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Wednesday, August 01, 2012

OTP- August 2012: The Leader Post: New stadium won’t have same appeal, says Bill ‘Spaceman’ Lee

“Building a new stadium down the street does not work unless (Ron) Lancaster spilled some DNA in the lot where they’re going to build the new stadium,” he added. “You have to refurbish (Mosaic Stadium). You’ve got to can all new ideas you might have and use the sacred ground. Fenway did that and that is why Fenway is loved. The new Yankee Stadium isn’t the same as it used to be.”

The former Boston Red Sox and Montreal Expos pitcher will not be running for the vacant mayor’s position in Regina later this year. With his opinion on the new stadium, he wasn’t sure he would garner many votes anyway. But that is nothing new to the former member of the Rhinoceros Party. Lee ran on the Rhino ticket in 1988 for president of the United States. Not surprisingly, he didn’t make the ballot in a single state. He said one of the high-ranking members within the party gave him a six-pack of Molson Canadian and asked him to run for president.

“I adhered to their funny philosophy,” Lee said. “My campaign slogan was ‘No guns, no butter. They’ll both kill you.’ And I only campaigned in federal prisons where I knew they couldn’t vote, and I only accepted a quarter in campaign contributions.”

With it being an election year in the U.S., Lee said he is all in for the re-election of Barack Obama.

“The only time (Mitt) Romney opens his mouth is when he needs to change feet,” Lee said of the Republican nominee. “If Obama does lose this, which I can’t see happening, then it’s because of a lady in Florida who works for Jeb Bush and Diebold, the voting-machine company. If Obama even comes close to losing this election, it’ll be fraud.”

Guess what, its the new OT politics thread!

Tripon Posted: August 01, 2012 at 12:04 AM | 5975 comment(s) Login to Bookmark
  Tags: boston, politics

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   2001. zonk Posted: August 14, 2012 at 11:21 AM (#4207951)

If the health industry as a whole raises prices by a billion to pay for the billion in rebates (which they can do if it's a built-in cost that the entire industry has to pay and there aren't large differences among the companies in administrative costs), it's the equivalent of playing "Got Your Nose" with a toddler.


Except you're conflating the health care industry with the insurance industry.... and the beauty here is that it does the insurance industry no good to try to make up the difference by changing reimbursement rates with providers because they'll still be bumping against the MLR caps.


Except you're not funding a public retiree health insurance option. You're providing general tax revenue to the Treasury. Didn't you guys above just scold Joe for arguing that Medicare taxes were some magic taxes that were different?


I'm playing on whatever turf the match is scheduled. My objection is that lack of correlation between payroll taxes and the deficit/debt impact. Both Medicare and Social Security are sitting on surpluses - i.e., the 'trust funds'. Those trust funds are financing the debt - to much larger extent than is, say, China. The exhaustion of those trust funds as benefits eventually outstrip revenue isn't an issue I'm trying to ignore -- but we ought to talk about it in the proper context... and that proper context is that those programs are a creditor of that debt, not a cause of that debt.

I'm perfectly willing to approach payroll taxes as independent from other taxes -- but then, we also need to approach the budgets and deficit impacts as equally separate entities. Or - we can bundle them all under a singular "tax burden" and then likewise look at the budget - including entitlements - as a whole.

What I won't do is split the programs -- revenue and benefits -- into two separate things because the convenience of distinction disappears on the spending side.

Sooo... pick A or B, I'll argue either - but apply A or B to both ends, not A at the front and B at the back.
   2002. zonk Posted: August 14, 2012 at 11:23 AM (#4207953)

Unless, of course, they simply raise the cost and just agree to pay providers more, essentially splitting premium increases from the consumer with providers, without actually providing any additional healthcare or administrative costs.


Wouldn't work - MLR binds the insurer. They pay the provider more - they simply pay the provider more and still end up having to an 80% (actually, I think it's 85% for large plans) MLR cap.

Unless you're suggesting illegal activities like kickbacks, I guess.
   2003. Dan Szymborski Posted: August 14, 2012 at 11:28 AM (#4207958)
I pay health insurance premiums. My expectation is that my premiums will be used primarily for health related services, and if they aren't spending the money I'm paying them to provide health related services on actual health related services, I shouldn't be paying them so much. I suppose the counter argument is "who cares what they spend it on?" which doesn't make that much sense to me, but that seems to be the position Dan is taking.

If I agree to a contract with a third party, it's none of my business how that money is used, outside of how it effects my willingness to enter into other future, voluntary transactions.


I guess I don't really get the argument against the 80% rule that doesn't amount to "it's not fair to lower their profits!", which I suppose brings us back to the question of why the profit motive in health insurance exists in the first place.


Why wouldn't it? It doesn't become some magical special thing just because the word "health" is in it. In fact, the part of the economy that deals with housing and the part of the economy that deals with food are far more crucial to health than the health market is.
   2004. Dan Szymborski Posted: August 14, 2012 at 11:33 AM (#4207961)
I'm playing on whatever turf the match is scheduled. My objection is that lack of correlation between payroll taxes and the deficit/debt impact. Both Medicare and Social Security are sitting on surpluses - i.e., the 'trust funds'. Those trust funds are financing the debt - to much larger extent than is, say, China. The exhaustion of those trust funds as benefits eventually outstrip revenue isn't an issue I'm trying to ignore -- but we ought to talk about it in the proper context... and that proper context is that those programs are a creditor of that debt, not a cause of that debt.

Again, your taxes didn't go to that specific purpose. The government can use the taxes that are labeled for Medicare for anything it wants.
   2005. Dan Szymborski Posted: August 14, 2012 at 11:35 AM (#4207964)
Unless you're suggesting illegal activities like kickbacks, I guess.

I'm not talking actual collusion - healthcare providers can easily see for their own that companies need to meet a quota and adjust their prices accordingly. It's no more a kickback than people selling corn for more because they know the industry had an ethanol quota they had to legally fill. It provides an incentive for higher costs for providing health care - the more that's paid for health care, the easier it is to meet the 80% quota. Medicare's efficiency in this quota is in part because their patients are, on average, sicker, which increases the costs and makes it easier to have a higher percentage of benefits going to health care.
   2006. Los Angeles El Hombre de Anaheim Posted: August 14, 2012 at 11:41 AM (#4207967)
Bouncing back to AWG news, Arctic ice could vanish in 10 years, scientists warn:
Data shows ice melting 50% faster than predicted by some polar scientists

Arctic sea ice is melting at a pace so much faster than once thought that the latest projections say it might disappear by as soon as 2022, according to measurements from the European Space Agency.

An analysis from the CryoSat-2 probe, launched two years ago as a purpose-built satellite for studying the thickness of Arctic ice, suggests that 900 cubic kilometres of ice have disappeared every year since 2004.

At such a dramatic rate, scientists say it's possible in 10 years that the Arctic could be ice-free for at least a day.
Your regular caveats apply.
   2007. Ron J2 Posted: August 14, 2012 at 11:41 AM (#4207969)
#1983 I can even cite an example from the health care field. Provinces negotiate huge generic drug purchases with the publicly stated purpose of using their tremendous bargaining power to drive down the price.
   2008. zonk Posted: August 14, 2012 at 11:42 AM (#4207972)
Again, your taxes didn't go to that specific purpose. The government can use the taxes that are labeled for Medicare for anything it wants.


No, legally it cannot. Those taxes go directly to the 4 individual funds (SS, SSDI, Medicare, and survivors, IIRC) under the umbrella Social Security trust fund. Neither congress nor the President has any authority to disperse those funds for purposes other than the programs themselves:


Notwithstanding any other provision of law, the receipts and disbursements of the Federal Old-Age and Survivors Insurance Trust Fund and the Federal Disability Insurance Trust Fund shall not be counted as new budget authority, outlays, receipts, or deficit or surplus for purposes of - (1) the budget of the United States Government as submitted by the President, (2) the congressional budget, or (3) the Balanced Budget and Emergency Deficit Control Act of 1985


Now - those trust funds are empowered to invest the surplus in Treasuries -- but just like you buying a bond has zero bearing on what that bond goes to pay for, so too with SS's investments.
   2009. zonk Posted: August 14, 2012 at 11:50 AM (#4207978)
I'm not talking actual collusion - healthcare providers can easily see for their own that companies need to meet a quota and adjust their prices accordingly. It's no more a kickback than people selling corn for more because they know the industry had an ethanol quota they had to legally fill. It provides an incentive for higher costs for providing health care - the more that's paid for health care, the easier it is to meet the 80% quota. Medicare's efficiency in this quota is in part because their patients are, on average, sicker, which increases the costs and makes it easier to have a higher percentage of benefits going to health care.


Except reimbursement rates are not negotiated as floating rates -- reimbursement rates are generally multi-year arrangements with providers or at most often, annually. And again - the baseline/floor for negotiations starts with CMS's rates.

And BTW - Medicare's MLR isn't 80% -- it's at least 90%, regardless of whose numbers you use. I'd also disagree with you regarding why Medicare hits this number, but it's immaterial to this discussion.
   2010. CrosbyBird Posted: August 14, 2012 at 12:07 PM (#4207986)
If I agree to a contract with a third party, it's none of my business how that money is used, outside of how it effects my willingness to enter into other future, voluntary transactions.

You'd leave open the option for that third-party to make certain guarantees of how the money is spend in contract, wouldn't you? In other words, you'd allow me to put terms in an insurance contract providing me with rebates if you don't pay out a certain percentage of charged premiums, right? Then it would be my business.

A friend of mine who works for an insurance company claims that the 85% rule is basically garbage, because the margins on a typical policy are much, much lower than 15%, and like all businesses, there's no reason to deliberately have high overhead. According to him, insurance companies already pay out more than 85% of premiums.

He also raised an interesting point about the "no copays for preventative care" issue. He said that when his company offers a group health care plan, it's the employer that determines the copay, not the insurance company. The insurance company simply uses a formula: if you have this copay, your premium is X, if you have a smaller copay, your premium is X+Y. The copay is simply a way for employers to pay less for group insurance by passing on a portion of the cost to the recipient of care.

That's one person's perspective from the inside, not some sort of definitive proof. I just thought it was interesting to hear.
   2011. steagles Posted: August 14, 2012 at 12:08 PM (#4207987)
Bouncing back to AWG news, Arctic ice could vanish in 10 years, scientists warn:
this possibility shouldn't be entirely surprising.

personally, i think we're well past the tipping point at which we could adequately shield the planet from significant environmental changes. the droughts and record high temperatures from this summer are a result of carbon emissions that were expelled into the atmosphere 30-50 years ago, and since then, our rate of carbon pollution has only skyrocketed due to the industrial advancement of the 3rd world.

and then once the ice starts melting, a vicious cycle starts, where ice melts because its hot, but then it only gets hotter, because ice is a much better reflector of sunlight than water, and so when the polar ice melts, the water that is created retains significantly more solar heat and our environment just gets hotter and hotter and hotter.


the climate change that we're now seeing is a catastrophic event, but i don't think it will be an extinction level event. i think our species is technologically advanced enough that we will figure out a way to continue to exist, but the environmental golden age that has allowed us to thrive for the last 20000 years, i think that is almost certainly over.
   2012. zonk Posted: August 14, 2012 at 12:09 PM (#4207989)
#1983 I can even cite an example from the health care field. Provinces negotiate huge generic drug purchases with the publicly stated purpose of using their tremendous bargaining power to drive down the price.


One of the flaws in Obamacare... TRICARE (the civilian/military public health care program) is allowed to negotiate prices directly with PhRMA - and it gets much better rates, both for what it pays and so far as the costs to beneficiaries than does Medicare Part D.

However, politically -- as Clinton found out in 1994 -- it's impossible to win a policy fight when you align against the AMA/AHA, PhRMA, AND AHIP. You'll lose and lose badly... so Obamacare basically took on solely AHIP, got tacit buy-in from the AMA/AHA, and cut a deal with PhRMA (a deal, incidentally, that has led to significant savings even as Obamacare closed the Part D 'donut hole').

The next round of reform will look at another leg of that stool.
   2013. Joe Kehoskie Posted: August 14, 2012 at 12:14 PM (#4207991)
Data shows ice melting 50% faster than predicted by some polar scientists

We've been hearing this for two decades now yet sea levels have been rising at a constant ~3mm per year. Also, only a few months ago the amount of ice in Antarctica was reported to be at record highs. If the Arctic is losing ice and Antarctica is gaining ice, that seems more like a global trend rather than evidence of an impending disaster.
   2014. Shredder Posted: August 14, 2012 at 12:16 PM (#4207993)
Wouldn't work - MLR binds the insurer. They pay the provider more - they simply pay the provider more and still end up having to an 80% (actually, I think it's 85% for large plans) MLR cap.

Unless you're suggesting illegal activities like kickbacks, I guess.
No, what Dan is suggesting is that insurance companies will just say "screw those damn customers, I'll just pay the doctors more! That'll show 'em", despite the fact that this provides no actual benefit to the insurer, such as, for example, keeping their current customers. Tell you what, Dan, you start up a health insurance company with the promise that if you don't spend enough of your collected premiums on health care, you'll give that extra money to doctors. I'll start one that promises that if I don't spend enough of my collected premiums on health care, I'll give it back to my customers. Let's see who gets more takers.
A friend of mine who works for an insurance company claims that the 85% rule is basically garbage, because the margins on a typical policy are much, much lower than 15%, and like all businesses, there's no reason to deliberately have high overhead. According to him, insurance companies already pay out more than 85% of premiums.
So how does he explains all the rebate checks that just went out?
   2015. zonk Posted: August 14, 2012 at 12:21 PM (#4208002)
A friend of mine who works for an insurance company claims that the 85% rule is basically garbage, because the margins on a typical policy are much, much lower than 15%, and like all businesses, there's no reason to deliberately have high overhead. According to him, insurance companies already pay out more than 85% of premiums.


So how does he explains all the rebate checks that just went out?


The only real quibble is about "typical" -- if he had said 'many' or 'plenty' of insurers are already running 85% MLRs, he'd be right. I'm not as anti-AHIP as most liberals, at least, not thoroughly so. There are insurers that successfully balance appropriate coverage decisions with profitability. However, there are also plenty that do not -- and if everyone's going to be forced to buy insurance, what Obamacare did was define plans minimums and industry standard MLRs.

For insurers already running at 80-85% - compliance should be a non-issue.
   2016. Joe Kehoskie Posted: August 14, 2012 at 12:25 PM (#4208004)
Tell you what, Dan, you start up a health insurance company with the promise that if you don't spend enough of your collected premiums on health care, you'll give that extra money to doctors. I'll start one that promises that if I don't spend enough of my collected premiums on health care, I'll give it back to my customers. Let's see who gets more takers.

I don't think Dan was suggesting that constantly raising insurance premiums would be a winning business model. It seemed like he was making the common-sense observation that insurance companies and doctors aren't likely to sit idly by and watch their earning power get reduced year after year without looking for ways to reverse the trend. As things stand, the vast majority of "savings" from Obamacare (and Medicare) come from the phony-baloney idea that doctors can keep being told to accept less and less money. The projected reimbursement rates under Obamacare in future decades are laughably unrealistic.
   2017. zonk Posted: August 14, 2012 at 12:43 PM (#4208020)

I don't think Dan was suggesting that constantly raising insurance premiums would be a winning business model. It seemed like he was making the common-sense observation that insurance companies and doctors aren't likely to sit idly by and watch their earning power get reduced year after year without looking for ways to reverse the trend. As things stand, the vast majority of "savings" from Obamacare (and Medicare) come from the phony-baloney idea that doctors can keep being told to accept less and less money. The projected reimbursement rates under Obamacare in future decades are laughably unrealistic.


You can't conflate doctors AND insurance companies like that -- they are not in cahoots. Providers negotiate rates with insurers - providers couldn't care less about insurer's profitability or whether they get under or over an MLR. Insurers negotiate rates with providers - insurers care about paying a good rate for services, not whether the provider increases its earning power.

As things stand, the vast majority of "savings" from Obamacare (and Medicare) come from the phony-baloney idea that doctors can keep being told to accept less and less money.


And this, as I've explained in multiple posts that you continue to ignore - is just nonsense... Neither the charity care cuts nor the Advantage cuts impact what the rates will be for open heart surgery, treating the common cold, or mending a broken leg. IPAB proposals might cut those rates -- but then, the AMA/AHA have fended off the '97 plan for 15 years now, so I doubt that they're too worried about it.

The projected reimbursement rates under Obamacare in future decades are laughably unrealistic.


There are no 'reimbursement rates' in Obamacare. Setting reimbursement rates are at the discretion of CMS, and one of the big components of the reimbursement formula (the 3 RVU classes) are actually provided by the AMA itself.

You keep trying to insist that the whole reimbursement cycle is a lot less complex than it is - and in that complexity is the opportunity for savings without directly cutting services covered or the like. No, it's not easy to do -- but if you uncover and then eliminate the system bilking that folks like Florida governor Rick Scott did back in the 90s, you can see enormous savings without cutting services. It's simply a matter of finding the sweet spot in a complex formula that employs a variety of factors to determine ultimate payment -- find which factor is being manipulated and you close that gap.
   2018. Ron J2 Posted: August 14, 2012 at 12:46 PM (#4208022)
#2010 I have a number of senior insurance execs in the family (actually all are retired now) and what your friend says matches up with what they've told me. Group policies tend to run even higher than that.
   2019. Shredder Posted: August 14, 2012 at 12:47 PM (#4208026)
As things stand, the vast majority of "savings" from Obamacare (and Medicare) come from the phony-baloney idea that doctors can keep being told to accept less and less money.
What's phony-baloney about it? It happens in just about every other industrialized country in the world, and they spend less money and get better outcomes.
You can't conflate doctors AND insurance companies like that -- they are not in cahoots. Providers negotiate rates with insurers - providers couldn't care less about insurer's profitability or whether they get under or over an MLR. Insurers negotiate rates with providers - insurers care about paying a good rate for services, not whether the provider increases its earning power.
And this is where the "competition" idea really makes no sense. As mentioned, providers negotiate rates with insurance companies. Providers hold the cards, and it's in their best interest to go with the insurers who will pay them the best rates. It's like free market competition in reverse. This changes when there is only one entity with whom providers can negotiate, which is why Medicare pays out less, which is way every country with single payer has lower medical costs, etc.
   2020. Ron J2 Posted: August 14, 2012 at 01:06 PM (#4208036)
#2019 There "should" be some savings in elimination of some of the veto points in the system. The US spends roughly twice as much on administration as second place (Canada -- and Canada's administrative costs are a good bit higher than anybody else)

   2021. Fred Lynn Nolan Ryan Sweeney Agonistes Posted: August 14, 2012 at 01:15 PM (#4208042)
Except you're conflating the health care industry with the insurance industry...

Not that this is unusual. I remember distinctly when Obama went from pushing "health care reform" to pushing "health insurance reform" without ever mentioning the new posters, slogans, etc. It felt oddly creepy, even Orwellian. Even now, nearly every public figure who discusses the issue seems to conflate the two... nowadays the Obama fundraising organization just calls it "health reform," which, well, that isn't anything at all, is it?
   2022. zonk Posted: August 14, 2012 at 01:29 PM (#4208050)

Not that this is unusual. I remember distinctly when Obama went from pushing "health care reform" to pushing "health insurance reform" without ever mentioning the new posters, slogans, etc. It felt oddly creepy, even Orwellian. Even now, nearly every public figure who discusses the issue seems to conflate the two... nowadays the Obama fundraising organization just calls it "health reform," which, well, that isn't anything at all, is it?


Eh, it's ("health care reform") been shorthand since Truman for such attempts.

As I mentioned above - "Health Care" is a three-legged stool... You've got the providers (AMA, AHA, etc), you've got the insurers (because most inpatient services could never be afforded out of pocket by 99.5% of Americans), and you've got the device & pharmaceutical industry (you could make a case that they shouldn't be bundled together, but whatever).

Every other health reform effort failed because those are three enormously powerful lobbies -- and it's impossible to take on all three at once.

Hence, this round of reform satiated one leg of the stool, made a deal with the another, but went about whittling and reshaping the third (much to its objection).

It's just not a system that lends itself well to 'branding' and bullet points if we want to seriously tackle the issue...
   2023. Dan Szymborski Posted: August 14, 2012 at 01:29 PM (#4208051)

No, legally it cannot. Those taxes go directly to the 4 individual funds (SS, SSDI, Medicare, and survivors, IIRC) under the umbrella Social Security trust fund. Neither congress nor the President has any authority to disperse those funds for purposes other than the programs themselves:


Sure they can. If these things suddenly became unpopular, they could amend that law with the stroke of a pen, and you'd have no standing to object to their use of your money.
   2024. zonk Posted: August 14, 2012 at 01:35 PM (#4208052)
Sure they can. If these things suddenly became unpopular, they could amend that law with the stroke of a pen, and you'd have no standing to object to their use of your money.


Ummmm.... sure... and I guess that they could amend the law outlawing currency and turning the US into a barter economy. I mean, I'll grant that your scenario is (mildly) more likely than mine but still, if that's your bar, then why are we even bothering with this whole discussion?

They can't legally do it now -- and that's without even getting into the case law regarding how these programs were established to begin with (i.e., I'm not even sure a simple piece of legislation would be able to just seize the trust funds or reallocate the revenue without eliminating the programs).

Either we're talking policy or philosophical what-ifs....
   2025. Joe Kehoskie Posted: August 14, 2012 at 01:40 PM (#4208056)
As things stand, the vast majority of "savings" from Obamacare (and Medicare) come from the phony-baloney idea that doctors can keep being told to accept less and less money.
And this, as I've explained in multiple posts that you continue to ignore - is just nonsense... Neither the charity care cuts nor the Advantage cuts impact what the rates will be for open heart surgery, treating the common cold, or mending a broken leg. IPAB proposals might cut those rates -- but then, the AMA/AHA have fended off the '97 plan for 15 years now, so I doubt that they're too worried about it.

So you object to me characterizing Obamacare (and Medicare) "savings" as based on a phony-baloney scheme, and yet you admit that those "savings" never actually materialize because the AMA/AHA have "fended off the '97 plan for 15 years now." Interesting.

As for the charity-care "savings," those are purely hypothetical at this point. Passing Obamacare doesn't magically change the fact that hospitals rack up huge expenses treating the uninsured. In NYC alone, 40 percent of all uninsured patients are illegal immigrants. Does anyone really believe that illegal immigrants are suddenly going to begin paying thousands for insurance when they can continue to use ERs for free? And does anyone really believe the government will allow hospitals to fail because of the costs of treating the uninsured?
   2026. ASmitty Posted: August 14, 2012 at 01:47 PM (#4208060)
Passing Obamacare doesn't magically change the fact that hospitals rack up huge expenses treating the uninsured. In NYC alone, 40 percent of all uninsured patients are illegal immigrants.


If only there was a way to alleviate the burden posed by uninsured patients by 60%...
   2027. Joe Kehoskie Posted: August 14, 2012 at 01:49 PM (#4208062)
What's phony-baloney about it? It happens in just about every other industrialized country in the world, and they spend less money and get better outcomes.

Total myth. If other countries have better care for cheaper prices, why do people from all over the world come to the U.S. for treatment?

Here's a report on wait times in Canada. Does this sound like a cutting-edge system the U.S. should try to emulate?

This edition of Waiting Your Turn indicates that waiting times for elective medical treatment have increased since last year. Specialist physicians surveyed across 12 specialties and 10 Canadian provinces report a total waiting time of 19.0 weeks between referral from a general practitioner and receipt of elective treatment.

At 104 percent longer than it was in 1993, this is the longest total wait time recorded since the Fraser Institute began measuring wait times in Canada.
   2028. Joe Kehoskie Posted: August 14, 2012 at 01:51 PM (#4208065)
If only there was a way to alleviate the burden posed by uninsured patients by 60%...

A third of the uninsured can't pay for it and/or have preexisting conditions that make them a high-risk and/or high-expense patient, another third are illegal immigrants, and the last third actually can afford health insurance but chooses to go without it. Unless the latter group all buys insurance that not only covers themselves but also pays for the former two groups, the math simply doesn't add up. The claim that more people will get more services for less cost is a total sham.
   2029. ASmitty Posted: August 14, 2012 at 01:58 PM (#4208070)
Here's a report on wait times in Canada. Does this sound like a cutting-edge system the U.S. should try to emulate?


Mrs. ASmitty is an ER Doctor, and a few weeks back I was at a function with some of her colleagues. One of the doctors, delighted to hear that I was not a physician, took the time to give me an unsolicited lecture on Obamacare. He told the following story:

"Imagine two patients with identical hip fractrues. The first patient sees a primary care provider and surgery is recommended. The primary care provider schedules the surgery, but the first available surgical date is in three months. Then, after three months, the surgery is delayed again for another thee months. Finally, six months later, the patient gets hip surgery. The second patient see a primary care provider, and surgery is recommended. The next day, surgery is scheduled and performed"

"Now," he said with a thin smile crossing his face, "what's the difference between these two patients?" he asked.

"I don't know," I said with bated breath, "what?"

"The first is a human," he said "and the second is a dog." Vets, he explained were a cash practice, so wait times were vastly superior.

Which then led me to the obvious follow-up: "But what happens to the dogs without cash?"

My wife was mad at me for a week.
   2030. Ray (RDP) Posted: August 14, 2012 at 02:13 PM (#4208083)
personally, i think we're well past the tipping point at which we could adequately shield the planet from significant environmental changes.


There is absolutely no reason why we should expect the environment not to change. It has always changed. Since, like, forever.

I swear if the environment suddenly didn't change, you people would be screaming like chicken little over that fact.
   2031. zonk Posted: August 14, 2012 at 02:17 PM (#4208085)
So you object to me characterizing Obamacare (and Medicare) "savings" as based on a phony-baloney scheme, and yet you admit that those "savings" never actually materialize because the AMA/AHA have "fended off the '97 plan for 15 years now." Interesting.


IPAB plans have a better chance -- the '97 change swapped out one of the key components of the reimbursement formula (MVPS, or Medicare Volume Performance Standard) with SGR (Sustainable Growth Rate). The problem was that it was a cleaver approach -- it would have applied universally and as such, even lopped rates in areas where provider participation in Medicare is already tenuous at best (general practitioners, for example). IPAB has the freedom to look at the entire menu of the many components that make up the reimbursement formula, and there are components of that formula that could be modified in a way that satisfies -- even gets embraced -- by certain provider types while others would fight it. Just like the multi-legged stool of health care reform itself, a scenario could be presented by IPAB that proposes a modest increase in various Part B formulas -- making the AMA or at least the parts of it that are not inpatient providers, happy, but making the AHA (and especially large providers like Rick Scott's old company which received the largest fraud fine in Medicare history, HCA) howl. It will then come down to congressional will -- but if you confine the pain to a small enough segment, with other segments lauding the change - it does have a chance.

If the IPAB plan is as unworkable as the '97 plan - yeah, it will just shelved like the MVPS/SGR swap-out.

As for the charity-care "savings," those are purely hypothetical at this point. Passing Obamacare doesn't magically change the fact that hospitals rack up huge expenses treating the uninsured. In NYC alone, 40 percent of all uninsured patients are illegal immigrants. Does anyone really believe that illegal immigrants are suddenly going to begin paying thousands for insurance when they can continue to use ERs for free? And does anyone really believe the government will allow hospitals to fail because of the costs of treating the uninsured?


No - they are not purely hypothetical. The component that jacked up reimbursement rates is gone. It's been eliminated. And indeed - plenty of hospitals have expressed concerns that the increase in insured patients won't make up the shortfall for what they get in Medicare reimbursement.

However, it's law. It's in effect (or will be, I don't recall the effective date on the change). To either restore it, or, to provide some other manner of funding like an additional say, block grant requires a further piece of legislation.

Same with the Advantage/medigap/choice cuts. They're law. They're in effect.
   2032. Monty Posted: August 14, 2012 at 02:17 PM (#4208086)
I swear if the environment suddenly didn't change, you people would be screaming like chicken little over that fact.


It's fun to make things up, isn't it?
   2033. Lassus Posted: August 14, 2012 at 02:18 PM (#4208087)
There is absolutely no reason why we should expect the environment not to change. It has always changed. Since, like, forever. I swear if the environment suddenly didn't change, you people would be screaming like chicken little over that fact.

Ray, I know more about patent law than you do about climate science. Tell me how much stock you would put in my statements regarding patent law.
   2034. Joe Kehoskie Posted: August 14, 2012 at 02:21 PM (#4208088)
Which then led me to the obvious follow-up: "But what happens to the dogs without cash?"

My wife was mad at me for a week.

Fun story, but emblematic of why liberalism is such a farce. Whether it's school choice or healthcare or whatever, liberals would rather that everyone get a lower-quality product or service than tolerate a system in which Person A can get better quality than Person B.
   2035. zonk Posted: August 14, 2012 at 02:22 PM (#4208091)
Mrs. ASmitty is an ER Doctor, and a few weeks back I was at a function with some of her colleagues. One of the doctors, delighted to hear that I was not a physician, took the time to give me an unsolicited lecture on Obamacare. He told the following story:

"Imagine two patients with identical hip fractrues. The first patient sees a primary care provider and surgery is recommended. The primary care provider schedules the surgery, but the first available surgical date is in three months. Then, after three months, the surgery is delayed again for another thee months. Finally, six months later, the patient gets hip surgery. The second patient see a primary care provider, and surgery is recommended. The next day, surgery is scheduled and performed"

"Now," he said with a thin smile crossing his face, "what's the difference between these two patients?" he asked.

"I don't know," I said with bated breath, "what?"

"The first is a human," he said "and the second is a dog." Vets, he explained were a cash practice, so wait times were vastly superior.

Which then led me to the obvious follow-up: "But what happens to the dogs without cash?"

My wife was mad at me for a week.


Heh... I like that.

It's doubly amusing that it was an ER doc who was trying to have this argument, since hospital finance basically sees ER care as a 'loss leader' at best. I'd think that an ER doc might notice that when department budgets are determined - it's generally a new neurologist, a new oncologist, a new endocrinologist, etc that get hired over additional ER staffing.

EDIT: Oops - rereading, I see your wife in the ER physician... I'm betting the the other physician was probably in one of the departments that is more of a profit center for the hospital.
   2036. Lassus Posted: August 14, 2012 at 02:26 PM (#4208094)
Fun story, but emblematic of why liberalism is such a farce.

I don't think conservatism is a farce, and this dichotomy is why nobody enjoys debating with you.
   2037. Tripon Posted: August 14, 2012 at 02:27 PM (#4208096)

Fun story, but emblematic of why liberalism is such a farce. Whether it's school choice or healthcare or whatever, liberals would rather that everyone get a lower-quality product or service rather than tolerate a system in which Person A can get better quality than Person B.


More like person B having to be put down because it costs too much to treat him. But that would be the dreaded death panels! Oh noes.
   2038. zonk Posted: August 14, 2012 at 02:28 PM (#4208098)

Fun story, but emblematic of why liberalism is such a farce. Whether it's school choice or healthcare or whatever, liberals would rather that everyone get a lower-quality product or service than tolerate a system in which Person A can get better quality than Person B.


It must be satisfying to live in a world where everything is so simple. I honestly envy folks like you sometimes, I really do.

Of course, back in our complex reality -- that person B, who you apparently agree IS getting care, even subpar care -- isn't paying for that care. It's being borne by a program - Medicare - that you also want to eliminate.
   2039. Joe Kehoskie Posted: August 14, 2012 at 02:30 PM (#4208101)
It will then come down to congressional will -- but if you confine the pain to a small enough segment, with other segments lauding the change - it does have a chance.

If the IPAB plan is as unworkable as the '97 plan - yeah, it will just shelved like the MVPS/SGR swap-out.

So in other words, almost the entirety of Obamacare's budgetary implications is premised on something that has only a chance of actually happening. You'll have to forgive me for being skeptical.

No - they are not purely hypothetical. The component that jacked up reimbursement rates is gone. It's been eliminated. And indeed - plenty of hospitals have expressed concerns that the increase in insured patients won't make up the shortfall for what they get in Medicare reimbursement.

However, it's law. It's in effect (or will be, I don't recall the effective date on the change). To either restore it, or, to provide some other manner of funding like an additional say, block grant requires a further piece of legislation.

Same with the Advantage/medigap/choice cuts. They're law. They're in effect.

Just because something is "the law" doesn't mean it will work as designed. The mere passage of Obamacare didn't eliminate major problems from America's healthcare system. Until 30 to 45 million people in the U.S. obtain coverage/insurance, wait times and quality of care are shown to remain the same, and costs are contained, Obamacare's promises are purely theoretical.
   2040. Greg K Posted: August 14, 2012 at 02:31 PM (#4208102)
I don't think Dan was suggesting that constantly raising insurance premiums would be a winning business model. It seemed like he was making the common-sense observation that insurance companies and doctors aren't likely to sit idly by and watch their earning power get reduced year after year without looking for ways to reverse the trend. As things stand, the vast majority of "savings" from Obamacare (and Medicare) come from the phony-baloney idea that doctors can keep being told to accept less and less money. The projected reimbursement rates under Obamacare in future decades are laughably unrealistic.

It's been a while since I took Canadian history but this sounds like the Saskatchewan Doctor's Strike of 1962.

EDIT: Weird, that link does actually work, you just have to click through.
   2041. ASmitty Posted: August 14, 2012 at 02:33 PM (#4208104)
EDIT: Oops - rereading, I see your wife in the ER physician... I'm betting the the other physician was probably in one of the departments that is more of a profit center for the hospital.


I don't really recall his specialization. Doctors are like white people; they all look alike to me.
   2042. Los Angeles El Hombre de Anaheim Posted: August 14, 2012 at 02:40 PM (#4208111)
Mrs. ASmitty is an ER Doctor, and a few weeks back I was at a function with some of her colleagues. One of the doctors, delighted to hear that I was not a physician, took the time to give me an unsolicited lecture on Obamacare. He told the following story:
Dude, I feel your pain. My wife works for a managed care provider, and I always end up being the guy doctors tell stories to. Doctors f'n love stories about themselves.
   2043. zonk Posted: August 14, 2012 at 02:43 PM (#4208114)
So in other words, almost the entirety of Obamacare's budgetary implications is premised on something that has only a chance of actually happening. You'll have to forgive me for being skeptical.


Who said "almost the entirety"? The charity care and advantage cuts are law now.

Just because something is "the law" doesn't mean it will work as designed. The mere passage of Obamacare didn't eliminate major problems from America'a healthcare system. Until 30 to 45 million people in the U.S. obtain insurance, wait times and quality of care are shown to remain the same, and costs are contained, Obamacare's promises are purely theoretical.


So do you care about the budgetary savings or the poor souls who don't have access to high levels of care.

Seriously, this is maddening -- we're talking about Medicare... which does NOT cover those "30 to 45 million" and indeed, since Obamacare didn't repeal EMTALA, those "30 to 45 million" will still have access to the same care they had before Obamacare. The only difference is that Medicare will no longer be indirectly subsidizing that care (to be clear - medicare does NOT directly get billed for those services... it's a formula applied to the reimbursement of covered beneficiaries).

Either we're talking about the provisions that impact Medicare or we're talking about the provisions that impact those ineligible for Medicare.

If you want to merge the too -- well, I welcome you aboard, because "Medicare for all" is something that virtually every liberal would gladly sign on to.
   2044. Ray (RDP) Posted: August 14, 2012 at 02:45 PM (#4208116)
Fun story, but emblematic of why liberalism is such a farce.


I don't think conservatism is a farce, and this dichotomny is why nobody enjoys debating with you.


Why? Because the truth about liberalism hurts?

The entire Obamacare system is a tradeoff where 270 million people are being forced to suffer a lower health care quality so that 30 million people can undeservingly enjoy a higher one.

Only in liberal la la land is that tradeoff not a farce.
   2045. Ron J2 Posted: August 14, 2012 at 02:46 PM (#4208118)
#2029 Nobody in their right mind would pick Canada's as the system to emulate. It's actually excellent at emergency care and, yes terrible wait times for (most) non-emergency services.

With the side bonus of the world's second worst administrative costs.

Funnily enough though, the late adapters didn't choose the Canadian model. All systems have their imperfections, but I'd suggest looking at Switzerland and Taiwan rather than Canada.

   2046. Lassus Posted: August 14, 2012 at 02:49 PM (#4208123)
Why? Because the truth about liberalism hurts?

Shut up, robot. Because your respect for variance is robotic.
   2047. ASmitty Posted: August 14, 2012 at 02:49 PM (#4208125)
The entire Obamacare system is a tradeoff where 270 million people are being forced to suffer a lower health care quality so that 30 million people can undeservingly enjoy a higher one.


How low a standard of care would be appropriate for a poor person? Serious question. What would be your bare-minimum? I think it's a necessary jumping off point for any healthcare discussion.
   2048. zonk Posted: August 14, 2012 at 02:52 PM (#4208128)
The entire Obamacare system is a tradeoff where 270 million people are being forced to suffer a lower health care quality so that 30 million people can undeservingly enjoy a higher one.


Except -- as people have pointed out -- Obamacare has very little direct impact on care.

If you want to barter chickens for your colonoscopy, you are free to barter chickens for your colonscopy. If you want to continue to refuse to take your prozac, you may continue to refuse to take your prozac.
   2049. Greg K Posted: August 14, 2012 at 02:53 PM (#4208130)
The entire Obamacare system is a tradeoff where 270 million people are being forced to suffer a lower health care quality so that 30 million people can undeservingly enjoy a higher one.

Not to enter into the fray (because I'm about the least educated person in the world when it comes to American healthcare...seriously, I'm trying to learn but most of this thread is Greek to me so far), but I'm pretty comfortable with this as a social decision. Of course, it all depends on how much the top quality of healthcare is suffering and how poor the care is that the "undeserving" are currently getting.

What's the point of being a tremendously successful society if you're not going to use that wealth to give everyone a certain quality of life?
   2050. McCoy Posted: August 14, 2012 at 02:55 PM (#4208133)
Why? Because the truth about liberalism hurts?

The entire Obamacare system is a tradeoff where 270 million people are being forced to suffer a lower health care quality so that 30 million people can undeservingly enjoy a higher one.

Only in liberal la la land is that tradeoff not a farce.


Well, conservatism is a political system in which 7 billion people are being forced to suffer a lower standard of living so that 3 million Americans and a handful of other people around the world can undeservingly enjoy a higher one.
   2051. Shredder Posted: August 14, 2012 at 03:01 PM (#4208138)
Whether it's school choice or healthcare or whatever, liberals would rather that everyone get a lower-quality product or service than tolerate a system in which Person A can get better quality than Person B.
Basically a bald-faced lie. No serious proponent of the public school system believes that private schools should not exist, or that kids who go to public schools should not be allowed to hire tudors or purchase other educational aids. No serious proponent of single payer health care believes that people with the means should not also be able to pay their own money for additional care. Liberals would prefer a system in which EVERYONE has access to a certain baseline standard of care, and if you want to go buy more for yourself, be my guest. Republicans grudgingly accept that poor people shouldn't die in the street (well, not the Good Face, I guess), but still rail on about the inherent "unfairness" of paying for "someone else's" medical care.
The entire Obamacare system is a tradeoff where 270 million people are being forced to suffer a lower health care quality so that 30 million people can undeservingly enjoy a higher one.
Another lie.
   2052. zonk Posted: August 14, 2012 at 03:03 PM (#4208140)
Funnily enough though, the late adapters didn't choose the Canadian model. All systems have their imperfections, but I'd suggest looking at Switzerland and Taiwan rather than Canada.


I concur on Switzerland - it's a model that I pushed for way back during the yearlong debate. Zero out the profit margins on the catastrophic care at the top and the preventive care at the bottom, using private insurers under stringent oversight to achieve that -- and then let the market deal with everything in the middle.

So, in effect - the government ensures you can afford to get your annual physical and likewise ensures you'll get care if one of those physicals turns up cancer, but you have to work it out on your own with the insurer whether say... crutches when you break your leg are covered.

Though... IIRC -- I thought Switzerland, not Canada, had the second highest administrative costs after the US?
   2053. Joe Kehoskie Posted: August 14, 2012 at 03:04 PM (#4208141)
Funnily enough though, the late adapters didn't choose the Canadian model. All systems have their imperfections, but I'd suggest looking at Switzerland and Taiwan rather than Canada.

Well, Canada is a wealthy country of only 35 million people, so if they're having trouble with universal coverage, that should have been a major red flag.

Switzerland is a wealthy country of 8 million people and Taiwan is a wealthy country of 23 million people. Assuming those systems are among the world's best, scaling them to a country of 310 million people seems daunting if not impossible.
   2054. The Yankee Clapper Posted: August 14, 2012 at 03:05 PM (#4208142)
Fun story, but emblematic of why liberalism is such a farce.

I don't think conservatism is a farce, and this dichotomy is why nobody enjoys debating with you.

This thread, or at least the parts I read, has many posts castigating conservatism and Republicans in terms far harsher than "farce". Seems like a double standard here.
   2055. Joe Kehoskie Posted: August 14, 2012 at 03:11 PM (#4208148)
How low a standard of care would be appropriate for a poor person? Serious question. What would be your bare-minimum? I think it's a necessary jumping off point for any healthcare discussion.

Medicaid already covers an estimated 70 million people in the U.S. The notion that poor people were left to fend for themselves with regards to healthcare is a total myth.

No serious proponent of the public school system believes that private schools should not exist, or that kids who go to public schools should not be allowed to hire tudors or purchase other educational aids.

LOL.

Liberals would prefer a system in which EVERYONE has access to a certain baseline standard of care, and if you want to go buy more for yourself, be my guest.

The U.S. already had that; see the "70 million on Medicaid" above.

The poor are being hurt much more by a U.S. education system that traps them in garbage schools than they were ever hurt by the pre-Obamacare health system. But since teachers unions donate more to Dem political campaigns than do poor people, we've seen just how quickly "principles" like "choice" and "baseline standards" go right out the window.
   2056. Greg K Posted: August 14, 2012 at 03:11 PM (#4208149)
Well, Canada is a wealthy country of only 35 million people, so if they're having trouble with universal coverage, that should have been a major red flag.

Switzerland is a wealthy country of 8 million people and Taiwan is a wealthy country of 23 million people. Assuming those systems are among the world's best, scaling them to a country of 310 million people seems daunting if not impossible.

Without knowing much about the Swiss and Taiwenese systems this does raise interesting questions. Are you sure the problems facing Canada are due to population? Zonk (who appears to know a thing or two about healthcare systems) is giving the impression that these countries actually operate different systems. Red flags are all well and good, but they usually mark where further investigation would be useful, not casual dismissal.
   2057. ASmitty Posted: August 14, 2012 at 03:15 PM (#4208152)
How low a standard of care would be appropriate for a poor person? Serious question. What would be your bare-minimum? I think it's a necessary jumping off point for any healthcare discussion.


Medicaid already covers an estimated 70 million people in the U.S. The notion that poor people were left to fend for themselves with regards to healthcare is a total myth.


That answers my question...not at all. I'm not saying poor people are fending for themselves. I'm asking WHAT YOU THINK THE MINIMUM STANDARD OF CARE SHOULD BE FOR SOMEONE WHO CANNOT PAY. An answer of "Medicaid exists" does not follow.
   2058. Matt Clement of Alexandria Posted: August 14, 2012 at 03:18 PM (#4208156)
Whether it's school choice or healthcare or whatever, liberals would rather that everyone get a lower-quality product or service than tolerate a system in which Person A can get better quality than Person B.
Joe doesn't know the difference between liberals and communists. This is not surprising.
   2059. Dan Szymborski Posted: August 14, 2012 at 03:19 PM (#4208157)
Basically a bald-faced lie.

Tell it to WHO, which uses equality of service as part of the rankings.


No serious proponent of the public school system believes that private schools should not exist, or that kids who go to public schools should not be allowed to hire tudors or purchase other educational aids. No serious proponent of single payer health care believes that people with the means should not also be able to pay their own money for additional care.


Agreed. Statist liberals want to make sure that their kids and their health aren't going to subject to the things they want for everyone else.
   2060. Ray (RDP) Posted: August 14, 2012 at 03:21 PM (#4208160)
Except -- as people have pointed out -- Obamacare has very little direct impact on care.


That sounds like doublespeak. Very little "direct" impact.

Things like waiting times have an impact on care.

And are you suggesting that one of the stated goals of Obamacare was not to improve quality?

In any event, the point remains: You cannot provide increased care for tens of millions of people at the same cost while not decreasing quality.
   2061. zonk Posted: August 14, 2012 at 03:21 PM (#4208162)
Without knowing much about the Swiss and Taiwenese systems this does raise interesting questions. Are you sure the problems facing Canada are due to population? Zonk (who appears to know a thing or two about healthcare systems) is giving the impression that these countries actually operate different systems. Red flags are all well and good, but they usual mark where further investigation would be useful, not casual dismissal.


The Swiss model is relatively similar to Obamacare -- compulsory insurance purchases, but the insurance is administered by private companies. Where the Swiss diverge is that they don't use a global MLR - rather, certain types of care (catastrophic and preventive) are mandated as 'zero profit' coverage, meaning - the policies have to be written in such a way that something like oncology is a covered service, but the insurers have to show that the breakdown of premiums for such services is essentially done without profit. I believe you can buy Swiss policies that are essentially 'minimum coverage'. Just like Obamacare - the out-of-pocket costs (premiums) have a cap of something like 8 or 9% of income. I think the primary difference is that Swiss coverage is generally done on the individual market, rather than via employers.


The Taiwanese model is straight-up single payer -- there's a national health insurance plan, there's a payroll tax to fund it, and everyone is covered by it. Taiwan has had to tweak its reimbursement schema a number of times, I know -- they had similar problems to those Medicare faces: namely, providers quickly found where the profit centers were and began over-providing certain services to take advantage.
   2062. Matt Clement of Alexandria Posted: August 14, 2012 at 03:21 PM (#4208163)
Parts (a) and (b) of Post 2059 are directly contradictory.
   2063. Joe Kehoskie Posted: August 14, 2012 at 03:22 PM (#4208164)
That answers my question...not at all. I'm not saying poor people are fending for themselves. I'm asking WHAT YOU THINK THE MINIMUM STANDARD OF CARE SHOULD BE FOR SOMEONE WHO CANNOT PAY. An answer of "Medicaid exists" does not follow.

The moral of your dog story in #2029 was that a dog without cash would get no treatment (or even die). That situation hasn't existed in the U.S. in generations, thanks to Medicaid and EMTALA.

As for "minimum standard of care," what are you looking for here? I assume Medicaid doesn't refer people to unlicensed doctors or anything of that sort. I've never read anything about people on Medicaid getting horrendous treatment or dying from neglect.

In an advanced society, standards should always be rising, but that can't be accomplished by magic. Obamacare purports to give more care to more people for less cost. It's a fantasy.
   2064. Los Angeles El Hombre de Anaheim Posted: August 14, 2012 at 03:24 PM (#4208167)
Joe doesn't know the difference between liberals and communists. This is not surprising.
Joe doesn't think there is a difference between liberals and communists. That's why these discussions die on the vine.
   2065. zonk Posted: August 14, 2012 at 03:25 PM (#4208168)
The U.S. already had that; see the "70 million on Medicaid" above.


Ummm... where did you get the "70 million"? I think the number is closer to 35-40 million - and technically, a fairly decent chunk of them are also Medicare covered, with Medicaid as extended coverage to help with copays, premiums, etc.

Besides, technically the "US" doesn't have it -- Medicaid is administered by the states individually, so you'll find wide variances on coverage. Certain states aren't facing Medicaid funding issues because they're bad at handling their Medicaid dollars...
   2066. Dan Szymborski Posted: August 14, 2012 at 03:26 PM (#4208170)
And are you suggesting that one of the stated goals of Obamacare was not to improve quality?

The goal of Obamacare is always defined as the other stuff that's not currently being criticized. Cost control? Coverage? Emergency care? Basic minimums? Condoms? Free preventative care? Obamacare is simply the political version of Katamari Damacy.
   2067. Dan Szymborski Posted: August 14, 2012 at 03:27 PM (#4208171)
Joe doesn't think there is a difference between liberals and communists. That's why these discussions die on the vine.

Nope, it's not people like zonk who tell lies, as a poster linked above to Politifact and Factcheck.org.

[Edit: Washington Post, too]

   2068. ASmitty Posted: August 14, 2012 at 03:27 PM (#4208173)
The moral of your dog story in #2029 was that a dog without cash would get no treatment (or even die).


Well, to be fair, the real moral of my story was that I'm witty and that my wife hates me.

As for "minimum standard of care," what are you looking for here? I assume Medicaid doesn't refer people to unlicensed doctors or anything of that sort. I've never read anything about people on Medicaid getting horrendous treatment or dying from neglect.


So you think Medicaid allows access to an adequate standard of care? More than adequate? Less? I'm not trying to trick you or anyone else with these questions. It's simple curiosity. Perhaps I'm reading it wrong, but Ray's quote seemed to imply that the poor were receiving an uneccessarily high standard of care.

   2069. zonk Posted: August 14, 2012 at 03:30 PM (#4208174)

That sounds like doublespeak. Very little "direct" impact.

Things like waiting times have an impact on care.

And are you suggesting that one of the stated goals of Obamacare was not to improve quality?

In any event, the point remains: You cannot provide increased care for tens of millions of people at the same cost while not decreasing quality.


Obamacare says nothing about waiting times, either. Before Obamacare, your wait time was based on two things: 1)the availability of the provider you needed to see, and 2)whether the provider you wanted to see was in your insurance network or not.

Now - one thing Obamacare did to offset insuring additional people is to also jack up spending on public health centers and clinics. It also implemented a medical equivalent of "Teach for America" -- i.e., doctors and nurses work a certain number of years at this clinic in exchange for educational debt forgiveness.

One of the stated goals of Obamacare IS 'quality improvement'... However, most of the quality initiatives come in two areas: 1)Minimum plan coverage, and 2)a whole host of small 'demonstration programs' that will be evaluated. Most of these are quite small - but they are numerous and it will be years before we see which of them are worth pursuing on a broader scale.
   2070. The Good Face Posted: August 14, 2012 at 03:31 PM (#4208175)
Republicans grudgingly accept that poor people shouldn't die in the street (well, not the Good Face, I guess), but still rail on about the inherent "unfairness" of paying for "someone else's" medical care.


They should die wherever they died before the modern welfare state started handing out "free" healthcare. As a olive branch to my liberal colleagues here, I'd be OK with a government funded "Deathatorium" where people COULD go to die. We could even mock up the inside so it would more closely resemble streets, those apparently being, by far, the favored place for people to perish.

Really though, our society's relationship with death and our obsession with staving it off for as many pointless days, weeks or months as possible is deeply unhealthy. Also, our literary tradition is greatly diminished when we remove the possibility of protagonists turning to crime to fund a beloved relative's operation.
   2071. zonk Posted: August 14, 2012 at 03:32 PM (#4208176)
Nope, it's not people like zonk who tell lies, as a poster linked above to Politifact and Factcheck.org.


What lie have I told?
   2072. Lassus Posted: August 14, 2012 at 03:36 PM (#4208180)
What lie have I told?

Somnething about teachers, probably.
   2073. Greg K Posted: August 14, 2012 at 03:38 PM (#4208181)
What lie have I told?

I think it's the one about "Doctor for America". Unless "Northern Exposure" is steering me wrong (and it never has in the past) that program has been in place since at least the mid-90s.
   2074. zonk Posted: August 14, 2012 at 03:43 PM (#4208183)
What lie have I told?



I think it's the one about "Doctor for America". Unless "Northern Exposure" is steering me wrong (and it never has in the past) that program has been in place since at least the mid-90s.


OK, OK -- this is correct... but 'Obamacare' significantly boosted the program -- virtually the entirety of Title V of of the law is dedicated towards changing the existing PCL program and creates other components that didn't previously exist.
   2075. Joe Kehoskie Posted: August 14, 2012 at 03:44 PM (#4208184)
Ummm... where did you get the "70 million"? I think the number is closer to 35-40 million - and technically, a fairly decent chunk of them are also Medicare covered, with Medicaid as extended coverage to help with copays, premiums, etc.

See, Obama's creating dependents so quickly it's hard to keep up ...

Medicaid now covers an estimated 70 million Americans and would cover an estimated 7 million more in 2014 under the Obama health law's expansion.


source: http://news.yahoo.com/anti-medicaid-states-earning-11-000-too-much-143508666.html (Aug. 14, 2012)
   2076. Shredder Posted: August 14, 2012 at 03:45 PM (#4208185)
Really though, our society's relationship with death and our obsession with staving it off for as many pointless days, weeks or months as possible is deeply unhealthy.
I don't disagree with you, but not everyone who needs life saving treatment has an untreatable terminal illness. Some people actually have life saving procedures performed and go on to live very full lives.
   2077. Ray (RDP) Posted: August 14, 2012 at 03:46 PM (#4208187)
Perhaps I'm reading it wrong, but Ray's quote seemed to imply that the poor were receiving an uneccessarily high standard of care.


No, my quote implied - in fact directly stated - that Obamacare sacrifices the care of 270 million people in order to improve the care of 30 million people.

I made no comment on whether the care the poor (*) are receiving now is too high, but when you're getting billions of dollars in care for free -- the current situation -- I don't see a reason for liberals to get so stressed about that situation that they decide to sacrifice the care of the vast majority of people as a "cure."

(*) Not that "the poor" and "the uninsured" are synonomous, of course. Many uninsured could pay if they chose to, or chose to prioritize differently.

   2078. Greg K Posted: August 14, 2012 at 03:47 PM (#4208188)
OK, OK -- this is correct... but 'Obamacare' significantly boosted the program -- virtually the entirety of Title V of of the law is dedicated towards changing the existing PCL program and creates other components that didn't previously exist.

Oh wow, I didn't know that. I assumed the premise of the show was based on an Alaska-specific "get all manner of professionals up here" policy. Gotta love when snark meets truth!
   2079. ASmitty Posted: August 14, 2012 at 03:52 PM (#4208191)
No, my quote implied - in fact directly stated - that Obamacare sacrifices the care of 270 million people in order to improve the care of 30 million people.


Well than give the error to me; my apologies. I drew the implication from the "so that 30 million people can undeservingly enjoy a higher one" language.

When it comes to health reform, I tend to take shots at both sides, as I really just want to understand it better. Ironically, sharing a bed with a physician is one of the worst ways to obtain reasoned analysis of health reform.

   2080. zonk Posted: August 14, 2012 at 03:52 PM (#4208192)

Medicaid now covers an estimated 70 million Americans and would cover an estimated 7 million more in 2014 under the Obama health law's expansion.




source: http://news.yahoo.com/anti-medicaid-states-earning-11-000-too-much-143508666.html (Aug. 14, 2012)


The numbers I get are 55 million adding up the classes that medicaid.gov lists -- however, they combine CHIP and Medicaid coverage to get a total of 31 million children, but CHIP isn't the same as Medicaid (indeed -- CHIP is specifically designed to fill the gap for dependents whose parents make too much to qualify for Medicaid).

The CHIP page says it covers 8 million.

So -- I see about ~45 million covered by Medicaid.

The numbers dance around a lot because again - states administer Medicaid. There are minimums -- and Obamacare does raise these minimums -- but, for example, the maximum income one can have in Texas to qualify for Medicaid is something like $6,000... I fail to see how someone making $6,500 annually could conceivably afford health care not provided by a government program.
   2081. Ray (RDP) Posted: August 14, 2012 at 03:57 PM (#4208195)
Well than give the error to me; my apologies. I drew the implication from the "so that 30 million people can undeservingly enjoy a higher one" language.


Well, when A is forced to pay for something for B, I tend to conclude that B is getting something he didn't deserve.

I'm funny like that.
   2082. Lassus Posted: August 14, 2012 at 03:58 PM (#4208196)
Ironically, sharing a bed with a physician is one of the worst ways to obtain reasoned analysis of health reform.

I'm sensing some kind of blackmail involved in this expanded narrative, but perhaps that's best left unexplored.
   2083. The John Wetland Memorial Death (CoB) Posted: August 14, 2012 at 04:00 PM (#4208198)

Samuel " Joe the Plumber" Wurzelbacher is not politically correct and he's proud of it. And to prove it, the Ohio Republican congressional candidate told a crowd of about 125 supporters in Arizona that the government should "put a damn fence on the border going with Mexico and start shooting."

"I'm running for Congress and that should be a bad thing to say," Wurzelbacher said, as the Prescott eNews first reported. "You know what, that's how I feel. I'm not going to hide it because I'm running for an office. I want my borders protected and I'm very, very adamant about that."

Wurzelbacher's remarks came during a Friday fundraising dinner for Arizona State Sen. Lori Klein. Last year Klein, an adamant gun rights activist, was criticized by gun control advocates after she pointed her raspberry-pink handgun at a reporter's chest during an interview to show him the laser sighting.

"It's just so cute," she said of her .380 Ruger handgun, before assuring the Arizona Republic reporter that while the gun had no safety, she "didn't have my hand on the trigger."



::FACEPALM::

Source

   2084. ASmitty Posted: August 14, 2012 at 04:00 PM (#4208199)
Well, when A is forced to pay for something for B, I tend to conclude that B is getting something he didn't deserve.

I'm funny like that.


Should poor people receive fire and police services? Or do they not deserve them?
   2085. Los Angeles El Hombre de Anaheim Posted: August 14, 2012 at 04:04 PM (#4208201)
Well, when A is forced to pay for something for B, I tend to conclude that B is getting something he didn't deserve.
This is what passes for capitalism now. If Adam Smith were alive, it would kill him.
   2086. Dan The Mediocre Posted: August 14, 2012 at 04:06 PM (#4208203)
Well, when A is forced to pay for something for B, I tend to conclude that B is getting something he didn't deserve.

I'm funny like that.


I can only imagine you yelling "Get a job you looters!" as you drive by an elementary school.
   2087. zonk Posted: August 14, 2012 at 04:08 PM (#4208207)
Well, when A is forced to pay for something for B, I tend to conclude that B is getting something he didn't deserve.


I don't recall who wrote it, but this is precisely why I've always loved the quote:

There are two novels that can change a bookish fourteen-year old's life: The Lord of the Rings and Atlas Shrugged. One is a childish fantasy that often engenders a lifelong obsession with its unbelievable heroes, leading to an emotionally stunted, socially crippled adulthood, unable to deal with the real world. The other, of course, involves orcs.

   2088. Mark Donelson Posted: August 14, 2012 at 04:11 PM (#4208211)
I can only imagine you yelling "Get a job you looters!" as you drive by an elementary school.

Funny, I never quite pictured Ray as Richard E. Grant.

EDIT: Yes, I know they're not yelling the same thing, or even the same sentiment, but somehow it came to mind.
   2089. Matt Clement of Alexandria Posted: August 14, 2012 at 04:11 PM (#4208212)
John Rogers of Kung Fu Monkey and Leverage wrote that.
   2090. The kids disappeared, now Der-K has too much candy Posted: August 14, 2012 at 04:14 PM (#4208216)
Every healthcare delivery system has problems.

When you design one (or, more likely - unless you're Singapore or something - have one evolve haphazardly over time) you're balancing a variety of factors - access (who has what level of coverage), timeliness/responsiveness, quality (in terms of outcomes), and cost among them.
The US does amazingly well wrt to timeliness, for those who can afford it (which is most people). We do really, really poorly wrt cost. Our health outcomes are so-so. We famously don't do very well wrt access.
It is virtually impossible to design a system whereby we improve wrt each of these things - you have to pick and choose as to what matters to you and your society.

***

Though... IIRC -- I thought Switzerland, not Canada, had the second highest administrative costs after the US?

Without looking it up, that's my recollection.

***

Where's snapper, btw?
   2091. Tripon Posted: August 14, 2012 at 04:15 PM (#4208218)
I really would like to see what a truly Libertarian society would look like. It'll be a curiosity to say the least, and I wonder if a people of like minded people can make it work.
   2092. Misirlou was a Buddhist prodigy Posted: August 14, 2012 at 04:16 PM (#4208220)
2055. Joe Kehoskie Posted: August 14, 2012 at 03:11 PM (#4208148)



Medicaid already covers an estimated 70 million people in the U.S. The notion that poor people were left to fend for themselves with regards to healthcare is a total myth.


Glad to see you are a supporter of Medicaid Joe. Welcome aboard.
   2093. ASmitty Posted: August 14, 2012 at 04:16 PM (#4208223)
When you design one (or, more likely - unless you're Singapore or something - have one evolve haphazardly over time) you're balancing a variety of factors - access (who has what level of coverage), timeliness/responsiveness, quality (in terms of outcomes), and cost among them.
The US does amazingly well wrt to timeliness, for those who can afford it (which is most people). We do really, really poorly wrt cost. Our health outcomes are so-so. We famously don't do very well wrt access.
It is virtually impossible to design a system whereby we improve wrt each of these things - you have to pick and choose as to what matters to you and your society.


Wait, I can't tell which idea you're demonizing. Are you sure you posted this on the internet?
   2094. Lassus Posted: August 14, 2012 at 04:16 PM (#4208224)
I really would like to see what a truly Libertarian society would look like. It'll be a curiosity to say the least, and I wonder if a people of like minded people can make it work.

I think we ask this all the time, but don't get a lot of places.


Where's snapper, btw?

Rickey Hutcheson indicated he had been in touch with him and said he was fine, simply spending time offline or some such.
   2095. zonk Posted: August 14, 2012 at 04:18 PM (#4208226)
I really would like to see what a truly Libertarian society would look like. It'll be a curiosity to say the least, and I wonder if a people of like minded people can make it work.


If nothing else, they'd be awfully easy to conquer... they might well all be armed to the teeth, but I can't imagine a bunch of lawyers engaged in unending arguments over easements would be too hard to march on.
   2096. Ray (RDP) Posted: August 14, 2012 at 04:21 PM (#4208231)
I really would like to see what a truly Libertarian society would look like. It'll be a curiosity to say the least, and I wonder if a people of like minded people can make it work.

I think we ask this all the time, but don't get a lot of places.


Hilarious.

"Hey, I'd like to see this. No, really, I would."
"So would I, but my friends and I won't agree to it. I wonder why we don't see it."
   2097. ASmitty Posted: August 14, 2012 at 04:23 PM (#4208233)
I wonder if a people of like minded people can make it work.


Is there such a thing? I'm reminded of an old "Twilight Zone" episode where, in the future, everyone looks essentially identical. An otherwise smoking hot chick, however, has a small mole which makes her hideous in the sea of women who all look like a mole-less copy of her smoking hotness.

Groups are only like-minded until you can isolate them long enough to allow themselves to splinter off into ridiculously petty denominations. Despite the fact that people treat US politics as thought the parties are polar opposites, US conservatives and US liberals are pretty damn close to each other in the universe of possible political beliefs. I'm sure the libertarians would eventually convince themselves that the "right-wing" libertarians and the "left-wing" libertarians are each out to destroy their country with their obvious folly.
   2098. Ron J2 Posted: August 14, 2012 at 04:25 PM (#4208238)
No serious proponent of single payer health care believes that people with the means should not also be able to pay their own money for additional care.


Actually you'll find that in Canada this is (almost) exactly what is argued. And the logic is that if you allow people to jump the queue you'll rapidly end up with a two tier system.

The (almost) is because nobody seriously argues against any form of medical tourism. Every year there are a certain number of went to the US for hip replacement (or other elective surgery) because of wait times stories. And now that I think about it, India has been advertizing cheap and quick elective surgery. IIRC it's been a big growth industry.

But then as I said, Canada's not a great model for these discussions. That's not to say it doesn't work, it's just that it's geared to do emergency well and the rest cheap (and even then, it has absurdly high administrative costs for a single payer system).

EDIT: I recall a few years back when there was a controversy about Vince Carter getting an MRI the day after he hurt himself. It's not that you can't get one quickly, it's just not the norm

   2099. PreservedFish Posted: August 14, 2012 at 04:25 PM (#4208239)
I think that, within a couple generations, the true Libertarian society would look pretty similar to normal society.

What I'm curious about is what the Libertarians think would happen if America just all of a sudden went FULL LIBERTARIAN.

edit > What would the death throes of the welfare state look like? How long before things were stable again, and then, how long before a new level of prosperity is achieved?
   2100. Lassus Posted: August 14, 2012 at 04:26 PM (#4208240)
Hilarious.
"Hey, I'd like to see this. No, really, I would."
"So would I, but my friends and I won't agree to it. I wonder why we don't see it."


WTF are you talking about?

I took Tripon's question as a request for an extended descrption involved a lot of "what if this" and "what if that" scenarios posited. As the Rands aren't taking over the earth any time soon, that's what I meant as far as not seeing a lot of examples written out otherwise. Don't get pissed at me that only a minority of people think your philosophy is a good idea.
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