Rob's House Posted July 18, 2012 Share Posted July 18, 2012 I have yet to hear anyone explain why the ACA is good for this country. Sure, I've heard a few platitudes and a few cherry picked provisions, most notably the requirement to cover pre-existing injuries (which is essentially the abolition of insurance as insurance), but no one has explained how this helps the general public, the country, or honestly, even individual segments of the population. Further, I've yet to hear anyone explain how a system that increases demand while decreasing supply doesn't lead to price explosion and a shortage of services? So for everyone that thinks this is good law, here's your chance to tell the rest of us why. Have at it. Link to comment Share on other sites More sharing options...
birdog1960 Posted July 19, 2012 Share Posted July 19, 2012 I have yet to hear anyone explain why the ACA is good for this country. Sure, I've heard a few platitudes and a few cherry picked provisions, most notably the requirement to cover pre-existing injuries (which is essentially the abolition of insurance as insurance), but no one has explained how this helps the general public, the country, or honestly, even individual segments of the population. Further, I've yet to hear anyone explain how a system that increases demand while decreasing supply doesn't lead to price explosion and a shortage of services? So for everyone that thinks this is good law, here's your chance to tell the rest of us why. Have at it. 30 million uninsured people become insured. it's the first step towards universal coverage. as a population, we will have better outcomes. Link to comment Share on other sites More sharing options...
Chef Jim Posted July 19, 2012 Share Posted July 19, 2012 30 million uninsured people become insured. it's the first step towards universal coverage. as a population, we will have better outcomes. So they just become magically insured? Poof....you have insurance I'l love to see how many of these 30 million never actually go through the process to become insured and continue to be a burden on us financially. Link to comment Share on other sites More sharing options...
Doc Posted July 19, 2012 Share Posted July 19, 2012 The only good things are covering kids until 26, paying for preventative care, and no exclusions for pre-existing conditions. The rest is crap that will push the country into financial ruin. Link to comment Share on other sites More sharing options...
/dev/null Posted July 19, 2012 Share Posted July 19, 2012 It created plenty of new jobs for lawyers, IRS Agents, and other Government workers Link to comment Share on other sites More sharing options...
Rob's House Posted July 19, 2012 Author Share Posted July 19, 2012 30 million uninsured people become insured. it's the first step towards universal coverage. as a population, we will have better outcomes. Serious question, because my knowledge on the subject is limited to second hand info (I haven't read the bill) but how will the additional 30 million be insured? Is that number accountable to those added to medicaid? It created plenty of new jobs for lawyers, IRS Agents, and other Government workers So it's not all bad. Link to comment Share on other sites More sharing options...
IDBillzFan Posted July 19, 2012 Share Posted July 19, 2012 The only good things are covering kids until 26, paying for preventative care, and no exclusions for pre-existing conditions. The rest is crap that will push the country into financial ruin. What "kid" is 26? Seriously. Link to comment Share on other sites More sharing options...
DC Tom Posted July 19, 2012 Share Posted July 19, 2012 What "kid" is 26? Seriously. Here's your answer. Link to comment Share on other sites More sharing options...
dayman Posted July 19, 2012 Share Posted July 19, 2012 (edited) Serious question, because my knowledge on the subject is limited to second hand info (I haven't read the bill) but how will the additional 30 million be insured? Is that number accountable to those added to medicaid? Through the entire scheme. It's all estimates but they (CBO) estimate over 30M more insured raising our overall insured to roughly 94% of legal non-elderly population The basic scheme as I generally understand it is as follows (includes my opinion): Guarantee issue and community rating (read: no preexisting discrimination ... generally if you are older and sicker you pay less if you are younger and healthier you pay more per community rating...controversial) Mandate to make that work (obvious controversy) Failure of political nerve to include "death panels" which we desperately need (there is a board that performs VERY limited functions that determine payment amounts not procedures and even then only when cost goals for medicare/medicaid goals fall short...this is our biggest shortfall w/ the bill IMO you NEED a board ) 80-20 rule (most like) 26 stay on insurance (most like) no life time limits on essential benefits (most like) preventative care w/ no cost sharing (ideally keep you healthy lowering your overall costs, critics say it prevents free market from working to lower costs IMO that's wrong the costs crisis is in the more serious care that represents 50% of the overall costs that 5% of us use) No dropping you when you are sick except for fraud (most like) mandatory appeals (no objections here) Medicaid expansion for basic minimum coverage for less then 133% of poverty line (for states taht take the money, it's free until 2020 then fed draws back and covers 90%....this is where a huge amount of uninsured come in) exchanges w/ credits and subsidies for those getting insurance on their own (This has problems imo most obviously there's a 2% tax on these plans but we are subsidizing/crediting the plans...classic government) Aggressive cost control experimentation in medicare/medicaid payment structures to slow rate of cost increases promotion of PCP/Health centers by giving them more money! (PCPs can make more from medicare/medicaid...encourage preventative/regular care and entry into this field...hospitals and specialists get less it hurts them) increased tools for fraud identification in medicare/medicaid CBO budget estimates are what they are nobody trusts them but they aren't bad Edited July 19, 2012 by TheNewBills Link to comment Share on other sites More sharing options...
birdog1960 Posted July 19, 2012 Share Posted July 19, 2012 Serious question, because my knowledge on the subject is limited to second hand info (I haven't read the bill) but how will the additional 30 million be insured? Is that number accountable to those added to medicaid? this might help, although i'm skeptical in your case.. 10% (3.1 million) will be newly insured young people on their parents coverage. some will now buy in the marketplace using their $4000 tax credit to make insurance affordable. and some with pre-existing conditions that couldn't get insurance at all wil nowl be able to buy it. and yes, many will be covered through medicaid. i certainly would have preferred medicare for all that desired it. but this is what was politically doable (and just barely). he played his hand as well as he could have from a progressive prospective. Link to comment Share on other sites More sharing options...
dayman Posted July 19, 2012 Share Posted July 19, 2012 All in all you can reason from basic ideology but we live in a messy public private model as is. To me the above is a step in the right direction...I honestly do believe that a public payer private provider done right is the most efficient way but if we aren't going to do that then this is the first step in doing the only other thing possible to do what every other rich nation does...try to provide basic healthcare to all citizens. Link to comment Share on other sites More sharing options...
ExiledInIllinois Posted July 19, 2012 Share Posted July 19, 2012 The only good things are covering kids until 26, paying for preventative care, and no exclusions for pre-existing conditions. The rest is crap that will push the country into financial ruin. Bad thing = Nobody wants to pay for the good things. But... They all want the good things... Ain't America great! Link to comment Share on other sites More sharing options...
Park Posted July 19, 2012 Share Posted July 19, 2012 I have yet to hear anyone explain why the ACA is good for this country. Sure, I've heard a few platitudes and a few cherry picked provisions, most notably the requirement to cover pre-existing injuries (which is essentially the abolition of insurance as insurance), but no one has explained how this helps the general public, the country, or honestly, even individual segments of the population. Further, I've yet to hear anyone explain how a system that increases demand while decreasing supply doesn't lead to price explosion and a shortage of services? So for everyone that thinks this is good law, here's your chance to tell the rest of us why. Have at it. It's Constitutional! That's good! And anything that helps people afford health care is good. People that want to deny others health care are bad. It created plenty of new jobs for lawyers, IRS Agents, and other Government workers Jobs are bad! Boooo! Link to comment Share on other sites More sharing options...
frostbitmic Posted July 19, 2012 Share Posted July 19, 2012 The best thing about Obamacare is that with the Republicans voting against it 472 times, it keeps congress away from screwing other things up. Link to comment Share on other sites More sharing options...
birdog1960 Posted July 19, 2012 Share Posted July 19, 2012 It's Constitutional! That's good! And anything that helping people afford health care is good. People that want to deny others health care , solely out of self interest, are bad. fixed. Link to comment Share on other sites More sharing options...
B-Large Posted July 19, 2012 Share Posted July 19, 2012 I have yet to hear anyone explain why the ACA is good for this country. Sure, I've heard a few platitudes and a few cherry picked provisions, most notably the requirement to cover pre-existing injuries (which is essentially the abolition of insurance as insurance), but no one has explained how this helps the general public, the country, or honestly, even individual segments of the population. Further, I've yet to hear anyone explain how a system that increases demand while decreasing supply doesn't lead to price explosion and a shortage of services? So for everyone that thinks this is good law, here's your chance to tell the rest of us why. Have at it. I am leaving my job, as well as my wife in 2014 if the ACA stays in place... my wife cannot get insurance and we stay in these awful jobs because of employer based insurance. We're reponsible people, and once we can buy private coverage were done. that being said, the good: 1. coverage for pre-exisitng conditions- what I find particularly troubling about this issue was that for many people the condition was of not fault of their own... does that mean they should always be at risk for financial ruin even if they want to cover themselves. 2. framework for privatizing Medicare- If the ACA is successful, and the States embrace this and it becomes good law, this is a natural step to making everyone ever the elederly part of the act.... this law is basically premium support for private insurance. the ACA keep the existing system in place, and makes sure everybody who wishes to partipate can do so. I would have prefered more focus on deductible health plans, anywhere from 1k- 10,000K- I mean people like to cite auto insurance as justification for the mandate, but what auto insurance policy pays for your wiper blades and new tires? I only vote Democrat because of Healthcare. Otherwise I would vote for fiscal conservatism and smaller federal government. I see the hypocrisy in that statement, however Heathcare is that important that I am willing to make the exception. The only good things are covering kids until 26, paying for preventative care, and no exclusions for pre-existing conditions. The rest is crap that will push the country into financial ruin. even that is a stretch- people should have to pay for routine expenses like an annual exam and annual labs. the cost is minimal, and you can fund HSA/Felx plans to pay fo it tax-free... Like I stated in another post, auto insurance doesn't pay for my tires, brakes, or preventative 5K oil change.... People need to start budgeting for their health just like anyting else... Through the entire scheme. It's all estimates but they (CBO) estimate over 30M more insured raising our overall insured to roughly 94% of legal non-elderly population The basic scheme as I generally understand it is as follows (includes my opinion): Guarantee issue and community rating (read: no preexisting discrimination ... generally if you are older and sicker you pay less if you are younger and healthier you pay more per community rating...controversial) Mandate to make that work (obvious controversy) Failure of political nerve to include "death panels" which we desperately need (there is a board that performs VERY limited functions that determine payment amounts not procedures and even then only when cost goals for medicare/medicaid goals fall short...this is our biggest shortfall w/ the bill IMO you NEED a board ) 80-20 rule (most like) 26 stay on insurance (most like) no life time limits on essential benefits (most like) preventative care w/ no cost sharing (ideally keep you healthy lowering your overall costs, critics say it prevents free market from working to lower costs IMO that's wrong the costs crisis is in the more serious care that represents 50% of the overall costs that 5% of us use) No dropping you when you are sick except for fraud (most like) mandatory appeals (no objections here) Medicaid expansion for basic minimum coverage for less then 133% of poverty line (for states taht take the money, it's free until 2020 then fed draws back and covers 90%....this is where a huge amount of uninsured come in) exchanges w/ credits and subsidies for those getting insurance on their own (This has problems imo most obviously there's a 2% tax on these plans but we are subsidizing/crediting the plans...classic government) Aggressive cost control experimentation in medicare/medicaid payment structures to slow rate of cost increases promotion of PCP/Health centers by giving them more money! (PCPs can make more from medicare/medicaid...encourage preventative/regular care and entry into this field...hospitals and specialists get less it hurts them) increased tools for fraud identification in medicare/medicaid CBO budget estimates are what they are nobody trusts them but they aren't bad I still think it is ABSURD that 20% of every healthcare dollar in essence is not spent on care. why does it cost 20% to administer a healthplan? Insurers don't provide anything in care deliver, just middle man payment. If we spend a Trillion dollars in the HC segment, 200B goes to exactly what? We also need to have advanced planning for Seniors... I can't even count how many times I hear very old people on our geraitric floor saying "I am just ready to go"... not forcing them into more treatments and misery is not a "death panel", it is respecting that individuals right to make decision abut their life and their care. Subsequently, this would save the system a fortune treating people who do not want it. Link to comment Share on other sites More sharing options...
birdog1960 Posted July 19, 2012 Share Posted July 19, 2012 I still think it is ABSURD that 20% of every healthcare dollar in essence is not spent on care. why does it cost 20% to administer a healthplan? Insurers don't provide anything in care deliver, just middle man payment. If we spend a Trillion dollars in the HC segment, 200B goes to exactly what? We also need to have advanced planning for Seniors... I can't even count how many times I hear very old people on our geraitric floor saying "I am just ready to go"... not forcing them into more treatments and misery is not a "death panel", it is respecting that individuals right to make decision abut their life and their care. Subsequently, this would save the system a fortune treating people who do not want it. it is absurd but couldn't be eliminated pratically now due to the recession. obama publicly admitted this. do you have any idea how many people have jobs in the health insurance industry? and how would the cons here feel about many of them transitioning to the public sector? we are talking about advanced directives (or are supposed to be) at annual wellness exams. that's part of the aca too. Link to comment Share on other sites More sharing options...
dayman Posted July 19, 2012 Share Posted July 19, 2012 (edited) it is absurd but couldn't be eliminated pratically now due to the recession. obama publicly admitted this. do you have any idea how many people have jobs in the health insurance industry? and how would the cons here feel about many of them transitioning to the public sector? we are talking about advanced directives (or are supposed to be) at annual wellness exams. that's part of the aca too. Plus it's not that absurd to begin with guys. They DO do a lot. You can't sit there and acknowledge how complicated the medical services sector is and then roll over and say the insurance companies do nothing. There are large administrative costs. And you can't sit there and say "yes, we need to work on transitioning pay structures and experiment with different ideas to control costs" and then say "the insurance companies do nothing." Not to mention it stayed private...so there are marketing costs as they compete with each other. And then yes, God forbid they take a profit which for most insurance companies is about 2%...putting it at the low end of all business. Don't demonize the insurance companies. They're the most picked on group in this whole mess and the damned truth is it's more the government and the medical providers that have ****ed up everything in the past. There is a lot of stuff here that will nudge (probably not enough) the doctors/hospitals and some serious stuff that will attempt to remedy the mistakes in the way medicare has paid stuff out as quickly as possible...so they're working on it as are the insurance companies...but you shouldn't demonize the insurance companies for making 2% profit and b/c you don't understand where the 20% on that dollar goes. How much off a $15K 12 hour hospital stay where the patient gets fluids and a Xanex do you think went to "patient care?" 20%? Edited July 19, 2012 by TheNewBills Link to comment Share on other sites More sharing options...
birdog1960 Posted July 19, 2012 Share Posted July 19, 2012 Plus it's not that absurd to begin with guys. They DO do a lot. You can't sit there and acknowledge how complicated the medical services sector is and then roll over and say the insurance companies do nothing. There are large administrative costs. And you can't sit there and say "yes, we need to work on transitioning pay structures and experiment with different ideas to control costs" and then say "the insurance companies do nothing." Not to mention it stayed private...so there are marketing costs as they compete with each other. And then yes, God forbid they take a profit which for most insurance companies is about 2%...putting it at the low end of all business. Don't demonize the insurance companies. They're the most picked on group in this whole mess and the damned truth is it's more the government and the medical providers that have ****ed up everything in the past. There is a lot of stuff here that will nudge (probably not enough) the doctors/hospitals and some serious stuff that will attempt to remedy the mistakes in the way medicare has paid stuff out as quickly as possible...so they're working on it as are the insurance companies...but you shouldn't demonize the insurance companies for making 2% profit and b/c you don't understand where the 20% on that dollar goes. How much off a $15K 12 hour hospital stay where the patient gets fluids and a Xanex do you think went to "patient care?" 20%? a govt run system could save a fortune on administrative costs. the va's administrative costs are much less than aetna's. with a gov't run system you could eliminate over allocation of resources on money making equipment. e.g. mri machines. we have way more radiologic capacity then needed. staff one machine round the clock and cut the number of machines in 1/2 at least. stop building new hospitals in areas with an overabundance of beds. stop advertising for doctors and hosapitals. stop selling questionable,but moneymaking procedures and tests. in summation, stop medicine as a business and make it a service aimed at providing the best care to the most people at the lowest cost. we could do that with a lot less administrators. Link to comment Share on other sites More sharing options...
dayman Posted July 19, 2012 Share Posted July 19, 2012 a govt run system could save a fortune on administrative costs. the va's administrative costs are much less than aetna's. with a gov't run system you could eliminate over allocation of resources on money making equipment. e.g. mri machines. we have way more radiologic capacity then needed. staff one machine round the clock and cut the number of machines in 1/2 at least. stop building new hospitals in areas with an overabundance of beds. stop advertising for doctors and hosapitals. stop selling questionable,but moneymaking procedures and tests. in summation, stop medicine as a business and make it a service aimed at providing the best care to the most people at the lowest cost. we could do that with a lot less administrators. I don't disagree that we could probably save about 12% administrative costs going to public payer. My point is, in terms of the system we have...the insurance companies NEED about 20% of that dollar. It's not pure waste in the environment we have so they shouldn't be demonized over it. The fact of the matter the common wisdom that the private sector is more efficient that the public sector just doesn't match up when it comes to healthcare...I don't deny that...but it's not b/c they're evil or making a killing off us...it's just the facts of life. To say "why have private insurers who get 20% when Britan and Canada have admin costs closer to 6-8%?" is fair...to say "our private insurers don't need 20% they're dirty cheats who steal" is not fair. As for gov't run healthcare system I don't doubt they could it more it more cheaply. It's a fact. But it's questionable if the service would be the same per dollar...for many non-emergency procedures the wait time could be months and even then they would cover everyone...but not everything...and yet taxes would still be high to pay for it. So what's the difference between the taxes you pay there and the premium you pay here as compared to a procedure not covered there but covered on your plan here? The answer to that question will vary depending on your income and the procedures you end up needing. But the idea is the same...both systems have their pros and cons...which is better for any given individual depends on that individual and their circumstances. I would agree though that ultimately I think the total socialization of that market is probably better for more more people than less. But that's neither here nor there b/c we will NEVER have that in America. As I said earlier I would say the best system for the US would ultimately be public payer, private provider...or "medicare for all" as you call it. But for now, given the circumstances...the ACA will have to do. Link to comment Share on other sites More sharing options...
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