D.C. Circuit guts ObamaCare

[Timsup2nothin]

They only have to add a couple of words to the statute to fix it. They could have done it already if they wanted to. No filibuster would be expected from the Dems for adding those couple of words.

Ah, but adding those couple of words does not meet the Republican established standard of 'fixing it'. They are all in office on a promise to rewind the clock and make it like it never happened. Their constituents would consider anything short of this miracle to be a betrayal.

This is the long term problem with appealing directly to the stupidity of voters. When you promise them something that is patently absurd, and they buy into it, eventually they realize that they have been conned.

 

[hobbsyoyo]

Where do the states come in? They already opted out.

For stupid, purely political reasons. The federal government is set to pay 100% of the cost for a while, then 90% and then I think it finally settles to like 70% of the entire cost of setting up an exchange and expanding medicaid.

But republican legislators, hellbent on just saying NO NO NO NONONONONONO to Obamacare didn't implement their own exchanges even though this could directly cause harm to their constituents if the federal exchange dies.


There was a great quote, wish I could be bothered to look it up, but it was a Republican governor who was taking heat for setting up a state exchange. And he came out and said that as a Christian, it's his duty to help people and setting up the exchange only helps people and there was no reason not to set one up for except for politics. His conscious wouldn't allow him to take that course for political gain.

If only more Christians would be christ-like.

As apposed to now, when they are rising much faster than inflation?

Rates are not rising at the same clip they were thanks to the law.

 

[El_Machinae]

As apposed to now, when they are rising much faster than inflation?

I see nothing that has stabilized the market. An inept competitor has entered, with a captive market share. That is not a huge change.

J

Healthcare costs have been rising faster than inflation for quite awhile. This this is why all the changed happened in the first place.

Hey, I feel for your position. Lots of us were looking at the growth rates (in costs) in our own countries, and in your country's Medicare vs. how prices were rising in general for you guys. The solution seemed obvious.

But yeah, with a one-time charge, things will appear to rise faster than inflation. My analogy with amortized insulation (being added to the heating bill) is a pretty good one. I'm not saying that the outcome will work out (I expect I won't), but you need to know what to look for when analyzing data.

 

[Crackerbox]

Err these millions who got health insurance under Obamacare got Medicaid, not Medicare. Medicaid is a rotten health plan that physicians are reticient to take new patients because the government negotiates down the repayment abysmally. As such, physicians can't afford to take on several new Medicaid patients.
http://obamacarefacts.com/sign-ups/obamacare-enrollment-numbers/
•In 2014 about 8 million enrolled in Medicaid, in 2015 about 10 million did.
•Millions more, who would otherwise not be insured, enrolled due to expanded coverage under the ACA and new requirements. This includes those enrolled under expanded employer coverage, and those who got covered outside of the Marketplace.


The reason so many millions got this Medicaid was because of extreme poverty because the country is IMPLODING. These folks have no jobs and no Hope. What good is insurance under those circumstances? It's a benefit only if sick, if you get a physician to take you on, and then and only then does it help you.

And where is the tax money to pay for this?

It's not like Obama promised whatsoever? No wonder people are up in arms. Just wait when you're told you need to quit smoking and lose weight to cut down on the costs and still be covered. Just wait until costs rise astronomically.

You do realize there is no magic wand suddenly producing physicians and rgistered nurses, right? That we can sign up impoverished people with Medicaid but unless we actually have more medical schools to train doctors (we haven'td any new ones created forever) and that we've been in a nursing shortage since the late seventies while maintaining a terrible attrition rate for those same nurses.

That adding more and more patients to the tiny handful of these medical staff leads to tons of medical record errors and misprescribing their medications, right?

OK, where are the new staff who will service them? Oh wait, there aren't any. The whole thing is a fiasco.

Should people have access to healthcare? Sure. Should it be a basic benefit? Sure. Doesn't that mean they have FREAKIN' Jobs? Nope, we let millions of illegals in because hey, they'll vote Democrat for more handouts. Yeah!

Say you're a business owner. The government tells you, "We want you to provide health care for these 8 million new patients. When you bill us for $200, we'll repay you $50." How long can you do that and keep the doors open to your business? How many of those millions can you reasonably handle when you're already full of patients? How can you afford to pay more office staff when the repayment is so abysmal?

Show me the math and the logic?

http://www.forbes.com/sites/peterub...cians-are-reluctant-to-see-medicaid-patients/
Medicaid only pays 61% of what Medicare pays in terms of reimbursement, and that's nothing compared to the actual bill. They government demands that only a tiny portion is paid on the bill. Sometimes it's a ruinous situation where the repayment is WORSE based upon the case, but not only this, say it's the birth of a child. A physician can be sued for some error for that might have happend 20 years ago on a delivery under Medicaid in which they netted less than $100. Can you imagine that? Do you realize that this is the most common lawsuit? Why are obstetricians leaving in droves? What obstetricians will there be, and what will it be like for patients under these rotten condition to see what few remain?

 

[RobAnybody]

An inept competitor has entered, with a captive market share. That is not a huge change.

No offense, but you clearly don't understand the ACA/Obamacare.

No new competitor has entered the market. That was the Private Option, which didn't happen. The government isn't selling insurance. You can't buy Obamacare. There is no product called Obamacare.

When you go on The Exchange, you'll see many insurance plan options that you can buy *from private companies*. The same private companies that existed before - Aetna, United, Blue Cross Blue Shield, etc.

They have more regulations on them than before (no denying coverage for pre-existing conditions, or even charging more; no different rates for males & females; etc.), but they are the same private companies that existed before the ACA.

EDIT:

Err these millions who got health insurance under Obamacare got Medicaid, not Medicare. Medicaid is a rotten health plan that physicians are reticient to take new patients because the government negotiates down the repayment abysmally. As such, physicians can't afford to take on several new Medicaid patients.

You're right about Medicaid/Medicare. Medicare is for 65+ people (& some under 65 disabled people). Medicaid is for poor people. Beyond that, though, they're incredibly similar.

Also, people on one hand complain about not keeping costs low. Then, they complain when the government uses its massive leverage to keep costs low. When you mention that the government "negotiates down the repayment abysmally", what exactly do you think they're trying to accomplish? They're stopping hospitals from charging $20,000 for a broken arm, or even $20 for a Band-Aid. Physicians can always "afford" to take on more Medicare/Medicaid patients. They just won't be able to charge them as much.

 

[kramerfan86]

I know a lot (most) did it for political reasons, but I think its fully legitimate to not make an exchange. A lot of states are simply broke now, and even if the federal government pays like 70% of it, its still a massive added cost that a lot of stage budgets cant absorb.

 

[Crackerbox]

You're right about Medicaid/Medicare. Medicare is for 65+ people (& some under 65 disabled people). Medicaid is for poor people. Beyond that, though, they're incredibly similar.

Also, people on one hand complain about not keeping costs low. Then, they complain when the government uses its massive leverage to keep costs low. When you mention that the government "negotiates down the repayment abysmally", what exactly do you think they're trying to accomplish? They're stopping hospitals from charging $20,000 for a broken arm, or even $20 for a Band-Aid. Physicians can always "afford" to take on more Medicare/Medicaid patients. They just won't be able to charge them as much.

NUTS! Are you serious? Do you have any idea how expensive medical school is? The average physician gets a BS, gets four years of medical school, then a minimum of three years of residency. This alone sets them back $500,000.

It gets worse, unless they're attending residency longer to become a specialist, then they set up a private practice as a Family Practice. How much do they make on average $125,000 per year. Sound like a lot? That's not what they clear but what they gross. Enormous costs like office costs, salaries, equipment, legal protection come out from that $125K. Being a pediatrician only gets you 95K.

One could open a small business in America and earn more than 125K a year.

Why does the Hospital/Medical Center charge so much? Because they have to to make money. You see most are nonprofits. These lose enormous amounts of money like through a sieve. Patients don't pay their medical bills. Reimbursements to managed care private insurance began asking for very low reimbursement due to what happened with Medicare and Medicaid. The only people who pay the brunt are the uninsured who pay 100% but this ISN'T the bulk of patients.

It's my belief that this caused a HUGE padding of bills in order to get reimbursed properly and created a terrible INFLATION of costs.

Oh yeah, at the same time RN's said, this is freakin' Bozo's Big Top Circus. I'm outta here to get a cushy job in Information Technology (where they convert the paper data to electronic records) or I'll become a pharm rep (a drug pusher to physicians).

Physicians left too. It wasn't like the old days. In the old days, a physician started a practice with better reimbursement. They could hire several physicians under them plus some Physician Assistants too. They could clean up, but they didn't make their money from their medical income. Oh no. They had cash flow. They had standing lines of credit by necessity and they had steady income. That meant they could invest those monies into other businesses like real estate or purchasing commericial property to rent to physicians' groups.

People bad mouth the medical centers, but the bulk are struggling to be beneficient and take care of the poor (since that's in their charter as nonprofits). The same is true of physicians. I wonder how many people would give up their lives from age 18-31 to be a physician? How many people would work 100 hour weeks? How many people would work for less money than a Walmart worker based upon hours worked as Residents during for three years minimum?

How many people would desire the possibility of being sued (often frivolously) from ex-patients? How many people wouldn't just go screw this!

 

[Zelig]

And having the worst ranked health care service for twice the cost among developed nations is working SO well for us right now.

It's pretty good if you don't count health outcomes for poor people.

 

[Zelig]

NUTS! Are you serious? Do you have any idea how expensive medical school is? The average physician gets a BS, gets four years of medical school, then a minimum of three years of residency. This alone sets them back $500,000.

There's no requirements for Americans to go to medical school in America, or for hospitals to hire American doctors. Medical school in India is pretty cheap. Or you know, even Canada if you don't like India - ~18% of people get through med school with no debt, 94% get through with less than $200k in debt.

 

[Crackerbox]

It's pretty good if you don't count health outcomes for poor people.

And why are they poor outcomes? Could it be they don't follow medical advice? Could it be the rotten pharmacutical compliance especially due to polypharmacy? Some might be on many medications, often generic so should be just fine, but they don't take them on time. They don't take all of them. They don't make lifestyle changes. And they're right back in the medical office, or worse the medical center with an extremely expensive bill that doesn't pay the physicians, the nurses, the ordelies, the technicians, etc. The medical center has to foot the bill looking for some sap paying cash who will pay the bill.
...
You can't give millions more medical insurance and not simultaneously hire a fraction of that number as RN's and physicians and technicians. It doesn't compute. Who will magically see all of these millions of patients? Does anyone think that there's a huge gap of empty time currently that the existing staff can fill in with new enrollees?

NUTS!

Yeah, that'll work. Already there's a stigma about Caribbean medical schools. We already have Americans who were wait-listed. They often sign up for these schools. They could only take so many. Canada just isn't much of a option given the number of them. Seriously talk to some wannabee Canadian medical students and hear about the shortage of medical school slots. Many of them are going to the Caribbean as well. They can't handle the influx. I seriously doubt placement of Americans who attended an Indian medical school. I'm not badmouthing them by any means. We have Americans attending med school in Mexico and the Phillipines. The system is BROKEN, hopelessly broken.

To attend these schools that are cheap for local residents, these Americans have enormous housing costs by living in many of these countries. Mexico is really the only option, and then only a handful are authorized to Americans for licensure in many American states.

Even if tomorrow we would suddenly open 100 new schools for physicians, it wouldn't work to fit the demand of the aging Baby Boomers especially due to Dementia. Then there's the enormous costs of Autism in the young, a major epidemic of cases. A ton of patients moved to Maine, swamping their resources by concentrating cases in one state. Can you imagine?

There's been concerted intentional effort to find enough RNs. We stole Irish nurses and Filipino nurses. We paid scholarships and had tutoring sessions for RNs. We had tuition reimbursement for them too. The net result after a 40 year shortage is just barely keeping our necks above water, for many RNs quit after seven years. The job is rotten and demanding and thankless and people leave.

 

[El_Machinae]

Well, you're worried about increased demand. Simple economics. Prices will rise due to demand, then supply will rise to help drop prices. It takes time to equilibrate, for sure. We can see how relatively cheap the 'poor' are in other nations with proper health insurance systems. So, we know what's possible.

The problem can be summarized as "suddenly lots of people can afford medical care! What will we DO?!?"

The long-run solution is affordable cures, but many people would rather argue about re-arranging the deck chairs.

 

[Crackerbox]

Well, you're worried about increased demand. Simple economics. Prices will rise due to demand, then supply will rise to help drop prices. It takes time to equilibrate, for sure. We can see how relatively cheap the 'poor' are in other nations with proper health insurance systems. So, we know what's possible.

The problem can be summarized as "suddenly lots of people can afford medical care! What will we DO?!?"

The long-run solution is affordable cures, but many people would rather argue about re-arranging the deck chairs.

Oh prices rose all right. They are skyrocketing for current medical insurance holders. The prices won't rise for the improverished who get Medicaid. They'll get it as a benefit.

America isn't Canada and not the UK. We can't expect Americans to suddenly be like other nations just because that worked in those countries.

It's an extremely ill concieved debacle. Not less than a $100 a month...a total lie.

Link to video.

The reality?
http://www.forbes.com/sites/theapot...-health-care-has-accelerated-under-obamacare/
The increases went up more for healthcare premiums for private healthcare. More!

Spoiler :

Most discussions of premium trends have failed to address the reality that the purported slowdown in health spending in recent years has occurred at a time that worker earnings also have slowed down relative to earlier periods. For example, the increase in average wages & salaries between calendar year 2012 and calendar year 2013 was only 0.7%. With the exception of the increase from 2008 to 2009 (remember that the recession officially began in December 2007 and ended in June 2009), this was the lowest rate of increase in all the years since 1999–a period which saw increases of 3.0% or more in 6 different years. In contrast, family health insurance premiums rose 3.8% between 2012 and 2013–a modest increase in absolute terms, but vastly faster than the rise of average wages and salaries.

In short, for the vast majority of Americans, employer-provided health coverage has become more unaffordable under Obamacare. Moreover, readers can see with their own eyes that the pace at which health care is becoming more unaffordable has accelerated rather than dissipated following passage of the “Affordable” Care Act.

Did The Typical Family Save $2500 in Premiums?

First as candidate and then as president, Barack Obama promised (more than a dozen times) that under his health plan, the typical family would enjoy savings of $2500 a year (!) [2]. The latest KFF/HRET figures are an unpleasant reminder of just how badly that promise was broken. Average premiums for employer-sponsored family health insurance coverage grew from $13,375 in 2009 to $16,834 in 2014–an increase of $3,459 or 4.7%. This is more than double the annual increase in earnings per FTE worker (2.2%) during the same period [3].
Too many people focus on the raw rate of increase in health insurance premiums without considering what was happening the worker earnings. 4.7% admittedly is lower than the 5.5% average annual increase in premiums observed from 2005 to 2006 and 2007 to 2008. But earnings growth during those two years was 4.6% and 4.5% respectively, meaning that that growth in health insurance premiums was outstripping wage growth by only 1% a year or less. In contrast, under Obamacare growth in family health insurance premiums have outstripped wage growth by an amount that is 2-1/2 times as large. Which world would you rather live in? One in which higher premiums are accompanied by wage growth that lags only 1% behind premium growth? Or a world with lower growth in premiums in which growth in wages lags 2.5% behind premium growth?

Look I want everyone to have healthcare. I'd like everyone to own a home too. It ain't gonna happen. We can't just give people things and think there won't be monumental tax consequences.

You want to cut down on medical costs, you improve the state of health for people when young, not when they're older and need medical care. Diet, exercise, smoking cessation, STD testing (for in many cases the majority like for genital herpes don't know they have it!), vitamins, strict compliance for prescription medicines, weight loss etc. The government will seize on this. They'll have case officers who will be talking to 40+ year olds and trying to do this far too late.

 

[JollyRoger]

The market has been adjusting to demand by making their model more paraprofessional intensive. All sorts of clinics relying on that model have popped up in my neck of the woods.

 

[Crackerbox]

So instead of the American people seeing a savings with Obamacare of $2500 as he promised, they're paying $3500 more. They won't have the people to service you. They use paraprofessionals instead to cut costs while charging you more. Oh this is better.

How screwed up can you get?

 

[El_Machinae]

Yeah, I know America isn't Canada. It'll be frustrating, looking around and seeing everyone else get basically the same outcomes for a fraction of the price, merely because we use different economic systems to get there.

There were a host of available models that worked. It's a shame the centrist Repubs didn't team up with the centrist Democrats to pass something viable.

 

[JollyRoger]

I guess you could come down with Affluenza and have a heart attack over a pauper's grave.

 

[Timsup2nothin]

The plight of poor impoverished doctors always strikes right to my heart. They need one of those commercials where they stare soulfully into the camera with their big doctor eyes and a voice over tells you that for just pennies a day you can adopt one.

 

[JollyRoger]

We could easily up the supply of doctors by providing more subsidies to education or write off loans for those willing to enter certain market segments.

 

[Crackerbox]

We could easily up the supply of doctors by providing more subsidies to education or write off loans for those willing to enter certain market segments.

We already have that! It's not working. Some physicians can work in impoverished rural areas and get tuition forgiveness (which is but a portion of their medical education loans) but the rotten trade off of course is that the offset isn't enough versus working elsewhere. This is going to produce a shortfall of 45,000 Family Practice Physicians alone, and that was prior to Obamacare which adds millions on to the tolls.

Spoiler :

Recruitment and retention of rural health care professionals continues to be a national challenge. A recent study from the Association of American Medical Colleges’ Center for Workforce Studies predicts that in the next decade there will be 45,000 too few primary care physicians—as well as a shortage of 46,000 surgeons and medical specialists. Similar primary care findings have been reported for other clinicians, such as physician assistants and nurse practitioners [1]. However, after a decade of dramatic decline in the proportion of U.S. medical school graduates who choose primary care residencies, 2010 and 2011 saw increases in the number who matched into primary care [2-4].

Health professions workforce shortages are exacerbated in rural areas, where communities struggle to attract and keep well-trained clinicians. Rural physician shortages have been documented for at least 85 years [5]. While 19.2 percent of the U.S. population lives in rural America, only 11.4 percent of physicians practice in rural locations [1]. The Bureau of Health Professions’ Office of Shortage Designation reports that in February 2011, 65 percent of primary care health professional shortage areas were rural.

Despite medical school initiatives to train rural physicians [6-10], rural areas continue to face greater health professions workforce shortages than do their urban counterparts. Recent HRSA-sponsored research revealed that 77 percent of rural counties in the U.S. are designated as primary care health professional shortage areas or HPSAs. In 2005, 165 rural counties lacked a primary care physician. Many primary care providers are nearing retirement (age 56 or older), and while they constitute 25.5 percent of the clinician workforce in urban areas, they make up 27.5 percent it in rural areas and 28.9 percent in remote rural locations.

So we despise physicians for making money after studying diligently for over ten years in their education and holding off marriage and having a family? Right. So we hate those who we perceive as rich while in reality they are anything but? Right. They didn't make a salary for over a decade, plus they have 500K in medical loans. Ummm, you think you could handle that? Right!

So the massive millions will be helped though you now see that there won't be adequate staff and you'll expect that this won't VASTLY exacerbate burnout and attrition due to that being hurled at them? Right!

Softhead liberalism isn't the solution. How about putting our best minds on it to pass a bipartisan plan that would actually be beneficial AND create new jobs AND provide new medical schools AND provide legal reform with malpractice AND do more public health in an intentional way to cut down on unnecessary health costs AND do something genuinely helpful so that RNs don't have such a high responsibility for so many under their care, etc?

We need comprehensive solutions not some feel good half-baked crap that costs more and gives less and ultimately breaks the existing system.

 

[JollyRoger]

I agree with you on the need for legal reform. Too many hoops are in place to successfully sue bad doctors.