shutdown

[SK in CV]

[quote=no_such_reality]
“But we have to pass the [health care] bill so that you can find out what’s in it….” Nancy Pelosi speaker of the House 2010

Maybe a real debate and real discussion instead of a ram rod ‘we won’ stuff it attitude of the first two year which is now the permanent attitude of both sides.[/quote]

That’s really a bunch of garbage. There was real discussion, for months and months. I read two different versions of the entire bill, plus the final bill before it was passed. Anyone who claims that there wasn’t real debate on the issues simply wasn’t paying attention. In fact, it was debated pretty heatedly here.

[ucodegen]

[quote=SK in CV]That’s really a bunch of garbage. There was real discussion, for months and months. I read two different versions of the entire bill, plus the final bill before it was passed. Anyone who claims that there wasn’t real debate on the issues simply wasn’t paying attention. In fact, it was debated pretty heatedly here.[/quote]But also note, that the passing of Obamacare cost the Democrats some of their House seats. In a change of opinion, or party vote, the House shows it first. Obamacare was never the 100% everybody for it shoe in that the media sometimes tries to portray it at. It got through House and Senate, largely on party-line votes.. now the other party gets its say… maybe because people responded to Obamacare by voting for more Republicans this time (swing voters).

While it is called “Affordable Health Care Act”, it does nothing to control costs. Instead it mandates paying a middleman, who takes their cut (see loss ratio for Insurance companies). The middleman happens to be Insurance companies, which oddly are partially responsible for Credit Default Swaps and their use (though not all involved in Health Insurance inhaled that stuff). It even taxes medical device manufacturers, who have to put up with a significant risk when inventing new devices, medical sensing equipment etc. How is taxing these industries cutting costs? How are you going to insure that this middle man has your interests at heart? Yet more laws? Another Insurance Commissioner (happened with auto insurance. Mandating auto insurance was supposed to reduce those costs, but it didn’t).. ie Heath Insurance Commissioner? How do we insure that he really works for us is not operating a Goldman style revolving door? Is it all supposed to magically work because the idea of affordable Health Care sounds good?

How about something useful.. how about all Hospitals have to publish their Chargemasters…. now that is transparency!
Lets start some competition between the Hospitals. Simple, but the powers that be don’t want something so simple and that will work.

[SK in CV]

[quote=ucodegen][quote=SK in CV]That’s really a bunch of garbage. There was real discussion, for months and months. I read two different versions of the entire bill, plus the final bill before it was passed. Anyone who claims that there wasn’t real debate on the issues simply wasn’t paying attention. In fact, it was debated pretty heatedly here.[/quote]But also note, that the passing of Obamacare cost the Democrats some of their House seats. In a change of opinion, or party vote, the House shows it first. Obamacare was never the 100% everybody for it shoe in that the media sometimes tries to portray it at. It got through House and Senate, largely on party-line votes.. now the other party gets its say… maybe because people responded to Obamacare by voting for more Republicans this time (swing voters).

While it is called “Affordable Health Care Act”, it does nothing to control costs. Instead it mandates paying a middleman, who takes their cut (see loss ratio for Insurance companies). The middleman happens to be Insurance companies, which oddly are partially responsible for Credit Default Swaps and their use (though not all involved in Health Insurance inhaled that stuff). It even taxes medical device manufacturers, who have to put up with a significant risk when inventing new devices, medical sensing equipment etc. How is taxing these industries cutting costs? How are you going to insure that this middle man has your interests at heart? Yet more laws? Another Insurance Commissioner (happened with auto insurance. Mandating auto insurance was supposed to reduce those costs, but it didn’t).. ie Heath Insurance Commissioner? How do we insure that he really works for us is not operating a Goldman style revolving door? Is it all supposed to magically work because the idea of affordable Health Care sounds good?

How about something useful.. how about all Hospitals have to publish their Chargemasters…. now that is transparency!
Lets start some competition between the Hospitals. Simple, but the powers that be don’t want something so simple and that will work.[/quote]

It does mandate cost controls. Many policy holders have already got their second refund due to the MLR limits. In exchange for that MLR floor, the insurance companies got mandatory coverage. They’ll end up ahead in the deal.

As will non-profit hospitals in states that will expand Medicaid coverage. But all hospitals have already seen decreased reimbursements and penalties for failure to meet readmission standards. It’s already caused consolidation in the space, and non-profits selling out to for profits, particularly in those states where Medicaid expansion won’t happen.

But in general I agree with you. The law was in part poorly written, and in part ill conceived. There was a lot more that could have been done. But I expect that ultimately it will reduce the rise total health care costs, expand the availability of coverage and be a step in the right direction to fix what was a many faceted irreparable model for health care financing. It wasn’t just health care providers making too much profit, or insurance companies making too much profit, or DME manufacturers or drug companies making too much money that caused the system to break. And no single thing will fix it.

[paramount]

Shouldn’t this shutdown be break even scenario?

I mean they’re not paying million + govt workers/contractors.

[scaredyclassic]

no.

[The-Shoveler]

[quote=paramount]Shouldn’t this shutdown be break even scenario?

I mean they’re not paying million + govt workers/contractors.[/quote]

From what I understand we are just giving some Fed workers a paid holiday, as when it does end (most likely in a few weeks time) most will be paid for the time off.

[spdrun]

There’s no guarantee that they’ll be paid other than historical precedent made during less fractious times. Which is depressing because I have close family who are affected.

It would be extremely stupid and nasty for the Reps to block payment, but stupidity and pettiness seem to be the orders of the day today.

[no_such_reality]

[quote=SK in CV]
But in general I agree with you. The law was in part poorly written, and in part ill conceived. There was a lot more that could have been done. But I expect that ultimately it will reduce the rise total health care costs, expand the availability of coverage and be a step in the right direction to fix what was a many faceted irreparable model for health care financing. It wasn’t just health care providers making too much profit, or insurance companies making too much profit, or DME manufacturers or drug companies making too much money that caused the system to break. And no single thing will fix it.[/quote]

The underlying systemic issue is what is causing our prior model to break. We’re not a heartless nation saying just let people die, so we EMTALA. EMTALA results in 80% of ER visits being uninsured. The ER is one of the LEAST cost effective points for treating people.

The facilities all then restructure their chargemaster to recoop their cost through insurance by factoring it in to the cost. So your ER is 5X what it really should be, because the bill is reimbursing the hospital for the fact that 4 out of 5 basically aren’t paying.

Your regular doctor is much the same. But instead of no-pays, they have Usual, Customary and Reasonable charges. And they have to work on collecting any amount over the various UCR which brings us back to the emergency room analogy.

IMO, the biggest savings of ACA will be driven by taking a large subset of the 40+ million uninsured and moving them from expensive, too little too late treatment in the ER, to less expensive, more preventative treatment up stream.

[spdrun]

Why couldn’t there simply have been a requirement that discriminatory charging be stopped. Same service, same charge, regardless of insurance status, as long as it’s paid in a timely manner.

[FlyerInHi]

[quote=spdrun]There’s no guarantee that they’ll be paid other than historical precedent made during less fractious times. Which is depressing because I have close family who are affected.

It would be extremely stupid and nasty for the Reps to block payment, but stupidity and pettiness seem to be the orders of the day today.[/quote]

Republicans cut employer health insurance from their own congressional staff. Now they want to take away the Obamacare subsidy. I doubt their own staffers won’t feel the pain.

[livinincali]

[quote=no_such_reality]
The underlying systemic issue is what is causing our prior model to break. We’re not a heartless nation saying just let people die, so we EMTALA. EMTALA results in 80% of ER visits being uninsured. The ER is one of the LEAST cost effective points for treating people.

The facilities all then restructure their chargemaster to recoop their cost through insurance by factoring it in to the cost. So your ER is 5X what it really should be, because the bill is reimbursing the hospital for the fact that 4 out of 5 basically aren’t paying.

Your regular doctor is much the same. But instead of no-pays, they have Usual, Customary and Reasonable charges. And they have to work on collecting any amount over the various UCR which brings us back to the emergency room analogy.

IMO, the biggest savings of ACA will be driven by taking a large subset of the 40+ million uninsured and moving them from expensive, too little too late treatment in the ER, to less expensive, more preventative treatment up stream.[/quote]

So let’s summarize. The ACA will allow more people to see regular doctors rather than go to the ER. As a result ERs should be utilized less often. Do you anticipate ERs being closed and/or ER staff being laid off in response to less ER usage? Or do you expect those charge masters to again adjust prices to re-coop the fixed costs of operating those ERs?

[SK in CV]

[quote=livinincali]
So let’s summarize. The ACA will allow more people to see regular doctors rather than go to the ER. As a result ERs should be utilized less often. Do you anticipate ERs being closed and/or ER staff being laid off in response to less ER usage? Or do you expect those charge masters to again adjust prices to re-coop the fixed costs of operating those ERs?[/quote]

No. ER’s utilization will go down, but revenues will go up because the number of patients with coverage will go up. Staffing may go down, but long waits at ER’s should go down. If anything, charges can be reduced for the reduced number of uninsured because less cost sharing will be necessary.

[FlyerInHi]

We are now moving fast from the shutdown over obamacare to the debt limit. Another 2 weeks to go.

[livinincali]

[quote=SK in CV]
No. ER’s utilization will go down, but revenues will go up because the number of patients with coverage will go up. Staffing may go down, but long waits at ER’s should go down. If anything, charges can be reduced for the reduced number of uninsured because less cost sharing will be necessary.[/quote]

Do we measure total health care spending in the country based on invoiced amounts or payments actually received?

[SK in CV]

[quote=livinincali][quote=SK in CV]
No. ER’s utilization will go down, but revenues will go up because the number of patients with coverage will go up. Staffing may go down, but long waits at ER’s should go down. If anything, charges can be reduced for the reduced number of uninsured because less cost sharing will be necessary.[/quote]

Do we measure total health care spending in the country based on invoiced amounts or payments actually received?[/quote]

Payments actually made.

[Author]

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