Obamacare Survives SCOTUS

[Sea Ray]

Once we get through all the rhetoric it does boil down to this: Americans cannot afford healthcare w/o gov't help. No developed country in the world delivers healthcare without gov't subsidies. We cannot have Americans paying $2K/mo plus deductibles for healthcare premiums. You just can't. But we still need to preserve competition in the workplace. I think the plan should be some sort of gov't plan for the pre-existing conditions folks and an open market for everyone else. This should be paid for with something like a national sales tax with some kind of rebate for seniors since they're fixed income and they've already paid for their healthcare thru Medicare. They should not be forced to pay for everyone else's too.

This would be a very complicated plan and I have NO confidence that our idiots in DC could write and administer such a plan. In the meantime they should approve HSAs for everyone right now and spread the word that there are non Obamacare policies out there

 

[Septic]

Lulz. So emotional. I’ll admit I pay a crap ton for healthcare and I pay considerably more now than I did five years ago for the same level of access and use so yeah you’re damn sure I want to reverse my costs. What idiot wouldn’t want to do that FFS? … oh …

Give the virtues signaling BS a rest nobody is buying it.

Dude, I pay 100% of the healthcare costs for seven individuals plus my own family if you want to compare receipts. I know what it means to vet deductibles, co-pays, network access and benefits for cost considerations for people who have less than I do.

No one wants to pay more, but people also don't want to be thrust into bankruptcy with a bad diagnosis. The dichotomy is that either we all pay more or millions of Americans face uncertainty in financial solvency.

But as long as you're one of the haves, f*** everyone else. Right?

 

[Sea Ray]

Please. What ideas have you posited that will result in ALL Americans being covered without additional cost? Tell you what, write your congressman with your idea and collect your Nobel prize in economics on your way to the ceremony where I kiss your ass.

For the record I gave my specific healthplan by starting its own thread a year or so ago:

My Healthplan

It only went for two pages thus people around here weren't too interested in problem solving

 

[lawgator1]

Nah. You can cough up the bucks for that.

Let me give you a direct example of how the system is so screwed up and how we're all paying for it. A few years ago my then teenage daughter went to the doctor for an annual checkup and she got two vaccinations (one was for flu). Our PPO actually paid the doctor $600 for that visit. We were charged $150 just to administer the vaccines. Not the vax itself. That was another charge. But since Obamacare pays 100% for these sorts of visits, no one bats an eye and life goes on. If patients were actually paying at the time of the visit, do you think that pediatrician could get by with charging $600 for a 20-30 min checkup? Hell no

The charge versus the amount actually paid are usually quite a distance apart.

 

[NorthDallas40]

Dude, I pay 100% of the healthcare costs for seven individuals plus my own family if you want to compare receipts. I know what it means to vet deductibles, co-pays, network access and benefits for cost considerations for people who have less than I do.

No one wants to pay more, but people also don't want to be thrust into bankruptcy with a bad diagnosis. The dichotomy is that either we all pay more or millions of Americans face uncertainty in financial solvency.

But as long as you're one of the haves, f*** everyone else. Right?

You keep on with that last line Mr Emotion. Remember when we started this discussion we both agreed that we recognize and prioritized healthcare and pay for quality healthcare plans. That’s it. Pound sand on your dichotomy you’re free to go pay for as much as you like. I’ll keep working towards reversing the useless government interference that merely added costs without any observable benefit. Now you can reply with your next emotional bull **** virtuous rant making excuses for government waste. And please don’t bring up your pro fiscal responsibility going forward after this emotional laden BS.

 

[NorthDallas40]

So one example of useful legislation without over reaching on direct interference is the Federal Surprise Balance Billing legislation which passed in December 2020 and goes into effect January 2022.

I’d guess this legislation addresses the dread most of us have, out of the blue ridiculous medical expenses, without touching our personal coverage. It is a limiter on the providers on when and how they can screw people over in out of network charges. This is good stuff. This enacts at a federal level the protections which many states have already done. Texas did this with SB 1264 a couple of years ago. It has to be done at the federal level because even though I live in Texas SB 1264 doesn’t protect me as my plan is governed by ERISA 1974 federal rules which also affect well over 100M Americans. So this extends that same kind of protection to another 100M+ Americans. This is what we need more of. Not direct government healthcare plan administration.

Federal Surprise Balance Billing Legislation: Key Takeaways - abeo

 

[volinbham]

1st, not-for-profit means basically nothing in this country, it’s mostly a tax shelter like churches use. The largest employer in the my state is UPMC (University of Pittsburgh medical branch) and they are technically non-profit… it’s a sham.

2nd, Yeah, SOME non-clinical personnel are required for critical functions, but if you did away with medical coding, bill collections, medical sales, etc then you could drive down costs considerably.

3rd, profit seeking isn’t ALWAYS at odds with what’s best for the patient, but it is all too often. If you only knew how hard doctors and nurses and allied health professionals had to fight to get basic materials that make a huge difference in patient care that are often denied because of “cost containment” you’d be staggered.

1 - factually wrong - it does have meaning and it's not a sham. There are no "owners" in not-for-profit for profit to be distributed to and "margin" is used within the organization rather than being distributed to owners.

2 - medical coding is required for government payers as well as private so it's not going away; I'm sure even NHS has medical coding bureaucrats. not sure what you mean by "medical sales" but the training on medical devices is needed whether it comes from "sales" or elsewhere. HR, regulatory compliance, IT infrastructure, procurement, etc all require non-clinical personnel

3 - you contradicted your statement that I responded to. Even in the absence of profit decisions that are not in the patient's best interest are driving by cost (see NHS in the UK refusing to let parents seek care out of the country).

As to the "struggle for materials" why do you think doing away with profit changes that? Materials have costs - they must be paid for by someone. The profit seeking motivation likely drives those costs down rather than up.

Have you ever taking a basic economics class or read a basic economics text? I'm not trying to be insulting but your statements ignore fundamental economic principles.

 

[volinbham]

Dude, I pay 100% of the healthcare costs for seven individuals plus my own family if you want to compare receipts. I know what it means to vet deductibles, co-pays, network access and benefits for cost considerations for people who have less than I do.

No one wants to pay more, but people also don't want to be thrust into bankruptcy with a bad diagnosis. The dichotomy is that either we all pay more or millions of Americans face uncertainty in financial solvency.

But as long as you're one of the haves, f*** everyone else. Right?

Even with all you pay not everyone has insurance so how much more are you prepared to pay (as one of the haves)?

I'll add that you say you pay 100% of your healthcare costs - technically that's only true if you or the others you pay for are a light users. If you or they are mid or heavy users of healthcare then others like you are paying part of your/their healthcare costs via pooled risk. The only way to pay 100% of your healthcare costs is to direct pay for all healthcare you consume.

 

[OHvol40]

Irrelevant. Margins are always weighed by % as that’s the only way to scale up or down in size when comparing businesses. And I’d probably run like hell from a business with razor thin margins like that in almost any market other than healthcare. People are always gonna get sick though. Especially last year and with Uncle Sam picking up the tab on COVID I’d guess hospitals did just fine.

Hospitals had to shut down elective procedures.

 

[volinbham]

Hospitals had to shut down elective procedures.

for both profit and not-for-profit hospitals; what is the role of elective procedures in contributing to operating revenues?

 

[OHvol40]

1 - factually wrong - it does have meaning and it's not a sham. There are no "owners" in not-for-profit for profit to be distributed to and "margin" is used within the organization rather than being distributed to owners.

2 - medical coding is required for government payers as well as private so it's not going away; I'm sure even NHS has medical coding bureaucrats. not sure what you mean by "medical sales" but the training on medical devices is needed whether it comes from "sales" or elsewhere. HR, regulatory compliance, IT infrastructure, procurement, etc all require non-clinical personnel

3 - you contradicted your statement that I responded to. Even in the absence of profit decisions that are not in the patient's best interest are driving by cost (see NHS in the UK refusing to let parents seek care out of the country).

As to the "struggle for materials" why do you think doing away with profit changes that? Materials have costs - they must be paid for by someone. The profit seeking motivation likely drives those costs down rather than up.

Have you ever taking a basic economics class or read a basic economics text? I'm not trying to be insulting but your statements ignore fundamental economic principles.

Basic economic principles apply in a sector that is essentially inelastic? Enlighten me.

 

[NorthDallas40]

Hospitals had to shut down elective procedures.

More irrelevant. I checked the margins. They did better than usual by a bit last year. 2.5 to 2.7 is better than average over the last 11 years I saw

 

[OHvol40]

for both profit and not-for-profit hospitals; what is the role of elective procedures in contributing to operating revenues?

I can speak for the hospitals that I work for, and our daily procedure numbers were essentially cut in half, along with the inpatient stays that accompany them. Of course it depends on what service lines a specific hospital provides. Smaller community hospitals that aren’t trauma centers where hit even harder I’m sure.

 

[volinbham]

Basic economic principles apply in a sector that is essentially inelastic? Enlighten me.

they still apply - see, basic economic principles would tell you that.

more specifically, HC isn't entirely inelastic and as numerous studies have found as you change an individual's financial contribution that demand expands and contracts with little impact on health outcomes (e.g. open bar vs cash bar).

in the simplest terms, revenues must exceed costs to remain a going concern (cashflow buffer). If you are serving only Medicare and Medicaid patients good luck covering your operating costs and you either need generous patrons or government subsidies to survive. It's why even not-for-profits seek revenue generating opportunities (private insurance patients, complicated invasive procedures, etc) so they can cover the costs of patients that cost more to serve than the revenue they generate.

As an answer to my question above - elective procedures are one of the revenue generators that subsidize other services

 

[volinbham]

I can speak for the hospitals that I work for, and our daily procedure numbers were essentially cut in half, along with the inpatient stays that accompany them. Of course it depends on what service lines a specific hospital provides. Smaller community hospitals that aren’t trauma centers where hit even harder I’m sure.

it was a trick question of sorts - these procedures are offered to subsidize other procedures. Even those not seeking profit do these to generate resources for other parts of the mission

 

[OHvol40]

they still apply - see, basic economic principles would tell you that.

more specifically, HC isn't entirely inelastic and as numerous studies have found as you change an individual's financial contribution that demand expands and contracts with little impact on health outcomes (e.g. open bar vs cash bar).

in the simplest terms, revenues must exceed costs to remain a going concern (cashflow buffer). If you are serving only Medicare and Medicaid patients good luck covering your operating costs and you either need generous patrons or government subsidies to survive. It's why even not-for-profits seek revenue generating opportunities (private insurance patients, complicated invasive procedures, etc) so they can cover the costs of patients that cost more to serve than the revenue they generate.

As an answer to my question above - elective procedures are one of the revenue generators that subsidize other services

There aren’t any markets that are entirely inelastic, anything could price itself out of demand theoretically… but HC is about as inelastic as any market you’ll find, as evidenced by the steep incline of price over the decades (in this country anyway) and the relatively unaffected demand. People will always get sick and injured.

 

[Septic]

Even with all you pay not everyone has insurance so how much more are you prepared to pay (as one of the haves)?

I'll add that you say you pay 100% of your healthcare costs - technically that's only true if you or the others you pay for are a light users. If you or they are mid or heavy users of healthcare then others like you are paying part of your/their healthcare costs via pooled risk. The only way to pay 100% of your healthcare costs is to direct pay for all healthcare you consume.

With a universal healthcare system it'd be unlikely that employment based group health plans would be a thing. You're right, I mispoke - I pay 100% of thier health insurance premiums.

 

[volinbham]

There aren’t any markets that are entirely inelastic, anything could price itself out of demand theoretically… but HC is about as inelastic as any market you’ll find, as evidenced by the steep incline of price over the decades (in this country anyway) and the relatively unaffected demand. People will always get sick and injured.

gasoline is inelastic, utilities are inelastic, tobacco demand is inelastic: elasticity is more about response of demand to changes in price rather than core economics.

I'd have to do some research on the "relatively unaffected demand" part of your assertion.

still, economic principles apply in relatively inelastic markets

 

[volinbham]

With a universal healthcare system it'd be unlikely that employment based group health plans would be a thing. Your right, I mispoke - I pay 100% of thier health insurance premiums.

by universal I presume you mean everyone has insurance; not everyone has government provided care. Switzerland has universal coverage but it is entirely delivered through private insurance (including for profit insurers) so they likely have employment based group health plans. the UK has universal coverage and care through NHS.

Are you suggesting single payer (government insurance for all) when you say universal healthcare system?

these discussions often get mired in terminology confusion between who has insurance, who pays for it and who provides care.

 

[Septic]

You keep on with that last line Mr Emotion. Remember when we started this discussion we both agreed that we recognize and prioritized healthcare and pay for quality healthcare plans. That’s it. Pound sand on your dichotomy you’re free to go pay for as much as you like. I’ll keep working towards reversing the useless government interference that merely added costs without any observable benefit. Now you can reply with your next emotional bull **** virtuous rant making excuses for government waste. And please don’t bring up your pro fiscal responsibility going forward after this emotional laden BS.

There's no requirement for emotion when facts are on my side.

Looks alot like your accusing others to throw everyone of the scent of your inability to put forth a solution to an issue that makes you look like total douche.

Lol at you trying to backhand a dig about fiscal responsibility - you Trump nut huggers are the last folks who ought to shoe horn those two words into a conversation. Seriously, try to keep up - I'm not defending the ACA, just pointing out that it's naysayers haven't put forth a single viable alternative. Not one.

 

[Sea Ray]

The charge versus the amount actually paid are usually quite a distance apart.

You're so brilliant. The point here is that folks will overwhelm the system with every little ache or pain if they have no skin in the game for going to the doctor

 

[NorthDallas40]

There's no requirement for emotion when facts are on my side.

Looks alot like your accusing others to throw everyone of the scent of your inability to put forth a solution to an issue that makes you look like total douche.

Lol at you trying to backhand a dig about fiscal responsibility - you Trump nut huggers are the last folks who ought to shoe horn those two words into a conversation. Seriously, try to keep up - I'm not defending the ACA, just pointing out that it's naysayers haven't put forth a single viable alternative. Not one.

What facts are on yourside here? The number of uninsured after ACA deployment isn’t largely different while costs have sky rocketed. So hell no I don’t want more ACA like you’re preaching I’ll take much less.

I’d deflect away from my emotional plea for more government interference too in your case if I were you, but for “But Trump…” really? Weaksauce

And scroll up a bit I’ve already offered an example of what makes more sense instead of chasing bad ACA money with more bad ACA money. The Federal Surprise Balance Billing legislation which goes into effect Jan 2022 and mimics for 100M+ Americans on ERISA federally mandated plans what is available in over half our state regulated plans now. THAT is the kind of legislation that leaves private insurers alone and protects people from bankruptcy due to ridiculous predatory over billing practices. And it’s long over due

 

[Septic]

by universal I presume you mean everyone has insurance; not everyone has government provided care. Switzerland has universal coverage but it is entirely delivered through private insurance (including for profit insurers) so they likely have employment based group health plans. the UK has universal coverage and care through NHS.

Are you suggesting single payer (government insurance for all) when you say universal healthcare system?

these discussions often get mired in terminology confusion between who has insurance, who pays for it and who provides care.

I think the Australian model looks most appealing, wherein the government foot the bill for public services but additional services are provided via private providers. If you want to buy your way to the front of the line, you'd have that ability. I'm sure there are ways to nit pick every model but our model costs the most, provides mediocre outcomes and leaves large swaths of the population out in the cold.

 

[volinbham]

I think the Australian model looks most appealing, wherein the government foot the bill for public services but additional services are provided via private providers. If you want to buy your way to the front of the line, you'd have that ability. I'm sure there are ways to nit pick every model but our model costs the most, provides mediocre outcomes and leaves large swaths of the population out in the cold.

I'd argue with the mediocre outcomes part. Procedure to procedure comparisons have us coming out on par with the best. Broader stats (like mortality or infant mortality) are confounded by things like our murder rate (compared to other OECD countries) or access to care issues (the last part of your comment above).

 

[Septic]

What facts are on yourside here? The number of uninsured after ACA deployment isn’t largely different while costs have sky rocketed. So hell no I don’t want more ACA like you’re preaching I’ll take much less.

I’d deflect away from my emotional plea for more government interference too in your case if I were you, but for “But Trump…” really? Weaksauce

And scroll up a bit I’ve already offered an example of what makes more sense instead of chasing bad ACA money with more bad ACA money. The Federal Surprise Balance Billing legislation which goes into effect Jan 2022 and mimics for 100M+ Americans on ERISA federally mandated plans what is available in over half our state regulated plans now. THAT is the kind of legislation that leaves private insurers alone and protects people from bankruptcy due to ridiculous predatory over billing practices. And it’s long over due

Costs haven't skyrocketed in any appreciable way that they were prior to the ACA. I've shown you those facts. You ignoring them doesn't make them cease to exist.

You still aren't wrapping your head that I'm not defending the ACA, just your inability to grasp that you've not offered up any cogent alternative. In fact, thus far all you've managed to do is let everyone know that you really don't gas about the uninsured Americans.

Pretending you care about the government costs is icing on a sheet cake full of bullsh*t.