JuanGuzman
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Posts posted by JuanGuzman
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Which 40-50 million people are you referring to? The 40-50 million who didn't have health insurance before Obamacare, or the extra 40-50 million on top of them who lost their insurance because of Obamacare?
This is just b.s. We can argue a lot about the merits of obamacare but the impact on the number of uninsured is not up for debate in my mind. My prediction every year for the next 6-7 years you will see drops in both the numbers of unisured as well as the proportion of uninsured. Lets just wait and see Census Bureau figures roll.
Yes your going to here isolated stories about some party losing their insurance but the net effect on insurance rolls will be massively positive. It's the same b.s. you here in the job market, all month you hear stories about a factory closing, or jobs being lost due to a mine closure etc, than bureau of labour statistics showss a report saying Average job creation in the last three months is 193,000. Job growth still isn't fast enough for my liking but we are interested in net change not isolated stories.
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Explain how the ACA addresses spending efficiency.
First things first, I should note that the best part of Obamacare is the fact that those 40-50 million people with out health insurance will get health insurance. That being said I believe ACA or Obamacare will have result in more efficient health spending then what was the status quo. Here a couple ways:
- The "Community Rating" which prohibits insurers from varying rates based on health status or claims history will mean reduced administrative costs as insurers stop devoting administrative dollars yp investigating peoples health history or gaming insurance contracts so that they include only healthy people in their risk pool. I think this has already been seen in reduced premiums and rebates for consumers.. from the June 2013 Kaiser study: the study focused on actual experience under the Affordable Care Act as it affected individual market consumers (those buying insurance on their own). The study found that the Medical Loss Ratio provision of the Act had saved this group of consumers $1.2 billion in 2011 and $2.1 billion in 2012, reducing their 2012 costs by 7.5%.
- Expansion of medicaid benfits to more people. Medicaid has been the most cost efficient insurer over the last decade.. performed better .
- Buying workhorse/brand name pharmaceutical drugs and using bulk buying to negotiate discounts, yes that means lower profits for pharmaceutical firms but lower costs health insurance.
- Moving away from fee-for-service to bundled payments.. bundled payments allow insurers to negotiate for one episode of care instead of doctors doing unesscessary treatments in the old fee for service model. I'm interested to see how this works for medicare but its expective to incentivize better care ass doctors and hospitals are rewarded for good treatment and lower re-admission rates ect. Most studies expect bundled payments to deliver better service for less cost. I think the RAND corporations expects savings of at least 5.4 per cent over a 10 year period
- penalties for cadillac plans... basically one of the ways employer delivered health insurance was encouraged in the U.S. is due to favourable tax treatment for health benefits, it would be treated differently than income and not tax so employers/employees were incentivized to take health insurance instead of income. The problem is that for really high income earners it makes sense to increase your health insurance benefits, rather be taxed at the highest rate.. you get these cadillac plants with small or nonexistent co-pays, deductibles, or caps that encourage the overuse of medical care, driving the cost up for the uninsured or those on other plans. The nex tax limiting cadillac plans is a good thing for spending efficiency.
- More people having access to preventative care, for instance heart diseases, diabetes, blood pressure etc. all develop over time. If those people who are now insured due to Obamacare start having regular check-ups, preventative care such as early diagnosis of diabetes can lower life time health spending.
- Section 3025 of the Affordable Care Act added section 1886(q) to the Social Security Act establishing the Hospital Readmissions Reduction Program, which requires CMS to reduce payments to IPPS hospitals with excess readmissions, effective for discharges beginning on October 1, 2012.
- (Edit) one more creating... online health exchanges is a good thing. One stop shop to compare prices allows for more competition (assuming the tech issues get solved)
Last but not least I believe Conservatives talking point on this is "DEATH PANELS" .. .but I think that
The establishment of indpendant advisory panels that limit "government spending" on treatments with low effectiveness and/or patients who aren’t going to live much longer is a good thing. Remember this only for government tax payer supported insurers programs. For me its such a contradiction that conservatives hate low-income people getting insured by goverment but then go around screaming bloody murder/DEATHPANELS when the government actually tries to spend more efficiently on treatment.
It just makes a lot of sense of panels to evaluate what treatments are working and what are just a waste of money. Then they relay that information to doctors and hospitals
- The "Community Rating" which prohibits insurers from varying rates based on health status or claims history will mean reduced administrative costs as insurers stop devoting administrative dollars yp investigating peoples health history or gaming insurance contracts so that they include only healthy people in their risk pool. I think this has already been seen in reduced premiums and rebates for consumers.. from the June 2013 Kaiser study: the study focused on actual experience under the Affordable Care Act as it affected individual market consumers (those buying insurance on their own). The study found that the Medical Loss Ratio provision of the Act had saved this group of consumers $1.2 billion in 2011 and $2.1 billion in 2012, reducing their 2012 costs by 7.5%.
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http://economistsview.typepad.com/economistsview/2013/12/us-ranks-near-bottom-in-efficiency-of-health-care-spending.htmlS ranks near bottom among industrialized nations in efficiency of health care spending. EurekAlert: A new study by researchers at the UCLA Fielding School of Public Health and McGill University in Montreal reveals that the United States health care system ranks 22nd out of 27 high-income nations when analyzed for its efficiency of turning dollars spent into extending lives.
The ... U.S.'s inferior ranking reflects a high price paid and a low return on investment. For example, every additional hundred dollars spent on health care by the United States translated into a gain of less than half a month of life expectancy. In Germany, every additional hundred dollars spent translated into more than four months of increased life expectancy.
The researchers also discovered significant gender disparities within countries.
"Out of the 27 high-income nations we studied, the United States ranks 25th when it comes to reducing women's deaths," said Dr. Jody Heymann, senior author of the study and dean of the UCLA Fielding School of Public Health. "The country's efficiency of investments in reducing men's deaths is only slightly better, ranking 18th." ...
"While there are large differences in the efficiency of health spending across countries, men have experienced greater life expectancy gains than women per health dollar spent within nearly every country," said Douglas Barthold, the study's first author...
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I thought it was a well written piece. Didn't catch an anti buffalo vibe at all. Just seemed like a honest telling of a very tragic night.
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When im talking cost curve im looking for a slowing or diminishing rate of growth Im in real per capita healthcare spending, ideally broken out by major payers e.g., private insurance, Medicare, and Medicaid. I'd also be interested on where the spending is occurring at hospitals, clinics etc.
On your access question im not familiar with the metrics but if there was good measurement for access id be interested to see what happens. My guess is total access will rise significantly
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If im wrong im wrong. If the numbers of uninsured goes up, or if the cost curve continues the current trend ill admit im wrong. Right now i think obamacare will be an improvement but I'd be prepared to admit im wrong if the evidence shows otherwise
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What does "per capita spending" include?
I think its a broad definition of any expenditures towards health e.g., doctor, nursing, technology, pharmaceuticals,
Which one?
Look, according to you it may be a good theory. And in time we may find that it is going to be better then what it is now. But, right now it is really really messing things up. Have you read all the articles out there? Seriously, did you see where an 89 year old woman now pays $500 a month on insurance with her preexisting condition and has to have maternity coverage despite being on welfare already which will only cover 15% of her costs and leave her nearly broke paying for her rent? Yeah, probably not but if you want to: http://www.tulsaworl...st/house...rent
How is it going to help her?
I have no idea but i thought if you were 89 you'd be medicare, or if you were on welfare on medicaid. Again I'm more interested in the big picture than anecdotes.
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Like I said to OCinBuffalo. The great thing about this debate is that we will see in a couple years if its worked or not. Shakey website launch aside, I'm sure its an improvement on the status quo. Its a good thing for america and I expect to be proven right.
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My GF is self insured and has been prior to this Obamacare bull ****. She has a basic health insurance plan, what comes to a Silver plan, if you are familiar. She had everything she needed and nothing more. Now, she got her letter this week. It went up by $89 a month. Why? Because she now has increased mental health coverage (she doesn't need), all sorts of maternity coverage (for which she had bare bones, because she is not planning on children at this time), and a majority of factors. Couple this with her income, which is far below what you would even want to know - and well... ACA is another proven failure. She is not even sure she will be able to keep many of her Dr's, including her OBGYN she's had since she started needing an OBGYN.
Sorry to hear about your GF. Anecdotal evidence is not persuasive to me though. The theory and the evidence says personal mandates will push down the cost of insurance for most people, although not all. As this article states it looks like the plan is working http://www.nytimes.c...pagewanted=all
Seriously, you're an idiot. The way to fix health care costs is to jack up the price of health insurance coverage? See above, please explain. You're by far a teet sucking ideologue cut off the hip of a liberal douche bag scum sucking bigot. And that'd putting it nice.
haha
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Hard to believe that somehow a study was able to capture accurately from all of those countries spending and life expectancies with comparable data quality. I don't put much weight on this. If I did then Cuba makes everyone look bad. That data really says that slashing spending on health care is our better option. That and there are these things called genetics and environment that the medical profession claims plays such large roles. If we move the US population to Japan do we all live several years longer? NO, not without other variables coming into play.
The problem with Obamacare is that it doesn't reduce the cost for people to buy insurance. It raises it through mandates, taxes and regulations and in turn gives care away to many. It will raise our nation's total spend which if you believe your graph will make the U.S. results even worse. Prior to Obamacare health insurance cost was rising much faster than inflation. Since Obamacare the increases have accelerated. That and Obamacare adds to the already large deficit.
First of all the data is OECD data, about as reputable as you can get. Second the one of the ways Obamacare will reduce cost is by improving the risk pool of the insured and reducing uninsured visits to hospitals when they actually require primary care.
Here is an article about costs falling as a result of affordable care: http://www.nytimes.com/2013/07/17/health/health-plan-cost-for-new-yorkers-set-to-fall-50.html?hp&_r=1&pagewanted=all&
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Germany? Here we go again.
Does Germany pay for its own defense? Does Canada?NO! I love how you clowns have the F'ing temerity to be critical of us, whilst basking in the security that WE PROVIDE!
If either you or Germany had to actually pay for the convenience of using OUR Navy, and OUR Air Power, never mind the once-again proven hammer that is our Army, as a deterrent to basically every scumbag country in the world taking your people as hostages and stealing your schit, this socialist paradise delusion would be over the next day.
Free trade, that you hate so much, except when it comes time to sell your oil, only exists due to the beneficence of the USA. Period.
If you actually had to protect your own shipping, or we charged you full price for protecting it, and your oil reserves, and infrastructure, you'd be paying us at least half of what your entire health care system costs. So, as I said: that's the same day your socialist delusion dies.
Are you really that stupid. You can't be that stupid, but maybe you are... First of all I'm not being critical of the U.S. I'm applauding OBAMA and the U.S. introducing the affordable care act because it is a major improvement on the status quo. also talk about going off topic, this argument is about an improvement to the U.S. health system and not whether nato countries are helped by having America's large military as a friend (they are).
Anyway just look at the chart below, the U.S. spends hell of a lot more than any country on health spending yet the outcomes in terms of life expectancy are pretty abysmal, (ideally you'd like to strip out car accidents and heart disease from this analysis because those are more prevalence in the U.S.) but the basic premise is the U.S. doesn't get much health care bang for their buck. Also not to mention the huge number of people who are uninsured in the U.S.
By the way when I am talking about administrative costs I'm not talking about care providers (e.g., your wrong example of doctors and techs), I'm talking about insurers trying to verify that a client didn't have a pre-existing condition, or a doctors office going back and forth with an insurer to see if the patient has insurance and what treatments it will cover etc. I think Harvard estimates that about 30 per cent of health spending in the U.S. goes to admin costs whereas single insurer countries that number is less than half of that.
A couple of other things random responses to all the illogical stuff you through in there. First I love free trade (why did you say I hated it?), I support it fully. I'm not a socialist either so don't call me one. I support free trade based on evidence and theory. And I support using government dollars for health insurance based on evidence and theory as well. Exercising basic logic really.
I actually do look forward to the next couple years leading up to the 2016 election, I will be periodically checking to PPP forum, I expect to see Obamacare being vindicated by a bending of the health care cost curve, signing up uninsured, improving health outcomes and becoming a very popular program. If Affordable Care fails to deliver on those I will admit that i was wrong, like I said obamacare is not with out faults (I can think of a number of improvements I'd like to see made to it) but right now I see ACA as a huge improvement. Looking forward to seeing it evolve over the next few years....
I hope that you'll be big enough to admit that you were wrong if Obamacare succeeds.
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Quick response to OCinBuffalo, you're an ideologue. To impatient to spend time thinking through issues so you just resort to your visceral response. You type up a bunch mindless b.s. call it a day and pat yourself on the back.
America's health system before obamacare was seriously screwed up. Too much money going to administrative costs as opposed to treatment. Highest per-capita spending of any oecd country with some of the worst health outcomes. Im not saying Canada's system is not with out flaws, in fact i never mentioned Canada, you just through it in there as a strawman. So i will instead say this every health system in the developed world be it Germany, UK, Scandinavian countries was out performing the U.S. status quo. The U.S. the most advanced/wealthiest country in the world had a crackpot healthy system. .. nothing to a shame of, in fact im proud of America for taking steps to fix it
From 50 million uninsured, to job lock, to Cadillac plans because of favourable tax treatment. The system was broken. As I said obamacare implementation has had many hiccups but the system will work see Germany or Massachusetts as an example. The great thing is this theory is testable, in a couple years come the next presidential election we will see who was right and who was wrong when it comes to obamacare.
If I remember correctly you're the blowhard who spent all of 2012 ranting about skewed polls and how gallup's poll was dead on and we could expect a mitt romney presidency, despite every other poll or aggregation pointing towards an Obama victory. Well you were proved wrong on that one and I think you'll be wrong on Obamacare. Hopefully you'll be hanging around POLLS then and I can remind you of it.
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to DC Tom. Yes. There are list of goods that private markets don't provide efficiently due economic externalities, free riders, public goods, natural monopolies , information asymmetries etc. Health Care is one of them. The U.S. Army is another. municipal water supply and treatment, fire & police services.... the list goes on.
In some cases technology is enabling efficient private sector delivery goods that were previously thought the to be best delivered by the public sector. For instance some are argue that advances in GPS/Camera Technology allow for road infrastructure to be built by the private sector by enabling cheaper toll booth technology
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I think economists accept thatthe dis-employment (e.g., min wage goes up total employment falls) effects of a higher minimum wage aren't as a consequential as expected. See: Card-Krueger Study. Still I think dis-employment from higher min waqes exists. I also don't think that min wage increases is the best way to reduce poverty as not all min. wage workers live near poverty line. Some are teenagers living at the family home, others may be part time workers who are not the primary earner in the family.
If you want to address min.wage workers living in poverty. I'd rather see an expansion of working tax benefits or a negative income tax.
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Affordable care is an imperfect solution but far superior to what was the status quo. Private market delivery of health insurance is rife with market failures that's why govt's need to step in. Same reason Govts regulate natural monopolies or invest in public goods like national defence. In healthcare the private market is unable to deliver the optimal amount health insurance people want to consume.
Obamacare will have and already has had significant hiccups with implementation but it's creation is one of the best things to happen to America in a long time. WooHoo!
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As a 6 year old, ever the contrarian, I was cheering for the Bills to beat the Giants in the superbowl despite my dad being a giants fan. As the Bills went on to lose more superbowls it became kind of a family joke that I was Bills fan (the lovable losers) even though in reality I had no interest in football at that age.
Anyway the family had CFL season tickets and Flutie was always in the running for most outstanding player. I never really liked Flutie in CFL cause he was on the wrong teams but when he moved to the NFL it was right around the time my friends and I started getting into the NFL. Flutie was a player I knew of, he was an incredible CFL QB, and I wanted to see him succeed in the NFL.
It seemed natural to root the Bills giving the old family joke, Flutie, and it also helped that they actually made the playoffs under Wade Phillips a couple times. Kids are natural front runners. Anyway it was between the Bills and Jaguars for a while (I just thought Fred Taylor was a beast & 12 year old me liked the jaguar name). Realizing I couldn't have "two teams" I decided to go all in for for the Bills and haven't looked back since. I just wish they would give me something to root for.
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I thought that was hillarious like most of the why your team sucks series. Really enjoyed the reader story about getting season tickets:
I live close by, love the NFL, and decided to get season tickets to the Bills last year.First game against KC: Four obese gentlemen then get seated to my immediate right, one wearing a Mexican wrestling mask and going by "NAAAAACHO" and another wearing a hard hat, proceed to lift their shirts and pretend to lick each other to encourage women above them for three quarters. Doesn't work. Guy behind me leaves after 2nd quarter.
Second game against NE: Took a partner from my law firm who's a Pats fan (didn't wear any pats stuff), never been to an NFL game. Guy in front of us, before kickoff, literally fell over the benches 3 times. Took off his jersey to reveal a large surgery scar. Falls on my boss. After the Bills drop three touchdowns in the third quarter, a woman starts screaming literal death threats at Pats fans. If I hadn't been smart enough to take him up front to see Tom Brady during warmups, I'd probably have been fired.
Third game against TEN: Two guys in the section over get in a standing, drunken yelling match after one shouts "OSKIE WEE WEE" and another shouts "ARGOOOOOOOS," chants from CFL teams. Guy attending the game alone in circa 1992 starter hat gets up literally 15 times during game, asks Quebecers next to us why they're speaking Spanish.
Fourth (night) game against MIA: Complete and total drunken shitfest. Hear from a local that Ralph Wilson personally banned night games until the NFL forced him because in the 80's a guy climbed to the top of the field goal posts. Fans turn aerial placard "thank veterans" promo into gigantic cardboard airplanes. Found out the next day a dude from Rochester died, shocked it wasn't more, and supposedly there were 30 DUI arrests.
Had three games left. Thank God for Stubhub.
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You would think if they were hoping to sign him the practice squad they would wait until the final round of cuts. I think the Bill's are done with him IMO
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100% healthy = 100% starting.... <100% healthy = 100% sit-em, until he reaches 100% healthy..
Agree with this. Everyone saw what happened with Robert Griffen last year, playing RG3 on a wonky knee in the playoffs let him to re-injured his knee (i think acl and lcl tear). Marrone should make sure Manuel is healthy and that means watching him practice full-go the week leading up the patriots matchup.
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My guess is Tuel keeps starting as long at the Bills are winning. Go with the hot hand, etc.
Unless he plays like Aaron Rodgers, absolutely not.
hahaha wouldn't it be nice to have to worry about either of these hypotheticals... unfortunately the chance of either materializing seems ridiculously low
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The best time to be a Bills fan is from the end of the season to the start. We are getting pretty close to the start.
too true. I was on top of the world after the Vikings preseason game, should of reminded myself of this
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Sad to hear. One of the things I was really looking forward to this year was watching Gilmore's progression from year 1 to year 2. I love watching Corners play man-to-man, In the Skin's preseason game, one play Gilmore was in Aldrick Robinson hip pocket on a comeback route, you could tell Gilmore was anticipating which what route was coming based on his early break, I assumed he knew this by watching the QB's drop + he had help over the top anyway Gilmore' drops what should have been a sure INT. But to me the play spoke to the promise and all the rave reviews Gimore has been getting in camp.
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I think the kid tried his hand at American college football first but crossed over to rugby (presumable because he wasn't good enough?). American Rugby should look at all the ex-NCAA footballers who arent good enough for the NFL. The talent pool just dwarfs the rugby players.
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With Byrd back in the fold, the starting D now has 8 out of 11 guys selected in the first or second round.
5 first rounders (Mario, Dareus, Lawson, McKelvin, Gilmore
3 second rounders (Byrd, A. Williams, Kiko)
1 third (Carrington)
1 fourth (Bradham)
1 fifth (K. Williams)
The first rounders are high ones too. Overall - Mario (1), Dareus (3), Gilmore (10), Leodis (11), Lawson (22).
The lowest guy, the fifth rounder, might be the best defensive player on the team.
I know some of those guys haven't lived up to their draft billing. And I know it doesn't really mean anything once the ball is snapped, but in terms of raw athletic talent it says something. Hope Pettine can put it all together.
Any idea how this compare's to the league average? It seems like we do have a lot players who went d 1 and rd 2... but then again so do a lot of teams
Just doing another AFC east team off the top of my head:
The patriots I count 7 1st or 2nd roundes Wilfork, Talib, Chandler Jones, Mayo, Hightower, Spikes, McCourty
Jets I count 7 to Muhammed, Coples, Cromartie, Richardson, Millner, D Harris, Calvin Pace,
could be forgetting some names...
The Affordable Care Act is Coming Home to Roost
in Politics, Polls, and Pundits
Posted
Show me the numbers, don't make stuff up