Obamacare

[Embar Angylwrath]

You don't do single payer well when you refuse to pay for it, you mean.

The VA got over $140 billion in funding FY '13. They have about 5.5 million patients. That's a little over $25,000 per patient in funding.

[Embar Angylwrath]

I don't think any country does single payer well. It would be nice to see someone start with a simple model that stopped the "one hospital trip from bankruptcy" syndrome and then stopped there.

Over here they keep legislating what private insurers can and can't cover. I don't understand the point...

Dd

We do have that model. It's called health insurance.

[Partha]

I don't think any country does single payer well. It would be nice to see someone start with a simple model that stopped the "one hospital trip from bankruptcy" syndrome and then stopped there.

Over here they keep legislating what private insurers can and can't cover. I don't understand the point...

Dd

We do have that model. It's called health insurance.

BAHAHAHAHAHAHAHAHAHAHAH

oh, wait, you were being serious.

BAHAHAHAHAHAHAHAHAHAHAH

[Partha]

You don't do single payer well when you refuse to pay for it, you mean.

The VA got over $140 billion in funding FY '13. They have about 5.5 million patients. That's a little over $25,000 per patient in funding.

Medical funding is 40% of the budget. That's $56 billion or a little over $10k a year per person in funding - which, when you consider they have to deal with everything from Agent Orange victims from Vietnam to limbless veterans from Afghanistan, is pretty measly. Maybe you could tell us, say, the cost of a prosthetic for an IED victim for example. You know, just to prove that you love dumping on vets too.

[Ddrak]

I don't think any country does single payer well. It would be nice to see someone start with a simple model that stopped the "one hospital trip from bankruptcy" syndrome and then stopped there.

Over here they keep legislating what private insurers can and can't cover. I don't understand the point...

Dd

We do have that model. It's called health insurance.

Not single-payer.

Dd

[Arathena]

I don't think any country does single payer well. It would be nice to see someone start with a simple model that stopped the "one hospital trip from bankruptcy" syndrome and then stopped there.

Over here they keep legislating what private insurers can and can't cover. I don't understand the point...

Dd

We do have that model. It's called health insurance.

Over three quarters of those who file bankruptcy to escape medical bills have health insurance.

[Embar Angylwrath]

That's a misleading statement.

From the article:

They concluded that 62.1 percent of the bankruptcies were medically related because the individuals either had more than $5,000 (or 10 percent of their pretax income) in medical bills, mortgaged their home to pay for medical bills, or lost significant income due to an illness.

Emphasis mine.

However, Peter Cunningham, Ph.D., a senior fellow at the Center for Studying Health System Change, a nonpartisan policy research organization in Washington, D.C., isn't completely convinced. He says it's often hard to tell in which cases medical bills add to the bleak financial picture without being directly responsible for the bankruptcies.

"I'm not sure that it is correct to say that medical problems were the direct cause of all of these bankruptcies," he says. "In most of these cases, it's going to be medical expenses and other things, other debt that is accumulating."

Emphasis mine.

[Embar Angylwrath]

And this is timely to the discussion.

http://www.nytimes.com/2013/08/13/us/a- ... =5065&_r=1&

No limits on out of pocket expenses at least through 2014. Ya' know, the aspect of Obamacare that was supposed to keep people out of bankruptcy.

[Arathena]

That's a misleading statement.

From the article:

They concluded that 62.1 percent of the bankruptcies were medically related because the individuals either had more than $5,000 (or 10 percent of their pretax income) in medical bills, mortgaged their home to pay for medical bills, or lost significant income due to an illness.

Emphasis mine.

However, Peter Cunningham, Ph.D., a senior fellow at the Center for Studying Health System Change, a nonpartisan policy research organization in Washington, D.C., isn't completely convinced. He says it's often hard to tell in which cases medical bills add to the bleak financial picture without being directly responsible for the bankruptcies.

"I'm not sure that it is correct to say that medical problems were the direct cause of all of these bankruptcies," he says. "In most of these cases, it's going to be medical expenses and other things, other debt that is accumulating."

Emphasis mine.

People with health insurance get sick, and go bankrupt due to medical bills and the compounding thereof with lost income due to the illness. Ergo, the health insurance system is not working as claimed.

And yes, Nationalized Romneycare/HeritageFoundationcare needs work. Too bad we gerrymandered in a House that's willing to destroy the country rather than fix it.

[Embar Angylwrath]

How would the lost income part be any different under Obamacare? If a person isn't able to work, regardless of the form of healthcare, wouldn't that person still face the same financial pressures?

I suspect that is the real cause of healthcare related bankruptcy, not the delta in healthcare coverage between what is covered and what is out of pocket. People can dig out of debt if they have enough time and can produce income. Its the not being able to produce income that drives most bankruptcies, and that dynamic wouldn't change under Obamacare.

[Minute]

My girl just finished her residency & started her practice as an OBGYN.

She's getting all kinds of different views on how the The Affordable Healthcare Act is going to effect her. It seems to me that considering the number of now covered patients that her business is going to increase considerably but she says that the big fear is going to be collecting for services performed. She also is afraid that it is going to prompt the administration to demand cut backs on tests & procedures that she will want to do because of their expense. I also wonder how it's going to effect her malpractice insurance. Anyone have any thoughts on how this is going to effect her?

Oh & I mean this outside of the increased taxes. That's already increased.

[Ddrak]

How would the lost income part be any different under Obamacare? If a person isn't able to work, regardless of the form of healthcare, wouldn't that person still face the same financial pressures?

I suspect that is the real cause of healthcare related bankruptcy, not the delta in healthcare coverage between what is covered and what is out of pocket. People can dig out of debt if they have enough time and can produce income. Its the not being able to produce income that drives most bankruptcies, and that dynamic wouldn't change under Obamacare.

How do you think it *should* work, independent of the offers on the table right now?

I suspect having people go bankrupt over medical issues in any sort of non-trivial numbers isn't cost effective to society as a whole.

Dd

[Embar Angylwrath]

I would argue our bankruptcy laws are very good for the economy, both personal and macro, and I would further argue it doesn't matter what causes the bankruptcy. Why is a bankruptcy stemming from medical circumstances that cause loss of income any worse than a bankruptcy arising form loss of income for other reasons?

[Embar Angylwrath]

My girl just finished her residency & started her practice as an OBGYN.

She's getting all kinds of different views on how the The Affordable Healthcare Act is going to effect her. It seems to me that considering the number of now covered patients that her business is going to increase considerably but she says that the big fear is going to be collecting for services performed. She also is afraid that it is going to prompt the administration to demand cut backs on tests & procedures that she will want to do because of their expense. I also wonder how it's going to effect her malpractice insurance. Anyone have any thoughts on how this is going to effect her?

Oh & I mean this outside of the increased taxes. That's already increased.

Really can't comment on the fear of collecting, other than with the exchanges, she'll be under contract (if she chooses to) with a health insurance company, not the government.

Unless she takes Medicare patients, and then yes, her fears are well founded. The Obama administration's plan to cut Medicare costs is to simply cut payments to doctors who take Medicare patients. It's gotten so bad that doctors are refusing Medicare patients, and guess where those patients end up.. the ER.

On the private insurance side, a small, but rapidly growing, number of doctors are refusing to be part of an insurance network. They've gone back to fee for service, and since they know they will get paid by their patients (or the majority of them anyway), their fees are lower.

@Dd - You wanted an idea of an alternative to private healthcare or single payer. The answer is what is happening now. Fee for service, coupled with catastrophic health insurance purchased on the open market, and allow insurance companies to compete across state lines. Let the government set minimum standards on catastrophic insurance lines (no lifetime caps, a must insure policy, minimum out-of-pocket expenses per year), and let the market do the rest.

[Ddrak]

I would argue our bankruptcy laws are very good for the economy, both personal and macro, and I would further argue it doesn't matter what causes the bankruptcy. Why is a bankruptcy stemming from medical circumstances that cause loss of income any worse than a bankruptcy arising form loss of income for other reasons?

How do you figure bankruptcy is good for an economy? I argue that avoidance of the cause is much better.

Why is medical bankruptcy worse? Because it's largely avoidable with a single payer system. Why is single payer better than catastrophic insurance with "no lifetime caps and must-insure"? I assume you're also fixing the premium price there to avoid the "set the premium at impossible levels" issue, in which case it's a completely non-free market and entirely a government hand-out to insurance companies. If you're fixing everything at a level where private companies can still make money then single payer is necessarily cheaper. If you're forcing companies to take a loss, then you have no insurance.

Additionally, in your scheme, is insurance mandatory? If not, can hospitals run credit checks before treating emergency patients or are they obligated to treat anyone with no regard to their ability to pay? How do you fix the "overdosed hobo" problem?

Dd

[Partha]

The ACA actually provided a boost in payments for 2013 and 2014 to primary care physicians who take Medicare, as a carrot to get more primary care physicians to take Medicare patients. Funding was also approved in the ACA for states to expand their Medicare rolls....which has been blocked by several states with (gee, go figure) Republican legislatures and/or governors. And, of course, President Obama does not create the budget, that's done in Congress, where many members of the House want to defund the ACA as a way to get around it, and so no votes have been brought to the floor, since leadership doesn't stay leadership if your party is seen as bankrupting Grandma and Grandpa in time for elections.

EDIT - also, Embar is one of those who equates money with morality, and his opinions are thus colored. Remember this when discussing bankrupt folks.

[Embar Angylwrath]

Do you have health insurance yet through Obamacare Partha?

If so, what is the cost and limits? Inquiring minds want to know.

[Harlowe]

Costs have gone down here, also some of us are getting rebate checks from the insurance companies soon. It seems to me that if your state isn't being a combative douche about it, you're going to benefit.

[Partha]

Do you have health insurance yet through Obamacare Partha?

If so, what is the cost and limits? Inquiring minds want to know.

Exchanges don't start here in Illinois until Oct. 1.

[Embar Angylwrath]

Costs have gone down here, also some of us are getting rebate checks from the insurance companies soon. It seems to me that if your state isn't being a combative douche about it, you're going to benefit.

Are you on the exchange? If not, have you compared your plan to a similar plan in the exchange?