ACA Effectiveness on Uninsured

[Belsnickel]

Just an interesting map and article to look at as far as how much the uninsured rates have dropped in each state.

http://www.vox.com/2016/1/6/10685676/uninsured-decline-rate

I'd like to see more information as far as costs, but not the overall rises in insurance costs (since those are not all caused by the ACA, as much as some would like us to believe, there were other factors in addition to that). The effectiveness of the Medicaid expansion is pretty clear, the question becomes how sustainable the expansion is int he long run.

[*wildcats forever*]

Getting people insured is a huge accomplishment, but keeping it affordable for 'meaningful coverage' is a healthcare reform act shortfall.

I don't know if you see it in your area, but where I live (Northern Kentucky) we have one organization, St. Elizabeth, that owns every medical service - hospitals, doctors, labs. The only competition is if you cross the river into Ohio, and when you do that you must remain in the network your insurer has established. No real cost control that one can see; just a monopoly. And that's an aspect that bothers me the most. No cost control, and no opportunity to shop around in the community in which I live.

Another cost aspect is the over-charging that occurs from St. Elizabeth, one that I personally experienced. After auditing a bill with the hospital. it went down over 20% after eliminating multiple charges for the same item, and eliminating line items for services not rendered.

Making healthcare available to all, plus establishing minimum coverage that makes sense are but two items that are necessary. Affordability for services and pharmaceuticals have yet to be addressed, at least not effectively. If you ever do get to see the detailed costs, it won't be a pretty picture regarding the impact on the average citizen.

[StLucieBengal]

Forcing coverage that's not needed is the issue.

[*wildcats forever*]

(01-06-2016, 02:40 PM)StLucieBengal Wrote: Forcing coverage that's not needed is the issue.

Where do you think coverage is not needed?

[fredtoast]

(01-06-2016, 02:40 PM)StLucieBengal Wrote: Forcing coverage that's not needed is the issue.

The issue is that insurance is not needed because we have hospitals that do not refuse service.

So why make all the hospitals paying customers pick up the tab for people who could afford insurance  but don't buy it because they still know they will be treated.

[Belsnickel]

(01-06-2016, 02:18 PM)wildcats forever Wrote: Getting people insured is a huge accomplishment, but keeping it affordable for 'meaningful coverage' is a healthcare reform act shortfall.

I don't know if you see it in your area, but where I live (Northern Kentucky) we have one organization, St. Elizabeth, that owns every medical service - hospitals, doctors, labs. The only competition is if you cross the river into Ohio, and when you do that you must remain in the network your insurer has established. No real cost control that one can see; just a monopoly. And that's an aspect that bothers me the most. No cost control, and no opportunity to shop around in the community in which I live.

Another cost aspect is the over-charging that occurs from St. Elizabeth, one that I personally experienced. After auditing a bill with the hospital. it went down over 20% after eliminating multiple charges for the same item, and eliminating line items for services not rendered.

Making healthcare available to all, plus establishing minimum coverage that makes sense are but two items that are necessary. Affordability for services and pharmaceuticals have yet to be addressed, at least not effectively. If you ever do get to see the detailed costs, it won't be a pretty picture regarding the impact on the average citizen.

We used to have a local hospital that was independent and while they had centers in areas that maybe lacked access to healthcare, most of the physicians and whatnot in the area were independent of the hospital system but had admitting and visiting privileges. So if you had to go in for something, your GP could come in and check on you.

A few years ago, Sentara purchased the independent hospital. Sentara is a sizable 'non-profit' based out of Norfolk that covers areas in most of Virginia. Now, all of those independent doctors can no longer come in to see their patients and some of the more 'mom and pop' feel has been lost (though in truth it was lost when they moved from the building my office is currently in to their new campus, yes I work in a former hospital). The staff haven't been too keen on it as there is a much larger focus on efficiency and what not. All of that being said, I can't speak much to the cost since I've only really started going to the doctor regularly and have been treated for things since the buyout, but I have found it overall not so bad.

We have enough competition here for the outpatient stuff that it keeps them more on their toes, I think. We also have independent lab companies, so that helps. Me personally, I actually utilize Sentara RMH services for all medical stuff because I like having my record more easily accessible between my GP and any specialists I may have to see.

All of that being said, what you point out in this post is getting at my issue all along with the "health care reform". It's not really reforming health care, it's just getting people insured. It isn't addressing the fact that the costs for these goods and services are what the real issue is and why it costs so much more for us than some other countries. It's exactly what doctors do to something they don't know how to cure, they treat the symptoms, not the disease itself. But we really need to start focusing on the disease.

[*wildcats forever*]

(01-06-2016, 02:54 PM)fredtoast Wrote: The issue is that insurance is not needed because we have hospitals that do not refuse service.

So why make all the hospitals paying customers pick up the tab for people who could afford insurance  but don't buy it because they still know they will be treated.

God forbid one of those uninsured gets something like MRSA, where the only effective medication costs something like $4500 for a two week prescription. Hospitals aren't doling out pharmaceuticals like that to UI ER patients. An extreme example maybe, but with rising drug costs, the cost of a couple of monthly prescriptions go a long way toward buying insurance that is good enough to offset that kind of out-of-pocket expense. 

Requiring all to have insurance is one of the first steps toward cost containment (if that is at all possible w/o a complete government takeover). It's just that there is a long road ahead to make any meaningful stride toward affordability for all.

[*wildcats forever*]

(01-06-2016, 02:58 PM)Belsnickel Wrote: We used to have a local hospital that was independent and while they had centers in areas that maybe lacked access to healthcare, most of the physicians and whatnot in the area were independent of the hospital system but had admitting and visiting privileges. So if you had to go in for something, your GP could come in and check on you.

A few years ago, Sentara purchased the independent hospital. Sentara is a sizable 'non-profit' based out of Norfolk that covers areas in most of Virginia. Now, all of those independent doctors can no longer come in to see their patients and some of the more 'mom and pop' feel has been lost (though in truth it was lost when they moved from the building my office is currently in to their new campus, yes I work in a former hospital). The staff haven't been too keen on it as there is a much larger focus on efficiency and what not. All of that being said, I can't speak much to the cost since I've only really started going to the doctor regularly and have been treated for things since the buyout, but I have found it overall not so bad.

We have enough competition here for the outpatient stuff that it keeps them more on their toes, I think. We also have independent lab companies, so that helps. Me personally, I actually utilize Sentara RMH services for all medical stuff because I like having my record more easily accessible between my GP and any specialists I may have to see.

All of that being said, what you point out in this post is getting at my issue all along with the "health care reform". It's not really reforming health care, it's just getting people insured. It isn't addressing the fact that the costs for these goods and services are what the real issue is and why it costs so much more for us than some other countries. It's exactly what doctors do to something they don't know how to cure, they treat the symptoms, not the disease itself. But we really need to start focusing on the disease.

It's a battle with many fronts. We've skimmed the surface on the provider side, but I'm thinking the insurer side is a major obstacle. Yeah they offer a service and charge a fee accordingly, like any business does......with some exceptions. 

As an example, I had a doctor (great man and even better physician) who became so frustrated with the difficulty in getting paid by the insurance companies and Medicare that he stopped honoring them. He changed to a cash-only business model, and then provided his patients with the necessary paperwork to apply for reimbursement. BTW his office call was only $50, about half of what the insurance billing rate was at the time. The insurance company's response to that was to no longer honor any prescriptions that doctor wrote. I had no choice but to change doctors to their network, unless I wanted to pay the total cost for my pharmaceuticals. A strong-armed tactic to preserve their monopoly.

And like Fred pointed out, the uninsured's costs are born by the rest of the paying public. Except for the fact that the providers raise there rates to recoup these losses by a factor so conservative that fewer and fewer found it not possible to keep paying the increase to their budget. Try to get your hands on those rate and cost figures.....

The financial impact on the unhealthy, ageing and elderly will just take some people out of the game of life, unless something like a single-payer/non-profit system is put into place....I think. And if you're thinking "Ha - that'll never happen to me", think again. We're talking about the human body, one of Nature's more frail entities. With science playing God with our food system, and industry wreaking havoc with our environment, your guess is as good as mine regarding long-term needs for decent health maintenance. The greed aspect has to be rolled back in the healthcare industry, and relatively soon.

[StLucieBengal]

(01-06-2016, 02:42 PM)wildcats forever Wrote: Where do you think coverage is not needed?

There is a lot of coverage that Obamacare forces us to take.... Like a single man still paying for a women's birth control coverage. There are loads of other examples. We should get to pick as choose what coverage we want.... But Ofc it won't work that way because this is how Obamacare inflates the rates for those who don't need some of these coverages.

[StLucieBengal]

(01-06-2016, 02:54 PM)fredtoast Wrote: The issue is that insurance is not needed because we have hospitals that do not refuse service.

So why make all the hospitals paying customers pick up the tab for people who could afford insurance  but don't buy it because they still know they will be treated.

I am ok with letting hospitals refuse service.

[fredtoast]

(01-06-2016, 08:12 PM)StLucieBengal Wrote: I am ok with letting hospitals refuse service.

Then you should move to a country that agrees with you instead of crying about it here.

[fredtoast]

(01-06-2016, 08:10 PM)StLucieBengal Wrote: There is a lot of coverage that Obamacare forces us to take....  Like a single man still paying for a women's birth control coverage.    There are loads of other examples.    We should get to pick as choose what coverage we want....   But Ofc it won't work that way because this is how Obamacare inflates the rates for those who don't need some of these coverages.

The only way to make the coverage affordable is to spread out the risk.

[fredtoast]

I also have to add the same disclaimer that I post in every thread aboput the ACA..........I don't like it because it was a sell out to the insurance companies. We should have had single pay system instead.

[SunsetBengal]

(01-06-2016, 11:48 PM)fredtoast Wrote: The only way to make the coverage affordable is to spread out the risk.

As long as women's cost are affected by the same factor, for having to help cover things related specifically to men, such as prostate cancer, E.D., low T, etc.  Then all is fair.  right?

[fredtoast]

(01-07-2016, 12:11 AM)SunsetBengal Wrote: As long as women's cost are affected by the same factor, for having to help cover things related specifically to men, such as prostate cancer, E.D., low T, etc.  Then all is fair.  right?

Except for ED that is the way it works.

[GMDino]

(01-06-2016, 08:12 PM)StLucieBengal Wrote: I am ok with letting hospitals refuse service.

How very "Christian Nation" of you.

[Mike M (the other one)]

(01-06-2016, 11:50 PM)fredtoast Wrote:  We should have had single pay system instead.

I can agree with that last statement, and would like to add For all USC's and green card holders and make sure it stays non-profit.

[Belsnickel]

(01-07-2016, 09:44 PM)Mike M (the other one) Wrote: I can agree with that last statement, and would like to add For all USC's and green card holders and make sure it stays non-profit.

Problem is that the people don't want to pay for it.

[*wildcats forever*]

(01-07-2016, 09:48 PM)Belsnickel Wrote: Problem is that the people don't want to pay for it.

A well-thought-out plan, presented properly by respected authorities would go a long way towards relieving common apprehensions. Bernie Sanders may be the only Presidential candidate that has put any energy into the subject. We need more 'public servants' chime in with their ideas, if that is at all possible.

[StLucieBengal]

(01-06-2016, 11:48 PM)fredtoast Wrote: The only way to make the coverage affordable is to spread out the risk.

I know. This is why I think we should be zero insurance system. We have subsidized the world's medicine enough.