Affordable Care Act

[Taz]

You want one area where other countries are better? Canada hasn't instigated a war, ever. The US has been at war for nearly its WHOLE EXISTENCE! And just spent TRILLIONS attacking countries for no reason.

Now that was classic. We're talking about health care, and I make specific claims that you couldn't even come up with a response to. I point that out and here you are saying "Yeah well what about instigating war?!?"....... Are we talking about war on a thread titled "Affordable Care Act"? If the title of the thread was "Affordable War Act", I wouldn't be mocking you right now.

You asked "Name one area, one measurement, in which they are better?" And I gave you one. You want one specifically about health care? Canada and other countries cover all their citizens without forcing them to be at the mercy of HMOs... and pay through the nose.

You do understand the concept of "context" right? Context is the idea of using preceding comments and statements, to understand the given text.

So when I ask a question, that was preceded by statements regarding health care, you should from that context, grasp that I am asking which measurement of HEALTH CARE, you would point to that the US comes up poorly compared to other nations.

The cost of health care, is not a statement of the quality of the health care. I already asked you, would you rather have a higher chance of dying, or wait years for treatment, for the savings of a few dollars?

And equally, I already pointed out that the taxes in all those countries is double that of the US.

I don't spend $10,000 a year on health insurance. Yet, under your "free" health care countries, I would have to pay at least that much in taxes, based on my income.

So would I rather pay several hundred for insurance, or several thousand in taxes... I'll take the much smaller insurance premiums.

You're defending a health system that no country in world would want to or has tried to replacate. MASSIVE EPIC FAIL!!!
Hint: The other countries cover everyone, your plan doesn't. BIG DIFFERENCE!

You must be joking. Clearly you are either ignorant, or have your head shoved so far up your ideology, that you can't see anymore.

Canada, the public SUED THEIR GOVERNMENT... to allow Capitalist Free-Market health care.

Now when people are SUING to get the ability to pay for health care.... When they supposedly get it "free".... that's a bad sign for socialism.

And when you look around the world, the less 'free' and more 'capitalist' the system is, the better it is. Germany, the vast majority of the country has pay-for-service private insurance.

In the UK, they have the highest rate of "medical tourism" in the world. What is Medical tourism? It's when you live a country with socialized "free health care" and yet choose to fly to a different country, and PAY for health care there.

And by the way, what hospitals do they go to in those countries? The government funded socialized hospitals in India? No, they go to the pay-for-service Capitalist hospitals.

Over and over.... people might "say" they like their socialized health care system, but in reality, they vote with their feet and their money, for capitalist hospitals.

Ancient history. Plus, nobody in Canada ever lost their house because they got sick.

 

[Andylusion]

Now that was classic. We're talking about health care, and I make specific claims that you couldn't even come up with a response to. I point that out and here you are saying "Yeah well what about instigating war?!?"....... Are we talking about war on a thread titled "Affordable Care Act"? If the title of the thread was "Affordable War Act", I wouldn't be mocking you right now.

You asked "Name one area, one measurement, in which they are better?" And I gave you one. You want one specifically about health care? Canada and other countries cover all their citizens without forcing them to be at the mercy of HMOs... and pay through the nose.

You do understand the concept of "context" right? Context is the idea of using preceding comments and statements, to understand the given text.

So when I ask a question, that was preceded by statements regarding health care, you should from that context, grasp that I am asking which measurement of HEALTH CARE, you would point to that the US comes up poorly compared to other nations.

The cost of health care, is not a statement of the quality of the health care. I already asked you, would you rather have a higher chance of dying, or wait years for treatment, for the savings of a few dollars?

And equally, I already pointed out that the taxes in all those countries is double that of the US.

I don't spend $10,000 a year on health insurance. Yet, under your "free" health care countries, I would have to pay at least that much in taxes, based on my income.

So would I rather pay several hundred for insurance, or several thousand in taxes... I'll take the much smaller insurance premiums.

You're defending a health system that no country in world would want to or has tried to replacate. MASSIVE EPIC FAIL!!!
Hint: The other countries cover everyone, your plan doesn't. BIG DIFFERENCE!

That argument is meaningless.

First, they can't try it in it's entirety.

Second, they do have private plans. Now why don't you explain why ?

And tells us why that is the big fail too.

All the citizens in other countries are covered, free to the user, ALL OF THEM ARE COVERED. The U.S. system is still catching up to that humane concept.

How is it more or less "humane"?

You act as though sinking the rest of the country in massive oppressive taxes, dooming people to work hundreds of hours just to pay the government, and live in poverty, while people wait on multi-year waiting lists... is somehow "humane".

The fact is, anyone can get any health care they want in America, provided they pay for what they get.

Is 100% "coverage", while being forced to wait years, or leave the country to get health care, a positive development?

Again, you keep talking like getting "coverage" is the same as getting "health care" it is not. Do you really want to avoid paying a bill so bad, that you are willing to risk your life?

 

[Andylusion]

Now that was classic. We're talking about health care, and I make specific claims that you couldn't even come up with a response to. I point that out and here you are saying "Yeah well what about instigating war?!?"....... Are we talking about war on a thread titled "Affordable Care Act"? If the title of the thread was "Affordable War Act", I wouldn't be mocking you right now.

You asked "Name one area, one measurement, in which they are better?" And I gave you one. You want one specifically about health care? Canada and other countries cover all their citizens without forcing them to be at the mercy of HMOs... and pay through the nose.

You do understand the concept of "context" right? Context is the idea of using preceding comments and statements, to understand the given text.

So when I ask a question, that was preceded by statements regarding health care, you should from that context, grasp that I am asking which measurement of HEALTH CARE, you would point to that the US comes up poorly compared to other nations.

The cost of health care, is not a statement of the quality of the health care. I already asked you, would you rather have a higher chance of dying, or wait years for treatment, for the savings of a few dollars?

And equally, I already pointed out that the taxes in all those countries is double that of the US.

I don't spend $10,000 a year on health insurance. Yet, under your "free" health care countries, I would have to pay at least that much in taxes, based on my income.

So would I rather pay several hundred for insurance, or several thousand in taxes... I'll take the much smaller insurance premiums.

You're defending a health system that no country in world would want to or has tried to replacate. MASSIVE EPIC FAIL!!!
Hint: The other countries cover everyone, your plan doesn't. BIG DIFFERENCE!

You must be joking. Clearly you are either ignorant, or have your head shoved so far up your ideology, that you can't see anymore.

Canada, the public SUED THEIR GOVERNMENT... to allow Capitalist Free-Market health care.

Now when people are SUING to get the ability to pay for health care.... When they supposedly get it "free".... that's a bad sign for socialism.

And when you look around the world, the less 'free' and more 'capitalist' the system is, the better it is. Germany, the vast majority of the country has pay-for-service private insurance.

In the UK, they have the highest rate of "medical tourism" in the world. What is Medical tourism? It's when you live a country with socialized "free health care" and yet choose to fly to a different country, and PAY for health care there.

And by the way, what hospitals do they go to in those countries? The government funded socialized hospitals in India? No, they go to the pay-for-service Capitalist hospitals.

Over and over.... people might "say" they like their socialized health care system, but in reality, they vote with their feet and their money, for capitalist hospitals.

Ancient history. Plus, nobody in Canada ever lost their house because they got sick.

Yeah, they might have lost their life. How is that a win?

The whole reason they sued to get capitalist pay for service health care, is because people were dying.

Do you really think keeping your house, while you are buried 6-feet down, is a good trade off?

 

[Taz]

You asked "Name one area, one measurement, in which they are better?" And I gave you one. You want one specifically about health care? Canada and other countries cover all their citizens without forcing them to be at the mercy of HMOs... and pay through the nose.

You do understand the concept of "context" right? Context is the idea of using preceding comments and statements, to understand the given text.

So when I ask a question, that was preceded by statements regarding health care, you should from that context, grasp that I am asking which measurement of HEALTH CARE, you would point to that the US comes up poorly compared to other nations.

The cost of health care, is not a statement of the quality of the health care. I already asked you, would you rather have a higher chance of dying, or wait years for treatment, for the savings of a few dollars?

And equally, I already pointed out that the taxes in all those countries is double that of the US.

I don't spend $10,000 a year on health insurance. Yet, under your "free" health care countries, I would have to pay at least that much in taxes, based on my income.

So would I rather pay several hundred for insurance, or several thousand in taxes... I'll take the much smaller insurance premiums.

You're defending a health system that no country in world would want to or has tried to replacate. MASSIVE EPIC FAIL!!!
Hint: The other countries cover everyone, your plan doesn't. BIG DIFFERENCE!

You must be joking. Clearly you are either ignorant, or have your head shoved so far up your ideology, that you can't see anymore.

Canada, the public SUED THEIR GOVERNMENT... to allow Capitalist Free-Market health care.

Now when people are SUING to get the ability to pay for health care.... When they supposedly get it "free".... that's a bad sign for socialism.

And when you look around the world, the less 'free' and more 'capitalist' the system is, the better it is. Germany, the vast majority of the country has pay-for-service private insurance.

In the UK, they have the highest rate of "medical tourism" in the world. What is Medical tourism? It's when you live a country with socialized "free health care" and yet choose to fly to a different country, and PAY for health care there.

And by the way, what hospitals do they go to in those countries? The government funded socialized hospitals in India? No, they go to the pay-for-service Capitalist hospitals.

Over and over.... people might "say" they like their socialized health care system, but in reality, they vote with their feet and their money, for capitalist hospitals.

Ancient history. Plus, nobody in Canada ever lost their house because they got sick.

Yeah, they might have lost their life. How is that a win?

The whole reason they sued to get capitalist pay for service health care, is because people were dying.

Do you really think keeping your house, while you are buried 6-feet down, is a good trade off?

Ok, I'm done here, you have no clue. Have fun.

 

[Sun Devil 92]

You do understand the concept of "context" right? Context is the idea of using preceding comments and statements, to understand the given text.

So when I ask a question, that was preceded by statements regarding health care, you should from that context, grasp that I am asking which measurement of HEALTH CARE, you would point to that the US comes up poorly compared to other nations.

The cost of health care, is not a statement of the quality of the health care. I already asked you, would you rather have a higher chance of dying, or wait years for treatment, for the savings of a few dollars?

And equally, I already pointed out that the taxes in all those countries is double that of the US.

I don't spend $10,000 a year on health insurance. Yet, under your "free" health care countries, I would have to pay at least that much in taxes, based on my income.

So would I rather pay several hundred for insurance, or several thousand in taxes... I'll take the much smaller insurance premiums.

You're defending a health system that no country in world would want to or has tried to replacate. MASSIVE EPIC FAIL!!!
Hint: The other countries cover everyone, your plan doesn't. BIG DIFFERENCE!

You must be joking. Clearly you are either ignorant, or have your head shoved so far up your ideology, that you can't see anymore.

Canada, the public SUED THEIR GOVERNMENT... to allow Capitalist Free-Market health care.

Now when people are SUING to get the ability to pay for health care.... When they supposedly get it "free".... that's a bad sign for socialism.

And when you look around the world, the less 'free' and more 'capitalist' the system is, the better it is. Germany, the vast majority of the country has pay-for-service private insurance.

In the UK, they have the highest rate of "medical tourism" in the world. What is Medical tourism? It's when you live a country with socialized "free health care" and yet choose to fly to a different country, and PAY for health care there.

And by the way, what hospitals do they go to in those countries? The government funded socialized hospitals in India? No, they go to the pay-for-service Capitalist hospitals.

Over and over.... people might "say" they like their socialized health care system, but in reality, they vote with their feet and their money, for capitalist hospitals.

Ancient history. Plus, nobody in Canada ever lost their house because they got sick.

Yeah, they might have lost their life. How is that a win?

The whole reason they sued to get capitalist pay for service health care, is because people were dying.

Do you really think keeping your house, while you are buried 6-feet down, is a good trade off?

Ok, I'm done here, you have no clue. Have fun.

No, you simply have no argument here.

You were done before you started.

 

[Andylusion]

You do understand the concept of "context" right? Context is the idea of using preceding comments and statements, to understand the given text.

So when I ask a question, that was preceded by statements regarding health care, you should from that context, grasp that I am asking which measurement of HEALTH CARE, you would point to that the US comes up poorly compared to other nations.

The cost of health care, is not a statement of the quality of the health care. I already asked you, would you rather have a higher chance of dying, or wait years for treatment, for the savings of a few dollars?

And equally, I already pointed out that the taxes in all those countries is double that of the US.

I don't spend $10,000 a year on health insurance. Yet, under your "free" health care countries, I would have to pay at least that much in taxes, based on my income.

So would I rather pay several hundred for insurance, or several thousand in taxes... I'll take the much smaller insurance premiums.

You're defending a health system that no country in world would want to or has tried to replacate. MASSIVE EPIC FAIL!!!
Hint: The other countries cover everyone, your plan doesn't. BIG DIFFERENCE!

You must be joking. Clearly you are either ignorant, or have your head shoved so far up your ideology, that you can't see anymore.

Canada, the public SUED THEIR GOVERNMENT... to allow Capitalist Free-Market health care.

Now when people are SUING to get the ability to pay for health care.... When they supposedly get it "free".... that's a bad sign for socialism.

And when you look around the world, the less 'free' and more 'capitalist' the system is, the better it is. Germany, the vast majority of the country has pay-for-service private insurance.

In the UK, they have the highest rate of "medical tourism" in the world. What is Medical tourism? It's when you live a country with socialized "free health care" and yet choose to fly to a different country, and PAY for health care there.

And by the way, what hospitals do they go to in those countries? The government funded socialized hospitals in India? No, they go to the pay-for-service Capitalist hospitals.

Over and over.... people might "say" they like their socialized health care system, but in reality, they vote with their feet and their money, for capitalist hospitals.

Ancient history. Plus, nobody in Canada ever lost their house because they got sick.

Yeah, they might have lost their life. How is that a win?

The whole reason they sued to get capitalist pay for service health care, is because people were dying.

Do you really think keeping your house, while you are buried 6-feet down, is a good trade off?

Ok, I'm done here, you have no clue. Have fun.

Dude, you've been done for a long long time. You just didnt' know it. You can't argue the facts. The facts are on our side. The waiting lists are on our side. The recent VA scandal, is just another example of socialized care. Every possible method of measuring health care outcomes, is on our side.

You have NOTHING. Never did.... and at this rate... never will. At least you finally figured it out, and stopped talking.

Until you show us your system working...... You are done here. Have fun.

 

[Luddly Neddite]

"You act as though sinking the rest of the country in massive oppressive taxes, dooming people to work hundreds of hours just to pay the government, and live in poverty, while people wait on multi-year waiting lists... is somehow "humane".

Is 100% "coverage", while being forced to wait years, or leave the country to get health care, a positive development?"


Andylusion describes exactly this:

 

[Andylusion]

Here is something else I am not sure is fair and I think if we keep SCOTUSCARE it could be fixed. I think if a health care insurance company offers any plan it is available to anyone. For example, US steel negotiates a price for health care. That price and plan would be one of the plans available to everyone. Those without any sort of negotiating power are actually paying for those who do and those who do might also be some of the highest paid people.

Union: U.S. Steel wants workers to pay up to $9,600 per year in health care costs

I'm not sure what you are talking about. US Steel has no more negotiating power, than any other business. All businesses shop around for health care, and there is nothing special that I can find about US Steel.

Do you have some example we can look at?

I also don't know what you are talking about with 'those without negotiating power are paying for those who do'. The only people who are paying for other people, are private patients are paying for gov-patients.

Obama care doesn't do much, but what it does do is increase the number of gov-patients, at the expense of private-patients.

If you really want negotiating power......

The way to get real negotiating power is to completely deregulate the entire market. No mandates. No regulations. No controls.

Allow anyone to open a medical school.
Allow anyone to open a clinic or hospital anywhere.

The cost to become a doctor will drop. The cost to open a clinic will drop. The cost to open a hospital will drop. The duopolies will disappear.

Eliminate the tax credit, and mandates that tie health care to businesses. This will move people into the open market, where insurance companies will be forced to compete for customers, and the customers will be the actual patients, instead of the business.

So I checked into the gov care. I filled out my information, clicked on get quotes. Nothing came up. New window, asking for my information. Put in my information, clicked on get quotes. Nothing came up. New window asking for my information. Next thing I know, I have a dozen phone calls by insurance agents, trying to sell me.

Turns out, I don't qualify for government health care. See, I work for a living. I'm not a public leach. So the government doesn't help people like me. They tax people like me. I get up every morning at 3 AM, and therefore I'm the one who has to pay for everyone who doesn't.

The web site had switched me over to private insurance sites, which is why I had to enter all my information over and over. Those sites forwarded my information to insurance brokers, which started spamming text messages and phone calls to my cell phone.

If this is your idea of a good system, I think you are nutz.

 

[Greenbeard]

Eliminate the tax credit, and mandates that tie health care to businesses. This will move people into the open market, where insurance companies will be forced to compete for customers, and the customers will be the actual patients, instead of the business.

The sentiment is right, but the execution won't work as you suggest.

We've seen pretty clearly over the last few years that a well-functioning market will indeed put intense pressure on insurers to attack underlying cost drivers to compete for customers. The result has been a surprising (and heretofore largely absent) emphasis on cost containment, including more individual responsibility to be price sensitive at the point if service. That's good.

But that's only been the case because these insurers are competing head to head in a transparent, structured marketplace. If we were to totally deregulate, as you suggest, that goes away. The incentive is no longer to attack the underlying cost drivers in the system, it's to be most creative in keeping people who actually need health services out of your risk pool. Restore the opacity and the Byzantine structure of the old "market" and the game goes back to finding ways to hide or shift the costs, not address them. Innovation is aimed not at getting a handle on ever rising health costs (as is the case in the new marketplaces now), but on making them someone else's problem, usually the public at large. The insurers once again become advantaged over the would-be consumer.

Moving more people out of group insurance and into the competitive marketplaces that exist now would likely be a good thing. But dumping 150 million more people into the old individual insurance markets that used to exist would be a catastrophe.

 

[Andylusion]

Eliminate the tax credit, and mandates that tie health care to businesses. This will move people into the open market, where insurance companies will be forced to compete for customers, and the customers will be the actual patients, instead of the business.

The sentiment is right, but the execution won't work as you suggest.

We've seen pretty clearly over the last few years that a well-functioning market will indeed put intense pressure on insurers to attack underlying cost drivers to compete for customers. The result has been a surprising (and heretofore largely absent) emphasis on cost containment, including more individual responsibility to be price sensitive at the point if service. That's good.

But that's only been the case because these insurers are competing head to head in a transparent, structured marketplace. If we were to totally deregulate, as you suggest, that goes away. The incentive is no longer to attack the underlying cost drivers in the system, it's to be most creative in keeping people who actually need health services out of your risk pool. Restore the opacity and the Byzantine structure of the old "market" and the game goes back to finding ways to hide or shift the costs, not address them. Innovation is aimed not at getting a handle on ever rising health costs (as is the case in the new marketplaces now), but on making them someone else's problem, usually the public at large. The insurers once again become advantaged over the would-be consumer.

Moving more people out of group insurance and into the competitive marketplaces that exist now would likely be a good thing. But dumping 150 million more people into the old individual insurance markets that used to exist would be a catastrophe.

No, I would disagree with you.

First, having a "structured marketplace" is a great way to drive up costs. The only way that small companies can ever compete with large companies, is by designing products that work outside the box. By forcing everyone into a "structured" box, you eliminate the ability for companies to make competitive products.

This is why many of the big insurance companies are now generally supportive of Obama Care. It eliminates competition, which allows them to raise prices.

You don't see a government controlled "structured marketplace" for office supplies. And shockingly, office supplies are extremely cheap.

Second, the entire problem we've had in health care, has been directly because of this enforced 'structured marketplace'. The whole reason we are where we are, is because we've been doing your line of thinking.

There are only about a half dozen Emergency rooms in Columbus Ohio. Of those, there are actually only four total providers. Riverside Methodist, Mount Carmel, Grant, and OSU University Hospital (which is terrible gov-care).

In an area of 2 Million people, why are there only a whooping four Emergency Health care providers?

Because government controls that market. If you and I got together, pooled our money, got some investors, and tried to open an Emergency Room service.... we couldn't do it. The government prevents outsiders from competing. It's called 'certificate of need'. Its a method to have a "structured market". You can't just let anyone into the market! That would be chaos!

Then you complain about health care costs being too high.

We saw the same thing with SouthWest Airlines. The government prevented SouthWest from expanding their service for decades. Why? Because we can't have an unstructured marketplace. Of course every place that Southwest was able to expand to, ticket prices dropped.

Additionally, the insurance companies make special contracts with health care providers. Because they only need to make a contract with three health care companies, and they have a lock on the market. They have a monopoly.

That couldn't happen if there were dozens of health care providers. But when there are only three main providers, it's easy to get a lock on the market. And when government prevents new providers from getting into the market, it's easy to have only a few main providers.

Lastly, you mention correctly that when business competes for customers, there is a pressure to lower price. While that is true, you don't seem to get that our system removes customers from the equation right at the start.

Again, this 'structured marketplace' by it's nature removes the patient from the feedback loop. When you get insurance through your work, which is required by the government regulations and mandates, who is the customer? Are you the customer? No. You are actually not the customer. You didn't determine what plan you had. Your company did.

Your company is the only customer that the insurance company cares about. Once the insurance company signs a contract with the business, you have no choice in the matter, and they know that. Again, they have a monopoly over you, thanks to this "structured market".

In a completely free market, where insurance is not tied to your employment, the insurance companies, and the hospitals, clinics, and doctors, would all have to compete for YOUR business. Not your employers business.

And we haven't even gotten to how Medicare and Medicaid drive up the cost of health care directly.

The point though is, a transparent market happens naturally, if the market is free of regulations. It's only in the highly regulated and controlled market (structured market), that you end up with system we currently have.

 

[Billo_Really]

Here's the reality of the ACA...

It has made more people accessible to healthcare. There is a marked increase in ER patients. In-care patients. This is causing "all" hospitals to increase their bed capacity, ER capacity through modernization projects. And for people like me, that's a good thing!

Modernization projects need engineers and architects to design the tenant improvements. There is no better patriotism one can show to this country, than contributing an increase in the construction industry.

God bless you, ACA.

 

[Greenbeard]

First, having a "structured marketplace" is a great way to drive up costs. The only way that small companies can ever compete with large companies, is by designing products that work outside the box. By forcing everyone into a "structured" box, you eliminate the ability for companies to make competitive products.

You're latching on to an adjective, not the actual content of my post. Without transparency, the ability of consumers to make apples-to-apples comparisons of competing products and send clear signals, and basic consumer protections there isn't a market. It becomes the same risk-shifting shell game it used to be, with no incentive to tackle underlying drivers of cost in the system. I already mentioned what constituted "innovation" under the old incentive structure.

Because government controls that market. If you and I got together, pooled our money, got some investors, and tried to open an Emergency Room service.... we couldn't do it. The government prevents outsiders from competing. It's called 'certificate of need'.

As near as I can tell, Ohio only has a CON requirement for long-term care beds. So you're going to need another explanation.

Additionally, the insurance companies make special contracts with health care providers.

Because they only need to make a contract with three health care companies, and they have a lock on the market. They have a monopoly.

That couldn't happen if there were dozens of health care providers. But when there are only three main providers, it's easy to get a lock on the market. And when government prevents new providers from getting into the market, it's easy to have only a few main providers.

You're conflating insurance markets (which is what I've been talking about) with provider markets, which are a different beast. You want more hospitals so that there's more competition, that's great. But hospitals have high fixed costs and their inpatient occupancy rate has been declining for years. So simply building a new hospital doesn't necessarily mean costs drop in an area--in fact, given their high fixed costs and the need to generate revenue by filling beds, costs in that area may well go up. That's why CON laws, misguided or not, came about in the first place. These aren't issues that can be fixed with a pithy slogan.

Again, this 'structured marketplace' by it's nature removes the patient from the feedback loop. When you get insurance through your work, which is required by the government regulations and mandates, who is the customer? Are you the customer? No. You are actually not the customer. You didn't determine what plan you had. Your company did.

The employer-based system is not the marketplace I described. I said in my last post that transitioning people out of ESI and into a real market (the recently created marketplaces for individual, not group, coverage) would likely be a good thing. But what you describe is not transitioning them into a real marketplace, but rather into the broken market that used to exist in the individual market.

 

[Andylusion]

Here's the reality of the ACA...

It has made more people accessible to healthcare. There is a marked increase in ER patients. In-care patients. This is causing "all" hospitals to increase their bed capacity, ER capacity through modernization projects. And for people like me, that's a good thing!

Modernization projects need engineers and architects to design the tenant improvements. There is no better patriotism one can show to this country, than contributing an increase in the construction industry.

God bless you, ACA.

That hasn't been proven. But let's even say it is true.

If the way in which the ACA has increased access to health care, is by increasing government borrowing and spending on health care programs..... then you basically are saying doing what Greece did, is a good thing.

Greece spent endless money to give the Greek public more and more services. How are they doing now? Not so good.

Is sacrificing the future, for the sake of more health care now, really worth it? Greece may never recover from what they are going through. If we do the same thing, because left wingers sacrificed the entire country for health care, that's not a win.

 

[Billo_Really]

That hasn't been proven. But let's even say it is true.

If the way in which the ACA has increased access to health care, is by increasing government borrowing and spending on health care programs..... then you basically are saying doing what Greece did, is a good thing.

Greece spent endless money to give the Greek public more and more services. How are they doing now? Not so good.

Is sacrificing the future, for the sake of more health care now, really worth it? Greece may never recover from what they are going through. If we do the same thing, because left wingers sacrificed the entire country for health care, that's not a win.

How does it increase government borrowing and spending?

And if you want to go there, nothing increases government borrowing and spending more than our obscene defense budget.

 

[Andylusion]

First, having a "structured marketplace" is a great way to drive up costs. The only way that small companies can ever compete with large companies, is by designing products that work outside the box. By forcing everyone into a "structured" box, you eliminate the ability for companies to make competitive products.

You're latching on to an adjective, not the actual content of my post. Without transparency, the ability of consumers to make apples-to-apples comparisons of competing products and send clear signals, and basic consumer protections there isn't a market. It becomes the same risk-shifting shell game it used to be, with no incentive to tackle underlying drivers of cost in the system. I already mentioned what constituted "innovation" under the old incentive structure.

Because government controls that market. If you and I got together, pooled our money, got some investors, and tried to open an Emergency Room service.... we couldn't do it. The government prevents outsiders from competing. It's called 'certificate of need'.

As near as I can tell, Ohio only has a CON requirement for long-term care beds. So you're going to need another explanation.

Additionally, the insurance companies make special contracts with health care providers.

Because they only need to make a contract with three health care companies, and they have a lock on the market. They have a monopoly.

That couldn't happen if there were dozens of health care providers. But when there are only three main providers, it's easy to get a lock on the market. And when government prevents new providers from getting into the market, it's easy to have only a few main providers.

You're conflating insurance markets (which is what I've been talking about) with provider markets, which are a different beast. You want more hospitals so that there's more competition, that's great. But hospitals have high fixed costs and their inpatient occupancy rate has been declining for years. So simply building a new hospital doesn't necessarily mean costs drop in an area--in fact, given their high fixed costs and the need to generate revenue by filling beds, costs in that area may well go up. That's why CON laws, misguided or not, came about in the first place. These aren't issues that can be fixed with a pithy slogan.

Again, this 'structured marketplace' by it's nature removes the patient from the feedback loop. When you get insurance through your work, which is required by the government regulations and mandates, who is the customer? Are you the customer? No. You are actually not the customer. You didn't determine what plan you had. Your company did.

The employer-based system is not the marketplace I described. I said in my last post that transitioning people out of ESI and into a real market (the recently created marketplaces for individual, not group, coverage) would likely be a good thing. But what you describe is not transitioning them into a real marketplace, but rather into the broken market that used to exist in the individual market.

Well, that was my point. The government regulations and controls, are exactly what has prevented the existence of a transparent market.

In any other market, without government intervention, a transparent market organically evolves into being.

With Health care, which is one of the most heavily regulated and 'structured' markets in this economy, a transparent market hasn't existed for around 70 years.

That's not an accident. Government involvement, by it's very nature, distorts markets.

Certificate of Need in Ohio
Certificate of Need

• The development of a new long-term care facility.
• The replacement of an existing long-term care facility.
• The renovation of or an addition to a long-term care facility that involves a capital expenditure of $2 million or more, not including expenditures for equipment.
• An increase in long-term care bed capacity.
• A relocation of long-term care beds from one site to another.
• Any other failure to conduct a reviewable activity in substantial accordance with the approved application for which a Certificate of Need was granted, if the change is made within five years after implementation, including a site or capacity change.
• The expenditure of more than 110 percent of the maximum expenditure specified in an approved Certificate of Need application.

You can not make a new facility, replace a facility, upgrade a facility, increase the number of beds, move the beds from one location to another, or spend more than 110% of the stated amount you are allowed by the Certificate of Need.

What is a Long-Term Care facility or Long-Term Care bed?

Lawriter - ORC - 3702.51 Hospital care assurance program - certificate of need definitions.

Ohio revised code, any bed covered by skilled nursing care. Any bed covered by Medicare or Medicaid. Any facility that is registered under the Social Security Act. Any Nursing home, county home, County Nursing Home, Hospice home.

That pretty much covers every single bed in the entire hospital, that a patient spends a night in.

The only exception would maternity wards, which ironically are covered by a different licensing system.

Maternity Units
Good luck getting that license.

What is a hospital, without a beds to take care of patients, and skilled nurses covering them? It's a doctors office.

Again, Certificate of Need, and other government regulations and controls on the market, are exactly what is causing the problems.

And yes, I get that hospitals love the CON laws, so that they won't go out of business. But that's why we have Nursing Homes that cost $100,000 a year. Regardless of the rationalization for it, that's why we have the problem we do.

If a new upstart company, can open a Hospital for a fraction of the cost, and is able to provide Hospital services much cheaper than the health care establishment.... yeah... they are going to go out of business.

That's how free-markets work. The bad results we currently have, is exactly because we don't have a free-market, and no one is going out of business.

Hospitals have high fixed costs, because of government regulations and controls on the market.

For example, why does it cost so much to get aspirin in the hospital? One reason is, according to Federal law, they can't buy a bulk container of aspirin, but rather individually wrapped aspirin. And they can't just have an nurse in training, or intern, give you the aspirin. No it must be a Registered Nurse or LPN, which of course costs a ton of money, to pay someone $70,000 to hand out Aspirin.

You should take a look at the endless codes and regulations on how a hospital must operate.
Code of Federal Regulations Hospital Conditions of Participation

You say "hospitals have high fixed costs" as if that's a given. No, it's not. They have high fixed costs, because government requires them to. It's a "given" because we've made laws making it a "given". But it doesn't have to be that way. Those hospitals in India, that have medical tourists coming to them from all over the world... they are almost completely unregulated. They don't even follow the regulations of the government hospitals that Indians go to.

Then you wonder why it's so much cheaper to have surgery there?

And I get that you were primarily talking about Insurance Markets, but if all you do is try and fix the insurance market, you will fail to lower costs. All of these things are interconnected.

All of the competition in the world in the insurance market, won't lower costs by very much. The poison of spiraling costs of health care, goes all the way down to the roots of the constraints of medical schools training limited numbers of doctors, all the way up to the top of individuals buying insurance.

They are all connected.

Lastly, your statement about deregulating, and ESI, seems odd.

You *seemed* to imply that Obama Care leads to a structured market, and that we would want to move people off of Employer Sponsored Insurance, into this structured market.

But that is not what Obama Care has done. Not by a long long margin.

Obama Care as moved more people onto ESI, and Medicare and Medicaid.

The individual market, has actually gone down, not up. And Medicare and Medicaid, is not a market system. In fact, both of those drive *UP* the cost of care. The more people insured through the government, the worse our health care costs are going to be.

So I'm not sure what you think I support, but this isn't it.

 

[Harry Dresden]

Reduce your military spending to say the average of the next 5 top spenders, and everyone could probably get free health care.

Nothing is free. Try and do that and the expense will just go up. Look at it like a pie, cut one piece a little smaller and the other pieces will just get bigger.

Ex: Canada has practically no military and can afford free health care for everyone.

my state has more people than Canada.....its somewhat easier doing that with 30 million people as compared to 300+million....

 

[Andylusion]

Reduce your military spending to say the average of the next 5 top spenders, and everyone could probably get free health care.

Nothing is free. Try and do that and the expense will just go up. Look at it like a pie, cut one piece a little smaller and the other pieces will just get bigger.

Ex: Canada has practically no military and can afford free health care for everyone.

Which explains why Canadians routinely travel to America to PAY for health care. Obviously it's just so incredibly free..... they felt bad and came here to pay for care.

 

[Greenbeard]

In any other market, without government intervention, a transparent market organically evolves into being.

Neither health insurance nor health care are office supplies. I thought that comparison above was in jest but now I'm beginning to think you're serious. The market structure and the incentives in question are unique and rather complex. That's why health economics exists as a sub-discipline. Health care is not and will never be "any other market," which is why we're even talking about it.

That pretty much covers every single bed in the entire hospital, that a patient spends a night in.

We'll no, it doesn't. "Skilled nursing" is not simply another name for "nursing," it pertains to a specific type of custodial care offered in a long term care facility (namely a SNF or other LTC setting). It doesn't apply to standard acute care settings. Ohio appears to have no CON requirements for acute care settings or emergency care.

Like I said, you need to find a different explanation.

And yes, I get that hospitals love the CON laws

, so that they won't go out of business.

Hospitals are going out of business, even (perhaps especially) in areas where they have no competitors. As I already mentioned, inpatient occupancy, and thus revenue, has been in a state of decline.

For example, why does it cost so much to get aspirin in the hospital? One reason is, according to Federal law, they can't buy a bulk container of aspirin, but rather individually wrapped aspirin. And they can't just have an nurse in training, or intern, give you the aspirin. No it must be a Registered Nurse or LPN, which of course costs a ton of money, to pay someone $70,000 to hand out Aspirin.

Hospital charges have very little to do with what anything actually costs. They mark up virtually everything because (1) they can, and (2) they're cross-subsidizing other services or expenses on which they would otherwise lose money.

You say "hospitals have high fixed costs" as if that's a given. No, it's not. They have high fixed costs, because government requires them to.

Hospitals are expensive organizations. They're generally prepared for a huge variety of eventualities and they tend to be the largest nongovernmental employer in a region.What cost is it you propose to eliminate through the magic of regulation? Staff salaries?

All of the competition in the world in the insurance market, won't lower costs by very much. The poison of spiraling costs of health care, goes all the way down to the roots of the constraints of medical schools training limited numbers of doctors, all the way up to the top of individuals buying insurance.

The exchanges have already shown very clearly that insurers competing in a real market on premium (which, granted, is a pretty new phenomenon for them) will either negotiate down prices with providers or exclude high priced providers from certain networks entirely. They'll support alternative payment models meant to support cost-saving, efficiency-promoting reorganizations of care delivery. And they'll devise insurance products meant to both encourage health on the part of consumers and make them more price sensitive when they actually look to access health care services. And that's why their premiums have been surprisingly low.

You *seemed* to imply that Obama Care leads to a structured market, and that we would want to move people off of Employer Sponsored Insurance, into this structured market.

The ACA has created a structured individual market, and price competition had been extremely robust (lower-than-projected premiums are one of the reasons the law is coming in hundreds of billions under budget.)

The group markets still exist and indeed the law has an employer mandate to preserve the status quo. But small (and ultimately large) employers can make use of the exchange infrastructure. And I have little doubt that exchanges will be the way forward for any market based approach to health insurance.

 

[Andylusion]

That hasn't been proven. But let's even say it is true.

If the way in which the ACA has increased access to health care, is by increasing government borrowing and spending on health care programs..... then you basically are saying doing what Greece did, is a good thing.

Greece spent endless money to give the Greek public more and more services. How are they doing now? Not so good.

Is sacrificing the future, for the sake of more health care now, really worth it? Greece may never recover from what they are going through. If we do the same thing, because left wingers sacrificed the entire country for health care, that's not a win.

How does it increase government borrowing and spending?

And if you want to go there, nothing increases government borrowing and spending more than our obscene defense budget.

I am all for slimming down our defense budget where it is wise to do so. In general, the left cuts money where it is most harmful, and then we have to spend twice as much money replacing what we shouldn't have cut.

That said... you people make it out like 90% of the budget is all defense, and we want to advocate cutting tiny 5¢ programs.

The reality is the exact opposite. Military spending is only about 16% of the budget. The vast majority, more than half, is entitlements and social programs.

The truth is, the leftists are the ones trying to cut the 5¢ off the budget, while ignoring the multi-Trillion dollar elephant.

And that's just the direct budget expenses. You are missing the liabilities.

This right here, is what sinks entire nations.

According to most estimates, and you can look up Medicare / Medicaid Unfunded liabilities on google, there are dozens of sources about it.... The health care reform has INCREASED future unfunded liabilities.

That's a problem. The military, if we really get into a pinch, we can cut the military.

This problem here.... people change how they live, when they think the government is going to cover their health care. We are going to owe TRILLIONS. And that's going to play havoc, just like it has in Greece.

 

[Andylusion]

In any other market, without government intervention, a transparent market organically evolves into being.

Neither health insurance nor health care are office supplies. I thought that comparison above was in jest but now I'm beginning to think you're serious. The market structure and the incentives in question are unique and rather complex. That's why health economics exists as a sub-discipline. Health care is not and will never be "any other market," which is why we're even talking about it.

That pretty much covers every single bed in the entire hospital, that a patient spends a night in.

We'll no, it doesn't. "Skilled nursing" is not simply another name for "nursing," it pertains to a specific type of custodial care offered in a long term care facility (namely a SNF or other LTC setting). It doesn't apply to standard acute care settings. Ohio appears to have no CON requirements for acute care settings or emergency care.

Like I said, you need to find a different explanation.

And yes, I get that hospitals love the CON laws

, so that they won't go out of business.

Hospitals are going out of business, even (perhaps especially) in areas where they have no competitors. As I already mentioned, inpatient occupancy, and thus revenue, has been in a state of decline.

For example, why does it cost so much to get aspirin in the hospital? One reason is, according to Federal law, they can't buy a bulk container of aspirin, but rather individually wrapped aspirin. And they can't just have an nurse in training, or intern, give you the aspirin. No it must be a Registered Nurse or LPN, which of course costs a ton of money, to pay someone $70,000 to hand out Aspirin.

Hospital charges have very little to do with what anything actually costs. They mark up virtually everything because (1) they can, and (2) they're cross-subsidizing other services or expenses on which they would otherwise lose money.

You say "hospitals have high fixed costs" as if that's a given. No, it's not. They have high fixed costs, because government requires them to.

Hospitals are expensive organizations. They're generally prepared for a huge variety of eventualities and they tend to be the largest nongovernmental employer in a region.What cost is it you propose to eliminate through the magic of regulation? Staff salaries?

All of the competition in the world in the insurance market, won't lower costs by very much. The poison of spiraling costs of health care, goes all the way down to the roots of the constraints of medical schools training limited numbers of doctors, all the way up to the top of individuals buying insurance.

The exchanges have already shown very clearly that insurers competing in a real market on premium (which, granted, is a pretty new phenomenon for them) will either negotiate down prices with providers or exclude high priced providers from certain networks entirely. They'll support alternative payment models meant to support cost-saving, efficiency-promoting reorganizations of care delivery. And they'll devise insurance products meant to both encourage health on the part of consumers and make them more price sensitive when they actually look to access health care services. And that's why their premiums have been surprisingly low.

You *seemed* to imply that Obama Care leads to a structured market, and that we would want to move people off of Employer Sponsored Insurance, into this structured market.

The ACA has created a structured individual market, and price competition had been extremely robust (lower-than-projected premiums are one of the reasons the law is coming in hundreds of billions under budget.)

The group markets still exist and indeed the law has an employer mandate to preserve the status quo. But small (and ultimately large) employers can make use of the exchange infrastructure. And I have little doubt that exchanges will be the way forward for any market based approach to health insurance.

I am absolutely serious. You can say "Health care isn't like office supplies" and yet what we have seen here in America, and around the world, is the fundamentals of economics work exactly the same. You can say it's not the same, but it works the same. You limit entry into the market... price goes up. You regulate the market.... price goes up. You limit competition in the market... price goes up. You attempt to control the price... shortages show up.

This is why you have places like India, where medical tourist hospitals, that are free from the regulations of the government, and are only controlled by the chaos and wild-cat fundamentals of economics based on supply and demand.... and you can have a surgery that cost $100,000 in the US, cost only $18,000 in India.

The fundamentals of economics don't magically change, because "this is health care!".

And every time you do, the result is disaster. Energy isn't like office supplies.... right? And then you end up with rolling black outs across California.

CON laws

But I posted the specific law, which said "Skilled Nursing, or Nursing.". Nursing or skilled nursing. That pretty much covers all nursing of any kind. Name a bed in a hospital in which there is no nurse in attendance?

You can't, and I can tell you why. I posted the list of laws governing hospitals, and one of the requirements is that there is a nurse assigned to every single bed which has a patient. By law, every single bed, has a nurse.

Now maybe there is some other part of the law, that I don't know about..... but.... based on what I read, CON laws cover every single bed in any hospital in the state of Ohio.

Hospitals are going out of business, and hospitals mark up everything they can, because they can and to subsidize other services they would lose money on.

Most of what you said is true, with the exception of "because they can". Clearly if hospitals are closing..... then they are marking up prices because they are trying not to close.

But what all of what you said, ignores the cause. Here is the cause....
Analysis: Why Rural Hospitals Are Closing | Daily Yonder | Keep It Rural

I have to admit I love these small time media outlets, who are not driven by a political bent, and have no problem just saying the truth.

In 1984 Congress changed the way Medicare paid hospitals. Instead of paying whatever hospitals claimed for taking care of Medicare patients, the agency began paying what it judged was reasonable for a particular illness.
That change was hard on a lot of hospitals, but the larger ones were able to live with it. For bigger hospitals, the length of patient stays averaged out. And, to the extent that Medicare was systematically underpaying, hospitals raised their charges to private insurance companies to make up the difference.
​

So Congress decided to determine how much is reasonable to pay, instead of hospitals telling government how much it cost them to provide care. Why? Because Medicare expenses were growing at an unsustainable rate.

Medicare under pays hospitals. So larger hospitals increase prices on privately insurance patients, to subsidize the cost of Gov-Patients on Medicare and Medicaid.

Small rural hospitals don't have that as an option, because most of the people in rural towns are on Medicare. The younger people generally move into the city to find work.

Now as you can see, every time that Medicare and Medicaid pay out less and less for care, the hospitals cost-shift that to private patients in higher and higher mark ups.

And what you just pointed out, was that they are not doing it because "they can", they are doing it because if they don't.... like rural hospitals can't... then they close.

The story goes on.......

In 1997 Congress authorized the Critical Access Hospital system to help fix these problems. The new bargain was, if a hospital of up to 25 beds in a rural area would accept some limitations on how long a patient could stay (a practical way to require them to transfer complicated cases), Medicare would pay them what the hospital reported it cost to take care of Medicare patients.

When Congress drafted the Affordable Care Act, it scheduled phase out of most of those special payment programs.
​

Have you ever wondered why you go to an inner city hospital, and find people there from an hour away? I've worked in hospitals, and that always confused me. This is why. The smaller hospitals were transferring patients out of their hospital, to bigger hospitals that could cost-shift the lack of payment from Medicare.

But Obama Care has started phasing out those programs. Why? Again, it's too expensive. They had to make Obama Care seem as though it wouldn't break the Federal Budget. So they cut some of these programs, that kept those rural hospitals alive.

All of this is to point out the regulation, and government intervention, is what has caused all of this. If every single patient, paid for their own care, we wouldn't be talking about this. Hospitals wouldn't be cost-shifting to private patients, jacking up prices. Rural hospitals would be charging what it cost to provide care, and not be closing. No one would be transferred hours away from friends and family.

What cost do I propose to eliminate through the elimination of regulation?

Well... everything I just listed above, for starters. I think we can hire interns and trainees to hand out cups of water and aspirin, instead of a $80,000 Registered Nurse. How about eliminating all the controls on Medical Schools? Supply of doctors goes up, cost of doctors goes down. Simple economics.

If it didn't cost $300,000, and take 10 years, to go through medical school, I wager doctors would be willing to work for less.

And honestly, we don't know what all could be done to lower cost, because no one can do anything to lower cost under the current system.

But you can't tell me that reducing or eliminating regulation can't possibly result in lower cost, because we can look around the world, and see that hospitals that do not have the regulations we do, operate at a fraction of our cost.

Who knows what new method of health care could be developed in a system where they are not constrained by government controls?

The exchanges have already shown very clearly that insurers competing in a real market on premium (which, granted, is a pretty new phenomenon for them) will either negotiate down prices with providers or exclude high priced providers from certain networks entirely.

They were doing that before the exchanges existed. That's actually part of the problem. Hospitals increase prices, to account for the negotiated discount. If a treatment costs $1,000, and the insurance companies have a 50% discount, how much does the hospital charge? $2,000.

This system harms the uninsured the most, because they have to pay the full, made up, price.

This is one of the reasons we don't have a transparent market. All of those costs on those bills are made up numbers, to account for the cost-shifting regulations, and the negotiated discounts. Again, if we had zero regulations..... all of that would go away.

The ACA has created a structured individual market, and price competition had been extremely robust (lower-than-projected premiums are one of the reasons the law is coming in hundreds of billions under budget.)

How do you claim, a market that has shrunk in size, is 'robust'? I just posted the raw numbers. The individual market has declined.

And no, the reason the law has come in under the budget, is because very few of the uninsured, got insurance. The budget was based on the idea that all 45 Million of the uninsured, would get insurance. That hasn't happened.

And I don't think price competition has been so great. The only reason prices have no gone up... is because benefits have declined. The base deductibles have increased dramatically.

Pretty easy to hold prices down, when you cut benefits by a ton.