Will Obamacare succeed where term limits failed?

[Lemur]

Poor lifestyle choices, Physician and specialist salaries, and Medical malpractice/insurance therefrom.

To which I would add the biggest rotting apple in the barrel: Unrealistic pricing.

You don't see many $500 hammers like you did in the old days of government contracting, but now you see plenty of $800 bags of saline solution that cost $1 to manufacture and distribute.

Price gouging, like so many government functions, has been privatized.

[Montmorency]

Unfortunately I doubt that the long-term trend would look much different with a continuation of the (former) status quo. The ACA isn't enough, but it's conceivable that overall the net is at least a little benefit. It could also be argued for as a component of a minimalist program - after all, the TPers weren't just spontaneously generated by the mooting of health-care reform...

notably salaries for medical licensed health care providers.

First, get at the chargemasters and the admin layers. If services rendered become much cheaper, insurers will in turn be left without an excuse to maintain high premiums. Physician and specialist salaries are not so harmful as the rest.

An alteration in the services provided (shift to preventative for example).

Simultaneously with discouragement of reflexive recourse to maximalist end-of-life care.

Consider not commissioning 6-figures in services to keep gramps vegging along for another few weeks or months.

[Montmorency]

Furthermore: Get providers to treat tried-and-true technologies and procedures with more respect, as opposed to pushing the latest pricy-yet-ineffective 'device of wonder' on credulous or bewildered patients. It makes no sense to invest hugely in expensive-but-unproven techs, especially with short-term obsolescence being the norm, unless it's all just a marketing trick on the part of hospitals, far closer to rock-walls and multimedia centers at colleges than anything else...

This hi-tech fetish has permeated American culture for something like a century, though, so - tied closely to the end-of life care issue, it is urgent that the public at large be divorced from such notions of 'newer is better', 'more expensive is better', and most importantly: 'I deserve the best!'

[Seamus Fermanagh]

...This hi-tech fetish has permeated American culture for something like a century, though, so - tied closely to the end-of life care issue, it is urgent that the public at large be divorced from such notions of 'newer is better', 'more expensive is better', and most importantly: 'I deserve the best!'

Now you're calling on a full-on alteration of a culture. Such changes rarely happen swiftly and virtually never by fiat. In fact, that last statement -- I deserve the best -- is much of the practical motivation behind the ACA, at least as far as creating the political support for it.

[Montmorency]

Heh, maybe there could be workarounds that don't entail tackling it head-on?

I'm just outlining detrimental elements of the system; of course I lack the ability to compel them out of existence by "fiat".

I'm just one of the tourists.

[a completely inoffensive name]

This hi-tech fetish has permeated American culture for something like a century, though, so - tied closely to the end-of life care issue, it is urgent that the public at large be divorced from such notions of 'newer is better', 'more expensive is better', and most importantly: 'I deserve the best!'

Nonsense. Science and technology will deliver unto us all, heaven on Earth. Who are you to decide that my grandma should not get as many procedures and machines as possible?

DEATH PANELS

[Papewaio]

Nonsense. Science and technology will deliver unto us all, heaven on Earth. Who are you to decide that my grandma should not get as many procedures and machines as possible?

Given how much Monty spanks your butt I always assumed Monty was your grandma...

[Montmorency]

Given how much Monty spanks your butt

???

...

Oh.

OOOOHHHHH

...

How much do you want?

[Seamus Fermanagh]

To which I would add the biggest rotting apple in the barrel: Unrealistic pricing.

You don't see many $500 hammers like you did in the old days of government contracting, but now you see plenty of $800 bags of saline solution that cost $1 to manufacture and distribute.

Price gouging, like so many government functions, has been privatized.

Most of which is nothing but a game. The manufacturer pays 1, charges more makes profit. The hospital charges 800 to offset costs on other levels. Insurance pays 32. The whole thing is a damn shell game.

[Lemur]

The manufacturer pays 1, charges more makes profit. The hospital charges 800 to offset costs on other levels.

There's truth in what you say, but the bolded bit is ... shall we say an extremely generous interpretation of hospital behavior.

[Seamus Fermanagh]

There's truth in what you say, but the bolded bit is ... shall we say an extremely generous interpretation of hospital behavior.

Well, one of the costs they are offsetting is that of indigents and illegals receiving primary care in hospital emergency rooms on a (like it or not) pro bono basis. It must mount up somewhere, because as a sector health care facilities don't show huge profit margins compared to pharmaceuticals (license to print money) or biotechnology (license to print money in large denominations).

Still, it must be noted that the ACA is an attempt (how effective we shall see) to stop the entirely pro bono care in emergency rooms in favor of complete health coverage and increased preventative care.

[Kralizec]

Out of random curiosity...

Mandatory insurances have existed in the Neth's for a considerable time now in some form or another. There is a group of people here, which was never that big and is considerably diminished today, which is opposed to the very concept of insurance on religious grounds. I gather that their idea is that random misfortunes are not random at all, but the Will of God, and that it's blasphemy or at least hubris to try to avoid the consequenses.

Is this line of thought at all common in the US?

[Seamus Fermanagh]

Out of random curiosity...

Mandatory insurances have existed in the Neth's for a considerable time now in some form or another. There is a group of people here, which was never that big and is considerably diminished today, which is opposed to the very concept of insurance on religious grounds. I gather that their idea is that random misfortunes are not random at all, but the Will of God, and that it's blasphemy or at least hubris to try to avoid the consequenses.

Is this line of thought at all common in the US?

No. Those who believe in full and complete pre-ordination are quite rare.

[Proletariat]

But the loser of the game is the self covered or out of pocket customer. They get the full 800$ charge for salt water in a plastic wrap and are charged 2 dollars each Tylenol administered when a bottle of hundreds costs under a few dollars at Costco. The problem of the insane pricing and the 'charge list' charade was examined in Time magazine a year back really well. It's what's wrong with healthcare and no one gets into it. Much more important than tort reform second maybe only to national health care or public option decision. That its just standard to not be told what any of the arbitrary or jacked up charges are being leveled at you by your healthcare provider is maddening. No one would accept buying software or food this way. So the freemarket works there in a way it can't in healthcare.

What I've learned as a therapist in the US army, some hospitals and some nursing centers for ten years. We're all being fleeced.

Most of which is nothing but a game. The manufacturer pays 1, charges more makes profit. The hospital charges 800 to offset costs on other levels. Insurance pays 32. The whole thing is a damn shell game.

[Xiahou]

I few years ago I had to get a chest x-ray and I didn't have insurance coverage. I called several hospitals... and none of them could tell me what a chest x-ray would cost me out of pocket. They honestly did not know. I was transferred to different departments, talked to different people, I never got a clear answer. Basically, I would have to come get the x-ray and they'd bill me- then I'd know what it costs.

Finally I found an outpatient surgery center in the phone book and they told me- $80. So guess where I went?

The point is- healthcare providers and consumers are both far isolated from the actual costs of their services. There is zero incentive on either side to keep costs low. If you want to see costs go down, you have to make people care what their healthcare costs.

If my car needs work done, I shop around for the best deal. People need to do the same for healthcare. For emergencies, you don't have much choice- but for everything else, there should be a price incentive.

There is no overall increased demand for being ill. People get sick regardless of having insurance or not. The overall healthcare system ie private and public has to care for the people and with chronically ill rarely if ever recovers any money.

This is a gross oversimplification. The threshold at which people seek treatment can vary greatly. If you have costly coverage or no coverage, you're less likely to go to a doctor for less serious problems.

[Seamus Fermanagh]

But the loser of the game is the self covered or out of pocket customer. They get the full 800$ charge for salt water in a plastic wrap and are charged 2 dollars each Tylenol administered when a bottle of hundreds costs under a few dollars at Costco. The problem of the insane pricing and the 'charge list' charade was examined in Time magazine a year back really well. It's what's wrong with healthcare and no one gets into it. Much more important than tort reform second maybe only to national health care or public option decision. That its just standard to not be told what any of the arbitrary or jacked up charges are being leveled at you by your healthcare provider is maddening. No one would accept buying software or food this way. So the freemarket works there in a way it can't in healthcare.

What I've learned as a therapist in the US army, some hospitals and some nursing centers for ten years. We're all being fleeced.

When I've insisted on paying out of pocket, or when the mother in law goes out of pocket to her dentist, there are different prices available. One can even negotiate a bit on them (the mother in law has few teeth left of her own, getting her cleanings done at the pediatric rate by arrangement).

On the other hand, prole', I do not doubt that many (most? all?) of us ARE being over-charged. As you have direct industry experience and I have not, your points carry weight with me. I've argued before that the current system is, in some ways, the proverbial camel (horse designed by committee) with too many in-built gaffes and shenanigans. It is neither a fee-for-service with insurance negotiated to suit each client situation NOR a government mandated and controlled system that is applied equally to all. It is a Frankenstein of both.

My thrust here has been to argue that the ACA is not going to get the job done in terms of making things better.

[Xiahou]

As the reports come in documenting the logistical train wreck that has been the Obamacare exchanges, we're beginning to hear murmurs that suggest that it may be postponed anyway, lest it collapse under it's own fail.

Obamacare Website Failure Threatens Health Coverage For Millions Of Americans

Under these circumstances, the lion's share of the people who do whatever is necessary to sign up through HealthCare.gov are likely to be the sickest and most expensive to cover because they have the greatest need, Laszewski said. That would make the pool of people covered very costly, causing health insurers to lose money and likely rethink whether they want to participate in the exchanges, he said. "The fundamental threat to Obamacare is we don't get enough healthy people in the pool to keep the rates reasonable, and they are in grave danger of that problem," he said.

If these problems persist longer -- weeks, months, a whole year -- the entire Obamacare project falls apart, Laszewski said: "It's a holy shit moment."

[Lemur]

"Under these circumstances, the lion's share of the people who do whatever is necessary to sign up through HealthCare.gov are likely to be the sickest and most expensive to cover because they have the greatest need"—yup, that's the scariest part.

Interesting that the Obama campaign was a best-practices model of how to do web, but once normal federal procurement is the basis, it all breaks down. Ah, dysfunction. Good article about it here.

The launch of the federal Obamacare website has been unforgivable, for a variety of reasons. Just a shocking mess. And I suspect it was preventable.

[Xiahou]

"Under these circumstances, the lion's share of the people who do whatever is necessary to sign up through HealthCare.gov are likely to be the sickest and most expensive to cover because they have the greatest need"—yup, that's the scariest part.

Are you being serious? .....I cant tell.