Debate Now An Unhappy Birthday for Obamacare?

[Greenbeard]

If you can point me to explanations (I've looked on the net briefly...I could not find anything by a source I trusted), I would be grateful. BTW: I don't trust anything that has ".gov" in it...or the Kaiser Foundation. I have no trust in right wing sources either.

PwC has a short primer on what's happening right now (the first item in particular is what I'm talking about, though the second is also closely related): "Healthcare reform: Five trends to watch as the Affordable Care Act turns five."

McKinsey has a longer piece (which has a bit more perspective on why it's taken so long to start aggressively doing this) on the subject: "The Trillion Dollar Prize: Using outcomes-based payment to address the US healthcare financing crisis."

Or read a short article from The Econoimst[/] laying out how these trends (including the payment shifts away form fee-for-service under the ACA) are fitting together: "Shock treatment:A wasteful and inefficient industry is in the throes of great disruption."

There's no shortage of reading material on payment reform and delivery system reform and the close relation between the two.

 

[eifiki]

IT's politics after all and to be honest no one would agree if you say it diferently. There are many stupid people who would not appreciate it but let's face it no one wants to create something that he can't oppose against later on, There are few good people and SO Ltd and Joyce Aboussie St. Louis Women Leaders in Action are in my list for the past 6 months. So let think again next time when involving nukes no one would appreciate something ike that as a plus. People are not so stupid like the leader think. Big mistake in that department if you ask me. And no Obama care doesn't work at all(my opinion on it) And it's not gonna any soon ..with all those problems and obstacles.

 

[Sun Devil 92]

The unpopularity of "Obamacare" is not going up month by month.

RealClearPolitics - Election Other - Public Approval of Health Care Law

Seems to be going up according to your graph.

What are we missing.

 

[Mertex]

They want the government to get out of healthcare and let market forces restore the system to the greatest, most efficient in the world that it was before the federal government started meddling.

Yes, because we know how well that was working before. Republicans keep claiming that the market self regulates, but we know that is a farce. Insurance companies were taking advantage of people left and right and I don't understand how anyone could think that this was okay.

I support Obamacare, but agree that there are things that need to be fixed. Many liberals like myself knew that it was important to get Obamacare passed knowing that it wasn't perfect, and knowing that once it was passed, we could work on fixing it. The other alternative was to ditch it and continue to live with the old system which was terrible with no hope of getting any reform. Conservatives didn't seem to be in any hurry to fix what we had before. Americans will be very disappointed in the Supreme Court rules that only the states that set up exchanges are entitled to the subsidies....millions will lose coverage.

Conservatives keep wanting to repeal it in its entirety but offer nothing in its place. What are they thinking? Quite obvious that no thought has gone into what will millions that have signed on will do....if the GOP were to succeed in repealing it.

Another myth, that insurance companies didn't like Obamacare, when actually they supported Obamacare from the start.

The fact that the health insurance industry supported Obamacare from the very beginning was entirely missed by the mainstream press.
To the famously credulous members of the mainstream press, it was easy to imagine that the insurers were actually among the opposition.
During the Presidential race of 2008, for instance, managed care companies donated far more money to both Barack Obama and Hillary Clinton than to any Republican candidate, even though both of these Democratic candidates publicly castigated the insurance companies for producing most of the problems in American healthcare, and promised to institute reforms that would drastically cramp their style and reduce their profits.
The Covert Rationing BlogWhy Health Insurance Industry Supported Obamacare - Obama Healthcare Reform and the Health Insurance Industry

A good read:

10 Reasons Most People Like Obamacare Once They Know What s Really In It Alternet

 

[Sun Devil 92]

If you can point me to explanations (I've looked on the net briefly...I could not find anything by a source I trusted), I would be grateful. BTW: I don't trust anything that has ".gov" in it...or the Kaiser Foundation. I have no trust in right wing sources either.

PwC has a short primer on what's happening right now (the first item in particular is what I'm talking about, though the second is also closely related): "Healthcare reform: Five trends to watch as the Affordable Care Act turns five."

McKinsey has a longer piece (which has a bit more perspective on why it's taken so long to start aggressively doing this) on the subject: "The Trillion Dollar Prize: Using outcomes-based payment to address the US healthcare financing crisis."

Or read a short article from The Econoimst[/] laying out how these trends (including the payment shifts away form fee-for-service under the ACA) are fitting together: "Shock treatment:A wasteful and inefficient industry is in the throes of great disruption."

There's no shortage of reading material on payment reform and delivery system reform and the close relation between the two.

Could not get at the first link.

The second link was a projection...not a report. BTW: Liked the part that said about 70% of doctors think compensation will go down. That's gonna help.

 

[Foxfyre]

The issue is not whether there were problems that needed to be fixed. There were. But the fix was not popular with most of the medical profession and the public was told a whole pack of lies about it. The insurance companies were guaranteed no loss of revenues if they signed on and of course those who structure their policies to get billions of government dollars were all for it. And all of this comes out of the taxpayer's pocket and saddles us, our children and grandchildren with unconscionable debt. And most economists agree it has contributed to a painfully slow recovery and created setbacks. The medical care system is losing healthcare professionals and healthcare is suffering as a result. If you know people in the profession, you know that is true.
What Do Actual Doctors Think About Obamacare Now - Forbes

It would have cost a tiny fraction of the cost to have left the rest of it alone and focused on helping the uninsured get insurance.

As for the GOP not having a plan in place to replace Obamacare, so what? When you put out a fire, what do you replace it with?

The free market had produced the best healthcare system in the world with government staying out of it except to provide necessary regulation. Once the government started getting involved with providing healthcare, that is when the worst problems began to develop. And the more government has gotten involved the worse it has become.

 

[Greenbeard]

Could not get at the first link.

The second link was a projection...not a report. BTW: Liked the part that said about 70% of doctors think compensation will go down. That's gonna help.

What are you looking for at this point? More on the rationale behind changing the way care is paid for and transforming the delivery of care (away from the fee-for-service "factory" approach mentioned somewhere above) or how this once-in-a-generation change is unrolling in practice?

 

[Greenbeard]

The issue is not whether there were problems that needed to be fixed. There were. But the fix was not popular with most of the medical profession and the public was told a whole pack of lies about it. The insurance companies were guaranteed no loss of revenues if they signed on and of course those who structure their policies to get billions of government dollars were all for it. And all of this comes out of the taxpayer's pocket and saddles us, our children and grandchildren with unconscionable debt. And most economists agree it has contributed to a painfully slow recovery and created setbacks. The medical care system is losing healthcare professionals and healthcare is suffering as a result. If you know people in the profession, you know that is true.

You say things that are completely false with such confidence.

Any given insurer is only "guaranteed" revenue if it offers the most competitive product(s). Which explains why price competition in the new marketplaces has been so robust so far--many rating areas around the country saw average premiums drop going into this year because insurers are jockeying like crazy to pick up and/or retain customers.

The ACA isn't adding to the debt--it was purposefully designed such that a mixture of cost savings and new tax revenues would cover the law's new spending. In practice, the new spending is turning out to be significantly lower than originally forecast, while the savings have turned out to be a lot larger than expected. Which means it's cutting the debt even more than expected.

The number of active licensed physicians (MDs and DOs) was 850,085 in 2010; 878,194 in 2012; and 897,420 as of March 2015. So this story of the system hemorrhaging docs doesn't match up with reality.

It would have cost a tiny fraction of the cost to have left the rest of it alone and focused on helping the uninsured get insurance.

Virtually all of the spending in the law is to help people get insurance.

The free market had produced the best healthcare system in the world with government staying out of it except to provide necessary regulation.

It makes very little sense to praise the market and then complain about your deductible (which is exactly the market-based mechanism for restoring consumerism and individual price sensitivity to the market). Just as it doesn't make a whole lot of sense to implicitly endorse a system in which premiums go down for people like me--relatively young, healthy, nary a medical claim--by raising them for people like you--relatively older and with big red flags in the family medical history.

As near as I can tell, many of your complaints about what's happening under the ACA are a reaction to the introduction/restoration of market dynamics to the system. That's not unique to you, that's true of most of the critiques favored by the right. I've watched the transformation of many on the right into closeted single-payer advocates with more than a little bemusement.

 

[Sun Devil 92]

The issue is not whether there were problems that needed to be fixed. There were. But the fix was not popular with most of the medical profession and the public was told a whole pack of lies about it. The insurance companies were guaranteed no loss of revenues if they signed on and of course those who structure their policies to get billions of government dollars were all for it. And all of this comes out of the taxpayer's pocket and saddles us, our children and grandchildren with unconscionable debt. And most economists agree it has contributed to a painfully slow recovery and created setbacks. The medical care system is losing healthcare professionals and healthcare is suffering as a result. If you know people in the profession, you know that is true.
What Do Actual Doctors Think About Obamacare Now - Forbes

It would have cost a tiny fraction of the cost to have left the rest of it alone and focused on helping the uninsured get insurance.

As for the GOP not having a plan in place to replace Obamacare, so what? When you put out a fire, what do you replace it with?

The free market had produced the best healthcare system in the world with government staying out of it except to provide necessary regulation. Once the government started getting involved with providing healthcare, that is when the worst problems began to develop. And the more government has gotten involved the worse it has become.

What is most frustrating is the lack of numbers.

Before there was Obamacare....what was the Federal Government spending on health care ? I suspect it was all tied up in Medicare and the VA.

Now what is the Federal Government spending on health care ? They certainly didn't cut any Medicare of VA costs.

Just the numbers. That's what I'd like to find.

Then we can discuss some of the other claims about how the ACA saved this or cost that.

Some numbers......

So here is a link to a 12 page report by the CBO.

http://www.cbo.gov/sites/default/files/03-13-Coverage Estimates.pdf

It calls out some numbers.....but no summary table. I have no way of knowing how those numbers relate to each other. Are some absolute ? Are some offsets ?

Just some simple numbers.

 

[Foxfyre]

The issue is not whether there were problems that needed to be fixed. There were. But the fix was not popular with most of the medical profession and the public was told a whole pack of lies about it. The insurance companies were guaranteed no loss of revenues if they signed on and of course those who structure their policies to get billions of government dollars were all for it. And all of this comes out of the taxpayer's pocket and saddles us, our children and grandchildren with unconscionable debt. And most economists agree it has contributed to a painfully slow recovery and created setbacks. The medical care system is losing healthcare professionals and healthcare is suffering as a result. If you know people in the profession, you know that is true.
What Do Actual Doctors Think About Obamacare Now - Forbes

It would have cost a tiny fraction of the cost to have left the rest of it alone and focused on helping the uninsured get insurance.

As for the GOP not having a plan in place to replace Obamacare, so what? When you put out a fire, what do you replace it with?

The free market had produced the best healthcare system in the world with government staying out of it except to provide necessary regulation. Once the government started getting involved with providing healthcare, that is when the worst problems began to develop. And the more government has gotten involved the worse it has become.

What is most frustrating is the lack of numbers.

Before there was Obamacare....what was the Federal Government spending on health care ? I suspect it was all tied up in Medicare and the VA.

Now what is the Federal Government spending on health care ? They certainly didn't cut any Medicare of VA costs.

Just the numbers. That's what I'd like to find.

Then we can discuss some of the other claims about how the ACA saved this or cost that.

Some numbers......

So here is a link to a 12 page report by the CBO.

http://www.cbo.gov/sites/default/files/03-13-Coverage Estimates.pdf

It calls out some numbers.....but no summary table. I have no way of knowing how those numbers relate to each other. Are some absolute ? Are some offsets ?

Just some simple numbers.

From a purely personal point of view, and admittedly that is probably prejudiced based on both experience and perception, I usually figure you can always safely add at least 50% to whatever numbers the government tells us is the cost, and probably reduce by 25% to 50% the cost cited by government critics and come up with a reasonable number to use.

It has been my ever more lengthy experience and observation that almost all government programs, at least those in the last half century, exceed their budgeted limits and all substantially exceed the projected estimates fed to we the people.

I guess what I'm actually saying here is that honest numbers are very difficult to come by, but in my opinion, we won't find them anywhere on a federal government website. And the numbers that are there will pretty much always be less than the actual expenditure or cost.

 

[Foxfyre]

And even while acknowledging the benefits to some via Obamacare, it is hard to imagine that we couldn't have found some way to help people without destroying the existing system and creating so many unintended negative consequences:

Floyd Brown, President of the Western Center for Journalism, equates Obamacare as a socialist scheme turned on his head--a system by which corporate America, i.e. the wealthy, are bailed out while the middle class and wage earners are squeezed harder than ever to pay the tab.
Obamacare Fines in 2015 Expect a 242 Hike Wall Street Daily

Josh Archambault, director of health care policy & program manager for the Middle Cities Initiative at the Pioneer Institute acknowledges that, based on early, incomplete numbers, that insurance premiums for most have increased only modestly. But deductibles and copays for most have increased substantially and the health services have contracted so that there are fewer doctors, hospitals, and other services available to policy holders.
"Most insurers have been changing their insurance plan designs dramatically under the federal law. Narrow networks, higher deductibles, and higher out of pocket costs when you visit a doctor are the new norm,” Archambault said. “In other words for many Americans under Obamacare, they are paying more and getting less.”
Obamacare 2015 Low premium increases high deductibles - Yahoo Finance

And while Obamacare is not the only factor creating financial difficulties for small, rural hospitals, it was the death blow for dozens and that trend is continuing in an alarming manner:
Rural hospitals beset by financial problems struggle to survive - The Washington Post

". . .(Dr. Lee) Hieb, a practicing orthopedic surgeon and author of “Surviving the Medical Meltdown: Your Guide to Living Through the Disaster of Obamacare,” believes leftists want health care to be as centralized as possible. This means fewer hospitals and fewer specialists.
Read more at Obamacare designed to close rural hospitals"​

 

[Greenbeard]

Now what is the Federal Government spending on health care ? They certainly didn't cut any Medicare of VA costs.

Just the numbers. That's what I'd like to find.

Then we can discuss some of the other claims about how the ACA saved this or cost that.

Some numbers......

Yes, they are in fact finding savings in Medicare. The ACA was designed to slow the growth of Medicare spending. The savings each year would then offset some of the ACA's new spending (new revenues would offset the rest). The result, if actual Medicare spending conformed to the expectations/requirements created by the ACA, would be a net reduction in the deficit.

The CBO releases the ten-year budget outlook every year (and usually updates it later in the year). Those contain actual Medicare spending for the previous year, as well as projections for spending over the coming decade based on the then-current trends and best information available (they always have a table titled something like "Baseline Projections of Mandatory Outlays" that contains this information).

The top row of the table below reflect the expectation for Medicare spending in an ACA-less world, as determined a few weeks before the law passed. The row below reflects the changes to Medicare spending made by the ACA--the cost savings--to make sure the books balanced and that the law didn't add to the debt. Medicare spending had to be at or below the green numbers to make the law's finances work as promised.

The bottom row reflects what Medicare spending actually turned out to be for 2012-14 (as well as what it's now anticipated to be in 2019 in light of the unprecedented slowdown in health care spending growth we're experiencing). Well below the ACA's target numbers in green. As I said, the promised savings haven't just materialized, they've been much larger than was needed to balance the ACA's new spending.

Medicare spending, billions of dollars

.	2012	2013	2014	2019
Pre-ACA Trend	581	638	710	962
Post-ACA Expectation (needed for ACA to reduce the deficit)	563	611	645	869
Reality	551	585	600	772

[TBODY] [/TBODY]

And, of course, the ACA's new spending has itself turned out to be significantly less than advertised. Meaning Medicare spending could've actually fallen less than the ACA's crafters envisioned and the books would've still balanced. Instead we've gotten more savings and less new spending than advertised back in 2010. The law is even better for reducing the deficit than it was expected to be.


Future Obamacare Costs Keep Falling | Wall Street Journal

Nearly five years after President Barack Obama signed the Affordable Care Act into law, federal budget scorekeepers have sharply revised down the projected costs of the signature bill.

In the latest projection, published by the nonpartisan Congressional Budget Office on Monday, the major provisions of the law will cost the government 11% less than they forecast six weeks ago, or $142 billion over the coming decade.

Overall, the health-care law will now cost 29% less for the 2015-19 period than was first forecast by the CBO when the law was signed in March 2010. Back then, the CBO and the congressional Joint Committee on Taxation estimated that for the last five years of their 10-year projection, Obamacare would cost $710 billion. Now, they expect it will cost $506 billion for the same period.

In 2019, for example, the agencies project Obamacare will cost $116 billion, which is down 33% from the initial forecast for the same year made in 2010.

 

[Sun Devil 92]

Yes, they are in fact finding savings in Medicare.

What does this mean ?

Savings that were there to be had absent the ACA ?

Savings created by the ACA ?

 

[Sun Devil 92]

Are there parts of Obamacare that have yet to be implemented ?

 

[Foxfyre]

Are there parts of Obamacare that have yet to be implemented ?

Yes. Some of it won't be fully implemented until next year, and, via executive order, some won't happen until Obama is out of office and somebody else will get blamed for it.

The fact is that the reason Medicare costs are down is because Obamacare cut Medicare by more than $700 billion by reducing payments to doctors and hospitals. And since few Senior Citizens have any different feasible option for healthcare other than via Medicare, that has severely shrunk the medical facilities available to senior citizens, there are fewer doctors willing to treat them, and dozens of small hospitals have closed their doors and many more are likely to do so making medical care much more difficult for some to access. And out of pocket costs for copays and deductibles are much higher.

Now I am not complaining about the cost cutting measures. Had it been across the board, without government mandates demanding that we all buy the same coverage, I would have applauded that. But for government to dishonestly pat itself on the back for cutting costs that created a reduction in services to senior citizens while just shifting that money plus a boatload more of it to other parts of the program is just plain dishonest.

 

[Sun Devil 92]

Are there parts of Obamacare that have yet to be implemented ?

Yes. Some of it won't be fully implemented until next year, and, via executive order, some won't happen until Obama is out of office and somebody else will get blamed for it.

The fact is that the reason Medicare costs are down is because Obamacare cut Medicare by more than $700 billion by reducing payments to doctors and hospitals. And since few Senior Citizens have any different feasible option for healthcare other than via Medicare, that has severely shrunk the medical facilities available to senior citizens, there are fewer doctors willing to treat them, and dozens of small hospitals have closed their doors and many more are likely to do so making medical care much more difficult for some to access. And out of pocket costs for copays and deductibles are much higher.

Now I am not complaining about the cost cutting measures. Had it been across the board, without government mandates demanding that we all buy the same coverage, I would have applauded that. But for government to dishonestly pat itself on the back for cutting costs that created a reduction in services to senior citizens while just shifting that money plus a boatload more of it to other parts of the program is just plain dishonest.

What I hear you saying is that the chart shown in post #72 may not be directly related to the ACA. I don't know that Greenbeard is claiming that either.

My statement that they were not cutting medicare was incorrect.

 

[Greenbeard]

Yes, they are in fact finding savings in Medicare.

What does this mean ?

Savings that were there to be had absent the ACA ?

Savings created by the ACA ?

As I've stressed in this thread several times, we're in the midst of something of a rolling revolution in the organization, delivery, and financing of health care in the U.S. And yes, the ACA is a significant factor in this change and its primary tool for being an agent of change is reforms to the Medicare program.

Payers, led by Medicare, are starting to pay health care providers to do better, be better, and do it while holding down cost growth. The financial incentives are changing, which in turn means the delivery strategies can change with them--toward team-based care, coordination across health care settings, with an eye toward prevention and better management of health conditions.

At a high level, the ACA demands savings. But it isn't just an edict from on high, it also contains a number of tools to make that feasible and accomplish it.

The law created financial incentives to prevent avoidable re-hospitalizations. Lo and behold, historic drops in preventable readmissions followed as hospitals got a lot more interested in preserving the health of their patients post-discharge.

Obamacare Incentives Slow Hospitals' Revolving Door

Then Redd, like more than 600 other Mount Sinai patients over the past three years, was singled out as a high-risk patient and assigned to one of 27 social workers focused on keeping patients out of the hospital. Mount Sinai created the program after the Affordable Care Act set up an incentive system to provide hospitals extra money for keeping people healthy, and penalize them for having too many patients readmitted too soon.

It offered incentives for the creation of new organizations that re-organized care delivery, eliminating some of the discord that drove up health costs:

Medicare Seniors Like ObamaCare's Team Approach

As the U.S. health care system moves away from fee-for-service medicine to more accountable care that uses a team of health professionals, seniors covered by Medicare say they are okay with these new models that include nurses, social workers and other allied health professionals in the front lines of their treatment, according to a new analysis.

Increasingly, the Medicare health insurance program for the elderly as part of the Affordable Care Act is moving to a system that rewards doctors and hospitals for working together to improve care. By contracting with entities known as accountable care organizations and patient-centered medical homes, the providers use a team approach that can involve lower cost providers and allied health professionals to provide seniors with more attention while at the same time keeping them healthy and out of more expensive care settings.

There are hundreds of these organizations now, serving millions of Medicare patients (and others).

Paying Doctors to Shun Hospital

In an attempt to tame growing Medicare costs, the Affordable Care Act encourages doctors and hospitals to form groups called accountable care organizations, or ACOs. The idea is to get doctors, hospitals, nursing homes, and other providers to work together to treat Medicare patients. They’re supposed to avoid unneeded or redundant procedures and emphasize preventive care and chronic-disease management. These alliances typically invest in electronic health records to track patient treatments and hire social workers to make sure patients take their medic

The ACA started tying Medicare payments to the quality of care offered, putting health care providers on the financial hook for the product they sold.

Do Structural Changes Drive the Recent Health Care Spending Slowdown? New Evidence

Value-based purchasing of hospital services has had a significant impact on hospital behavior. Hospitals are highly sensitive to changes in financial incentives. Movement away from a preponderance of fee-for-service payments is also likely to permanently alter hospital behavior. For instance, emphasis on reduced readmissions has reportedly changed how hospital managers think about care delivery, from the care delivered within their four walls towards coordinating care outside their four walls as they track patients as they return to the community or to various post acute care settings.

An observation is that hospitals and other providers are being called to change their care delivery models and business models as payment systems evolve. In a general sense this is leading to a re-engineering of care- slow to start with, but gaining momentum over time. The ACA, with its call for CMMI grants, shows the potential magnitude of private and public sector experiments with alternative organizational forms such as ACOs and medical homes in combination with payment system incentives in the form of payments for value, payment bundling and capitation and prompting the health care industry to reconsider delivery models that reduce incentives for volume of care under fee-for- service. As organizational forms and payment models evolve, augmentation of computing powers and more ready access to “big data” claims files emphasizes an ability to better understand the consequences of change in terms of clinical and economic outcomes.

And they're only stepping up their game from here on: HHS sets goals for expanding new Medicare payment models

The Obama administration wants 30% of payments for traditional Medicare benefits to be tied to alternative payment models such as accountable care organizations by the end of 2016. The administration also has set a goal of hitting 50% by the end of 2018.

The administration wants even larger portions of hospital payments to be tied to quality- or value-based payment models. HHS indicated that it wants 85% of Medicare's hospital payments made through programs such as the Hospital Value-Based Purchasing Program or the Hospital Readmissions Reduction Program by the end of 2016. That threshold kicks up to 90% two years later.

It is the first time that the federal agency has set specific goals for overhauling the payment system for standard Medicare beneficiaries, which has traditionally relied on a fee-for-service model. That system has long been criticized for providing economic incentives for providers to offer a greater volume of care regardless of outcomes. Currently, 20% of Medicare payments for traditional beneficiaries are made through alternative payments models, which also include bundled payment arrangements, according to HHS.

“We believe these goals can drive transformative change, help us manage and track progress and create accountability for measurable improvement,” HHS Secretary Sylvia Mathews Burwell said in a statement announcing the targets.

The savings are real, the changes are real. And this stuff didn't exist pre-ACA. It's pretty unlikely that per capita Medicare spending would now be falling (as it now is) in the absence of the Affordable Care Act.

Are there parts of Obamacare that have yet to be implemented ?

At this point, not really. Some small fraction of the population is still in a grandfathered pre-ACA health plan. A small minority of employees are working for employers who won't be subject to the employer mandate for a few more months. The only large remaining piece is the excise tax on high-cost health plans (due to be implemented in 2018).

 

[Greenbeard]

The fact is that the reason Medicare costs are down is because Obamacare cut Medicare by more than $700 billion by reducing payments to doctors and hospitals. And since few Senior Citizens have any different feasible option for healthcare other than via Medicare, that has severely shrunk the medical facilities available to senior citizens, there are fewer doctors willing to treat them, and dozens of small hospitals have closed their doors and many more are likely to do so making medical care much more difficult for some to access. And out of pocket costs for copays and deductibles are much higher.

At best this is hyperbole. The "much higher" deductible--presumably you mean for hospital services--is less than $200 higher than it was more than half a decade ago--the Part A hospital inpatient deductible is $192 higher today than it was 6 years ago, in 2009 when Obama took office ($1,068 in 2009 vs. $1,260 today).

Meanwhile on the physician services front, the Part B premium has risen less than ten bucks in the last six years (from $96.40 with a $135 deductible in 2009 to $104.90 with a $147 deductible today).

Meanwhile, the Medicare Payment Advisory Commission (an independent body that advises Congress on Medicare policy) found, again, in its March 2015 Report to Congress that seniors in Medicare have slightly better access to services than pre-Medicare older folks with private insurance. So let's hold the hysteria on how "severely shrunken" their choice of providers has become.

As for small hospitals closing, that's not a Medicare issue. That's an issue with states choosing to reject the ACA's Medicaid expansion. PwC has found that the ACA's solution to those hospitals' fiscal challenges is working where states have chosen to implement it:

Physicians, hospitals and health systems operating in the 26 states and the District of Columbia that pursued the option to broaden Medicaid coverage with federal dollars have seen a significant rise in paying customers and volume, while dramatically reducing uncompensated care levels. This year alone LifePoint Hospitals has seen a 30.3% reduction in its uninsured and charity care patients, according to reports filed with the US Securities and Exchange Commission (SEC) and data released during their second quarter earnings call.

For-profit health systems, operating more than 500 hospitals in the US, report far better financial returns through the first half of the year than expected, owed in large part to expanded Medicaid, according to quarterly earnings reports filed this summer with the SEC.

The growth in Medicaid expansion states starkly contrasts the experience in the 24 states that did not expand the joint federal-state health program. In those states, hospitals continued to see flat or sagging admission rates and little reduction in the number of uninsured, largely non-paying patients.

While these trends were expected, the gap in Medicaid enrollment between expansion and non-expansion states is greater than most industry analysts predicted. After a strong start to the year, health systems have recalculated their previous estimates to adjust for higher than expected enrollment and revenues. Many have projected a strong finish to the year.

In states that have expanded Medicaid, an influx of newly insured patients has helped reverse long-running hospital trends such as declining admissions and a rise in uncompensated care. Given the emerging picture of health system haves and have nots, it is understandable why many hospital executives continue to urge state lawmakers to expand Medicaid where they haven’t already.

Hospitals in expansion states have already seen a pick-up in volume. As more and more people seek out routine primary care, a community’s overall health should improve. But in non-expansion states, lower- income individuals may continue to have limited access to care and strain the safety net.

 

[Sun Devil 92]

Great claims on both sides.

Is Obamacare Slowing Health Care Spending - Forbes

In general, there has been no trend in annual changes in health care spending during the Obama presidency. However, health care spending increases in recent years are definitely lower than they have been in the past. As I have previously reported, today’s low annual increases in health care spending (including their increase relative to GDP) are part of a long run trend stretching back to the early years of the first George W. Bush Administration. Obamacare obviously had nothing to do with that.

Not that I believe any of this.

Who can you believe ? Once again, these numbers come with little or no context for someone like me who knows so little.

I think in terms of basics. It would be great to have an Obamacare for Dummies page somewhere.

 

[Foxfyre]

Great claims on both sides.

Is Obamacare Slowing Health Care Spending - Forbes

In general, there has been no trend in annual changes in health care spending during the Obama presidency. However, health care spending increases in recent years are definitely lower than they have been in the past. As I have previously reported, today’s low annual increases in health care spending (including their increase relative to GDP) are part of a long run trend stretching back to the early years of the first George W. Bush Administration. Obamacare obviously had nothing to do with that.

Not that I believe any of this.

Who can you believe ? Once again, these numbers come with little or no context for someone like me who knows so little.

I think in terms of basics. It would be great to have an Obamacare for Dummies page somewhere.

For sure there are endless opinions out there and myriad pretty charts and graphs and proclamations from both sides each providing opposing information and citing different numbers.

And it is pretty much a given that the built in bias from each source will determine what their 'report card' will show so far. The govenrment and leftist sources give it pretty good marks. Everybody else not so much.

After the government has lied to us again and again and again about what to expect from the ACA--that much we do know for a fact--it is also a fact that Obama has issued multiple executive fiats to change the law to delay the most disastrous consequences as those began to show up. And the more onerous requirements were always delayed until after the 2012 and 2014 elections--no surprise there. Some particular unpopular provisions won't kick in until next year, so it will be some time before we can know how good or bad it will be.
Questions and answers on the latest ACA delay

Ultimately it will all come down to personal perception. Leftwingers who want leftist programs like ACA to succeed will scour the internet looking for ways to support it and make it look good. And they will believe the sources they find.

Rightwingers who are more skeptical of and opposed to big government solutions to most things, believe the ACA will be another massively expensive and ultimately unsustainable government program, and will hunt for and point out the negatives.

It seems those who have suffered no significant difference in their healthcare are pretty ambivalent about it.

And those who are receiving government subsidies to lower their healthcare costs are happy and they don't care that others are being forced to pay their bills for them.

And people like my husband and myself who are paying significantly more out of pocket, who have lost beloved doctors, who are seeing wait times for healthcare much increased and seeing the healthcare available to us shrunk, and who know health care professional who have no confidence that it isn't going to get a lot worse, definitely have our own perceptions.