Beginning of the end, for Obamacare?

[StLucieBengal]

(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.

Do restaurants avoid serving low income areas?  Last time I checked there were them in these areas.   You assumption doctors would leave is absurd.   As absurd that all restaurants would leave because the community is poor .

Where there is a need .... There will be someone there to provide the service.

[oncemoreuntothejimbreech]

(12-04-2015, 09:12 PM)JustWinBaby Wrote: 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.

The billion I mentioned was arbitrary and isn't spread over 300 million people.  Let's use your number, $2T+.  Five percent of $2+ trillion after costs is 100 billion, right?  One hundred billion relative to 2 trillion is peanuts, but still a shit load.

[oncemoreuntothejimbreech]

(12-04-2015, 09:30 PM)JustWinBaby Wrote: 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.

But, price gouging and discriminatory rates are capitalism.

[oncemoreuntothejimbreech]

(12-04-2015, 10:30 PM)StLucieBengal Wrote: 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.

Who is filling the family practitioner void we have now?

[oncemoreuntothejimbreech]

(12-04-2015, 10:33 PM)StLucieBengal Wrote: Do restaurants avoid serving low income areas?  Last time I checked there were them in these areas.   You assumption doctors would leave is absurd.   As absurd that all restaurants would leave because the community is poor .

Where there is a need .... There will be someone there to provide the service.

Then why are there poor areas which are medically underserved currently?

[SunsetBengal]

(12-04-2015, 10:58 PM)oncemoreuntothejimbreech Wrote: Then why are there poor areas which are medically underserved currently?

That, is a loaded question.  The honest answer would cause too many tangent arguments to cover in one thread.

[*Nately120*]

(12-04-2015, 10:33 PM)StLucieBengal Wrote: Do restaurants avoid serving low income areas?  Last time I checked there were them in these areas.   You assumption doctors would leave is absurd.   As absurd that all restaurants would leave because the community is poor .

Where there is a need .... There will be someone there to provide the service.

The types of restaurants in low income areas is decidedly of the cheap and crappy variety.  I don't see why the types of doctors who serve them would be any different.

[oncemoreuntothejimbreech]

(12-04-2015, 11:12 PM)SunsetBengal Wrote: That, is a loaded question.  The honest answer would cause too many tangent arguments to cover in one thread.

The honest answer is these are shitty areas where people don't want to live unless they absolutely have to live in those areas. I know. I grew up I one of those shitty areas. That's why these shitty areas basically buy doctors as indentured servants who leave as soon as the time commitment expires. 

[oncemoreuntothejimbreech]

(12-04-2015, 11:31 PM)SunsetBengal Wrote: Not to mention the bulk of the residents being shitty people, who have little regard for their own lives, or the lives of others..

I grew up in Brown County, Ohio. It's primarily white blue collar tradesmen or farmers who watch Fox News who can't get enough of the baby Jesus and guns who are on the lower end of the socioeconomic scale. 

[oncemoreuntothejimbreech]

Looks like I quoted you before you deleted your answer.

[SunsetBengal]

(12-04-2015, 11:38 PM)oncemoreuntothejimbreech Wrote: I grew up in Brown County, Ohio. It's primarily white blue collar tradesmen or farmers who watch Fox News who can't get enough of the baby Jesus and guns who are on the lower end of the socioeconomic scale. 

Oh, I am quite familiar with that sort of environment.  I own property in Gallia Co. Ohio.  Mostly good folk, with a small percentage of subculture that is addicted to drugs.  Sounds like America, only in smaller doses..

[StLucieBengal]

(12-04-2015, 11:21 PM)Nately120 Wrote: The types of restaurants in low income areas is decidedly of the cheap and crappy variety.  I don't see why the types of doctors who serve them would be any different.

Yes obviously we live in a world where you get what you pay for. Why shouldn't medical be the same way? It's basically that now . We are just fooled into thinking we are covered.

[*Nately120*]

(12-05-2015, 03:07 AM)StLucieBengal Wrote: Yes obviously we live in a world where you get what you pay for.    Why shouldn't medical be the same way?   It's basically that now .  We are just fooled into thinking we  are covered.

Because some people can't pay for good stuff?  I'm just saying if medicine is just another business then low income areas are going to get the McDonald's Value Menu of medical care.

[JustWinBaby]

(12-04-2015, 10:52 PM)oncemoreuntothejimbreech Wrote: The billion I mentioned was arbitrary and isn't spread over 300 million people.  Let's use your number, $2T+.  Five percent of $2+ trillion after costs is 100 billion, right?  One hundred billion relative to 2 trillion is peanuts, but still a shit load.

The billion you mentioned WAS arbitrary, and I used it to make the point that what you THINK sounds like a lot of money ISN'T when spread over 300M+ people.  It's a lot less than $100B, because Healthcare Insurance isn't all of, or even most of, the $2T+ industry.

Insurance is an easy target - that's what pandering, scapegoating politicians tend to do to round up sheeple to vote for them.  It's actually a very small piece of the solution.

Yes, IT IS PEANUTS...and look at how distracted you are and jimmies rustled over peanuts (which, has very debatable benefits when you consider some of the negatives mentioned) instead of demanding real solutions.

[JustWinBaby]

(12-04-2015, 10:54 PM)oncemoreuntothejimbreech Wrote: But, price gouging and discriminatory rates are capitalism.

No, you clearly don't understand capitalism.  Price gouging and discriminatory rates don't happen with free and open markets - it is not sustainable without limits to competition, such as regulation.  And, no, I'm not saying all regulation is bad.

The entire, basic foundation of free markets is that politicians and corporations do not and cannot extract rents from consumers.

[fredtoast]

(12-05-2015, 12:45 PM)JustWinBaby Wrote: No, you clearly don't understand capitalism.  Price gouging and discriminatory rates don't happen with free and open markets - it is not sustainable without limits to competition, such as regulation.  And, no, I'm not saying all regulation is bad.

So that is why there were no monopolies until the government made them illegal?

I think you need to brush up on your history a little.

A completely free market allows the people at the top to keep winning more and more.  They use their wealth to create more wealth in a cycle until an overwhelming majority of society lives in poverty wile a miniscule percentage at the top control all the wealth.

[oncemoreuntothejimbreech]

(12-05-2015, 12:45 PM)JustWinBaby Wrote: No, you clearly don't understand capitalism.  Price gouging and discriminatory rates don't happen with free and open markets - it is not sustainable without limits to competition, such as regulation.  And, no, I'm not saying all regulation is bad.

The entire, basic foundation of free markets is that politicians and corporations do not and cannot extract rents from consumers.

Companies charge as much as they can where they can for as long as they can to make as much profit as possible.  What's not to understand?

The pharmaceutical companies aren't forced to charge exorbantant amounts in the US for the same medications they charge less for in other countries.  They choose to charge the exorbantant amounts.  And look at you trying to blame someone . . . anyone . . . other than the company doing the price gouging.

[*Nately120*]

Ida know, when my ol' man was still alive he had to have brain surgery that was billed at over $150k. I suppose if insurance didn't exist we would have paid out of pocket for that, but I'm not sure the price would have fallen quite enough to make it manageable. That was a single operation, not to mention the scores of visits, MRI's, specialists, post-operation treatments, chemo and so on and so forth. Add into that the "unnecessary" MRI that discovered his cranial bleeding wasn't caused by nasal polyps as diagnosed, but actually a stage C tumor in his brain.

I know the idea is that if one doctor says "I'll do it for $150k" and another says "I'll do it for $100k" it is competition that sets a market value, but legit medical intervention isn't like a cheeseburger where scores of entry-level workers can be given a pre-fabricated burger and assemble it for the masses.

[Benton]

(12-04-2015, 10:33 PM)StLucieBengal Wrote: Do restaurants avoid serving low income areas?  Last time I checked there were them in these areas.   You assumption doctors would leave is absurd.   As absurd that all restaurants would leave because the community is poor .

Where there is a need .... There will be someone there to provide the service.

yeah, because a 100$ office visit (more if there's any tests or medication) is the same as a $1 cheeseburger


plus, look at the restaurants in low income areas. Fast food. Locally owned diners. You aren't going to find a rain forest cafe or a $100 a plate steak joint.

[JustWinBaby]

(12-05-2015, 03:20 PM)fredtoast Wrote: A completely free market allows the people at the top to keep winning more and more.  They use their wealth to create more wealth in a cycle until an overwhelming majority of society lives in poverty wile a miniscule percentage at the top control all the wealth.

No, that is not necessarily the case and a purely socialist view ignorant of how economies and companies actually generate a profit.  Regulation creates plenty of barriers to entry.  Other natural barriers to entry sometimes exist, such as economies of scale (think Amazon), but many monopolies actually come to exist through acquiring competitors. MS is or was basically a monopoly. Google arguably as well. Amazon, even EBay. All those companies, however, have actually created great consumer benefit.

Even then, monopolies are not inherently evil nor does that equate to unfair pricing or gouging.  Capitalism is about supply and demand, not manipulating either side to steal economic rents.

People like to bash capitalism because bashing corporate profits has always been a faceless, victimless crime.

People, and especially politicians, just don't want to admit it's not rich people eating your lunch but, almost literally, tens of millions of skilled workers from India, China, etc coming into the global economy to compete for jobs.