[Pops]

Headline from Politico:
Dog Catches Car, Now What?

Congressional Republicans are setting up their own, self-imposed deadline to make good on their vow to replace the Affordable Care Act. With buy-in from Donald Trump’s transition team, GOP leaders on both sides of the Capitol are coalescing around a plan to vote to repeal the law in early 2017 — but delay the effective date for that repeal for as long as three years.

http://www.politico.com/story/2016/12/o ... ace-232025

LOL. So after 58 (?) votes to kill it and 6 years convincing America that the Heritage Foundation/Romneycare Personal Responsibility law is a mess, Rs now are planning to repeal Ocare in the first 100 minutes... but post-date effectiveness 3 years.

One problem is that there is a deadman switch, once repeal passes Insurance cos can immediately drop out of the markets and stick with the more lucrative employer based market—not surprisingly, exchange customers have more health problems - many are there because they were dumped and excluded by the pre-ocare insurance system.

If it wasn't such a sad reflection of our disfunction I'd laugh out loud.


(You can merge this if you want, but Ocare isn't a good thread title anymore)

[Plantagenet]

once repeal passes Insurance cos can immediately drop out of the markets and stick with the more lucrative employer based market—

Insurance companies are already dropping out of the markets to stick with the more lucrative employer based market. For instance Aetna announced last summer they are dropping out of 11 Obamacare markets. This has been going onfor a couple of years now, along with most of the Ocare co-ops going bankrupt.

Thats why Ocare premiums and deductibles have been skyrocketing in many places.

health-insurers-exit-from-obamacare-leaves-little-insurance-choice

Cheers!

[Pops]

We compare unsubsidized 2016 nongroup marketplace premiums to the average employer sponsored insurance premiums in all 50 states and 73 metropolitan areas. We adjust second lowest cost nongroup marketplace premiums to account for the differences in actuarial value, induced utilization, and age distribution of enrollees. We find that nationally, nongroup marketplace premiums are 10 percent lower than the average employer sponsored insurance premium, after the adjustments. There is variation at across states and metropolitan areas, but more than ¾ of states and more than 80 percent of metropolitan areas having lower marketplace than employer premiums.

http://www.urban.org/research/publicati ... -insurance

[Cog]

The market place premiums are lower because the insurance sucks compared to what is offered through employers.

[Plantagenet]

We compare unsubsidized 2016 nongroup marketplace premiums....

Thats nice, but we're already into the 2017 year, with 2017 premiums. And thats important because 2017 Ocare premiums are MUCH HIGHER. They are so high that many Ds now call for Ocare reform. Bill CLinton, for instance, described Ocare as "the craziest system in the world."

the-cascade-of-2017-obamacare-premium-hikes-has-arrived

You just can't compare premiums anyway---you have to look at deductibles as well. Ocare deductibles are very high---NPR reported yesterday that for an average family the deductible can be $12,000.

That means a family that pays all its premiums----lets say for the sake of discussion the premium was $800 month in 2016 and now it will go up to $1000 month for a family of four or $12000 per year, does't get needed healthcare in some cases until they pay another $12,000 of deductible cost for a total of $24,000 per year before the insurance starts paying. Working class families can't afford that.

The bottom line is that in 2017 Ocare premiums are set to rise an average of 22-25% over the 2016 levels---and in some states the increase is going to be 50-80%

cheers!

[Pops]

From what I gather people are opting for lower premium plans, lower premiums mean higher deductibles, fewer docs, limited networks, etc. No surprise really, most aren't switching from an employer plan, they didn't have anything before. So it seems like we're going down the same road as ever with for profit insurance, even with minimum benefits by law, uniform marketing materials to make comparison easier, etc, people shop for a deal.

[vtsnowedin]

The first thing Trump and Congress should do is make every dollar paid for healthcare, Premiums ,deductibles, prescriptions, and all the rest tax deductible regardless if paid by an employer or the patient themselves.
Second they should require that $1000 per person of medical expense be paid for by insurance companies before any deductible is charged to the premium payer, and then expenses should be split fifty/ fifty until the deductible is met.

[AgentR11]

In the end, there is a core problem for the repeal crowd.

Americans will not tolerate a return to pre-existing condition exclusions. Problem is, insurance companies can't insure individuals effectively if that remains the law. So everyone with individual policies will end up with no insurance, and relying on the ER for services. An ER trip is orders of magnitude more expensive for public health than a GP visit within insurance context. That cost is real. And there is only one payer whose check won't bounce. The state.

That is a fundamental fact of health insurance in the US.

Its why Romney's plan looked the way it did; same with obama care; etc.

Now, if they're serious about the three year delay; that is actually a good sign, it means they do have time to amend it repeatedly to get to something that is actually sound policy that can function if Trump gets a second term; but also should do little structural damage that would inhibit the current Dem thought of simply reducing the age of medicare enrollment in order to capture 90% of the health care costs in the US.

[Ibon]

When I have time in the days ahead I am going to contribute to this thread. It's a big topic. Just to preface, I sold medical devices internationally for 20 years in my previous business and know very well the differences between the US market and international markets and the pricing differences. In addition I have lived in Europe, Canada, Thailand, Panama, Mexico and the Philippines and have been a resident in these countries and received healthcare. I will share some anectodal stories. I will only post here details of what I have observed outside the US in order to keep with the theme of this thread, in what direction the US needs to move in.

I will start with the most fundamental basic point and elaborate on this repeatedly with the posts I intend to share here in the days ahead. The problem with US healthcare is not the insurance companies. It is all about the inflated price tag of medical procedures, hospital stays, drugs, medical equipment. This is the primary source of the problem. Secondary, the exhorbitant amount of money that is spent on end of life procedures. What I hope to share in these posts is that there is an exponential difference in the price of healthcare between the US and the rest of the world that in no way reflects the actual care received by patients. Why this all happened is another topic which maybe others will contribute. My contribution here will be contrasting the US to other systems and focusing on the price differences throughout the whole chain from equipment aquisition, to service, drugs, procedures, etc.

More later. Time to take some guests on a walk.

[Plantagenet]

Americans will not tolerate a return to pre-existing condition exclusions.

Of course not. AND They don't have to.

Before the Ocare mandate, many states had special pools and/or plans that covered people with pre-existing conditions. For instance, here in Alaska the state had a separate insurance pool just for people with pre-existing conditions.

Just last week Alaska got a waiver to create the pool again, because the medical expenses of a few people who so large that they were causing the rates for everyone in Alaska to go up 50-100% per year. The state determined that 400 people were responsible for a hugely disproportionate part of the Ocare insurance premiums in Alaska. Alaska is going to pull these people out of the Ocare pool, and just have the state pay directly for their insurance costs in a separate, high risk pool. That will stop the huge premium increases for everyone else, and it could've saved Ocare, if this had been done nationwide.

alaska-republicans-back-bill-to-prevent-obamacare-meltdown-in-state

This is a much smarter approach to the problem then lumping everyone together as is done in Ocare. Maybe this approach will be adopted nationwide and become part of Trumpcare---who knows?

[Pops]

So when Alaskans get sick, insurers don't pay, the taxpayers do.
Thereby preserving the profits of insurance cos.
Nice.

[Plantagenet]

So when Alaskans get sick, insurers don't pay, the taxpayers do.
Thereby preserving the profits of insurance cos.

The underlying premise of Ocare is that insurance companies are going to make profits. Thats why Ocare rates are going up next year by 20-30-40 even 80% in states across the country. The Obamacare rates are being jacked up to preserve profits for the insurance companies.

Yes, the Alaska fix for Ocare has the state paying directly for the insurance for a small pool of people with pre-existing conditions requiring very expensive medical treatment. But the result of this approach is lower insurance premiums for all the other people of the state who are in the Obamacare insurance program. And finding a way to stop the explosive rise in Obamacare premiums is a good thing.

Cheers!

[evilgenius]

I think the problem with healthcare costs in the US is a fundamental one. There is no market based pricing. Part of this has an obvious reason: if you break your leg falling on the ice outside of your house you don't call around or ask the ambulance to take you to the cheapest place. People, also, don't ask about price when they are dealing with a health issue. They may have some remove from the immediacy of an emergency, but they don't take advantage of that in order to find the cheapest provider. As a consequence the entire healthcare system is built around marketing itself along the lines of whether they can provide a service, not a service for a certain price. I say provide a service because quality of service is also not a part of their marketing. It is assumed by the public that if a service is available it will meet some minimum standard.

There are many reasons why people don't push for the cheapest price. Some people are not allowed to seek alternatives outside of a straight jacketed pricing system. Some people like their doctors, or believe in quality. For others, who might like to choose based upon some kind of cost vs benefit basis, there may not be enough information available as to the actual quality of the healthcare available to them, or the prices involved. There may be some standard pricing as well, but did you know those prices are set by committees of doctors associated with the AMA in many cases? Those prices are not market based. You can't get into finding that information out yourself for very long either before you become mired in commitment to the provider at hand. It isn't possible, unless you live on an island, to achieve honest discovery among all of the available options by yourself.

Recently, where I live, there was a surgical tech at one of the local hospitals who exposed hundreds of people to all of his diseases because he wanted to get high off of the drugs they were supposed to receive. It turned out that there was no system for identifying suspect people like him. They tend to have a trail, but like bad cops who move from town to town only deep reporting ever uncovers it. The hospitals have a deep interest in you not knowing. They prefer to quietly fire somebody, who will most likely start work very soon the next state over. You can't just look up a hospital to see what level of quality its staff has. You can't look up doctors for complaints. Nobody follows outcomes and reports on them, good or bad. In my town there are publications that put out the best of list for certain things having to do with medicine, but there is no list of shady operators who no one ought to go to. They get treated the same as every other provider, and become full of patients the same.

What the healthcare system in the US lacks is information, not money. Currently, we throw all kinds of money at it in hopes that will solve something. Throwing money at insurance doesn't help either because, by definition, it introduces an information obscuring middle man between the carer and the cared for. You aren't buying an advocate. We have yet to throw transparency or full disclosure at it, in order to give people real choice.

[Newfie]

Somewhere about 30% of health care dollars are lost in the insurance system. It's a bit contentious but Politifact finds it "mostly true."

http://www.politifact.com/oregon/statem ... re-dollar/

On top of this I think we spend a great deal of money because folks are not getting good primary care but let problems go until they become very expensive ER problems because they don't have health care. That was basically the argument for "managed care", that it would reduce costs by taking better care of people. That better care never materialized. They just squeezed the providers and patients.

I'm not disagreeing about the various arguments above. I'm just noting this factor IN ADDITION.

[Newfie]

http://www.commonwealthfund.org/publica ... tive-costs

Synopsis

Administrative costs account for 25 percent of total U.S. hospital spending, according to a new study that compares these costs across eight nations. The United States had the highest administrative costs; Scotland and Canada had the lowest. Reducing U.S. per capita spending for hospital administration to Scottish or Canadian levels would have saved more than $150 billion in 2011.

[Plantagenet]

Somewhere about 30% of health care dollars are lost in the insurance system. It's a bit contentious but Politifact finds it "mostly true."

http://www.politifact.com/oregon/statem ... re-dollar/

This is one of the biggest flaws in Obamacare. We'd be better off with either a national healthcare system that doesn't use private insurance companies or a truly competitive market where all the insurance companies have to compete on price. The Ocare system wound up with way too many markets with only one insurance company, and the lack of competition meant that the insurance premiums could be jacked way up.

On top of this I think we spend a great deal of money because folks are not getting good primary care but let problems go until they become very expensive ER problems because they don't have health care. That was basically the argument for "managed care", that it would reduce costs by taking better care of people. That better care never materialized. They just squeezed the providers and patients.

Yup. Thats 100% right.

Since most people with Ocare have HUGE deductibles, they aren't going to get good primary care because they know their insurance won't cover it. The current Ocare system where the insurance has huge deductibles is actually making this problem worse rather than fixing it.

--------------------

And increases in US hospital administrative costs are also linked to Ocare. Ocare added a HUGE number of new regulations, all of which require expanded administration. The last time I went to the doctor there was a third person in the room, just to track what the doctor was doing to comply with Ocare regulations.

It was better before with just me and the doctor. The third person didn't add anything but more administrative expense.

Cheers!

[Subjectivist]

Well until something actually gets passed its hard to guess how it will turn out, but I am hopeful the multi state insurance feature often talked about does get enacted. Right now my wifes company supplies insurance through Massachusettes because that is where they have their headquarters. The level of confusion this causes in Ohio are remarkable because the assumption is residents have insurance from companies in the state, so charges get sent to the wrong insurer and make a mess. If we get a nationwide system all those headaches should clear up, and companies will be able to offer local insurance even though they are headquartered in a different state.

[evilgenius]

Somewhere about 30% of health care dollars are lost in the insurance system. It's a bit contentious but Politifact finds it "mostly true."

http://www.politifact.com/oregon/statem ... re-dollar/

On top of this I think we spend a great deal of money because folks are not getting good primary care but let problems go until they become very expensive ER problems because they don't have health care. That was basically the argument for "managed care", that it would reduce costs by taking better care of people. That better care never materialized. They just squeezed the providers and patients.

I'm not disagreeing about the various arguments above. I'm just noting this factor IN ADDITION.

That's partly right. I can cite an example from my own life, in how I had to pay out of my own pocket two days ago to get a flu shot.

What, however, do you tell somebody who weighs three hundred pounds, and wants to weigh three hundred pounds? Once you get past the big bones lies and the slow metabolism drivel, you'll likely discover a person's issues with their spouse or personal depression or their parents. There's a whole side to healthcare that doesn't even exist for most people. That's the side that helps them to realize the roots of their problems and gives them the ammunition to actually change who they are. This part doesn't get solved, perhaps oddly, by going to church, like the conservatives in America would like us to believe. It probably gets reinforced! Which isn't to say that such institutions shouldn't be a part of the process, but that they ought to be called out for failing as well.

What we are is surrounded by an entire world that doesn't tell the truth. If you want to find that out, you have to do it yourself. But how do you do that in a culture that doesn't call you out for being wrong either? How does a person begin to realize that their own personal self-worship party has gone off the rails? I mean, we all probably get told, in one way or another, several times a day about our own faults, but choose not to listen. Most of the time we are right not to listen. You can't make a life out of what is wrong with you. But that's the issue, when you don't listen at all that's exactly what most people tend to wind up doing.

[Newfie]

I agree on the personal responsibility aspect. My Wife agrees also and as a counselor her profession is to help people come to grips with themselves.

There should be certain limits set.

Obese people do not get medical care for obesity related diseases.
Smoker? No treatment for lung cancer.
Riding a motorcycle wo a helmet? No state care if you crush your can.
Etc.

And before folks whine again about this there are plenty of precedents.
Speeding tickets? Your premium goes up.
For some professions of you are over weight you are let go.

As it stands we reward or enable poor behavioir which we all have to pay for.

If I go into a food store or Walmart I see many folks who are grossly obese and they are buying junk food. I know healthy food is more expensive, but no more so than doubling or tripling the QUANTITY of food consumed.

We need to get over that.

[Pops]

The flaw with for profit healthcare is that the customer is a captive, I can choose to walk to the store but I can't choose to not take insulin - well I can.

Another problem with insurance based care is it is adversarial, insurance cos profit from not providing a service so there is a whole layer of bureaucracy on the provider side trying to get paid, ditto the insurer side trying to not pay.

And then, it is piece work, outcomes don't matter to the provider's bottom line, only the number of procedures—practice.

Too few GPs, due to the doctors cartel, AMA

As for responsibility, OCare, Romneycare, the R plan from the '90s all had mandates, likely the most unpopular feature of Ocare (besides the O) for regular folks. Probably 2nd least popular is that it is a government program, you know, elites and all that.

But you can exclude any number of people for any number of reasons to keep the price low, those already terminal, those likely to become terminal, those whose parents were terminal, lol