This may not be a focus of many premeds, but...

[BlackBox]

---

Members do not see this ad.

...I've been watching the House debate the ACA/Debt ceiling bill and I'm just embarrassed for them. You can choose your them in this case.

This may actually be a good thing to talk about b/c it may come up at interviews (it has in the past).

Your thoughts?

 

[FormerPhysicist]

This doesn't have to do with the ACA specifically, but apparently the members of Congress still get paid in the event of a government shutdown. I'm not sure why that makes sense, regardless of the relatively small size of their salaries vs. the debt ceiling. They really shouldn't be paid for doing so badly at legislating that they managed to shut down the government.

As for the ACA, if Republicans want it defunded so badly, then they should work on a viable alternative reform plan. Until then, it's all just posturing.

 

[NuttyEngDude]

As for the ACA, if Republicans want it defunded so badly, then they should work on a viable alternative reform plan. Until then, it's all just posturing.

Yeah, it has nothing to do with medicine or health insurance and everything to do with politics. Generally, there is probably some think-tank-strategy somewhere that has calculated that this shut down will generate more % of a vote from a certain demographic for the political party. It is a sign 'o the times.

 

[BlackBox]

Yeah, it has nothing to do with medicine or health insurance and everything to do with politics. Generally, there is probably some think-tank-strategy somewhere that has calculated that this shut down will generate more % of a vote from a certain demographic for the political party. It is a sign 'o the times.

Agreed. I feel like it's turned into a game of positional-blame in order to rally the base.

 

[Starry]

It is a pretty sticky mess, that's for sure.

The Republican case against Obamacare seems pretty weak, to be honest. This is their tagline: ObamaCare And Its Unconstitutional Mandate Drives Up Health Care Costs, Increases Insurance Premiums, Hurts The Quality Of Health Care, Raises Taxes, And Blows Up The Deficit (http://www.gop.com/news/research/the-case-against-obamacare/)

First, it's not unconstitutional. The Supreme Court already upheld the law. Second, health care costs are going to go up as volume goes up, but the main reason behind high costs in health care is not overwhelming patient volume. Third, although I don't know much about insurance premiums, I think that an increase of $2,100 per family is less, on average, than we pay now for people who don't have insurance. Fourth, more equal access to care leads to better quality of health care for everyone (introductory sociological theory.) Fifth, ObamaCare only raises your taxes if you don't get insurance. And I think most people will get insurance because the fact is, most people WANT insurance. Finally, our deficit is really freaking huge already, so I don't see how making it a bit huger is a problem.

However, in interviews, I'm going to do my best to say something like, "I am behind the idea of Obamacare, but like everyone else in the US, I don't have any idea how it will play out IRL. I understand that there are conservative concerns about rising healthcare costs, putting a burden on taxpayers, and the fiscal deficit; however, I also see the benefits of increasing access to healthcare." And I'll probably end it at that.

 

[ES2]

I have to agree with all the above posts, and also add that I'm pretty disgusted with our congress and legislature.

 

[BlackBox]

Third, although I don't know much about insurance premiums, I think that an increase of $2,100 per family is less, on average, than we pay now for people who don't have insurance.

This is a very important point b/c rising healthcare costs can partially be attributed to medical problems that go untreated for years and become more costly. I think diabetes is the poster child for this.

 

[Spinach Dip]

I'm pretty disgusted with our congress and legislature.

I find this statement impossible to disagree with.

 

[Chillbo Baggins]

Fifth, ObamaCare only raises your taxes if you don't get insurance. And I think most people will get insurance because the fact is, most people WANT insurance.

I don't want it, yet I have to get some or else the government will punish me? I thought this was America. 😕

Finally, our deficit is really freaking huge already, so I don't see how making it a bit huger is a problem.

That's a pretty bad strategy for ever getting out of debt, lol. Sure, you can't get rid of it all at once, but you still have to try to make gains. 😉

 

[Starry]

I don't want it, yet I have to get some or else the government will punish me? I thought this was America. 😕

That's a pretty bad strategy for ever getting out of debt, lol. Sure, you can't get rid of it all at once, but you still have to try to make gains. 😉

Think of it like a tax, just like all the other taxes that go towards infrastructure or government stuff. Although you may never use a certain bridge, you still pay for it whether you like it or not, because it will benefit America as a whole. A punishment would be like sending you to jail.

If healthy young people don't pay insurance because their risk of illness is low, insurance skyrockets because everyone will only get insurance when they need it, which is a horrible strategy. It also prevents young people from sinking into inescapable debt if something does happen to them, since they generally don't have any financial backing to rely on anyway. I remember reading a news story about a young man who got into a traffic accident. He wasn't insured. As young people, we don't need more expenses on top of student loans. I'd much rather pay a few hundred every year than a few hundred thousand if something happens to me.

And I agree the deficit is pretty bad. But it's been bad ever since I was in middle school. Sigh.

 

[Valar Dohaeris]

The Republican case against Obamacare seems pretty weak, to be honest.

I'll start by saying I don't care if it's the idea of a Republican, Democrat, whatever. It's about finding a solution.

This is their tagline: ObamaCare And Its Unconstitutional Mandate Drives Up Health Care Costs,
-one of the biggest lines from Obama for the ACA was that it will "bend down the cost curve of health care". Thus far, the ACA has failed abysmally. In '11, premiums rose 9% (exceeding $15,000 on average per year). Furthermore, the rising deductibles are being shifted by employers onto the the employees. If you pay for insurance, this really sucks.

Increases Insurance Premiums,
-fact. By insuring the uninsured (which I am for), you bring in high risk people into your insurance pool (the poor, people with pre-existing conditions, etc.). To offset these costs, insurance companies pass off higher premiums to their customers. This is the biggest reason the ACA is using the mandate-to bring young, healthy people into the insurance pool to lower overall risk.

Hurts The Quality Of Health Care,
-to be seen

Raises Taxes,
-without doubt. To bring 37 million uninsured under insurance, the govt. will expand Medicaid eligibility up to a % of the poverty line (I think subsidies are allowable up to ~400% or so..someone may want to check this). To expand Medicaid, the govt. will fund 97% of the money thru 2020. Where does the fed get money? Us. After that, the water gets murky, and with many state budgets already strapped, it is easy to understand why many states have refused to expand Medicaid.

And Blows Up The Deficit,
-"blow up" is strong, but the strain on the Massachusetts budget was considerable. Again, to be seen. I don't really think a lot of the people eligible for expansion will even be aware they are able to get govt. subsidized healthcare insurance.

(http://www.gop.com/news/research/the-case-against-obamacare/)

First, it's not unconstitutional. The Supreme Court already upheld the law. Second, health care costs are going to go up as volume goes up, but the main reason behind high costs in health care is not overwhelming patient volume. Third, although I don't know much about insurance premiums, I think that an increase of $2,100 per family is less, on average, than we pay now for people who don't have insurance. Fourth, more equal access to care leads to better quality of health care for everyone (introductory sociological theory.) Fifth, ObamaCare only raises your taxes if you don't get insurance. And I think most people will get insurance because the fact is, most people WANT insurance. Finally, our deficit is really freaking huge already, so I don't see how making it a bit huger is a problem.

However, in interviews, I'm going to do my best to say something like, "I am behind the idea of Obamacare, but like everyone else in the US, I don't have any idea how it will play out IRL. I understand that there are conservative concerns about rising healthcare costs, putting a burden on taxpayers, and the fiscal deficit; however, I also see the benefits of increasing access to healthcare." And I'll probably end it at that.

typed this on my phone, hopefully not too many typos

 

[Valar Dohaeris]

As for solutions, I've been really impressed with what Dr. Brent James has done at Intermountain over in Utah/Idaho. That's the future.

I can go into more detail if anyone is interested. I work for a large healthcare system in R&D in policy implementation. We look for solutions all day long.

 

[Yuyukachoo]

I don't want it, yet I have to get some or else the government will punish me? I thought this was America. 😕



That's a pretty bad strategy for ever getting out of debt, lol. Sure, you can't get rid of it all at once, but you still have to try to make gains. 😉

Nothing is more annoying than people who gamble on their health and complain about it when they lose.

 

[pyrrion89]

If you coerce insurance companies into certain profit-losing endeavors, like taking people with pre-existing conditions and not being able to boot your sick members off the insurance plan (recission), then you have to sweeten the deal by making health insurance mandatory, thereby increasing the pool of members and offsetting the extra costs of providing humane insurance.

The real solution is to make all insurance companies not-for-profit like in Germany and Japan.

 

[Reckoner]

If you coerce insurance companies into certain profit-losing endeavors, like taking people with pre-existing conditions and not being able to boot your sick members off the insurance plan (recission), then you have to sweeten the deal by making health insurance mandatory, thereby increasing the pool of members and offsetting the extra costs of providing humane insurance.

The real solution is to make all insurance companies not-for-profit like in Germany and Japan.

Not that I necessarily disagree with you here, but what do you think makes this solution better than a single-payer system?

 

[pyrrion89]

Not that I necessarily disagree with you here, but what do you think makes this solution better than a single-payer system?

The Swiss have the same system as the Germans, and they transitioned out of the free-for-all market health care we have now. They use private insurance companies that are not-for-profit. (I'm not sure if they also have a public option.) Seems like an easier transition in that it preserves our current infrastructure a bit. There are many systems out there that use private health insurance (but not for profit) while keeping spending low ( <11% GDP) and allowing universal coverage.

 

[Reckoner]

The Swiss have the same system as the Germans, and they transitioned out of the free-for-all market health care we have now. They use private insurance companies that are not-for-profit. (I'm not sure if they also have a public option.) Seems like an easier transition in that it preserves our current infrastructure a bit. There are many systems out there that use private health insurance (but not for profit) while keeping spending low ( <11% GDP) and allowing universal coverage.

That's a valid point. There are some things I think single-payer does better (ex. consolidating negotiating power to keep prices down), but I think I agree with you here. Not that either outcome is very likely in the near future...

 

[darknight]

Who is going to pay the broken plates?

 

[ES2]

The Swiss have the same system as the Germans, and they transitioned out of the free-for-all market health care we have now. They use private insurance companies that are not-for-profit. (I'm not sure if they also have a public option.) Seems like an easier transition in that it preserves our current infrastructure a bit. There are many systems out there that use private health insurance (but not for profit) while keeping spending low ( <11% GDP) and allowing universal coverage.

I wonder if the lobbyists in DC would ever allow this to happen.

 

[TheWeeIceMan]

Fifth, ObamaCare only raises your taxes if you don't get insurance. And I think most people will get insurance because the fact is, most people WANT insurance. Finally, our deficit is really freaking huge already, so I don't see how making it a bit huger is a problem.

Medicare tax increases under Obamacare.

I actually don't think that most people who don't have insurance WANT insurance, but neither of us can prove it either way.

Yeah, I actually have the same mentality with my credit card debt. I mean, shoot, it's like free money, how can you expect me not to spend it?

 

[scarletgirl777]

-one of the biggest lines from Obama for the ACA was that it will "bend down the cost curve of health care". Thus far, the ACA has failed abysmally. In '11, premiums rose 9% (exceeding $15,000 on average per year). Furthermore, the rising deductibles are being shifted by employers onto the the employees. If you pay for insurance, this really sucks.

Increases Insurance Premiums,
-fact. By insuring the uninsured (which I am for), you bring in high risk people into your insurance pool (the poor, people with pre-existing conditions, etc.). To offset these costs, insurance companies pass off higher premiums to their customers. This is the biggest reason the ACA is using the mandate-to bring young, healthy people into the insurance pool to lower overall risk.

Given that the ACA hasn't really been started yet, I don't see how data from 2 years ago is helpful for determining if it saves money. Personally, I am skeptical that the system as a whole will save a lot of money. I think it will help a lot of individual hospitals that right now currently spend a lot of money on charity care. It will reduce a lot of inefficiencies because care providers will no longer have to deal with as many situations where the patient doesn't have insurance.

If you already have insurance through your employer, there's no reason your premium will increase. Right now, individual insurance companies are coming up with proposals that they have to send to each individual state if they want to participate in these exchanges. Obviously, they are only submitting proposals that are profitable. If the companies can't come up with a profitable proposal that the individual state insurance authorities find acceptable, they are rejected and therefore they just don't participate. So there's nothing for the insurance company or the consumer to lose here. If you don't like the insurance being sold on the exchanges and you already have insurance, don't buy it. If you don't have insurance, the exchanges are your best option.

I also personally feel that having health insurance is a matter of personal responsibility. Auto insurance is mandatory in every state and no one has a problem with it. This is because even though America is all about respecting people's freedom, we recognize that people do not plan and save enough to pay the large and unpredictable costs associated with a car accident. Given that medical costs for a cancer diagnosis or a major trauma are even higher than the cost of replacing a car, requiring everyone to have health insurance seems even more logical. The 25 year old who feels like he doesn't need insurance because he works out and lifts 3 times a week still feels entitled to care if he gets drunk and falls out a window, or he gets leukemia and needs a bone marrow transplant. The Medicaid expansion, the subsidy program, and even the individual mandate are all important parts of the plan to get health insurance within financial reach for everyone.

Talk about universal health care was definitely something that came up multiple times when I interviewed for medical school...if you are a thinking human being, you should have at least some cursory knowledge of what's going on, and if you are claiming to be passionate about medicine and aspiring to be a physician, then even moreso.

 

[BlueLabel]

Whom is going to pay the broken plates?

It's who. And idk what you're talking about.

 

[darknight]

It's who. And idk what you're talking about.

Please excuse my writing. IDC.

 

[psswrd]

I actually don't think that most people who don't have insurance WANT insurance, but neither of us can prove it either way.

 

[Reckoner]

Please excuse my writing. IDC.

But really...what were you talking about?

 

[Starry]

I actually don't think that most people who don't have insurance WANT insurance, but neither of us can prove it either way.

Interesting how we have different views on this point. Just goes to show how differing personal experiences can lead to very different beliefs about the world. I'm honestly curious about this, does anyone have any hard statistics about the % of uninsured Americans who want insurance?

 

[Reckoner]

Interesting how we have different views on this point. Just goes to show how differing personal experiences can lead to very different beliefs about the world. I'm honestly curious about this, does anyone have any hard statistics about the % of uninsured Americans who want insurance?

A Gallup poll had ~1/4 of respondents saying they would opt to pay the penalty (in terms of current levels of uninsured people that's something like 15 million, I think). It's hard to judge whether they don't want healthcare, live in a state that isn't expanding Medicaid and can't afford it, or just aren't well informed about the exchanges, though.

Source: http://www.washingtontimes.com/blog...thirds-uninsured-sign-under-obamacare-survey/

Better source breaking down demographics of post-ACA uninsured levels using the older Census survey: http://healthaffairs.org/blog/2013/...re-act-a-demographic-and-geographic-analysis/

 

[TheWeeIceMan]

Interesting how we have different views on this point. Just goes to show how differing personal experiences can lead to very different beliefs about the world. I'm honestly curious about this, does anyone have any hard statistics about the % of uninsured Americans who want insurance?

Let my clarify, since the way I phrased my point was probably misleading. You implied that almost everyone who doesn't have insurance, wants insurance. I actually think that there is a sizable portion of this uninsured population that doesn't want insurance (at least if they have to pay for it). I didn't mean to imply that most people don't want it.

 

[Starry]

Let my clarify, since the way I phrased my point was probably misleading. You implied that almost everyone who doesn't have insurance, wants insurance. I actually think that there is a sizable portion of this uninsured population that doesn't want insurance (at least if they have to pay for it). I didn't mean to imply that most people don't want it.

Ohhhh I see, I misunderstood your point 😀

Thanks to Reckoner for that post! I'll read more later, gotta prep for my sociology exam tomorrow o.o

 

[notbobtrustme]

The Republican case against Obamacare seems pretty weak, to be honest. This is their tagline: ObamaCare And Its Unconstitutional Mandate Drives Up Health Care Costs, Increases Insurance Premiums, Hurts The Quality Of Health Care, Raises Taxes, And Blows Up The Deficit (http://www.gop.com/news/research/the-case-against-obamacare/)

Not only is it weak, it's hypocritical. The ACA is basically the proposal put forth by the Heritage Foundation (a very conservative think-tank) during the last debate surrounding healthcare in the early '90s. The whole basis of this plan was to instill some personal responsibility in people by forcing them to buy health insurance. Before the ACA, Romney used the Heritage Foundation's guidelines to bring health insurance reform to Massachusetts.

 

[Burla]

Watching Jon Stewart rip on everyone for this right now lulz

 

[SunsFun]

The Swiss have the same system as the Germans, and they transitioned out of the free-for-all market health care we have now. They use private insurance companies that are not-for-profit. (I'm not sure if they also have a public option.) Seems like an easier transition in that it preserves our current infrastructure a bit. There are many systems out there that use private health insurance (but not for profit) while keeping spending low ( <11% GDP) and allowing universal coverage.

This is a legit point. Assuming that my understanding of German healthcare is correct, it is a much more efficient and logically sound system. You have many public entities that compete with each other for all of the German citizens. The government gives certain amount of money preset amount of money for each person depending on that person's conditions. The entity cannot refuse to accept a patient but a patient is free to chose any entity he or she wants. Those entities negotiate with hospitals and practices for services provided. The entity is incentivized to keep the costs low because they only keep the amount that is left over from paying the hospital or a clinic for services from the allowance they receive. They hospitals are incentivized to keep prices low and patients healthy to continue to due business since the first could chose not to do business there and the patients can chose different hospital or switch their "provider".

This description may not be 100% correct but I believe that it captures the overall idea of what healthcare there is like. Reminds me of a charter school system.

 

[BlueLabel]

It is a pretty sticky mess, that's for sure.

The Republican case against Obamacare seems pretty weak, to be honest. This is their tagline: ObamaCare And Its Unconstitutional Mandate Drives Up Health Care Costs, Increases Insurance Premiums, Hurts The Quality Of Health Care, Raises Taxes, And Blows Up The Deficit (http://www.gop.com/news/research/the-case-against-obamacare/)

First, it's not unconstitutional. The Supreme Court already upheld the law. Second, health care costs are going to go up as volume goes up, but the main reason behind high costs in health care is not overwhelming patient volume. Third, although I don't know much about insurance premiums, I think that an increase of $2,100 per family is less, on average, than we pay now for people who don't have insurance. Fourth, more equal access to care leads to better quality of health care for everyone (introductory sociological theory.) Fifth, ObamaCare only raises your taxes if you don't get insurance. And I think most people will get insurance because the fact is, most people WANT insurance. Finally, our deficit is really freaking huge already, so I don't see how making it a bit huger is a problem.

However, in interviews, I'm going to do my best to say something like, "I am behind the idea of Obamacare, but like everyone else in the US, I don't have any idea how it will play out IRL. I understand that there are conservative concerns about rising healthcare costs, putting a burden on taxpayers, and the fiscal deficit; however, I also see the benefits of increasing access to healthcare." And I'll probably end it at that.

1. To put this in perspective, we're talking about the same body that has delivered unto the public such gems as "separate but equal" and the inspiring notion that "negros are regarded as beings of an inferior order" with "no rights which the white man was bound to respect."

The Court's decisions aren't divine commandments handed down from the Heavens. They're the words of men and women who are usually competent, but are subject to biases and stubbornness and ideology, and are fallible just like everybody else. To those who view ACA as unconscionable, the judicial option is simply off the table because the Court has interpreted it as Constitutional. Nevertheless, it has been upheld as the law of the land, and opponents of ACA must continue to suffer the act until a legislative solution can be realized. And I'm sure many of them are still wondering what on earth Chief Justice Roberts was thinking.

2. You openly admit that greater demand will lead to rising health care prices, then for some reason disregard this as it is not currently the main driver of rising prices. First of all, that assessment is applicable to the current situation. How is that relevant to the effect ACA will have on health care costs? Secondly, if as you admit costs are expected to rise, why was the legislation shopped as an important and necessary solution to the problem of rising health care costs?

3. Even in the favorable territory evaluated thus far, rates are expected to rise by an average of 24%. This figure is expected to be significantly higher for less regulated states, i.e. the majority for which data has not yet been released. I mean, people are seeing their rates rise by over 100% in some places (even California). I'm not following your explanation for how this will actually end up being a good deal for these people.

4. Better quality care for everyone? Are you sure about that? ACA is leading to significantly fewer health care provider options for consumers. Americans insured by their employers, despite being promised up and down by proponents of the act that "if you like your plan, you can keep your plan", are seeing them modified to keep costs down and avoid the taxes imposed by ACA. Hundreds upon hundreds of companies are retooling their plans or even shunting employees onto the exchanges to control costs, or worse, cutting their hours to keep from having to provide coverage at all. This doesn't seem to equate to the empyrean health care wonderland you learned about in your introductory sociology class, but it's been awhile since I took one so maybe you could edify me.

5. It's misleading to claim the ACA only raises taxes in that circumstance because there is a litany of taxes levied under the act that will affect just about everyone directly or indirectly. Aside from the individual mandate tax, it also unleashed the employer mandate tax, the Excise Tax on Comprehensive Health Insurance Plans, the Tax on Health Insurers, the Tax on Innovator Drug Companies, the High Medical Bills Tax, the Medicine Cabinet Tax, the Tax on Indoor Tanning Services, and the Excise Tax on Charitable Hospitals, just to name a few. Also, the act includes several tax deduction eliminations such as the deduction for employer-provided retirement prescription drug coverage which obviously will directly affect current recipients in the same way as a tax increase.

6. "We already owe a ton of money, running up some more debt won't make a difference." Okay I'll play ball, I do dimly appreciate the nuances of fiscal policy. Let's put it this way, based on the evidence, I have some pretty serious reservations as to the expansionary nature of the proposed deficit spending, and even more about its implications in terms of our long-term debt-to-GDP ratio dynamics. But my short answer to this point is: spoken like someone who's never balanced a checkbook.

 

[Reckoner]

But my short answer to this point is: spoken like someone who's never balanced a checkbook.

Sooo....anyone smart enough to use internet banking? Seriously though, can we put an end to this particular ad hominem, please? It's petty and lazy.

Anyway, with regard to #2, you should check out this series of posts: http://theincidentaleconomist.com/w...health-care-system-so-expensive-introduction/
You're right that growing demand is a factor, but definitely not the only one, nor the largest.

Actually, that whole blog is worthwhile reading if you're interested in healthcare policy.

 

[BlueLabel]

Sooo....anyone smart enough to use internet banking? Seriously though, can we put an end to this particular ad hominem, please? It's petty and lazy.

Anyway, with regard to #2, you should check out this series of posts: http://theincidentaleconomist.com/w...health-care-system-so-expensive-introduction/
You're right that growing demand is a factor, but definitely not the only one, nor the largest.

Actually, that whole blog is worthwhile reading if you're interested in healthcare policy.

Uh if you actually read the paragraph in which that line appears, I think it's pretty clear that the thrust of my argument had nothing to do with her personal finances. That line was really just there for the lulz; because I didn't predicate my argument on that basis no logical fallacy was committed.

For example, it wouldn't be ad hominem if I were to mention in passing that you're an idiot.

 

[notbobtrustme]

But my short answer to this point is: spoken like someone who's never balanced a checkbook.

You don't understand the deficit right now then. The government is making free money off each T-bill issued because the rate on the T-bill is less than inflation/growth. Every T-bill issued today and for the past 5 years has been free money to the government because the return they are getting off those T-bills is worth more than the interest they will pay on it.

Would you refuse a loan of 1,000 dollars at 1% interest when you KNOW that you can get 5% ROI guaranteed? If you say no, then apply that logic to the government.

 

[Reckoner]

Uh if you actually read the paragraph in which that line appears, I think it's pretty clear that the thrust of my argument had nothing to do with her personal finances. That line was really just there for the lulz; because I didn't predicate my argument on that basis no logical fallacy was committed.

For example, it wouldn't be ad hominem if I were to mention in passing that you're an idiot.

Calm down, just trying to keep things civil...

 

[Valar Dohaeris]

Given that the ACA hasn't really been started yet, I don't see how data from 2 years ago is helpful for determining if it saves money.

--Actually, ACA went into effect during the first quarter of 2010. The sequestration and budget changes by the CBO have certainly already impacted hospital systems. Good news: hospitals will not get hosed on free treatment. 60 cents on the dollar isn't bad compared to nothing on the dollar. Bad news: the CBO has already given budget cuts to hospitals around the country. The reason you see many smaller hospitals closing is because they are almost always subsidized by the major tertiary hospitals within a system. The budget cuts make the profit margins on these systems razor-thin. The tertiary hospitals can't fund the smaller hospitals, and they close. This is happening now.

Personally, I am skeptical that the system as a whole will save a lot of money. I think it will help a lot of individual hospitals that right now currently spend a lot of money on charity care. It will reduce a lot of inefficiencies because care providers will no longer have to deal with as many situations where the patient doesn't have insurance.

--Agreed.

If you already have insurance through your employer, there's no reason your premium will increase.

--Again, your premium may increase. Part of the ACA mandated what insurers must cover under a plan. If your employer has to spend more for coverage added through the ACA, the increase in premiums will be passed on to the employee. Kaiser Foundation has several studies showing this already happening. As someone who pays for their own health insurance (employer based), I can say it has happened to me.

Right now, individual insurance companies are coming up with proposals that they have to send to each individual state if they want to participate in these exchanges. Obviously, they are only submitting proposals that are profitable. If the companies can't come up with a profitable proposal that the individual state insurance authorities find acceptable, they are rejected and therefore they just don't participate. So there's nothing for the insurance company or the consumer to lose here.

--Not just any insurance company can hop in the exchange with a decent proposal. We're talking BCBS, Coventry, Cigna, United. The big boys. And it's not so much about it being profitable. The fed just offered to pay for insurance for 37 million people..they already have huge incentives to put forth standardized insurance plans into the exchange.

If you don't like the insurance being sold on the exchanges and you already have insurance, don't buy it. If you don't have insurance, the exchanges are your best option.

I also personally feel that having health insurance is a matter of personal responsibility. Auto insurance is mandatory in every state and no one has a problem with it. This is because even though America is all about respecting people's freedom, we recognize that people do not plan and save enough to pay the large and unpredictable costs associated with a car accident. Given that medical costs for a cancer diagnosis or a major trauma are even higher than the cost of replacing a car, requiring everyone to have health insurance seems even more logical. The 25 year old who feels like he doesn't need insurance because he works out and lifts 3 times a week still feels entitled to care if he gets drunk and falls out a window, or he gets leukemia and needs a bone marrow transplant. The Medicaid expansion, the subsidy program, and even the individual mandate are all important parts of the plan to get health insurance within financial reach for everyone.

Talk about universal health care was definitely something that came up multiple times when I interviewed for medical school...if you are a thinking human being, you should have at least some cursory knowledge of what's going on, and if you are claiming to be passionate about medicine and aspiring to be a physician, then even moreso.

.

 

[Deadlifts]

As for solutions, I've been really impressed with what Dr. Brent James has done at Intermountain over in Utah/Idaho. That's the future.

I can go into more detail if anyone is interested. I work for a large healthcare system in R&D in policy implementation. We look for solutions all day long.

I second this. It's also admirable in the sense that a lot of the quality improvement initiatives they undertake in the organization without a guarantee they will see any savings themselves. Not only are they getting better quality outcomes for patients but it saves [the insurance companies] a boat load of money.

 

[Valar Dohaeris]

I second this. It's also admirable in the sense that a lot of the quality improvement initiatives they undertake in the organization without a guarantee they will see any savings themselves. Not only are they getting better quality outcomes for patients but it saves [the insurance companies] a boat load of money.

And you know what sucks about it? Because fee for service is the current setup, Intermountain has taken serious financial hits. Better outcomes for them = a bottom line in the red. Granted, they do get lots of funding based on their success..but come on. It's almost perverse.

 

[BlueLabel]

You don't understand the deficit right now then. The government is making free money off each T-bill issued because the rate on the T-bill is less than inflation/growth. Every T-bill issued today and for the past 5 years has been free money to the government because the return they are getting off those T-bills is worth more than the interest they will pay on it.

Would you refuse a loan of 1,000 dollars at 1% interest when you KNOW that you can get 5% ROI guaranteed? If you say no, then apply that logic to the government.

I'm well aware of the recent T note yields, unlike you, apparently. The short-term bonds have yielded negative consistently, but the 20- and 30-year note yields have remained over 0 in real dollars for most of the past 5 years. As of today, only the 5-year note has a negative yield. I admit that the low yields together demonstrate widespread confidence (currently) in the ability of our government to service its debts, but you are absolutely, 100% dead wrong when you say "every T bill issued today and for the past 5 years has been free money".

But that isn't really the issue. Nothing at all was said about current market confidence in US debt; rather, I raised questions about the long-term consequences of a high debt-to-GDP ratio and what the ACA means for long-term solvency. By assuming too great of a fiscal burden today, we could be exacerbating an already worrisome long-term picture. It doesn't matter how cheap debt is, you still have to pay the money back eventually.

And remember, the markets will happily lend you way too much money for your own good, then turn on you when they get leery. This is how your debt reaches junk-bond status: see Greece, Spain, Ireland, Portugal, and Italy. It's what we do with the debt we take on that matters, and the implications it has for our fiscal future. That's the point I tried to make before you geniuses jumped all over a one-sentence aside while ignoring multiple paragraphs of supported argument.

 

[BlueLabel]

Calm down, just trying to keep things civil...

I was just raising a hypothetical; I'm cool as a cucumber.

For the record, I happen to think it's pretty lazy to focus on a single, essentially irrelevant point (and mischaracterize it as a logical fallacy) instead of even attempting to deal with the actual substance of an argument.

 

[aesculapian]

I also personally feel that having health insurance is a matter of personal responsibility. Auto insurance is mandatory in every state and no one has a problem with it. This is because even though America is all about respecting people's freedom, we recognize that people do not plan and save enough to pay the large and unpredictable costs associated with a car accident. Given that medical costs for a cancer diagnosis or a major trauma are even higher than the cost of replacing a car, requiring everyone to have health insurance seems even more logical. The 25 year old who feels like he doesn't need insurance because he works out and lifts 3 times a week still feels entitled to care if he gets drunk and falls out a window, or he gets leukemia and needs a bone marrow transplant. The Medicaid expansion, the subsidy program, and even the individual mandate are all important parts of the plan to get health insurance within financial reach for everyone.

Is it terrible that I think this point gets taken too far sometimes? America, the land of the free, the home of the brave.. where no one can take away your right to own a gun! Where you can say all the racial slurs and no one can stop you because you have the right to free speech! Where you can throw a tantrum and shut down the government, all in the name of freedom and liberty and justice for all! ........

Anyway. I thought this quote was pretty well-said so 👍.

 

[aesculapian]

And OP, I'm glad you started this thread. Politics may not be a focus of many pre-meds, but the way health care is provided for in this country should be. To reiterate:

if you are a thinking human being, you should have at least some cursory knowledge of what's going on, and if you are claiming to be passionate about medicine and aspiring to be a physician, then even moreso.

 

[BlueLabel]

Is it terrible that I think this point gets taken too far sometimes? America, the land of the free, the home of the brave.. where no one can take away your right to own a gun! Where you can say all the racial slurs and no one can stop you because you have the right to free speech! Where you can throw a tantrum and shut down the government, all in the name of freedom and liberty and justice for all! ........

Anyway. I thought this quote was pretty well-said so 👍.

So there's this thing called the Bill of Rights...

But I see where you're coming from. In general it seems we're most willing to accept limits on our freedom when we feel unsafe.

 

[Reckoner]

I was just raising a hypothetical; I'm cool as a cucumber.

For the record, I happen to think it's pretty lazy to focus on a single, essentially irrelevant point (and mischaracterize it as a logical fallacy) instead of even attempting to deal with the actual substance of an argument.

I apologize, you didn't use it as ad hom, you're right. That's usually what people are doing when they trot out that particular line, which is what I was referring to. Poorly worded on my part. I didn't respond to the whole post because it's long and I had things to do. The whole "dems can't balance checkbooks" stereotype is just a pet peeve of mine, and I thought it soured an otherwise decent post.
Anyway, I agree with some of what you said, but I still recommend reading that link I posted. It does a good job illustrating just how complex the problem is.

 

[The Kraken]

So there's this thing called the Bill of Rights...

But I see where you're coming from. In general it seems we're most willing to accept limits on our freedom when we feel unsafe.

I like you.

 

[scarletgirl777]

Originally Posted by scarletgirl777 View Post
Given that the ACA hasn't really been started yet, I don't see how data from 2 years ago is helpful for determining if it saves money.

--Actually, ACA went into effect during the first quarter of 2010. The sequestration and budget changes by the CBO have certainly already impacted hospital systems. Good news: hospitals will not get hosed on free treatment. 60 cents on the dollar isn't bad compared to nothing on the dollar. Bad news: the CBO has already given budget cuts to hospitals around the country. The reason you see many smaller hospitals closing is because they are almost always subsidized by the major tertiary hospitals within a system. The budget cuts make the profit margins on these systems razor-thin. The tertiary hospitals can't fund the smaller hospitals, and they close. This is happening now.

--Not just any insurance company can hop in the exchange with a decent proposal. We're talking BCBS, Coventry, Cigna, United. The big boys. And it's not so much about it being profitable. The fed just offered to pay for insurance for 37 million people..they already have huge incentives to put forth standardized insurance plans into the exchange.

The most important part of ACA, the ability for uninsured people to buy affordable health care, started 2 hours ago. The sequestration is not part of the ACA, that was the result of the failure of Congress to come up with a budget, part of an unrelated Tea Party tantrum. Cannot believe we went the greater part of a year without a real budget!

My point about the exchanges is that the existence of the exchanges will not affect premiums of people not in exchanges. Premiums may go up for other reasons both related and unrelated to ACA, but they have nothing to do with the fact that other unrelated people are buying coverage in a separate unrelated health plan. Just because a plan is run by the same insurance company doesn't mean it's related. Many Medicaid plans are run by private insurance companies, and that has no effect on the premiums of the private plans these companies are running.

 

[surfdoc29]

The most important part of ACA, the ability for uninsured people to buy affordable health care, started 2 hours ago. The sequestration is not part of the ACA, that was the result of the failure of Congress to come up with a budget, part of an unrelated Tea Party tantrum. Cannot believe we went the greater part of a year without a real budget!

My point about the exchanges is that the existence of the exchanges will not affect premiums of people not in exchanges. Premiums may go up for other reasons both related and unrelated to ACA, but they have nothing to do with the fact that other unrelated people are buying coverage in a separate unrelated health plan. Just because a plan is run by the same insurance company doesn't mean it's related. Many Medicaid plans are run by private insurance companies, and that has no effect on the premiums of the private plans these companies are running.

Sorry, but that's blatantly incorrect. My wife and I (along with many people I know) received a letter this week stating that the health insurance policy we've held for 2 years is being cancelled due to the ACA. To receive similar coverage we are being forced to choose from plans with premiums nearly double what we were paying before.

Therefore to say that if you already have insurance you like you can just stay on it and your premiums won't be affected by the ACA is entirely false.

 

[BlueLabel]

The most important part of ACA, the ability for uninsured people to buy affordable health care, started 2 hours ago. The sequestration is not part of the ACA, that was the result of the failure of Congress to come up with a budget, part of an unrelated Tea Party tantrum. Cannot believe we went the greater part of a year without a real budget!

My point about the exchanges is that the existence of the exchanges will not affect premiums of people not in exchanges. Premiums may go up for other reasons both related and unrelated to ACA, but they have nothing to do with the fact that other unrelated people are buying coverage in a separate unrelated health plan. Just because a plan is run by the same insurance company doesn't mean it's related. Many Medicaid plans are run by private insurance companies, and that has no effect on the premiums of the private plans these companies are running.

Almost every point made here is wrong.