in an effort to sound smart?

 

5. How about instead we measure, completely, and therefore be able to manage, completely, our care process? Like....you know, what every other line manager does in every other F'ing industry in the world? But I forgot: Where would we be without $25 million grants, so we can come up with "Patient outcomes based on effective clinical risk assessment" assclownery?

 

6. Blaming anyone for RVU besides the government is patently retarded. Who created the system? Who keeps F'ing with it? Jesus. That's like saying that we shouldn't blame the government, because the Joing Comission/State Surveyors use private contractors. Idiocy. It's the government's awful mousetrap, and ONLY the government can either build a better one, or GTFO.

 

And before you try to gloss it over birdog: MEDICARE is yet again responsible for this, because they originated it. Just like with 85% of the other stupidity in health care. This is why when I hear "Medicare for all" I either laugh or yell at the speaker, depending on my mood.

 

7. You spend more time typing and less caring for 1(one) reason: bad data model design. The EMR systems you have all started the same way: replace the paper. The problem? Paper, the vehicle, has its own rules/limitations. Those rules were transferred to electronic systems because: stupid. Instead of looking at your data, in terms of just: your data? Your data was looked at in terms of how it was looked at on paper, and this paradigm was used to create the EMR data model.

 

Uber FAIL. Now, we are doing more to retain the ghost of paper forms past....than we are actually providing a way to track the care process. The data model in place has been about form emulation/chasing CRM rainbows that don't make sense in health care, and not about the data you need, and more importantly, the data you DO NOT need, especially: right now.

 

Hence, yeah, you're going to typing, and typing, because? You need to fill out the form, because dammit, we have to fill out the form. Get it?

 

 

 

There's ton more. But this is all u get today.

[John Adams]

Straight out of central casting, I give you "Consultant."

[birdog1960]

here's the original article proposing rvu's and the resource base relative value scale http://archive.today/GHjjg it's from a group at harvard led by dr hsaio. none of the authors worked for the govt. medicare adopted rvrbs with bush's 1989 budget. but the power was and is mostly in the hands of the commitee i cited.

 

oc, it would advance your argument to link to some articles supporting your case. you rarely do. there's likely a reason for that.

Edited April 26, 2014 by birdog1960

[B-Man]

So much for the 'Obamacare resurgence'

 

 

 

 

 

 

 

From the new Washington Post/ABC News poll:

The

Post

–ABC poll found that 44 percent say they support the law while 48 percent say they oppose it, which is about where it was at the end of last year and in January. Half of all Americans also say they think implementation is worse than expected.

 

Last month, a

Post

–ABC poll found 49 percent of Americans saying they supported the new law compared with 48 percent who opposed it. That finding was more positive for the administration than most other polls at the time. Democrats saw it as a possible leading indicator of a shift in public opinion, but that has not materialized

.

 

A 58 percent majority say the new law is causing higher costs overall, and 47 percent say it will make the health-care system worse. While a majority say the quality of the health care they receive will remain the same, a plurality expect it to result in higher personal costs for that care.

[Dorkington]

So it appears to me that support for healthcare laws (ACA or otherwise) is purely linked to price and coverage quality.

 

Question:

 

What change(s) would cause prices to fall WHILE improving coverage quality?

 

Followup:

 

What can we, the voters, do to implement the above change(s)?

Edited April 29, 2014 by Dorkington

[TakeYouToTasker]

.

Question:

 

What change(s) would cause prices to fall WHILE improving coverage quality?

Doing away with burdensome regulations which strain doctors and their staffs. Open up marketplaces by allowing individuals to shop across state lines for policies that are in-line with their needs.

 

]Followup[/b]:

 

What can we, the voters, do to implement the above change(s)?

Elect officials who will do these things.

[IDBillzFan]

[/i]

Doing away with burdensome regulations which strain doctors and their staffs. Open up marketplaces by allowing individuals to shop across state lines for policies that are in-line with their needs.

 

 

Elect officials who will do these things.

 

It would also be great if we could pick the specific coverage we want based on our situation without someone demanding we must get some ridiculously over-the-top coverage for items we'll never use. . Start with a base coverage, and then add fees for, say, maternity coverage, birth control, etc. And I agree...let us shop across state lines and watch what that simple change will do.

Edited April 29, 2014 by LABillzFan

[B-Large]

I think a review of the history of RVU use, the governance over their levels and what changes might be coming soon might clarify your thinking here. this article does a very good job: http://www.nejm.org/...56/NEJMp1310583

 

"ideally, physicians work would be reimbursed on the basis of patient outcomes that use effective clinical risk assessment"

 

"natural reform of RVU_based systems is limited by the secretive, proprietary and specialty based nature of the AMA's RVU committee which functionally sets RVU levels".

 

from the outset, 1 RVU in 1 specialty was to be of equal value to an RVU in any other. Many would argue that even before the bastardization of the entire concept, the calculus valued specialists. I can't recall the number of diabetes office visits that originally equalled a single bypass surgery but i believe it approached a weeks worth. from a population based health perspective this is absurd. Then the secret little committee which is overwhelmingly specialty weighted decide to add on a conversion factor to rvu's which is a multiplier that is invariably higher for specialists than for primary care.

 

and the results? well, firstly we have the desired ratio (at least as found in most of the rest of the more cost and outcomes efficient nations in the world) of specialists to primary care reversed. This necessarily leads to time constraints and shorter patient visits since primary care is the front line. It also leads to very expensive care as people with scalpels and xray machines and those administrating them like to use them as profit centers.

 

we also have about 50% of all physicians employed, although I can't find any figures that substantiate your claim that those are majority primary care. personal experience tells me differently. And then we get claims like yours that primary care is subsidized and lucky to be so. nothing could be further from the truth. we're relatively undervalued and the corrupt system of setting RVU levels is to blame. Importantly, those responsible are not government officials.

 

Primary Care is subsidized through the support agreement, but I don't think they are lucky to be so... I think it has become just a reality of the land. The benchmark RVU's for a primary care provider, who also has commited to academic and research, it is impossible to hit your salary and benefits. No doubt the RVU system needs revamped- but I still don't see how a PCP working in academic medicine will ever be stand alone and self supporting- I don't think Specialties balk any more than they have to, understand the important role primary care plays.

 

[/i]

Doing away with burdensome regulations which strain doctors and their staffs. Open up marketplaces by allowing individuals to shop across state lines for policies that are in-line with their needs.

 

 

Elect officials who will do these things.

 

It doesn't make a difference if healthy people don't buy into risk pools. Still, nobody has articulated why this premise would bring down the cost of insurance, increase widespead or total access, or do anything more that what was offered prior to 2010. These are national companies, they set rates based on local populations, do we think that BC/BC is going to offer a uhealthly person from Mississippi a rated policy for healthy people in Colorado? I hear this Sell Across State Lines solution from people all the time, what exaxtly does it accomplish?

[Dorkington]

What regulations increase the costs of health services? Ones intended to protect the consumer, or something else?

 

Curious also about how shopping across statelines would work for the same reasons B-Large list. That being said, it is a "free market" solution.

 

Is that the solution? Just removing regulations? And then healthcare would be cheap, and higher quality?

[Rob's House]

What regulations increase the costs of health services? Ones intended to protect the consumer, or something else?

 

Curious also about how shopping across statelines would work for the same reasons B-Large list. That being said, it is a "free market" solution.

 

Is that the solution? Just removing regulations? And then healthcare would be cheap, and higher quality?

 

One of the problems is that they did the exact opposite of what would bring costs down by mandating coverage of wide ranging non-essential services for a plan to qualify. If my insurance policy covers all manner of services that I might use but don't really need, the risk of incurring expenses increases for my insurance company, and thus the price of premiums goes up. It's not possible that the architects of this legislation didn't understand this. They just lied through their teeth about the effect it would have on costs.

 

This could also drive up the cost of those services because there is now more money available to chase those services. When demand increases and supply remains constant the price goes up.

Edited April 29, 2014 by Rob's House

[Dorkington]

If you remove the insurance coverage regulation, and remove the mandates, isn't that exactly where we were in recent history? Weren't prices going up pretty quickly still?

[Deranged Rhino]

If you remove the insurance coverage regulation, and remove the mandates, isn't that exactly where we were in recent history? Weren't prices going up pretty quickly still?

Health insurance as an institution is the problem. Get rid of them, solve a lot of problems. Unfortunately, their pockets are too deep and their lobby too strong.

[Rob's House]

If you remove the insurance coverage regulation, and remove the mandates, isn't that exactly where we were in recent history? Weren't prices going up pretty quickly still?

 

Not as quickly as they are now. But that's just one example. Speaking more broadly, and without getting too detailed, when you increase the regulations with which people must comply you're necessarily creating hurdles to the free flow of commerce. Those hurdles increase costs, whether that is the cost of lawyers to figure out how you must navigate the new regulations, modifications you must make, etc. The pertinent analysis with regards to efficiency is whether the added safeguards you get from the increase in regulation justifies the increase in cost.

 

The problem is that I've described the way an economist (or rational human) would look at the situation. Politicians don't care about efficiency.

[keepthefaith]

If you remove the insurance coverage regulation, and remove the mandates, isn't that exactly where we were in recent history? Weren't prices going up pretty quickly still?

Yes, rates were rising much faster than inflation. Now they'll rise faster than faster than the rate of inflation, many businesses will trim payrolls and consumers will have fewer choices of coverage and doctors.

[Dorkington]

Ok, so removing regulations would decrease basement prices. Would they decrease prices overall? Would removing regulations ensure that coverage is more comprehensive, and that more people would have relevant coverage? Or is it just back to "if you can't afford it, you don't deserve it"?

 

For the life of me, I can't wrap my head around any "solutions" that aren't either a universal healthcare system, or a single payer insurance system. I'm open to free market ideas, but I don't really understand how they solve things in this case, hence the (possibly) stupid questions.

 

Yes, rates were rising much faster than inflation. Now they'll rise faster than faster than the rate of inflation, many businesses will trim payrolls and consumers will have fewer choices of coverage and doctors.

 

Is this just an assumption, or has there been proof of increased speed of price increases compared to before ACA? And is that a price increase for the same level of coverage?

Edited April 29, 2014 by Dorkington

[Rob's House]

Ok, so removing regulations would decrease basement prices. Would they decrease prices overall? Would removing regulations ensure that coverage is more comprehensive, and that more people would have relevant coverage? Or is it just back to "if you can't afford it, you don't deserve it"?

 

For the life of me, I can't wrap my head around any "solutions" that aren't either a universal healthcare system, or a single payer insurance system. I'm open to free market ideas, but I don't really understand how they solve things in this case, hence the (possibly) stupid questions.

 

 

 

Is this just an assumption, or has there been proof of increased speed of price increases compared to before ACA? And is that a price increase for the same level of coverage?

 

If you only consider one side of the equation your perspective will be skewed. What we have here is a failed policy. It's an abject failure because it helps only a fraction of the people we were told it would help and at a substantially greater cost than we were told.

[B-Large]

Ok, so removing regulations would decrease basement prices. Would they decrease prices overall? Would removing regulations ensure that coverage is more comprehensive, and that more people would have relevant coverage? Or is it just back to "if you can't afford it, you don't deserve it"?

 

For the life of me, I can't wrap my head around any "solutions" that aren't either a universal healthcare system, or a single payer insurance system. I'm open to free market ideas, but I don't really understand how they solve things in this case, hence the (possibly) stupid questions.

 

 

 

Is this just an assumption, or has there been proof of increased speed of price increases compared to before ACA? And is that a price increase for the same level of coverage?

 

Heres the bottom line.

 

Free Market in healthcare is pay in cash, if you can't pay, you don't get. That is where price would come in line with a cosumers ability to pay for services., you would see fierce compeition for people who had money to pay, and you would see crystal clear price transprancy. You would see alot of hospitals close, innovation in pharma and tech would wane, and there would be alot of fellow Americans whose life would be vastly shortened. Amercians in general arent really comfortable with that scenario.

 

Every other system is a cost shifting model. Cost Shifting, Cost Sharing, Wealth Distribution, etc- its all the same. The difference in access, delivery and rationing will be just about the same in a Single Payor Model, Socialized Medicine model or the Private Insurance model- just who do you feel the most comfortable with restricting and trying to limit your care. We argue they are vastly different, but in the end are very similar

 

The best we can hope for is the partial free market hybrid. To me, this means ALOT of money out of a citzens pocket before insurance pays for a dime- it will force people to be thoughtful and deliberate about what care they seek, and were the seek it out. You pay for your penvetative care, you pay for basic services, you pay for the small tickets items.

 

To me, there is no free lunch, everybody pays, and everybody will eventually take. Rarely do I think Government can do somethig better, but I'd love to get State based Single Payor a real shot- maybe it would suck, and I eat crow- but how much worse could it be than the boondoggle we have now, and had in the past? Probably not much worse.

[IDBillzFan]

Heres the bottom line.

 

Free Market in healthcare is pay in cash, if you can't pay, you don't get. That is where price would come in line with a cosumers ability to pay for services., you would see fierce compeition for people who had money to pay, and you would see crystal clear price transprancy. You would see alot of hospitals close, innovation in pharma and tech would wane, and there would be alot of fellow Americans whose life would be vastly shortened. Amercians in general arent really comfortable with that scenario.

 

No one here, conservative or otherwise, has ever had a problem with a safety net for those with genuine need. What you need to do is verify the need without people running around yelling how it's racist to make a poor person prove they're poor.

 

We would be able to significantly help many of the poor EASILY if we did one thing well: PROVE they are not only poor, but are incapable of improving on their lot. Make a massive effort to go after fraud. Let's go after people who commit fraud against the government like we treat a white NBA owner who doesn't like blacks. Give it THAT kind of discussion. THAT kind of effort and commitment.

 

Billions are lost in fraud. Step one should be to get it back from every fraudulent act out there, not create a new law that is prime breeding ground for new fraud.