[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.

[SK in CV]

[quote=backintown]For those interested in this topic, it is definitely worthwhile to watch this 2007 documentary by the Dutch Public Television. The Netherlands is generally a country I don’t associate with sponsored prejudice, hatred, bigotry or racism, and is arguably in a fairly neutral position regarding this matter.

[/quote]

If you don’t normally associate The Netherlands with hatred, bigotry or racism, you probably should.

http://www.jpost.com/Opinion/Op-Ed-Contributors/Anti-Semitism-in-the-Netherlands-308210

[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.

[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.

[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.

[SK in CV]

[quote=no_such_reality]So far, so good, only 1 in 10,000 bursting into flames after striking road debris…

Tesla shares fall after mysterious car fire and analyst downgrade

All snark aside, still great looking technology even if the Media is more infatuated with it than Apple and Jobs.[/quote]

Thank goodness someone noticed that the company isn’t flawless. I was getting killed on a call spread. Just need it to drop another $20.

[SK in CV]

[quote=no_such_reality]So Obama extends the employer mandate by a year unilaterally and that’s fine.

The Republicans ask for it on the individual mandate and that’s extortion.

Hypocrits.[/quote]

Not exactly. Elections have consequences. The executive branch has powers that the legislative branch does not.

[SK in CV]

[quote=no_such_reality][quote=SK in CV][quote=no_such_reality]No SK, the house already sent over appropriations to reopen critical parts of the government which the Senate rejected.

The Senate is playing our way or the highway and the Media is singing the tune saying the Republicans are to blame.[/quote]

Imagine this scenario. We have president Romney, a Republican controlled Senate and a Democratic controlled house. And the house refuses any continuing resolution that doesn’t include raising the top tax bracket from 39% to 45%. They’ve refused any conference on the issue with the Senate for nine months. The government shuts down, and they send appropriations bills over to the Senate that only include continuing funding for Obamacare, Head Start and the NIH.

Which party would be playing “my way or the highway”?[/quote]

Nice extortion, just like the media.

[/quote]

Exactly. The republicans are playing as if they can change laws by funding only the parts of law that they approve of. That is extortion. Pay up or we burn the house down.

[SK in CV]

[quote=The-Shoveler][quote=SK in CV][quote=livinincali]
The bottom line being the media and analysts are lying when they say not raising the debt ceiling means a default. No, it just means there’s an immediate and large cut to government spending.[/quote]

It also means a severe recession. A spike in unemployment. Probably a depression.[/quote]

Not likely to happen,

As it would all but kill off most local municipalities pension systems (the real thing the Fed has been so desperate to save, not so much the housing market as most everyone believes but the tax base and stock market are the real targets).

Also it would likely increase the Debt even further.[/quote]

It would undoubtedly happen. See Greece. See every single time the Federal government has drastically cut spending.

The Fed is in it for the banks. Not for wall street. Not for pensions. Not for unemployment. Its primary goal is to keep inflation down. That’s what banks MUST have. Everything else is secondary.

Oh, and under your scenario, how can the debt be increased without a increase in the debt limit (which is not the issue congress has been debating the last 3 weeks anyway)? Kind of back to square one. Cuts to government spending increase deficits.

[SK in CV]

[quote=livinincali]
The bottom line being the media and analysts are lying when they say not raising the debt ceiling means a default. No, it just means there’s an immediate and large cut to government spending.[/quote]

It also means a severe recession. A spike in unemployment. Probably a depression.

[SK in CV]

[quote=no_such_reality]No SK, the house already sent over appropriations to reopen critical parts of the government which the Senate rejected.

The Senate is playing our way or the highway and the Media is singing the tune saying the Republicans are to blame.[/quote]

Imagine this scenario. We have president Romney, a Republican controlled Senate and a Democratic controlled house. And the house refuses any continuing resolution that doesn’t include raising the top tax bracket from 39% to 45%. They’ve refused any conference on the issue with the Senate for nine months. The government shuts down, and they send appropriations bills over to the Senate that only include continuing funding for Obamacare, Head Start and the NIH.

Which party would be playing “my way or the highway”?

[SK in CV]

[quote=livinincali][quote=SK in CV]Social Security benefits are a current debt. [/quote]

Read the supreme court case. My interpretation of the opinion sounds like social security is not a debt obligation. Maybe you have some source of information that contradicts this supreme court case but I haven’t seen it. Seems like they could they could use the rational justification of we don’t have the money to pay in full to not pay at all or not pay in full. Therefore there would be no debt obligation to default on.

[/quote]

There is an obligation. The SCOTUS decision didn’t decide that the obligation didn’t exist. It decided that congressional action which provided for termination of benefits for deported communists was legal. Which was exactly my point. Congressional action can reduce or terminate benefits. But absent that kind of action, SS benefits are an obligation of the federal government.

[SK in CV]

[quote=no_such_reality]
The Senate already rejected that.

I want the coin. It should be small, like a dime, made of 100% tin and not shiny. Obama should hold it up and say watch this, turn to Lew and hand it to him and say, make a deposit and pay our bills.

Just for sh*ts and giggles.

In all seriousness, the Media is being complete whores on this topic and could do the world a favor and really report the complete obstinance and idiocy occurring from both parties on it.

The Republicans will lose on this one and be perceived as even more disruptive and petty. Sadly, that will actual play well in somewhere between 33%-51% of the house districts.[/quote]

You’re missing the point. The coin won’t solve the problem. The coin is a debt limit issue. That isn’t what is causing the shut down. The shut down is being caused by the house not passing a clean continuing resolution, not the senate. The senate already passed one.

[SK in CV]

[quote=livinincali][quote=SK in CV]
How is not sending out medicare checks or cutting social security checks or failing to pay a defense contractor not defaulting on government debt? It is. Those are still government debts.[/quote]

Failing to pay for work already performed may be a default but not issuing a social security check is not a default of debt. It could be classified as a default of a obligation created by a law that government passed but you can choose to change that law. Actually you can change that law rather easily as it isn’t in the constitution even though it would be impossible politically. That’s what happened in Greece when they had to reduce their budget. Government pension payments were cut dramatically.

Certainly you could cut 30% of military spending and they would have to cut employees and cancel orders for planes and ships but that wouldn’t be a default either. You could close the Department of Education and that wouldn’t constitute a default. You could cut the payments for various medical service Medicare will pay for. All of those things would be unpopular but they wouldn’t be a default of debt. They aren’t debt to begin with. They are spending obligations created by government bills that could be overturned.

The Supreme court has already ruled that social security is a tax and entitlement program so it isn’t a debt the federal government has to it’s people. See this supreme court case. http://en.wikipedia.org/wiki/Flemming_v._Nestor%5B/quote%5D

Mostly right, but you’ve changed the equation. If the government doesn’t pay debts already incurred, that’s defaulting on debt, irrespective of whether the debt is secured by a bond or a note. Social Security benefits are a current debt. They can’t be reduced without an act of congress. Certainly future expenditures can be cut, and effectively they already have been. Without a continuing resolution, most new government debt can’t be incurred. (SS benefits being one exception.) If this problem isn’t solved, the recession of 5 years ago will look like a delightful walk in the park. The debt limit will be almost incidental.

[SK in CV]

[quote=6packscaredy]the fact that the markets seem unconcerned about serious repercussions makes me think that serious repercussions are more likely than currently thought.[/quote]

In 3 of 4 major indicators, the market is concerned. Equities are down. The dollar is down. Gold is up. The only market that doesn’t seem to be concerned this moment is the bond market. Though the immediate issue before congress is only mildly threatening to bonds, and that threat is probably offset by the pressure the hostage taking in Washington places on the Fed to maintain quantitative easing at current levels.

[Author]

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