Ray Jay wrote: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.

I'm sure they are. And they were already heavily vested in the old system (and presumably are looking at both possible political angles). Of course, what businesses in an industry don't tend to like is change, particularly radical change to the playing field (unless they are going to directly and obviously benefit).

Insurers were not happy about the ACA, but now it is in, they won't be happy about it being repealed (especially if it happens in a poorly managed way, such as halfway through it being introduced and with no time to unwind it). That may not be down to 'vesting' (which implies a direct interest) so much as not wanting to have to spend the time and money it takes to re-build their business plans and "stock prices, marketing plans, staffing levels, and corporate strategies".

Believe me, especially in large companies, that kind of stuff is painful.

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

So, evaluate the ACA on those terms. Doctors can't afford the Medicare flood.

Dr. Ted Mazer is one of the few ear, nose and throat specialists in this region who treat low-income people on Medicaid, so many of his patients travel long distances to see him.
Contribute to Our Reporting

The lobby of Dr. Hector Flores’s office in East Los Angeles, where more than a third of his practice’s 26,000 patients are now on Medicaid.

But now, as California’s Medicaid program is preparing for a major expansion under President Obama’s health care law, Dr. Mazer says he cannot accept additional patients under the government insurance program for a simple reason: It does not pay enough.

“It’s a bad situation that is likely to be made worse,” he said.

His view is shared by many doctors around the country. Medicaid for years has struggled with a shortage of doctors willing to accept its low reimbursement rates and red tape, forcing many patients to wait for care, particularly from specialists like Dr. Mazer.

Yet in just five weeks, millions of additional Americans will be covered by the program, many of them older people with an array of health problems. The Congressional Budget Office predicts that nine million people will gain coverage through Medicaid next year alone. In many of the 26 states expanding the program, the newly eligible have been flocking to sign up.

Many patients are going to lose their current doctors and insurance. Plus, for many, including smokers, prices are going up. Now, some may say, "I'm glad smokers have to pay more. It's only fair."

Okay, but isn't that a "pre-existing condition?" Isn't that discrimination?

Furthermore, who is more likely to smoke--the rich or the poor?

We are seeing cancer patients being forced to change doctors. Patients are being given fewer choices--hospitals are closing down, insurance companies are narrowing their networks to save money, etc.

So, it's bad for doctors and bad for MOST patients.

danivon wrote:

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

True, costs have gone up. We have insurance. We can shop around. We know exactly what we're paying and what we will get reimbursed. That is a far cry from the current human system--even under the ACA.

Doctor Fate wrote:Many patients are going to lose their current doctors and insurance. Plus, for many, including smokers, prices are going up. Now, some may say, "I'm glad smokers have to pay more. It's only fair."

Okay, but isn't that a "pre-existing condition?" Isn't that discrimination?

Smoking is not a 'condition', it's a behaviour. It leads to a greater risk of conditions, and those if pre-existing would be covered, but if there was a free market in insurance, insurance companies would set rates for smokers higher simply because they are a higher risk

Furthermore, who is more likely to smoke--the rich or the poor?

Like you suddenly care.

So, it's bad for doctors and bad for MOST patients.

Please substantiate the 'most'. And the doctor you quoted is not going out of business, he's just not going to take on additional Medicare patients.

danivon wrote:

Doctor Fate wrote:Many patients are going to lose their current doctors and insurance. Plus, for many, including smokers, prices are going up. Now, some may say, "I'm glad smokers have to pay more. It's only fair."

Okay, but isn't that a "pre-existing condition?" Isn't that discrimination?

Smoking is not a 'condition', it's a behaviour. It leads to a greater risk of conditions, and those if pre-existing would be covered, but if there was a free market in insurance, insurance companies would set rates for smokers higher simply because they are a higher risk

Furthermore, who is more likely to smoke--the rich or the poor?

Like you suddenly care.

So, it's bad for doctors and bad for MOST patients.

Please substantiate the 'most'. And the doctor you quoted is not going out of business, he's just not going to take on additional Medicare patients.

Smoking is as much a condition as overeating.

I've been concerned about overtaxing the poor and working class for decades. Recently, I've complained about Democrats raising sales taxes, tolls, and cigarette taxes in MA. Democrats profess to be for the common man, but they work us over every chance they get.

When cigarettes cost more than marijuana, something is askew.

Were all going to suffer. The Medicaid roles are swelling. Rates are going up. Networks are narrowing. That's "most."

Ray Jay wrote: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. .

Ha, Ray, you're showing your age. Like Doctor Evil demanding "one million dollars, hahahaha!!!" They probably budgeted just a bit more than "tens of thousands."

geojanes wrote:

Ray Jay wrote: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. .

Ha, Ray, you're showing your age. Like Doctor Evil demanding "one million dollars, hahahaha!!!" They probably budgeted just a bit more than "tens of thousands."

Yes, good catch; I meant tens of thousands of hours, but I'm probably still under.

Doctor Fate wrote:Smoking is as much a condition as overeating.

As in, not a condition by itself, but a risk factor for other.

I've been concerned about overtaxing the poor and working class for decades. Recently, I've complained about Democrats raising sales taxes, tolls, and cigarette taxes in MA. Democrats profess to be for the common man, but they work us over every chance they get.

Not really relevant to the healthcare debate, but yes, I agree that sales taxes fall hardest on those with low incomes, which is why I oppose the Conservatives in the UK having increased VAT. Before Thatcher came in, it was 8%. In 1979 it nearly doubled to 15%. In 1991 the Conservatives put up again to 17.5%, and then in 1994 extended it to domestic energy bills at 8% (they had wanted to put them up to the full 17.5% but lost a key vote.

And after they were returned to power in 2010, they made it 20%.

So it's not just 'liberals' who screw the working poor.

Of course, if people want to avoid cigarette taxes (and the increased premiums smokers pay, and the increased health risks associated with smoking), they could quit. And not blame the government.

When cigarettes cost more than marijuana, something is askew.

As much a result of criminalisation and failed drugs policy. I'd be quite happy with legalised and heavily taxed pot.

Were all going to suffer. The Medicaid roles are swelling. Rates are going up. Networks are narrowing. That's "most."

I was really hoping for numbers, not just vague doom-mongering. How many people will be worse off (with evidence, not just a number picked out of mid-air)?

danivon wrote:

Doctor Fate wrote:Smoking is as much a condition as overeating.

As in, not a condition by itself, but a risk factor for other.

I don't know. Listen to Dr. Michelle Obama sometime and tell me obesity is not a "condition" by itself.

I've been concerned about overtaxing the poor and working class for decades. Recently, I've complained about Democrats raising sales taxes, tolls, and cigarette taxes in MA. Democrats profess to be for the common man, but they work us over every chance they get.

Not really relevant to the healthcare debate, but yes, I agree that sales taxes fall hardest on those with low incomes, which is why I oppose the Conservatives in the UK having increased VAT. Before Thatcher came in, it was 8%. In 1979 it nearly doubled to 15%. In 1991 the Conservatives put up again to 17.5%, and then in 1994 extended it to domestic energy bills at 8% (they had wanted to put them up to the full 17.5% but lost a key vote.

And after they were returned to power in 2010, they made it 20%.

So it's not just 'liberals' who screw the working poor.

It is in this country.

Of course, if people want to avoid cigarette taxes (and the increased premiums smokers pay, and the increased health risks associated with smoking), they could quit. And not blame the government.

Yes, but they don't. Meanwhile, the taxes are so onerous that people break all manner of laws to avoid them. Should we tax cigarettes to the point where people have to commit crimes to afford them? Should there be any limit on taxing them?

When cigarettes cost more than marijuana, something is askew.

As much a result of criminalisation and failed drugs policy. I'd be quite happy with legalised and heavily taxed pot.

It's being legalized, slowly but surely. However, it's just getting cheaper.

Were all going to suffer. The Medicaid roles are swelling. Rates are going up. Networks are narrowing. That's "most."

I was really hoping for numbers, not just vague doom-mongering. How many people will be worse off (with evidence, not just a number picked out of mid-air)?

Please, refute any of the following:

1. More people are going to be on Medicaid. Medicaid has been shown to be substandard.
2. Fewer doctors are accepting Medicaid because of the lower payment rates.
3. Fewer doctors will be in most networks in order to keep prices down.
4. Smokers will pay higher rates.
5. People who don't receive subsidies will pay higher rates. As but another example:

But something is really wrong with California, my home state where I shall likely return next summer. The cheapest quote I could find, from Anthem Blue Shield, was $1,796 a month, with a $10,000 family deductible, and $19 co-pay for generic prescription ($50 for name-brand). If I want so splurge and get a plan with no deductible well then Covered California has a deal for me, for a mere $3,349 a month. (At that price why wouldn’t I just pay cash out of pocket?)

Here’s the screen grab of the low cost plans:

6. If the young fail to flock to sign up, the rates will go through the roof. Why is that? Because it's meant to hose them. Young and healthy folks will pay through the nose.

The only people who benefit: those with pre-existing conditions. This is a lot of turmoil for a relatively small number of people whose situation could have been dealt with in a simpler way.

Doctor Fate wrote:

danivon wrote:

Doctor Fate wrote:Smoking is as much a condition as overeating.

As in, not a condition by itself, but a risk factor for other.

I don't know. Listen to Dr. Michelle Obama sometime and tell me obesity is not a "condition" by itself.

So it's not just 'liberals' who screw the working poor.

It is in this country.

Really? So the Republicans who this year put through Sales Tax increases in Ohio and Kansas are liberals? (I think also Virginia, North Carolina and Pennsylvania are seeing or have seen plans to increase sales tax from the GOP) And the national Republican policy to enforce sales tax on online sales is a 'liberal' one?

Of course, if people want to avoid cigarette taxes (and the increased premiums smokers pay, and the increased health risks associated with smoking), they could quit. And not blame the government.

Yes, but they don't.

And this is their problem, right?

Meanwhile, the taxes are so onerous that people break all manner of laws to avoid them. Should we tax cigarettes to the point where people have to commit crimes to afford them? Should there be any limit on taxing them?

If people committed crimes to obtain cars, would you support making card cheaper so they didn't have to?

Were all going to suffer. The Medicaid roles are swelling. Rates are going up. Networks are narrowing. That's "most."

I was really hoping for numbers, not just vague doom-mongering. How many people will be worse off (with evidence, not just a number picked out of mid-air)?

Please, refute any of the following:

No. because none of those are telling me the answer to my question, which was "How many people will be worse off?". You've claimed 'most' (and indeed that you're "all going to suffer"). but numbers? Beyond you. More vagueness and rhetoric isn't helping.

but in response to your list of whinges...

1. More people are going to be on Medicaid. Medicaid has been shown to be substandard.

How many of those were on something better than Medicaid before, and how many on something worse than Medicaid (ie: nothing)?

2. Fewer doctors are accepting Medicaid because of the lower payment rates.

Which have been going down for some time and are supposed to have been much lower already but successive Congresses have put off the rate changes.

3. Fewer doctors will be in most networks in order to keep prices down.

At some point they will need to accept patients, if they want work.

4. Smokers will pay higher rates.

So? That means non-smokers will pay lower rates. Smokers already pay higher rates for Life Insurance. You object to the use of subsidies, but here you seem to be complaining that non-smokers won't be subsidising the higher risk smokers.

5. People who don't receive subsidies will pay higher rates

Sez a blogger.

6. If the young fail to flock to sign up, the rates will go through the roof. Why is that? Because it's meant to hose them. Young and healthy folks will pay through the nose.

[/quote]"If.."

So, again. How many is "most"?

danivon wrote:So, again. How many is "most"?

Enough to guarantee Democrats are going to get their butts kicked next fall if massive changes aren't made.

Let's see, some facts:

1. Polls show the program is not popular.
2. Polls for the President have plunged since the craptastic launch of the website and the media finally noticing what a liar he is.
3. The program is a disaster thus far. 100K "sign-ups" in November. That doesn't mean they necessarily paid.
4. The website still does not work (you can't even pay).
5. Plouffe promises it will be "great" by 2017!
6. Democratic politicians are getting plenty nervous:

The biggest test for Sunday’s HealthCare.gov deadline isn’t the number of people who can use the site or how quickly the pages load for them. It’s whether Democrats start to calm down. . .

“There’s a window here; I’m not quite sure how long it is. The Democratic leaders have given the White House some space to try to work out these kinks,” says Jim Manley, a Democratic strategist and former spokesman for Senate Majority Leader Harry Reid. . .

Public approval of the health care law—upside-down since it passed—has only gotten worse amid the botched website rollout. That has vulnerable Democrats scrambling for ways to show their constituents they’re trying to fix the law.

“You need to explain what you’re trying to fix, and you’d better be trying to fix something. If there’s nothing you want to fix, there’s something wrong with you,” Democratic pollster Mark Mellman told National Journal.

7. If "most" are going to get better outcomes, when might we expect the Administration to be able to demonstrate that? Isn't the onus on them? Isn't that what governments do--quiet jittery markets? Oh, right, this government prefers jittery markets--forgot about that.

Doctor Fate wrote:

geojanes wrote: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.

Play make believe for a moment: imagine there's no heaven, hell, Republican or Democrat: Just Americans with different ideas on how to make a system that works better than it currently does. It isn't hard to do.

In such an environment, could the ACA be fixed both technologically and legislatively? And while I understand that reasonable people would have differences of opinion on what that would entail, don't you think they could come to a consensus if our lawmakers left all the politics in the back room? I think so, and the idea is not as crazy as it sounds. In times of national crisis this kind of coming together happens, because, after all, you've got to be an American before you can be a Republican or a Democrat. Could the ACA mess our system up so badly that we approach a crisis where our lawmakers for forced to work together? It's not out of the realm of possibility, which could leave rational people in the odd situation of waiting for things to get worse, to approach crisis levels, so we can come together and fix the problem. Crazy.

Doctor Fate wrote:

Danivon wrote:So, again. How many is "most"?

Enough to guarantee Democrats are going to get their butts kicked next fall if massive changes aren't made.

Which doesn't answer the question at all, merely showing that your priority is election results rather anything else. How tiresome - and it clearly shows how much you 'care' about the actual issue or the people affected. All you want is to be supporting the winning team in the next big game.

I think you should swap politics for sports.

Doctor Fate wrote:Let's see, some facts:

Do they answer my question? Do they add anything particularly new to the debate? Quick answer - no and no.

1. Polls show the program is not popular.

Yes. We know. But polls are a measure of opinion, not a measure of fact.

2. Polls for the President have plunged since the craptastic launch of the website and the media finally noticing what a liar he is.

Yes. We know. But polls are a measure of opinion, not a measure of fact. Again.

3. The program is a disaster thus far. 100K "sign-ups" in November. That doesn't mean they necessarily paid.

Yes. We know (for some value of 'disaster').

4. The website still does not work (you can't even pay).

Yes. We know. But you already mention that in 2&3.

5. Plouffe promises it will be "great" by 2017!

And?

6. (link to Democrats under pressure due to unpopularity of programme who want a 'fix').

Yes. We know. But that's just an extension of 1 & 2, but with some of 5.

7. If "most" are going to get better outcomes, when might we expect the Administration to be able to demonstrate that? Isn't the onus on them? Isn't that what governments do--quiet jittery markets? Oh, right, this government prefers jittery markets--forgot about that.

I'm not asking them a question here, I'm asking you, because you made a pretty clear and unequivocal statement, and instead of substantiating it are just repeating the same partisan talking points over and over.

As for the jittery market, you did notice that the DJIA is at 16,000, and the S&P500 is at 1,800? The overall US market seems to be doing quite well. Both are at unprecedented levels. The S&P contains a fair number of healthcare companies too. So maybe you mean just that sector.

Except that the Healthcare sector index seems to have been rising smoothly all year, with no real instability in recent months or weeks (apart from the blip that hit everything during the shutdown).

The market in the market is not jittery. As a capitalist I guess you know what that means.

geojanes wrote:Play make believe for a moment: imagine there's no heaven, hell, Republican or Democrat: Just Americans with different ideas on how to make a system that works better than it currently does. It isn't hard to do.

Perfectly willing to play the game, as long as you will too.

T or F: In an altruistic, all-American, apolitical system, we would have the ACA.

False. Such a Rube Goldberg contraption could only exist in a polarized, divided country.

In such an environment, could the ACA be fixed both technologically and legislatively? And while I understand that reasonable people would have differences of opinion on what that would entail, don't you think they could come to a consensus if our lawmakers left all the politics in the back room?

I have no doubt.

I think so, and the idea is not as crazy as it sounds. In times of national crisis this kind of coming together happens, because, after all, you've got to be an American before you can be a Republican or a Democrat.

Quick, name another "crisis" entered into by a straight party-line vote, after which the President continuously attacked the minority party?

Could the ACA mess our system up so badly that we approach a crisis where our lawmakers for forced to work together? It's not out of the realm of possibility, which could leave rational people in the odd situation of waiting for things to get worse, to approach crisis levels, so we can come together and fix the problem. Crazy.

It could happen. If the President was Gerald Ford or Bill Clinton, or even Reagan. It won't happen because the current President was talking about Republicans wanting to "deny healthcare" to millions of Americans last week.

Rhetoric matters.

You burn bridges and then, guess what? They're not available.