Beginning of the end, for Obamacare?

[oncemoreuntothejimbreech]

(12-05-2015, 12:42 PM)JustWinBaby Wrote: 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.

Well, 300 million aren't paying in.  If you're gonna try to bullshit me, why don't you spread that money over the total population of the globe to make it seem like even less?

If I'm talking about health insurance, why make the comparison to total healthcare unless your goal is to deliberately obfuscate the topic with an apples to oranges comparison?  Okay, pick a number.  Gimme a number for the total costs of health insurance so we can figure out how many billions in profit the insurance companies earn annually so I can watch you rationalize why all those billions in annual profit really aren't billions in annual profit.

Insurance companies are an easy target because they are an easily visible part of the problem.  There is a dance that goes on between the health insurance companies, the health insurance providers, and the government (Medicare/Medicaid).  In order to reduce cost to the tax payer, the government sets limits to what they will reimburse providers for their services.  Sometimes the reimbursement is less than the actual cost of the service the provider provides to the patient.  The insurance companies base their reimbursement schedule to the providers based upon the government limits.  Both the government and the health insurance companies make the reimbursement system so complicated and layered with administrative bullshit they then nickel and dime the providers every step of the way to pay the providers as little as possible IOT frustrate the providers to they point they'll just give up because it is too much of pain in the ass to get paid for the actual work provided.  So the providers (who are busy taking care of patients) have to hire layers and layers of their own administration (coding, billing, etc) to fight the government and the health insurance companies for every nickel and dime due to them for providing the services to the patient in the first place.  Because the provider's administrators need to pay for the layers of administration, the providers, and the provided services they increase the costs of services to make up for the reduced reimbursement they know they will receive.  And that cycle continues ad infinitum. ad naseum.

Not too long ago, I was in an argument with an insurance adjuster (who is a bean counter, not a clinician) over a pre-authorization for an abdominal CT scan because I was worried the patient's pain was caused by an abdominal aortic aneurysm.  Normally, I would order an ultrasound.  It's cheaper and usually just as good to diagnose a AAA.  However, obesity is a known limitation which may cause you to miss the diagnosis.  If an AAA ruptures 50% of patients will die almost immediately.  Therefore, it is important you don't miss the diagnosis.  ***** wants me to order the US instead of the test I ordered because I have tried the US.  I explain to ***** even if the US is negative I'm still going to order the CT which will only increase the total cost.  ***** still wants me to order the test I don't want or need.  Two weeks  ago, another argument with another insurance adjuster over a prescription.  I prescribed a specific medication because out of the possible medications I could use it had the least amount of potential interactions with her medications she was taking which already had possible interactions.  After spending about 30 minutes on the phone with the adjuster, she tells me the prescription would go before the pharmacy board and they would make their decision within the next 7 days . . . while the patient waits.  If you want to be a fluffer for the insurance companies, be my guest, just do it someplace else.

In closing, you can go peddle your bullshit someplace else because I ain't buyin'.

[JustWinBaby]

(12-05-2015, 03:23 PM)oncemoreuntothejimbreech Wrote: 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?

Apparently, in your case, supply and demand.

I don't think you have a clue about how pharma really works, much less the concept of a return on R&D.  You also appear clueless about why drug prices are different in different countries (hint: single payor).

But allow me to fill you in - there is very little profit in global pharma because the prices are generally set to barely cover cost.  So the lionshare of profits - which is where money for R&D comes from - come from the US.  This is what it means when people say the US funds global healthcare.  Sure, I'm all for getting out of that game as soon as Donald Trump tells me how he's going to get Mexico and China to pay their fair share.

I'm not even going to bother talking about patents and why those protections must exist.

[JustWinBaby]

Quote:=oncemoreuntothejimbreech

Well, 300 million aren't paying in. If you're gonna try to bullshit me, why don't you spread that money over the total population of the globe to make it seem like even less?

Sure, you can continue to argue like someone who doesn't understand jack squat about economics, business and finance. You certainly don't need me to help you demonstrate what you are clueless about.

I'm not bullshitting you, you don't know how to analyze the issues. The number of insureds is irrelevant - do you disagree that 300M+ are getting care, and contributing to healthcare costs, whether they have insurance or not? And why is this even a debate when the goal is to insure everyone? Profits of health insurers was never a huge pot of gold, and if you feel like a sucker for believing that you should.

You can continue carrying the good liberal torch because you've drank the kool-aid about who the big baddies are causing all the problems, or you can actually learn what's going on and then maybe demand and vote for people with solutions.

Or you can continue to make senseless rants on a message board and vote for politicians who promise you they will punish the big bad healthcare companies, and then turn around and pass regulations that arbitrarily strengthen the competitive position of those same companies.

[JustWinBaby]

(12-05-2015, 04:09 PM)oncemoreuntothejimbreech Wrote: If you want to be a fluffer for the insurance companies, be my guest, just do it someplace else.

If you want to talk about incompetence which exists in pretty much every industry, then rant on.  But it's really nothing more than a personal anecdote that has little to do with rising healthcare costs.

Don't accuse me of being a fluffer for insurance companies just because you're clueless about economics.  Stick with doctoring.  You're problem is you're so focused on insurance companies scratching out a profit (which is closer to 0 when you remove their investment returns on reserves) that you fail to recognize or acknowledge the role insurance companies have in keeping costs down.

Yet, you cite the govt (Medicare) as the foundation of the nickle and diming and layers of bureacracy and billing created....and so you're solution is more govt, because capitalism is evil? Sounds to me like you actually know govt and regulation is a big part of what is driving the costs, but you just can't admit it. Like a good liberal, more govt is always the solution to ineffective govt.

But it's probably in your own self-interest to pile on the insurance companies hoping nobody will notice doctors and hospitals make comparatively more money in the US, too.

[6andcounting]

Lasik eye surgery and cosmetic plastic surgery have never been covered by insurance and their prices have dropped. When demand is elastic due to price sensitivity of consumers, prices will drop. If everyone demands as much as possible without considering price, suppliers will produce as much as possible and charge as much as possible. This is great because medical supplies and services are available basically everywhere at any time with no waiting lists or resource rationing, but it also prevents prices from falling.

[JustWinBaby]

(12-05-2015, 04:09 PM)oncemoreuntothejimbreech Wrote: Because the provider's administrators need to pay for the layers of administration, the providers, and the provided services they increase the costs of services to make up for the reduced reimbursement they know they will receive.  And that cycle continues ad infinitum. ad naseum.

OK, I get it now.  This is less about the profit insurance companies take from consumers and more about how they turn the screws to take money out of your pocket to pass on to consumers.

[*Nately120*]

(12-05-2015, 04:51 PM)6andcounting Wrote: Lasik eye surgery and cosmetic plastic surgery have never been covered by insurance and their prices have dropped. When demand is elastic due to price sensitivity of consumers, prices will drop. If everyone demands as much as possible without considering price, suppliers will produce as much as possible and charge as much as possible. This is great because medical supplies and services are available basically everywhere at any time with no waiting  lists or resource rationing, but it also prevents prices from falling.

I get what you are saying, but you're also pointing out completely elective surgery (for the most part).  The fact that Lasik has to compete with "just wear contacts" or Zoey whatshername making every woman want to have bad enough eyesight to wear glasses is part of the reason it's more of a service than surgery.  

[JustWinBaby]

(12-05-2015, 05:06 PM)Nately120 Wrote: I get what you are saying, but you're also pointing out completely elective surgery (for the most part).  The fact that Lasik has to compete with "just wear contacts" or Zoey whatshername making every woman want to have bad enough eyesight to wear glasses is part of the reason it's more of a service than surgery.  

And there's other advances, as well, with robotics and other procedures that help costs through lower hospital/recovery times.

There's the real issue that the US subsidizes global healthcare, and then there's a perception problem because sick people ultimately have to fund healthcare.  People don't think of their insurance as partly funding research and advancements for when they do get sick.  People don't understand or see the benefit of insurance they don't use.

I don't know about you, but I can't wait to screw the insurance company out of a few pennies on the dollar when I'm eligible for Medicare!  So much better and no evil capitalist eating my lunch.

I mean, gotta love these debates - the problem is the evil insurers!  But not the largest insurer, mind you.  Nope, because if insurance is the problem than making the largest insurer even larger and a monopoly is clearly the solution.  But, of course, only if it's govt run!

[6andcounting]

(12-05-2015, 05:06 PM)Nately120 Wrote: I get what you are saying, but you're also pointing out completely elective surgery (for the most part).  The fact that Lasik has to compete with "just wear contacts" or Zoey whatshername making every woman want to have bad enough eyesight to wear glasses is part of the reason it's more of a service than surgery.  

Necessary life saving surgery doesn't have a substitute (well, death, but yeah) and people are going to demand it regardless of cost, your point is valid. Even with inelastic demand, prices would still go down if competition has to compete for customers. Health saving plans and catastrophe insurance would address the high costs with life saving medical procedures, while still encouraging people to be price conscious in areas where they want to save money.

[StLucieBengal]

(12-05-2015, 03:18 AM)Nately120 Wrote: 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.

They don't already?

[StLucieBengal]

(12-05-2015, 03:52 PM)Benton Wrote:

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.

You aren't going to fix medicine by giving everyone top tier medical coverage: Even single payer would just be low level medicine for everyone . Just let people pay for the quality of care they want.

This way if people want to bankrupt themselves to make sure they live a few months longer then that's their choice. Or they can sacrifice long term care to help the living.

This should be right up the alley of the pro choice crowd .

[JustWinBaby]

(12-05-2015, 07:48 PM)StLucieBengal Wrote: This should be right up the alley of the pro choice crowd .

No matter the issue, if you want something you cannot afford then someone else should pay for it.  And not a loan you pay back, no no no that would be slavery.

[*Nately120*]

(12-05-2015, 07:58 PM)JustWinBaby Wrote: No matter the issue, if you want something you cannot afford then someone else should pay for it.  And not a loan you pay back, no no no that would be slavery.

So if some guy with $167 in his bank account runs a red light and sends me to the hospital who pays?  Oh it won't matter because without insurance it'll only cost a few hundred bucks to repair and rehabilitate someone for 6-12 months.

[StLucieBengal]

(12-05-2015, 09:33 PM)Nately120 Wrote: So if some guy with $167 in his bank account runs a red light and sends me to the hospital who pays?  Oh it won't matter because without insurance it'll only cost a few hundred bucks to repair and rehabilitate someone for 6-12 months.

Looks like you will take him to court. Maybe the judge will force him to be your butler.

[JustWinBaby]

(12-05-2015, 09:33 PM)Nately120 Wrote: So if some guy with $167 in his bank account runs a red light and sends me to the hospital who pays?  Oh it won't matter because without insurance it'll only cost a few hundred bucks to repair and rehabilitate someone for 6-12 months.

Well, of course, the taxpayer should pay.  And if you happen to be a taxpayer, well then enjoy your white privilege.

[GMDino]

(12-06-2015, 06:26 AM)JustWinBaby Wrote: Well, of course, the taxpayer should pay.  And if you happen to be a taxpayer, well then enjoy your white privilege.

[fredtoast]

(12-05-2015, 06:40 PM)6andcounting Wrote: Necessary life saving surgery doesn't have a substitute (well, death, but yeah) and people are going to demand it regardless of cost, your point is valid. Even with inelastic demand, prices would still go down if competition has to compete for customers. Health saving plans and catastrophe insurance would address the high costs with life saving medical procedures, while still encouraging people to be price conscious in areas where they want to save money.

It is impossible to "value shop" for health care when you do not even know what you need.

Are you seriously going to go to a doctor and tell him what you need, then get an estimate of the cost and go around to other providers?

I did not have health insurance for a short period of time when I first started working for myself.  When I called a doctors office they could not even tell me what an office call would cost because they did not know what the doctor would need to do during that visit.  If you don't believe me then try it yourself.

[*Nately120*]

(12-06-2015, 06:26 AM)JustWinBaby Wrote: Well, of course, the taxpayer should pay.  And if you happen to be a taxpayer, well then enjoy your white privilege.

I refuse to pay taxes until the government can assure me my tax money will only go to all the lazy ass white people on welfare.  We have to send a message, ya know!

[JustWinBaby]

(12-06-2015, 10:14 AM)GMDino Wrote:

Ironic that irony flies over your head yet again. I can explain it for you, if you like.

[StLucieBengal]

(12-06-2015, 12:43 PM)Nately120 Wrote: I refuse to pay taxes until the government can assure me my tax money will only go to all the lazy ass white people on welfare.  We have to send a message, ya know!

Hey if it makes you feel better.... Let's boot everyone off benefits.