Is Obamacare going to make things worse?

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by Quantum Windbag, Jul 2, 2010.

  1. Quantum Windbag
    Offline

    Quantum Windbag Gold Member

    Joined:
    May 9, 2010
    Messages:
    58,308
    Thanks Received:
    5,014
    Trophy Points:
    245
    Ratings:
    +5,221
    I could have sworn this was one of the big selling points for this abomination.

    Health overhaul may mean longer ER waits, crowding - Yahoo! News
     
  2. SFC Ollie
    Offline

    SFC Ollie Still Marching

    Joined:
    Oct 21, 2009
    Messages:
    28,742
    Thanks Received:
    4,418
    Trophy Points:
    183
    Location:
    Extreme East Ohio
    Ratings:
    +4,457
    Doctors are already warning Medicare patients.
     
  3. syrenn
    Offline

    syrenn BANNED

    Joined:
    May 10, 2010
    Messages:
    47,839
    Thanks Received:
    10,387
    Trophy Points:
    0
    Ratings:
    +10,403
    ER's need to learn and use the word:

    Triage

    and just start telling people who come in for visits, they are NOT emergency's and go to their regular doctors.

     
  4. Jeremy
    Offline

    Jeremy TRANSFER!!!

    Joined:
    Jun 11, 2010
    Messages:
    7,777
    Thanks Received:
    1,188
    Trophy Points:
    98
    Ratings:
    +1,190
    Does a one legged duck swim in circles?
     
  5. Greenbeard
    Offline

    Greenbeard Gold Member

    Joined:
    Jun 20, 2010
    Messages:
    6,809
    Thanks Received:
    1,200
    Trophy Points:
    200
    Location:
    New England
    Ratings:
    +1,323
    I'm curious about something. I frequently find that conservatives will say something like "no one opposes health care reform, I just want to do it differently." And then they usually clarify that their goals are roughly the same as people in the center or on the left: improving cost, quality, and access.

    But then a story like this comes out and a common reaction among conservatives I've interacted with has been an attitude something like "see, the goal of expanding access is misguided because we don't have the capacity for it." The implication there being that our system's strengths arise in part because a fair number of people are excluded from it and bringing more people into it is a fundamentally bad idea.

    I'm not yet sure how to reconcile this. Is that an admission that health care reform suggestions coming from conservatives are (or ought to be), by their very nature, not designed to allow more people to access care? One would think that would extend to affordability, too (i.e. making care more affordable would also put strains on provider capacity). So I'm let wondering what, philosophically, a conservative reform would be designed to do? What's the aim there?
     
  6. Quantum Windbag
    Offline

    Quantum Windbag Gold Member

    Joined:
    May 9, 2010
    Messages:
    58,308
    Thanks Received:
    5,014
    Trophy Points:
    245
    Ratings:
    +5,221
    The law that passed was not about reforming health care, it was about controlling it. Health care cannot be reformed through regulations that perpetuate the problems, and claiming that it is a right only makes things worse. The only rights we have are things other people do not have to subsidize, if they are subsidized they are entitlements.

    There were a lot of bills over the years that tried to address the real problems in health care, and all of them were ignored in order for that Obama could claim he got something done. This law does not address the rising cost of malpractice insurance, does nothing to give the consumer real options, and forces people to buy into a systems that is doomed to failure.
     
    • Thank You! Thank You! x 2
  7. Greenbeard
    Offline

    Greenbeard Gold Member

    Joined:
    Jun 20, 2010
    Messages:
    6,809
    Thanks Received:
    1,200
    Trophy Points:
    200
    Location:
    New England
    Ratings:
    +1,323
    That's easy to say because discussion on this particular forum (and in many other places) focuses almost entirely on the 300 pages of the law relating to insurance market reform. The rest of the law--the bits pertaining to actual health care--go unnoticed. The primary care workforce capacity-building provisions of the law are a throwaway line in the OP's article. The investment in community health centers doesn't seem to get any mention at all.

    Is there ever much discussion of interoperable EHR adoption, care coordination through models like the medical home or accountable care organization, payment reform to transition to a system that prices health as an output good of our health care system, or the long-term shifts toward emphasizing quality and effectiveness?

    You mention subsidization but this doesn't jibe with your other posts. I take it that you don't like the the tax exemption for employer-based plans. And yet in the other thread you advocated tax privileged creations like HSAs, which allow consumers to pay for health-related expenses with pre-tax dollars, privileging consumption on health care goods over other types of consumption. The current tax code subsidizes employer-provided health insurance, and it subsidizes direct spending on health care from things like HSAs. Should we end all of those entitlements or just keep the ones you like?

    What bills did you like? Paul Ryan and Tom Coburn's bill (which created structures suspiciously similar to the health insurance exchanges)?

    More to the point, you didn't answer my question. What is the point of any reform in your view? I assume it's not increasing access (or its relative, lowering costs) because that would strain capacity and I gather from this thread that this is to be avoided at all costs. So what goal should reform try to achieve? Or should there be no reform at all?
     
    Last edited: Jul 2, 2010
  8. Quantum Windbag
    Offline

    Quantum Windbag Gold Member

    Joined:
    May 9, 2010
    Messages:
    58,308
    Thanks Received:
    5,014
    Trophy Points:
    245
    Ratings:
    +5,221
    I am not responsible for other peoples posts, so don't tell me what other people do not talk about. Community health centers are a joke. They exist to service people who do not have other medical coverage, and this law is supposed to extend coverage for everyone. Funding for two of them in Vermont was buy in to buy the vote of Bernie Sanders of Vermont, and they were extended to other states when the hoopla about special deals started to cover it up. Yet Vermont is still getting two of them. Interesting, isn't it?

    I don't talk about those because I haven't figured out all the catches yet. But if you want to talk about the new menu requirements for restaurants that will keep smaller from expanding due to the prohibitive costs and all the other bad things I do know about in the law then we can certainly do that.

    Where have I ever supported subsidization of anything? I think you are confusing me with someone else. As a rule of thumb, eliminating all tax breaks for anyone is a good idea. If someone sits me down I might admit to exceptions, but there is no reason make a practice of it.

    I didn't like any of them really, but I like parts of some of them. I even like parts of the law that actually passed, but the mistake was trying to do everything at once, and not even addressing the things that have actually driven down health care costs.

    The goals of reform should be simple. Provide the opportunity for everyone to get health care when they need it, allow people to choose what they want to cover if they choose to purchase insurance, and allow them to negotiate directly with doctors over costs. Why is it that things like plastic surgery, lasik, and optometry, which are not generally covered by insurance, has gone down in cost over the years, while other medical treatment has gone up faster than inflation? Could it be because market forces actually work the way people who believe in the free market believe?

    I don't know how to reach all the goals we need to, but trying to do it all at once, using a model that hasn't worked anywhere else, is not the answer.
     
  9. Greenbeard
    Offline

    Greenbeard Gold Member

    Joined:
    Jun 20, 2010
    Messages:
    6,809
    Thanks Received:
    1,200
    Trophy Points:
    200
    Location:
    New England
    Ratings:
    +1,323
    Wow, I had to actually check and make sure I was in the thread I thought I was in--namely, the one about the possibility that strained ERs will require alternate places to get urgent care and, more broadly, about the need for primary care capacity development. And yet the value of CHCs seems to go unnoticed in such a thread. Odd.

    And no, they're not simply for the uninsured, over a third of those who rely on CHCs are covered by Medicaid (and, of course, many more people will be eligible for Medicaid in just over three years). Since one of the key points in your article--quoted in your OP no less--is that many of those who strain ER capacity are Medicaid patients who simply need to find a regular place for primary care, one would think you'd make the connection to expanded CHC capacity. But I can wait.


    I really don't understand this conspiracy theory mindset. The world isn't out to get you. And improving health policy isn't necessarily a red-blue issue. Even red states are experimenting with things like care coordination models to try and improve quality while reducing costs. Oklahoma converted its SoonerCare choice program to a patient-centered medical home model almost two years ago.

    The "catch" is that our current delivery system is massively inefficient in almost every aspect.

    Yes, that's exactly what I want to talk about. All the scary bad things you've read about the law and your aversion to menu labeling. Maybe you'll pick up some rep points from conservative members of the board--you can use the discussion as a spring board for running for USMB president.

    I mean, really did you honestly just say let's ignore the delivery system reforms so I can trash menu-labeling? Please, get serious. We're not on TV here, man.

    Weren't you the one promoting "How American Health Care Killed My Father"? If not, my apologies.

    Even if it leads to ER overcrowding?

    I'm not quite sure how to put these two together.

    Medical spending has risen faster than inflation, medical costs overall are rising. If elective, non-urgent procedures like these were included in insurance coverage, I'm sure that total spending on them would be higher but that doesn't necessarily indicate that the procedures themselves would be more expensive or that their costs wouldn't have fallen. In fact, the argument behind tort reform as a cost control is that it will reduce unnecessary procedures--that is, the problem is pegged as being primarily one of volume, not necessarily of procedure-by-procedure cost. For example a quick search suggests the following about heart valve surgery:

    Between 1992 and 1997, length of hospital stay decreased from 13.4 to 8.0 days and cost decreased from $37,047 to $21,856. Similarly, between 1992 and 1997 for mitral valve repair, length of stay decreased from 15.6 to 8.1 days and cost decreased from $45,072 to $21,747. The net result over the time period from 1988 to 1997 was an average decline in the cost of operation of $785 a year, adjusted for other factors. ​

    Granted, since the examples you're using are elective the potential additional demand should be taken into account, but at the same time the structure of the market for that particular procedure (relatively simple with providers easily able to enter the market for it, which is why the number of providers offering the procedure has grown so much) mitigates some of that.

    But what happens when you consider non-elective or time-sensitive procedures? Or complex procedures offered through institutions (e.g. a hospital) for which your personal bargaining power is exceptionally low and the costs of the procedure are simply too high for you to pay unassisted? That's why insurance pools to pay for health costs were formed in the first place. You could easily make an argument that those pools are overused now but your solution only works well in a specific subset of circumstances.
     
    Last edited: Jul 3, 2010
  10. Quantum Windbag
    Offline

    Quantum Windbag Gold Member

    Joined:
    May 9, 2010
    Messages:
    58,308
    Thanks Received:
    5,014
    Trophy Points:
    245
    Ratings:
    +5,221
    The strain is coming because we are not going to have enough doctors, not because we don't have enough ERs. Did you miss that part in the article I posted? Does building CHCs somehow magically create doctors? Like I have said, this law does nothing to address the problems.

    Adding in government regulations and control is going to make it more efficient? What universe do you live in?

    This is not a conspiracy, even if the world is out to get me. You cannot replace incompetency and inefficiency through the government, you can only replace it through free market competition that forces an industry to adapt to its customer base.

    The government cannot "fix" health care, it is the problem with health care. This has nothing to do with what I have heard, as any honest person who is reading my posts would know. I am an informed consumer, and I resent the fact that the government thinks I cannot make my own decisions. Until the government gets out of the delivery system entirely there will be no reform, so don't go trying to tout what is not going to happen.

    I recommended it because it tells, form the perspective of a consumer, what the problems are. That does not mean I think he has all the right answers, something I am sure that he will admit himself. Before you go assuming you know my position on a subject you should ask.

    ERs are not for health care, they are for emergency treatment.

    Why not? My company has a health insurance plan that covers drug and alcohol treatment, something I absolutely do not need. It is covered because the state requires health insurers to offer it, so everyone who has health insurance pays for something no one who is working for my company needs. If I was able to buy health insurance like I buy home insurance I could choose what I want to pay for, and what I do not, and determine my own deductible. Because my home insurance does not cover painting the house I shop around and determine the best price I can get for the work I want done.

    Why don't we do this with health insurance? Because we cannot, all we can do is watch helplessly as heath care spirals out of control, all because a bunch of lobbyists and politicians know more about what we need than we do.

    See, you think we can't make decisions, and that we need someone looking out for us. The market will adjust if we let it, that is easily demonstrated by the fact that it works in every other instance where it exists. Will it work out that some people will not be able to afford everything they want? Yes, but that is going to happen anyway. There will be no way that the resources will be available for everyone to get anything they need, which is the best argument I can think of to keep the government out of health care as much as possible. People might resent insurance companies who deny them services they think they need, but they will absolutely revolt once the government starts doing the same thing. You can deny that all you want, but that outcome is inevitable if the government stays involved in health care.
     

Share This Page