[Health Care Threads merged - please stop creating new threads]

[Passepartout]

What makes you think we met in Maui?

Oops. We were joined by another TUGger with a very similar username to yours. I just searched and darn it, it wasn't you. Pleasant get together and perhaps more pleasant dinner overlooking Lahaina harbor afterwards. Sorry you missed it.

 

[Beefnot]

In full disclosure, that was written by a USPS employee. Fair points though I will recant. USPS is a pretty doggone efficient organization all things considered.

Yea, perhaps so. But, then you recanted, so it's hard to really tell where you stand. I'm not sure what statement you were recanting then. I guess you meant only the post office. But, it really doesn't matter. I think people understood where I was coming from.

I recanted USPS only, which is why I had stricken it out in my repost.

 

[Ken555]

No spin here. The 7 million is significant because it's the number the original estimates were built off of. Other significant numbers are how many are actually enrolled and paid, how many were previously uninsured, and how many of the young population are in the mix.



To it's credit, the Obama administration did an incredible job marketing the program.

Yes, this is significant. Imagine how many might have signed up had the website and everyone advocated signup by those who have been marginalized by existing policies. I suspect many more will be helped by this new law next year.

And, don't forget the numbers for those who couldn't change policies due to pre-existing conditions and now are able to and save a considerable amount each month. I count this category as significant a change as those who weren't insured.


Sent from my iPad

 

[SMHarman]

It's the evil profit motive vs. the inefficiencies and costs of another government program. I'm not taking a side on this, just saying there's advantages and disadvantages for both.

Please list these inefficient government programs. Most government programs operate more efficiently than similar private programs.

Seriously ??? Go down the list... Post Office, Medicare, Medicaid, Disability, Social Security. They all are notorious for being inefficient with fraud, waste, and abuse. Things happen in those programs that just don't happen in private enterprise.

Are you saying otherwise?

Huh I'm being challenged to provide efficient government programs because I'm challenging the prior assertion that government is inefficient. Nothing like a straw man!!!

Sent from my LT26i using Tapatalk

Jim, let me clear it up for you on how it went down this path. Hopefully it will clear up your fog.

After this chain, I listed several government programs that I believe were not run efficiently (I don't want to list them again because I don't think we need to hash them out individually.) Then one program on my list became the focal point of yesterday's discussion. The strange thing is I never got a direct response to my question to SMHarman, only his post describing my question as a "straw man" when I quoted his exact post.

I was quoting you... I know it got lost in the mix. A generallization of the inefficiencies of government programs.

We then took apart the efficient USPS as an example were we could pull apart the government directed USPS and the private FedEx/UPS

 

[ace2000]

I was quoting you... I know it got lost in the mix. A generallization of the inefficiencies of government programs.

No problem. Nobody else cares and if they do they can look at the posts (#940 and #959). I think it's pretty well laid out.

I've moved on. If I'm falsely accused of using a "straw man" (#959) and playing "games" by Ken (#960), I'm probably going to defend myself. I'm willing to leave it at that.

 

[ace2000]

And, don't forget the numbers for those who couldn't change policies due to pre-existing conditions and now are able to and save a considerable amount each month. I count this category as significant a change as those who weren't insured.

I'll add one more significant number - how many uninsured have signed up through the Medicaid expansion? That number has probably made the biggest dent in the uninsured.

 

[Passepartout]

I'll add one more significant number - how many uninsured have signed up through the Medicaid expansion? That number has probably made the biggest dent in the uninsured.

I heard on the (NPR) radio this morning that an additional 9 million were signed up for Medicaid on top of those 7.1 Million who signed up for ACA. That number doesn't count the 3.1 million young people who are covered on their parent's policies. They are different entities. Whether that number were new enrollees to Medicaid or if that number included those who were on Medicaid before it's (optional by state) expansion was not made clear.

Indeed, the expansion of Medicaid to those too poor to qualify for ACA, may be the 'back door' into 'single payer' healthcare. Like in Great Britain, Canada, France, Germany, Japan and the other countries with single payer, The Gov't Health Service- or whatever they call it- is very basic- a safety net. People in those societies who want 'elective' procedures, dentistry, eyeglasses, or any but the most basic services pay extra for coverage for that.

 

[SMHarman]

Indeed, the expansion of Medicaid to those too poor to qualify for ACA, may be the 'back door' into 'single payer' healthcare. Like in Great Britain, Canada, France, Germany, Japan and the other countries with single payer, The Gov't Health Service- or whatever they call it- is very basic- a safety net. People in those societies who want 'elective' procedures, dentistry, eyeglasses, or any but the most basic services pay extra for coverage for that.

In the UK the NHS does not cover adult dental or vision, but does cover pediatric vision and dental and dental during pregnancy.
Basically NHS is your healthcare, not your dental or vision plan.
NHS covers everything cradle to grave but at times for non urgent elective surgery you will wait. The result of a system using 90+% of resources rather than having hundreds of MRI machines sitting around idle most of the day or etc.
What the middle and upper classes then buy is a top up cover. In many respects it is quite a limited policy, like an HMO here, you will still first see your general practicioner. Many of the more affordable ones require that if the procedure can be done timely on the NHS they perform it, however if there is a waiting list for the NHS you can elect private and that treatment is covered on your insurance.
The insurance excludes whole classes of treatment as the private system is not set up to cover them including delivering babies and dialasis as a couple that come to mind.
This kind of insurance also has the added social benefit that if you are having the work done privately then you are not taking the place of someone else without the insurance in the NHS system.

But the NHS also trains the doctors, largely at its own expense with (i think) a requiring a commitment from the doctor at the back end to continue to provide service to the NHS.

http://www.nhscareers.nhs.uk/explore-by-career/doctors/training-to-become-a-doctor/

This means doctors are not as highly paid in the UK in cash terms, but with liability coverage taken care of by the NHS and training costs also taken care of by the NHS they are also not hundreds of thousands of dollars in debt resulting in not needing quite as many $$ to service that debt and pay for liability coverage.

http://www.nhscareers.nhs.uk/explore-by-career/doctors/pay-for-doctors/

There are many pieces of the healthcare puzzle to fix in the US. For example, treatment costs can be reduced by reducing doctor training costs as detailed above.

 

[Passepartout]

Sounds like a perfectly sensible system the Brits have there. I hope I live long enough to see something similar here.

Jim

 

[bogey21]

I heard on the (NPR) radio this morning that an additional 9 million were signed up for Medicaid on top of those 7.1 Million who signed up for ACA. That number doesn't count the 3.1 million young people who are covered on their parent's policies. They are different entities. Whether that number were new enrollees to Medicaid or if that number included those who were on Medicaid before it's (optional by state) expansion was not made clear.

The numbers have me confused. I think I remember hearing that the ACA was enacted to provide coverage to some of the 35 million who were uninsured when it was enacted. Now I hear there are 40 million uninsured notwithstanding the 7 million who have signed up for the ACA and the 9 million who signed up for Medicaid. I must have something wrong as this doesn't make sense to me.

George

 

[Passepartout]

The numbers have me confused. I think I remember hearing that the ACA was enacted to provide coverage to some of the 35 million who were uninsured when it was enacted. Now I hear there are 40 million uninsured notwithstanding the 7 million who have signed up for the ACA and the 9 million who signed up for Medicaid. I must have something wrong as this doesn't make sense to me.

George

Does it really matter whether the number is 35 million or 40 million? The number is squishy. People are born. People die. People go to work and get insurance, people drop out. Whatever the number was this morning, or yesterday, or last week, it's a different number tonight.

The important number is the many many people who didn't have insurance last November and December before ACA took effect, and have coverage now.

 

[Conan]

Here's an interesting take on the numbers covered and not covered:

Even with millions of Americans gaining access to health care thanks to Obamacare—seven million have signed up, but 9.5 million are now covered thanks to Obamacare (Medicare expansion, kids who can stay on their parents health care plans until they're 26)—the Congressional Budget Office estimates that 30,000,000 Americans will remain uninsured in 2017 despite Obamacare. That number is not expected to budge. There were 60,000,000 uninsured Americans before the passage and implementation of the Affordable Care Act and halving the number of uninsured Americans is a huge achievement and a hard-won victory. But... again... still: 30,000,000 uninsured Americans. So the hardships, bankruptcies, and deaths due to lack of access to health care will continue. But instead of 45,000 Americans dying every year because they lack health coverage, after 2017 we can look forward to "only" 22,500 Americans dying annually because they lack access to health coverage. That's "just" 7.5 9/11s. Every year. Forever.
http://slog.thestranger.com/slog/archives/2014/04/01/obamacare-enrollment-hits-7000000-number

He goes on to say that this will be the case unless/until "we" win the fight for a single-payer system that covers all American citizens.

 

[ScoopKona]

The Gov't Health Service- or whatever they call it- is very basic- a safety net. People in those societies who want 'elective' procedures, dentistry, eyeglasses, or any but the most basic services pay extra for coverage for that.

One of the things that drives me loopers about living in America (and yes, I was born here -- I can trace it back to well before the revolution), is that those "elective" procedures like eyeglasses cost pennies on the dollar compared with the horrible consequences of people on the freeway who need a new prescription.

It is simply stupid that some people have to choose between new glasses/contacts/surgery and food/rent/utilities. How much would it cost each of us to insure that we aren't driving on I-95 with someone who hasn't had an eye exam in 20 years? A sawbuck? 20 bucks? Freakin pennies on the dollar if you ask me.

I wish to [not allowed to say] that we would ALWAYS institute the "pennies on the dollar" plan, in all cases all the time.

 

[ace2000]

The numbers have me confused. I think I remember hearing that the ACA was enacted to provide coverage to some of the 35 million who were uninsured when it was enacted. Now I hear there are 40 million uninsured notwithstanding the 7 million who have signed up for the ACA and the 9 million who signed up for Medicaid. I must have something wrong as this doesn't make sense to me.

The numbers are a continuous moving target and the graph below shows why. The amount of uninsured when the law was enacted was closer to about 55 million.

 

[ace2000]

Please note the asterisked item below the graph. There are several states that have decided to not play along with the Medicaid expansion. The bottom level of the blue line may be overestimated because of that.

 

[ace2000]

I heard on the (NPR) radio this morning that an additional 9 million were signed up for Medicaid on top of those 7.1 Million who signed up for ACA.

There have been several sources quoting the LA Times research over the last few days. I'll provide a link to the source below.

My summary:

- 6 million have signed up on the new marketplace (we now know that number has been shifted upwards to 7 million).

- About one third of whom were previously uninsured (7M * .33 = 2.3 million)

- 4.5 million previously uninsured have signed up through Medicaid

- 3 million have gained coverage under the "under 26" provision.

Net gain in uninsured: about 9.5 million - 10 million


http://www.latimes.com/nation/la-na...l-20140331,0,6550360,full.story#axzz2xYx7CcJb

 

[ace2000]

Does it really matter whether the number is 35 million or 40 million?

I think this is a fair point. Do any of these numbers matter? Of course they do, because that's what future premiums are based off of... actual numbers.

However, I'm with Jim - do they really matter to the average "Joe"? If I was a politician on the "anti-ACA" side, I'd be staying away from talking about the numbers and focus on other arguments.

 

[bogey21]

Definitely progress. Was it worth the cost to taxpayers and the impact on those who lost their doctors, hospitals and insurance they liked? Only time will tell.

George

 

[ace2000]

Definitely progress. Was it worth the cost to taxpayers and the impact on those who lost their doctors, hospitals and insurance they liked? Only time will tell.

George

George - don't ruin the party. Those costs are being passed on to future generations. We all say we care about our national debt, but nobody else besides you and I feel it's showstopper.

 

[Passepartout]

Definitely progress. Was it worth the cost to taxpayers and the impact on those who lost their doctors, hospitals and insurance they liked? Only time will tell.

Who has lost doctors or hospitals or insurance they liked? People get to choose the insurance that is accepted by their doc/hospital before they buy it. Only an idiot would buy insurance that is not accepted by their provider. As to 'insurance they liked', Insurance companies were freed to re-issue any plans they offered. As you know, insurers review their plans and change their policies every year anyway. This year they were simply required to have minimum standards on their offerings.

Over time, it will be easier when one can go online or walk into an 'insurance center' and see a simple menu. Maybe like this:

Bronze plan: $4000 deductible- 50% pay after met at $X price
Copper plan: $3,000 " - 60% " at a little more
Silver plan : $2,000 " - 70% " at a little more
Gold plan : $1,000 " - 80% " at even more

All plans have X number of visits & all diagnostics paid with no deductible or co-pay. Choose your plan and insurance company based on the doc/hospital in it's plans.

As has been said time and again over the 4+ months we've managed to keep this thread going without it being closed (THANK YOU, MODERATORS) the ACA is just a start. It's a work in progress. Much modification remains to get more people insured, lower costs, make coverage more universal. As you said, George, Time will tell.

 

[geekette]

Who has lost doctors or hospitals or insurance they liked? People get to choose the insurance that is accepted by their doc/hospital before they buy it. Only an idiot would buy insurance that is not accepted by their provider. As to 'insurance they liked', Insurance companies were freed to re-issue any plans they offered. As you know, insurers review their plans and change their policies every year anyway. This year they were simply required to have minimum standards on their offerings.

Over time, it will be easier when one can go online or walk into an 'insurance center' and see a simple menu. Maybe like this:

Bronze plan: $4000 deductible- 50% pay after met at $X price
Copper plan: $3,000 " - 60% " at a little more
Silver plan : $2,000 " - 70% " at a little more
Gold plan : $1,000 " - 80% " at even more

All plans have X number of visits & all diagnostics paid with no deductible or co-pay. Choose your plan and insurance company based on the doc/hospital in it's plans.

As has been said time and again over the 4+ months we've managed to keep this thread going without it being closed (THANK YOU, MODERATORS) the ACA is just a start. It's a work in progress. Much modification remains to get more people insured, lower costs, make coverage more universal. As you said, George, Time will tell.

Right, if one lost anything, they chose to. No one was required to buy via exchange, a person could certainly select a policy from the ins co they already had. If people swapped to cheaper plans that did not contain the providers/facilities they wanted, then they made the compromise based on price.

My primary doctor has always made a point of accepting whatever ins a patient had so one need not stop at "well, they aren't on the list, I just won't ever go to that doctor again". everything is negotiable, why wouldn't one attempt to get the provider and ins co to make it happen? OR, go to whomever you like, it's really only a question of Who Pays, you or ins co. Another choice...

 

[Beefnot]

Who has lost doctors or hospitals or insurance they liked? ..... Insurance companies were freed to re-issue any plans they offered......This year they were simply required to have minimum standards on their offerings.

Theoretically speaking, I would imagine that the required minimum standards can cause insurers to drop certain plans or raise the pricing on similar plans such that an individual may need to opt into a different plan that does not reflect the risk that s/he was willing to accept and which contains a different network of doctors that does not include their preferred provider.

 

[Passepartout]

We all say we care about our national debt, but nobody else besides you and I feel it's showstopper.

I think we agree more than you think. However we feel there are different ways to deal with it. There are those that feel that the pickle we got ourselves into has been brought about by unwise and un-thought-through wars (Iraq and Afghanistan and Panama and Granada come to mind), corporate welfare (Wall Street and GM bailouts), farm subsidies to conglomerates like Cargill and ADM. Military contracts to states with powerful politicians, (don't dare consider closing an airbase or shipyard or cancelling a billion dollar EACH! jet fighter) and such items as the famous $600 toilet seats. Millions of research dollars to develop pens that write in zero gravity for astronauts. Russia gives their cosmonauts pencils. The list goes on and on.

Meanwhile Americans go without healthcare in the wealthiest country in the world. People go bankrupt while their doctors have to flip a coin to decide which of their Mercedes or Tesla's or Porsche's to take to work. It's a matter of priorities. You have yours and I have mine.

In the Reagan Years, top tax rate was 92%, now it's 39%. I don't think we need to go back to the pre-Reagan rates, but some compromise might be in order.

Jim

 

[SMHarman]

Right, if one lost anything, they chose to. No one was required to buy via exchange, a person could certainly select a policy from the ins co they already had. If people swapped to cheaper plans that did not contain the providers/facilities they wanted, then they made the compromise based on price.

My primary doctor has always made a point of accepting whatever ins a patient had so one need not stop at "well, they aren't on the list, I just won't ever go to that doctor again". everything is negotiable, why wouldn't one attempt to get the provider and ins co to make it happen? OR, go to whomever you like, it's really only a question of Who Pays, you or ins co. Another choice...

Thats nice of them. At my employers renewal this year I made a list of key doctors. Mrs SMHarmans, Miss SMHarmans etc and called them with the list of coverage options (7 different options) I had, put ticks in boxes and then when all done had to stick with Cigna otherwise someone was switching doctors.
The illusion of choice is a wonderous thing!

 

[ScoopKona]

In the Reagan Years, top tax rate was 92%, now it's 39%. I don't think we need to go back to the pre-Reagan rates, but some compromise might be in order.

Actually, in the Reagan years it topped out at 50% You have to go back to the Eisenhower years for the 90+% rates. http://www.ntu.org/tax-basics/history-of-federal-individual-1.html

I am ALL for raising taxes. The very wealthy 1% controls 90% of the wealth in this country but pay only 70% of the taxes. That shifts the tax burden to the middle class (because the poor can't pay it).

Control 90% of the wealth? Then pay 90% of the taxes. Fair is fair.