danivon wrote:

Doctor Fate wrote:Would it be okay to repeal it and replace it with something that might actually work?

If that something is defined, it might be a start.

I agree. But I worry that there are so many pigs feeding from this trough. The US spends 17.6% of its GDP on healthcare. In most European nations its about 11, give or take. That's 6.5% of GDP that's on the table. A lot of people are making their living off of that 6.5% and they don't want any savings, and while Obama's made it easy by screwing up the launch, a part of the opposition to ObamaCare is coming from those who don't want any change because of their own self-interest. Going backwards (repealing ObamaCare) is a gift to these special interests and makes the odds of getting no real reform quite high. Instead, if ObamaCare doesn't work or only marginally moves the needle, wouldn't it be better to fix it? Learn from the mistakes and fix the parts that don't work? Politically, I agree that might not be a good for the GOP, but if it makes better policy and helps more Americans, isn't that still the right thing to do?

geojanes wrote:

Ray Jay wrote:

freeman3 wrote:What I am asking you to explain is how a pure free market would cure the practice of hospitals charging outrageous fees.

I don't think it would cure it, but if the individual is able to shop around and ask questions about charges before a procedure, they can certainly have cost be part of their decision-making process. But if government and/or insurance is paying, the individual is not motivated to do so in most cases.

When I went to the emergency room for a kidney stone, the last thing on my mind was how much it would cost. Medicine, at least acute care, is in a special class of service that cannot be shopped.

Exactly. It's not something easily predictable as a 'consumer' - when and what kind of healthcare may be needed in the future, and when you really need it, choice is not necessarily a priority over availability.

Sure, our NHS has the 'moral hazard' of people taking too much, but it costs a lot less and takes a lot of stress out of the consumer's mind. It ain't perfect, but we don't have that 6.5% of GDP (or to put it another way, the 50% overhead) to contend with.

geojanes wrote:

Ray Jay wrote:

freeman3 wrote:What I am asking you to explain is how a pure free market would cure the practice of hospitals charging outrageous fees.

I don't think it would cure it, but if the individual is able to shop around and ask questions about charges before a procedure, they can certainly have cost be part of their decision-making process. But if government and/or insurance is paying, the individual is not motivated to do so in most cases.

When I went to the emergency room for a kidney stone, the last thing on my mind was how much it would cost. Medicine, at least acute care, is in a special class of service that cannot be shopped.

Sure, there are plenty of times when you can't shop, and certainly kidney stones are one of them (my sympathies). But I don't see why you deny the larger point? Most medical spending is not emergency. Certainly there are some savings to be had by empowering the consumer with education and some skin in the game.

Ray Jay wrote:Sure, there are plenty of times when you can't shop, and certainly kidney stones are one of them (my sympathies). But I don't see why you deny the larger point? Most medical spending is not emergency. Certainly there are some savings to be had by empowering the consumer with education and some skin in the game.

I agree, people should understand what they're paying for and how much things cost (doctors should understand this too, and they never do.) But it's not like shopping for a TV: not only are there times when you're unable to advocate for yourself, but medicine is complicated and there can be wildly different outcomes depending on the quality of care, which is much more difficult to understand. So I'm not denying your larger point, in concept, but I am saying that just making a better market for medical services wouldn't solve all problems.

Geo:

a part of the opposition to ObamaCare is coming from those who don't want any change because of their own self-interest.

Doesn't it cut both ways? There are others who have a vested interest in keeping ACA. The more government interference in markets, the more you create opportunities for those who spend their energy on politicking for their special interest. Obamacare (and Obama) have done nothing to address that.

Ray Jay wrote:Geo:

a part of the opposition to ObamaCare is coming from those who don't want any change because of their own self-interest.

Doesn't it cut both ways? There are others who have a vested interest in keeping ACA. The more government interference in markets, the more you create opportunities for those who spend their energy on politicking for their special interest. Obamacare (and Obama) have done nothing to address that.

You might be right, but who are those people? I can point to whole industries that currently exist solely off the fat of the medical system. Who's going to live off the fat of ObamaCare? Honestly, I don't know enough to even start guessing. But if ObamaCare is able to move the needle on cost--and that's not a sure thing--then at least there will be fewer people suckling off the teat of our medical costs.

danivon wrote:

freeman3 wrote:What I am asking you to explain is how a pure free market would cure the practice of hospitals charging outrageous fees.

Because OBAMA, of course.

Tripe.

Actually, imagine for a moment that the government was NOT involved at all. What would happen?

Hospitals would either charge reasonable rates or go out of business when people did not pay their exorbitant fees. That would be a "free market."

However, we have not had that for many decades.

Note well: I have not advocated a "free market," mostly because some people are too dependent upon government to handle a "free" market.

However, we could have a "competitive" market: One in which quality of service actually mattered; one in which we could actually compare prices.

The "beauty" of Obamacare is that it discourages competition while claiming to promote it. Again, if it "promotes" competition, how is it possible that a few States have ONE company selling insurance in them? Why is EVERY plan mandated to carry certain coverages, coverages that many people don't need? Why is a company forced to spend 80% on patient care? In a competitive market, companies would be fighting for customers. That regulation alone is enough to put the lie to the notion that the ACA "promotes competition." It says quite the opposite.

Ray Jay wrote:

freeman3 wrote:What I am asking you to explain is how a pure free market would cure the practice of hospitals charging outrageous fees.

I don't think it would cure it, but if the individual is able to shop around and ask questions about charges before a procedure, they can certainly have cost be part of their decision-making process. But if government and/or insurance is paying, the individual is not motivated to do so in most cases.

Exactly. We are so removed from costs and doctors are so burdened with regulations and paperwork, there is no simple means to shop around.

It is far easier to sort out what actual costs are for my dogs visiting the vet. When they have needed surgery, I've known exactly what it was going to cost and I had to think it through.

Am I saying we should have to think about foregoing needed surgery? No, I'm saying there are so many fees, hidden costs, etc., that it is virtually impossible to calculate what surgery would cost on a human being. Why is that? If the ACA wanted to promote competition, it could have done that. It didn't.

geojanes wrote:

Ray Jay wrote:

freeman3 wrote:What I am asking you to explain is how a pure free market would cure the practice of hospitals charging outrageous fees.

I don't think it would cure it, but if the individual is able to shop around and ask questions about charges before a procedure, they can certainly have cost be part of their decision-making process. But if government and/or insurance is paying, the individual is not motivated to do so in most cases.

When I went to the emergency room for a kidney stone, the last thing on my mind was how much it would cost. Medicine, at least acute care, is in a special class of service that cannot be shopped.

Sure, but that's hardly the norm, is it?

geojanes wrote:

danivon wrote:

Doctor Fate wrote:Would it be okay to repeal it and replace it with something that might actually work?

If that something is defined, it might be a start.

I agree. But I worry that there are so many pigs feeding from this trough. The US spends 17.6% of its GDP on healthcare. In most European nations its about 11, give or take. That's 6.5% of GDP that's on the table. A lot of people are making their living off of that 6.5% and they don't want any savings, and while Obama's made it easy by screwing up the launch, a part of the opposition to ObamaCare is coming from those who don't want any change because of their own self-interest. Going backwards (repealing ObamaCare) is a gift to these special interests and makes the odds of getting no real reform quite high. Instead, if ObamaCare doesn't work or only marginally moves the needle, wouldn't it be better to fix it? Learn from the mistakes and fix the parts that don't work? Politically, I agree that might not be a good for the GOP, but if it makes better policy and helps more Americans, isn't that still the right thing to do?

Yes, but as I've said dozens of times, the President has so poisoned the well (and continues to do so) that there is no chance in hades of the GOP mending this bill. It will either fly or flop on its own.

Now, should the Republicans just suck it up and do what's right? No.

Why not?

Because the President has, even this last week, tried to blame everything on them. If they work to fix this mess, who will claim the win? He will.

Does that matter? Yes, because it will guarantee that this will be seen as a Democratic victory and plus for Americans. Is that bad? Well, not if you're a Democrat.

Look, the Democrats played politics with this thing for 4-plus years and now the GOP is supposed to play the altruistic martyr party? No one is that dumb, not even Boehner.

Even when it is not an emergency, healthcare is often about necessity.

Yes, there are emerging 'vested interests' in the ACA, but let's be honest they can't be that vested yet as the word implies passage of time and the ACA is not even fully rolled out yet.

There will of course always be interest groups even in a less regulated market - those with power will be more able to push and pull a market to their advantage than without. In a free (or free-ish) market the power resides with capital - owners and wealthy consumers. In a regulated market the balance is supposed to be more fair, but of course politics means political power (whether in terms of influence or money) can twist that.

The main interest group on healthcare should be patients. Then clinical professionals and staff. That's where my priorities would be.

geojanes wrote:

Ray Jay wrote:Geo:

a part of the opposition to ObamaCare is coming from those who don't want any change because of their own self-interest.

Doesn't it cut both ways? There are others who have a vested interest in keeping ACA. The more government interference in markets, the more you create opportunities for those who spend their energy on politicking for their special interest. Obamacare (and Obama) have done nothing to address that.

You might be right, but who are those people? I can point to whole industries that currently exist solely off the fat of the medical system. Who's going to live off the fat of ObamaCare? Honestly, I don't know enough to even start guessing. But if ObamaCare is able to move the needle on cost--and that's not a sure thing--then at least there will be fewer people suckling off the teat of our medical costs.

Web site developers? In all seriousness, large insurance companies and some medical providers.

I've read estimates that the ACA will cost $200 billion per year. Doesn't that make sense? Someone is going to pay for the additional health care. Now someone is going to talk about the expensiveness of emergency care because their ideology tells them those savings will be huge even though the evidence is not there..

Ray Jay wrote: In all seriousness, large insurance companies and some medical providers.

And were they not already vested interest in the pre-ACA situation? In some ways they are disadvantaged (with a hit on max profits for insurers, for example).

Danivon:

Yes, there are emerging 'vested interests' in the ACA, but let's be honest they can't be that vested yet as the word implies passage of time and the ACA is not even fully rolled out yet.

I can assure you that insurance company executives and lawyers have spent tens of thousands of dollars considering all the angles of ACA. They are actively involved in the regulatory language that is being drafted. They are building business plans on this 3 year old law, and their stock prices, marketing plans, staffing levels, and corporate strategies have already have factored in the pluses and minuses. Vesting is very quick in this day and age.

Doctor Fate wrote:It is far easier to sort out what actual costs are for my dogs visiting the vet. When they have needed surgery, I've known exactly what it was going to cost and I had to think it through.

Yes, but your dogs can't actually tell you what they want, how much pain they are in etc. And we put down dogs who are 'beyond help'. You can decide not to pay for something a vet mentions, but it's the dog upon whom the outcome of the decision falls.

Besides, back in 2011 this article was pointing out that - ‘Pet Care’ Inflation: Health Care Costs Have Soared, and Not Only for Human Beings

A more recent article shows that still the costs are rising faster than overall inflation and millions are uninsured - Vet costs rise, but few pet owners opt for insurance.

But despite the fact that Americans are spending more on vet care, fewer than 1 percent of the estimated 171 million dogs and cats in the United States are insured. That compares with 26 percent in Great Britain and 48 percent in the Netherlands.

''I don't think Americans love their pets any less than in Europe," said Laura Bennett, CEO of Embrace Pet Insurance, "but they don't like insurance as much."

In the United Kingdom, "the veterinarians had a good experience, and the people had a good experience," with pet-care coverage, said Bennett, who grew up there. In fact, the industry took such a firm hold that many employers offer pet-care coverage to their employees as a perk. In the United States, few major employers have followed suit.

Am I saying we should have to think about foregoing needed surgery? No, I'm saying there are so many fees, hidden costs, etc., that it is virtually impossible to calculate what surgery would cost on a human being. Why is that? If the ACA wanted to promote competition, it could have done that. It didn't.

Certainly the human healthcare industry in the USA is not transparent. But I'm not convinced that a freer market would make it so. Largely the insurance side of it does change things, because often the costs change depending on whether you are insured or not, as well as the level of the insurance and their relationship with providers.

Now, yes, we could have had reform that sets prices or at least enforces fixed cost lists, but that would be quite an increase in regulation.