Beginning of the end, for Obamacare?

[*Nately120*]

(12-04-2015, 05:57 PM)Benton Wrote: Dems with the majority weren't any better. I remember "Hey, we get elected, we'll get out of a ground war with the wrong people." Which, of course, has turned into multiple ground wars with the wrong people.

Yep, everyone has the answers when they are in no position to do anything about it.  I call that the "backup QB is totally awesome and we need to play him" syndrome of politics.

[Benton]

(12-04-2015, 06:09 PM)StLucieBengal Wrote: House freedom caucas

Ah, when you said there were enough true conservatives to make sure a true bi-partisan agreement was reached, I didn't think you were pinning hopes on 35 of 435 members.



Besides, the Freedom Caucus is composed, by and large, with people who don't want to do much of anything. Not doing anything isn't really reform. 

[GMDino]

(12-04-2015, 06:06 PM)StLucieBengal Wrote: End all health insurance.   Everything is paid out of pocket.   Prices would drop like a rock and doctors would be more focused on patient care like they used to be.   You would see a lot more personal service from your doctor to keep your business.    Big jump in concierge care.

Serious question:  How do you think that would affect the number of doctors available?

I totally agree insurance is a huge scam, but wouldn't your idea drive down doctor pay so much few would enter the field?

[StLucieBengal]

(12-04-2015, 06:36 PM)GMDino Wrote: Serious question:  How do you think that would affect the number of doctors available?

I totally agree insurance is a huge scam, but wouldn't your idea drive down doctor pay so much few would enter the field?

Possibly. Which would affect the field 15-20 years down the line.     I think we would see more nurse practitioners working under a doctor.   But most typical doctor visits can be handled by the NP.  

I think we would see the most dedicated to medicine still enter the field.

I will admit that we may have a tough 3-6 months or so as the market adjusts.

[GMDino]

(12-04-2015, 06:41 PM)StLucieBengal Wrote: Possibly. Which would affect the field 15-20 years down the line.     I think we would see more nurse practitioners working under a doctor.   But most typical doctor visits can be handled by the NP.  

I think we would see the most dedicated to medicine still enter the field.

I will admit that we may have a tough 3-6 months or so as the market adjusts.

Follow up:  Isn't that also against the "free market" determining wages and prices?  If the number of doctors is cut in half they can charge more for their services.  I get that without the mark ups and middle men prices should drop...but you still can't just go to the mall and get a polio shot or get an arm reattached.  

Its just more complicated than that.

Single payer is still the best, but it won't happen for the same reasons.  No one in the field wants to start making less for what they do.

[StLucieBengal]

(12-04-2015, 06:47 PM)GMDino Wrote: Follow up:  Isn't that also against the "free market" determining wages and prices?  If the number of doctors is cut in half they can charge more for their services.  I get that without the mark ups and middle men prices should drop...but you still can't just go to the mall and get a polio shot or get an arm reattached.  

Its just more complicated than that.

Single payer is still the best, but it won't happen for the same reasons.  No one in the field wants to start making less for what they do.

Single payer locks down prices at the federal level .

My suggestion allows local markets to set their prices. So low income areas pay less. Doctors will get what people are willing to pay .

A doctors charges $100 (made up number) for a visit now because they can ... I they can get that much under my proposal then they will charge it. If they can only get $20 then they need more customers.

Doctors are people and people want to make the most money they can. It will come down to what people are willing to pay. That's why I mentioned concierge medicine above. You pay like a club fee and then get discounted rates. It's almost like the doctor is insuring you to an extent. What happens when he insures you..... He doesn't waste money on useless tests or medicines.

[Benton]

(12-04-2015, 06:53 PM)StLucieBengal Wrote: Single payer locks down prices at the federal level .

My suggestion allows local markets to set their prices.   So low income areas pay less.   Doctors will get what people are willing to pay .  

A doctors charges $100 (made up number) for a visit now because they can ...  I they can get that much under my proposal then they will charge it.   If they can only get $20 then they need more customers.  

Doctors are people and people want to make the most money they can.    It will come down to what people are willing to pay.  That's why I mentioned concierge medicine above.    You pay like a club fee and then get discounted rates.   It's almost like the doctor is insuring you to an extent.   What happens when he insures you.....  He doesn't waste money on useless tests or medicines.

This line of thinking is the same kind of logic tech guys use when they recommend the cheapest printer for your department, without consulting service guys... and you end up with printers that cost more in toner than you paid for them.

[oncemoreuntothejimbreech]

(12-04-2015, 06:06 PM)StLucieBengal Wrote: End all health insurance.   Everything is paid out of pocket.   Prices would drop like a rock and doctors would be more focused on patient care like they used to be.   You would see a lot more personal service from your doctor to keep your business.    Big jump in concierge care.

How do you propose getting rid of the health insurance companies and why do you hate capitalism?  If prices drop like a rock, what makes you think doctors would be more focused on patient care and not on their dwindling revenue?  If doctors aren't focused on patient care now, what are they focused on?  More and more people would be unable to afford their care and this would only further exacerbate a pre-existing problem.

[oncemoreuntothejimbreech]

(12-04-2015, 06:41 PM)StLucieBengal Wrote: Possibly. Which would affect the field 15-20 years down the line.     I think we would see more nurse practitioners working under a doctor.   But most typical doctor visits can be handled by the NP.  

I think we would see the most dedicated to medicine still enter the field.

I will admit that we may have a tough 3-6 months or so as the market adjusts.

If the prices drop like a rock doctors and their dwindling revenue aren't going to hire more NPs, they will hire less to reduce their overhead.  We already have a shortage of family practice doctors because of specialization and this will encourage more doctors to specialize further exacerbating the FP shortage.

[oncemoreuntothejimbreech]

(12-04-2015, 06:53 PM)StLucieBengal Wrote: Single payer locks down prices at the federal level .

My suggestion allows local markets to set their prices.   So low income areas pay less.   Doctors will get what people are willing to pay .  

A doctors charges $100 (made up number) for a visit now because they can ...  I they can get that much under my proposal then they will charge it.   If they can only get $20 then they need more customers.  

Doctors are people and people want to make the most money they can.    It will come down to what people are willing to pay.  That's why I mentioned concierge medicine above.    You pay like a club fee and then get discounted rates.   It's almost like the doctor is insuring you to an extent.   What happens when he insures you.....  He doesn't waste money on useless tests or medicines.

Low income areas are underserved areas.  Low income areas which pay less will see their doctors migrate to areas which pay more and new doctors avoiding underserved, low income areas altogether. This will send the low income areas without doctors to the EDs further exacerbating the inappropriate use of the ED for routine care to receive care they can't pay for and the debt burden will be shifted upon the tax payer.  I don't waste money on tests and medicines now.  More than likely, I'm arguing with an insurance adjuster to pay for the test I did order which they don't want to pay for.  More often than not, I'm arguing with the patient not to order a test or prescribe a medication which they don't need.

[JustWinBaby]

(12-04-2015, 06:36 PM)GMDino Wrote: I totally agree insurance is a huge scam, but wouldn't your idea drive down doctor pay so much few would enter the field?

Why do you think this?  You do realize average margins for health insurance companies is only in the neighborhood of 5%?  Healthcare care costs are not being driven by insurance, which is why the alleged savings of Obamacare was always a fraudulent case.

Pricing for drugs, doctors and hospitalization is all whacked out.  Insurance companies only pay like 10-20% of that price, which is why we need insurance.  That's really the point StLucie is making because it doesn't operate like a free market.

Supposedly cash payers can negotiate pricing, but I don't know how anyone does that after the fact coming in to the emergency room for chest pains or a broken leg.  Unless you're worth $10M+, it only takes one fairly serious incident (or medication) in your lifetime to wipe out whatever you saved being uninsured.

[Vas Deferens]

(12-04-2015, 07:47 PM)oncemoreuntothejimbreech Wrote: Low income areas are underserved areas.  Low income areas which pay less will see their doctors migrate to areas which pay more and new doctors avoiding underserved, low income areas altogether. This will send the low income areas without doctors to the EDs further exacerbating the inappropriate use of the ED for routine care to receive care they can't pay for and the debt burden will be shifted upon the tax payer.  I don't waste money on tests and medicines now.  More than likely, I'm arguing with an insurance adjuster to pay for the test I did order which they don't want to pay for.  More often than not, I'm arguing with the patient not to order a test or prescribe a medication which they don't need.

Don't worry, some magical charity will take care of all of this so tax payers don't have to.

[oncemoreuntothejimbreech]

(12-04-2015, 07:58 PM)JustWinBaby Wrote: Why do you think this?  You do realize average margins for health insurance companies is only in the neighborhood of 5%?  Healthcare care costs are not being driven by insurance, which is why the alleged savings of Obamacare was always a fraudulent case.

Pricing for drugs, doctors and hospitalization is all whacked out.  Insurance companies only pay like 10-20% of that price, which is why we need insurance.  That's really the point StLucie is making because it doesn't operate like a free market.

Supposedly cash payers can negotiate pricing, but I don't know how anyone does that after the fact coming in to the emergency room for chest pains or a broken leg.  Unless you're worth $10M+, it only takes one fairly serious incident (or medication) in your lifetime to wipe out whatever you saved being uninsured.

What's 5% of a billion dollars?  A shit load.  That's the BS the insurance tell you, we only make a pitiful 4% profit.  They aren't hurting for money.  There are not-for-profit insurance companies sitting on piles of money which far exceed their liability if all their customers turned in a claim simultaneously.  Insurance companies aren't the sole reason for increased costs, but they are a significant reason.  Pharmaceutical companies are responsible for serious price gouging in the US for the same medications which sell for significantly less in other countries.  A capitalism model you defend.  All of this is capitalism.  You can't defend capitalism on one hand then complain about the cost of capitalism.

[oncemoreuntothejimbreech]

I'm curious, why is it those who defend capitalism believe companies can charge whatever they want, but not when it comes time for them to pay for their own healthcare?

[JustWinBaby]

(12-04-2015, 08:08 PM)oncemoreuntothejimbreech Wrote: What's 5% of a billion dollars?  A shit load.  That's the BS the insurance tell you, we only make a pitiful 4% profit.  They aren't hurting for money.  There are not-for-profit insurance companies sitting on piles of money which far exceed their liability if all their customers turned in a claim simultaneously.  Insurance companies aren't the sole reason for increased costs, but they are a significant reason.  Pharmaceutical companies are responsible for serious price gouging in the US for the same medications which sell for significantly less in other countries.  A capitalism model you defend.  All of this is capitalism.  You can't defend capitalism on one hand then complain about the cost of capitalism.

What's a billion dollars spread over 300M people?  Not even enough for a cup of coffee at Starbucks.  That's the problem when this debate is always framed in dollars instead of the relevant metrics.  Healthcare is a $2T+ industry in the US alone - the 5% margin to health insurers is peanuts relative to the total cost.

5% off your bill.  That's what insurance is taking from you.  You get rid of that, and maybe some additional savings on administrative costs....you get maybe a one-time decrease of 10%, and then costs will resume their upward trajectory - incrementally cost increases would be 5% lower (so 5.7% instead 6% or whatever).

I don't begrudge what doctors and surgeons make - they made a huge investment in themselves.  The fat margins are mainly in pharma and equipment.  The US subsidizes global healthcare.  That's the other big part of it.

[GMDino]

(12-04-2015, 07:58 PM)JustWinBaby Wrote: Why do you think this?  You do realize average margins for health insurance companies is only in the neighborhood of 5%?  Healthcare care costs are not being driven by insurance, which is why the alleged savings of Obamacare was always a fraudulent case.

Pricing for drugs, doctors and hospitalization is all whacked out.  Insurance companies only pay like 10-20% of that price, which is why we need insurance.  That's really the point StLucie is making because it doesn't operate like a free market.

Supposedly cash payers can negotiate pricing, but I don't know how anyone does that after the fact coming in to the emergency room for chest pains or a broken leg.  Unless you're worth $10M+, it only takes one fairly serious incident (or medication) in your lifetime to wipe out whatever you saved being uninsured.

I think its a scam in the sense that you pay for something you hope you never need to use.  When you DO use it they don't cover everything no matter how long you paid in to it.  And then they charge you more for the pleasure of having used something you paid for in case you needed to use it.


That's all....

[JustWinBaby]

(12-04-2015, 08:22 PM)oncemoreuntothejimbreech Wrote: I'm curious, why is it those who defend capitalism believe companies can charge whatever they want, but not when it comes time for them to pay for their own healthcare?

I wasn't defending capitalism but merely stating facts - I'm curious as to why you can't understand either.

Second, opposing price gouging and discriminatory rates is not opposing capitalism - you have that very backwards.

[JustWinBaby]

(12-04-2015, 09:25 PM)GMDino Wrote: I think its a scam in the sense that you pay for something you hope you never need to use.  When you DO use it they don't cover everything no matter how long you paid in to it.  And then they charge you more for the pleasure of having used something you paid for in case you needed to use it.


That's all....

You get what you pay for - that's pretty much the opposite of being scammed.  EVERY type of insurance is irrational to purchase in terms of expected value.  There's a whole range of options available (or there were, prior to Obamacare) according to your risk preferences.

[StLucieBengal]

(12-04-2015, 09:36 PM)JustWinBaby Wrote: You get what you pay for - that's pretty much the opposite of being scammed.  EVERY type of insurance is irrational to purchase in terms of expected value.  There's a whole range of options available (or there were, prior to Obamacare) according to your risk preferences.

I miss my choices pre Obamacare.

[StLucieBengal]

(12-04-2015, 07:38 PM)oncemoreuntothejimbreech Wrote: If the prices drop like a rock doctors and their dwindling revenue aren't going to hire more NPs, they will hire less to reduce their overhead.  We already have a shortage of family practice doctors because of specialization and this will encourage more doctors to specialize further exacerbating the FP shortage.

I am quite sure someone will fill the void left and grind out patients.  Besides if a doctor is good patients will stay with them.    I am fully aware profits will drop and probably run some out of the business.    This will force changing how they conduct their practices.   I don't see a problem with that...   People will go where they get the best care for the cost.  

The neighborhood doctor would actually return.