Except that even these early results are no where near the projections and costs that were anticipated in a piece of legislation that most politicians never fully read, no less understood. I've spent over 40 years in healthcare and most any executive you will speak to will tell you that it's a piece of crap and has only added significantly more administrative costs than were anticipated and pharma, med device and insurance companies have profited more than they did before the ACA. Sure it's early (and the results thus far are awful), but the worst is yet to come. (Cadillac tax for one....).
Electoral Future of the Republican Party
- Thread starter shu09
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I realize probably a vast majority of health care professionals hate the ACÁ, However, many health care professionals dislike it due to taking money out of their pockets. Can the ACA be tweaked? For example, having California insurance companies compete with Nj companies help lower costs by increasing competition? Are there other tweaks that can be made to the system that can make it work better, cheaper and more efficiently?
Or is moving to a single payer Medicare for everyone type of system the answer? We can all agree that something had to be done with health care can't we? The question was how? If healthcare professionals can come up with a better plan, what would that look like? It is a question that needs answering and also have the realization that nothing will be perfect.
The whole notion to justify the ACA by saying "something had to be done" is just plain dumb. Spending all of that time, money and energy to put out a piece of legislation that is garbage is worthwhile? Doing nothing versus passing the ACA would have been preferable.
There are number of things that should have been done which would've provided more access at a lower cost which have been discussed previously. And most healthcare executives will rattle off the same list. The ACA was nothing more than a wealth redistribution that has hit the middle class the hardest.
And there aren't many good reasons for the price discrepancies that you see between Canada and the US. Healthcare is an industry that needs to have price transparency in order to fix that yet the ACA conspicuously didn't address it.
There are number of things that should have been done which would've provided more access at a lower cost which have been discussed previously. And most healthcare executives will rattle off the same list. The ACA was nothing more than a wealth redistribution that has hit the middle class the hardest.
And there aren't many good reasons for the price discrepancies that you see between Canada and the US. Healthcare is an industry that needs to have price transparency in order to fix that yet the ACA conspicuously didn't address it.
How long is long enough for you to judge? I want to mark my calendar and give you an equally smarmy response when you are proven wrong.
I don't need a financial background to tell you how it's going to go down. There is a brain drain in the medical field, already, and the ACA directly impacts the "bottom feeders" of the profession: primary care providers. These folks make up the majority of practicing physicians, by a long shot. They're overburdened, underpaid, and in enormous debt, in most cases. Individually, their billing is peanuts compared to the subspecialists, particularly those that do procedures.
Since you're not in the industry (but you have been to Planned Parenthood), you don't see the primary care people scampering for the higher ground of private industry, especially pharma, or outright quitting or retiring. But it's happening, and they are being replaced by cheaper labor, including PA's, NP's, and poorly trained foreign medical graduates.
So not only are the metrics terrible in "keeping your doctor" and affordability -- you're banking on a fine to get people to sign up (for high deductible plans, no less) -- but the quality of cut-rate medical care, while the insurance companies continue to thrive, is suffering, badly. You expect the same people who can't be expected to get a voter ID to pay a fine? LOL
But...give it time. It will get worse.
http://nypost.com/2016/10/16/now-even-democrats-can-see-the-obamacare-death-spiral/
That's a great point and one that is already happening. There is already a physician shortage and in five years you will be seeing NP's and PA's reading an EMR and treating you (less education, less training than PC docs).
Well, yes I am no longer in the industry as I have changed specialties with a new firm but I was involved in the industry as an auditor for NJ / PA hospitals. There were definitely shifts post ACA and how the Hospitals were dealing with the law including buying up physician practices as that became more attractive to both sides post ACA.
All I am saying is we need to wait to see if these shifts will have an impact on outcomes and utilization. You know that will take many years before we know the answer to that. Will we have the same quality of care in 2025 as we did in 2010? Maybe. Will utilization be down? Maybe. Will health outcomes be different? Maybe. You can say "they will be" all you want... but eventually the data will be available to support or refute your claim.
and yes... people will pay the fine because it is a part of filing their taxes. Or are you suggesting that people are going to stop filing their taxes because of the ACA?
And we should be measuring things along the way, because some of these shifts are worse than forecasted for a variety of reasons that were never considered or ignored. I don't need to wait until 2025 to call Obama a dope.
You have been calling him that since he started running for president... I wouldn't expect you to stop now...
It wasn't designed as a short term fix. It was designed to change the way people use healthcare. There are signs of that happening such as children going to the doctor less and using less medication... I am not going to judge it by who is getting rich and who is joining/leaving the profession. I will judge it based on utilization, outcomes and pricing... but not until a reasonable amount of time has passed after it has been fully implemented.
I saw you mention the Cadillac tax as being a bad thing. I disagree. I think it is a great thing to stop companies from offering way more coverage than people need as a form of compensation, and encouraging over utilization of care.
It wasn't designed as a short term fix. It was designed to change the way people use healthcare. There are signs of that happening such as children going to the doctor less and using less medication... I am not going to judge it by who is getting rich and who is joining/leaving the profession. I will judge it based on utilization, outcomes and pricing... but not until a reasonable amount of time has passed after it has been fully implemented.
I saw you mention the Cadillac tax as being a bad thing. I disagree. I think it is a great thing to stop companies from offering way more coverage than people need as a form of compensation, and encouraging over utilization of care.
Merge, you are ignoring my point. It is already missing many of the milestones that were anticipated and forecasted when the bill was passed. You want to ignore all Results along the way until 2025?
And I'm not arguing that the Cadillac tax is a bad thing, but your candidate Clinton has already said she wants to repeal it. So essentially all of the benefits have been taken over the first three years and many of the ways to pay for them are being delayed or Repealed. Your government at work once again.
I guess I had Obama pegged correctly from the start…
You literally just used the Cadillac tax as an example of the worst yet to come a few posts ago... but you're not arguing against it?
Clinton is not "my candidate" - Just happens to be leaps an bounds better than Trump so she is getting my vote and I disagree with her on this issue. The Cadillac tax is a politically damaging tax so i am not sure if it will last but I hope it does... Not for the extra revenue, but so companies will stop selecting these types of plans.
I really don't care about short term milestones. What I care about is availability, outcomes, utilization and pricing and I am not ready to make a judgement there. Nor should anyone be before it is fully implemented while allowing a period of time for people to adjust to it.
I'm arguing against the whole ACA, which the tax was part. Your argument is that it's politically damaging, so you're saying its a good idea for Clinton to rescind a critical part of the ACA, because it's not politically expedient? Now that's a contradiction!
Not caring about short term milestones? That strikes me as pretty irresponsible. I should tell my board "Don't worry about monthly and quarterly results even if I miss them badly....just wait 10 years and everything will be fine".
When the quality and number of providers is diminished, outcomes will unavoidably worsen.
"but the worst is yet to come. (Cadillac tax for one....)." - What you said was pretty clear.
I am not saying it is a good idea... Just that we live in a reality of political soundbites. I have had doubts of the Cadillac tax coming to fruition because voters respond to it poorly even though it is a good idea.
Nice straw man...
It's reality...how can you just stick your head in the sand for a decade and not pay any attention to how it's performing to expectations each year? Like I said...that's irresponsible.
No one is sticking their head in the sand but the entire thing is designed with LONG term goals. Moving towards the higher deductible plans, and shifting the way way pay for healthcare, you are asking Americans to change their habits and lifestyle choices... This goes WAY beyond enrollment numbers, and the short term costs... I don't think the impact of the penalties will have a true impact on the enrollment numbers until 2018 as I explained earlier. Then, healthy people will be more likely to buy into the plans which will increase enrollment as well as providing a healthier pool of the privately insured... The years 2018 through 2020 would be a better period to make judgments about enrollment. During that period and for the next 5-10 years we will be seeing if it is impacting utilization and costs or not.
Merge, what don't you understand about hitting short term milestones (that the ACA set) while you also plan to meet the long term goals? Doesn't it concern you that their projections and results this early on are way off? For the third time...irresponsible.
Good lord... I am not involved with the decision making process. How could it be responsible for me as an outside observer to make a judgement about it? When the law first passed, I remember saying to you that it would take about 10 years to judge it. This is how I saw the law then and is still how I see it today. I don't care about the BS politics that people have played to avoid the ACA hitting milestones like preventing the medicaid expansion or blocking funding of advertising for public healthcare options.
I care about LONG TERM results of the ACA. The short term milestones are meaningless to me.
Call me whatever you want...
It does not concern me that the ACA enrollment is lower than expected especially before the penalty for not having insurance has fully kicked in... and the metrics on cost are going to be higher as the initial enrollees are more likely to be low income or sick.
Enrollment, while important, is not going to be HOW I judge the ACA.
I will judge based on trends in outcomes, utilization cost and availability to get care.. and that will take time.
I THINK that it will take time to judge the entirety of the law. You disagree.
It does not concern me that the ACA enrollment is lower than expected especially before the penalty for not having insurance has fully kicked in... and the metrics on cost are going to be higher as the initial enrollees are more likely to be low income or sick.
Enrollment, while important, is not going to be HOW I judge the ACA.
I will judge based on trends in outcomes, utilization cost and availability to get care.. and that will take time.
I THINK that it will take time to judge the entirety of the law. You disagree.
I think the insurance company (providers) have made their judgement pretty clear of what they think of ACA. As a small business owner me too - I and my employees have less coverage, much higher premiums and much higher copays - its'a friggin blast and I was covering all my employees and doing the right thing before. Small Business owner and health insurance = Bend over, no lube, insert ACA.
Not to worry....by 2025 everything is going to be rosy.....you may not have a business by then, but we need to be patient...cough, cough...
Interesting. Question more for me than for a debate
1. What is the employee size of your business?
2. Before ACA what percentage of health coverage were you as the employer paying. (i.e, did you employees contribute anything to the cost of their health care?)
Also, the economy may be humming by then after 8 years of very dismal growth (after a deep recession when economic growth should be much, much better as history shows), just give it more time.
Your 2nd question is important to the debate.
Premium increases were rising at record rates prior to Obama taking office. To shift some of the rising premium costs, high deductible plans started becoming more popular around 2006. Premiums / deductibles would not be significantly different today had we never passed the ACA.
We have been able to provide coverage to millions more Americans than prior to the ACA to a similar level of insurance while providing free preventative care, and preventing companies from denying preexisting conditions and lifetime maximums.
and yes... the impact of the ACA will only be truly understood after a long period of time. Insurance companies had large losses re insured by the government which ends in 2016. The penalty will also fully kick in next year and we are likely to see some price stabilization going forward in the plans.
Can you provide an example of a recovery being much better than the one we had after a recession which was as bad as we had?
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Which one of those recessions do you think was as bad as the last one?
Because your answer should be none of them.
It is none and that just makes the point I've been trying to make all along which these charts prove: the deeper the recession, the quicker and better the recovery. Except for the most recent one.
To me, that defies logic and common sense.
If you fell into a hole, it would take you longer to get out of a deeper hole than a shallower hole. It's the same in most, if not all, aspects of life. The economy included.
Obama: "You can keep your insurance company and your rates will not go up."
How's that working out?
Also:
Jonathan Gruber one of the architects of Obama Care said last year that the “stupidity of the American voter” helped pass the law.
Oh, last but not least:
The FBI earlier today sent a letter to Democrats and Republicans in Congress that they have found new emails from Weiner's (wife/ex-wife is a top aide for Hillary) mail server (not the Russian's lol) and has reopened the investigation into Hillary's emails. Stay tuned...
Drip, drip, drip...
How's that working out?
Also:
Jonathan Gruber one of the architects of Obama Care said last year that the “stupidity of the American voter” helped pass the law.
Oh, last but not least:
The FBI earlier today sent a letter to Democrats and Republicans in Congress that they have found new emails from Weiner's (wife/ex-wife is a top aide for Hillary) mail server (not the Russian's lol) and has reopened the investigation into Hillary's emails. Stay tuned...
Drip, drip, drip...
If all things were always equal in how we reacted to a crisis, and we had the same insustrial responce after each recession, you're argument would make sense... but we are not in a vacuum and your argument is far too simplistic of an idea.
It's a nice rationalization on your part but you aren't arguing with me, you're arguing with many, many top economists who are much smarter than me.
I would be happy to take them on as well. There are economists that are on board with what I am saying as well.
There are just too many variables to say this recovery should have been faster because they have historically been faster really can't be accurate. Historically he recessions were not combined with the entire country losing half of the value of their homes.
they also had other factors helping their recovery like new industry, new technology, population growth, ability to lower interest rates, government willing to invest. Yes, growth has been slow but we have finally seen unemployment get to a place where wages are growing again. We didn't overreact to the recession causing a bubble which would have collapsed by now. We have also outpaced the recovery by most if not all of the other countries which were impacted by the crisis.
There really is no precident for a recovery period under this bad of a recession so it's better to judge it based on how we reacted and what we could have done differently.
