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Government Shutdown / Obamacare ******** Thread Part III

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Old
01-01-2014, 09:50 PM
  #901
Ozamataz Buckshank
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Quote:
Originally Posted by Beef Invictus View Post
Or now that insurance companies have far more money coming in from more customers, hospitals and med supply corps can charge more because they know the money is there to be had.



That's what I suspected. Until they address the oligopoly up top, nothing is going to get fixed. Right now we're just shuffling deck chairs on the Titanic.
It was the best we could get thanks to a spineless Obama and Bluedogs

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01-01-2014, 09:53 PM
  #902
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Originally Posted by Beef Invictus View Post
That's what I suspected. Until they address the oligopoly up top, nothing is going to get fixed. Right now we're just shuffling deck chairs on the Titanic.
The problem is that so many people in various roles (hospitals, pharma, some doctors, etc) are profiting wildly from the ridiculous current system, and those people have a lot of money that they're happy to invest trying to keep things the way they are. Generally, proposals about curbing costs are met with protests that quality of care will get much worse, and the economy will be harmed. Sure, the economy of people who are becoming millionaires off a broken medical system, but money would flow back into the pockets of people who get sick or injured - a group which includes people from various financial backgrounds.

The time to fix this was probably before America started wasting hundreds of billions of dollars a year on overpriced medical care. Given that lobbying money really talks quite loudly, I'm not confident that the problem will be fixed to any significant degree.

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01-01-2014, 10:02 PM
  #903
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Originally Posted by Ilkka Sinisalo View Post
The problem is that so many people in various roles (hospitals, pharma, some doctors, etc) are profiting wildly from the ridiculous current system, and those people have a lot of money that they're happy to invest trying to keep things the way they are. Generally, proposals about curbing costs are met with protests that quality of care will get much worse, and the economy will be harmed. Sure, the economy of people who are becoming millionaires off a broken medical system, but money would flow back into the pockets of people who get sick or injured - a group which includes people from various financial backgrounds.

The time to fix this was probably before America started wasting hundreds of billions of dollars a year on overpriced medical care. Given that lobbying money really talks quite loudly, I'm not confident that the problem will be fixed to any significant degree.
You're right, sadly.

There's a blog I'm trying to find again, written by a doctor. He seeks to get people to understand what's broken with the healthcare system. As he described it at one point, we have all the worst parts of ever other system with almost none of the upsides. If I can find it again I'll post the link. It isn't uplifting.

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01-01-2014, 10:46 PM
  #904
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Remember charges by hositals and physicians have been disconnected from traditional Mbusiness practice" (ie cost plus a reasonable profit margin) for a long time due to the fact that insurers have dictated what they will pay regardless of what the service actually cost. Basically charges are driven by the insurers, and the insurers want to make it look to their customers like they are getting them a ygood deal, so the hospital has to charge from 50 to 100% more than they know they will collect. Its a truly fucked up system.

As for doctors groups complaining about attempts to control costs by unilaterally cutting reimbursement to providers, you have to understand the medicaid already pays so poorly that we actually lose money seeing medicaid patients, and barely break even on medicare. The fact is you can't just keep paying less, you need to reduce our expenses. Having to have a huge administrative staff because the rules required to get paid are complicated and differ somewhat for each different payor costs a lot of money, and those people get paid before the physician sees a dime..

And hospitals are forced to spend quite literally millions of dollars on jumping through the ever changing hoops of organizations like CMS and the Joint Commission, which extracts iits cash every three years.

Add to that the profits that go to insurance company shareholders and for profit hospitals, and there is a massive amount of money being spent on health care in this country that has nothing to do with providing health care

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01-07-2014, 03:15 PM
  #905
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So Rand Paul claims Obamacare automatically enrolled one of his sons in Medicaid. It turns out Rand Paul was wrong (big surprise, I know). Rand Paul's son enrolled himself in Medicaid.

Rand Paulís latest Obamacare whopper falls apart: The Kentucky senator's latest claims about Obamacare and Medicaid get thoroughly debunked

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01-07-2014, 04:08 PM
  #906
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Does Rand Paul ever stop lying??

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01-07-2014, 04:09 PM
  #907
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Does Rand Paul ever stop lying??
Does it matter? People seem to reflexively believe idiots like him, even when they're wrong. And they're almost always wrong.

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01-07-2014, 04:11 PM
  #908
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Does it matter? People seem to reflexively believe idiots like him, even when they're wrong. And they're almost always wrong.
See also: Rob Ford.

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01-07-2014, 04:26 PM
  #909
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Does it matter? People seem to reflexively believe idiots like him, even when they're wrong. And they're almost always wrong.
Just like the global warming debate: it has nothing to do with the facts, it has to do with them saying what someone wants to hear.

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01-07-2014, 04:35 PM
  #910
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See also: Rob Ford.
I forgive Rob Ford because he's entertaining.

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01-08-2014, 11:47 AM
  #911
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Originally Posted by Troy McClure View Post
So Rand Paul claims Obamacare automatically enrolled one of his sons in Medicaid. It turns out Rand Paul was wrong (big surprise, I know). Rand Paul's son enrolled himself in Medicaid.

Rand Paulís latest Obamacare whopper falls apart: The Kentucky senator's latest claims about Obamacare and Medicaid get thoroughly debunked
I suspect what happened was when he registered he was told he qualified for medicaid and was directed to enroll. Nobody is "automatically" enrolled... hell that would solve a lot of the enrollment problems if it could do that

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01-08-2014, 12:46 PM
  #912
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I suspect what happened was when he registered he was told he qualified for medicaid and was directed to enroll. Nobody is "automatically" enrolled... hell that would solve a lot of the enrollment problems if it could do that
Right, because Rand Paul isn't a liar who makes **** up when it could benefit him politically.

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01-08-2014, 01:05 PM
  #913
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Right, because Rand Paul isn't a liar who makes **** up when it could benefit him politically.
I can imagine the conversation.

Son: I've got medicaid.

Rand: You're helping Obamacare succeed?

Son: No dad, I was automatically enrolled, I swear.

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01-11-2014, 03:46 PM
  #914
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Obama administration to end contract with CGI Federal, company behind HealthCare.gov

Quote:
Federal health officials are preparing to sign early next week a 12-month contract worth roughly $90 million with a different company, Accenture, after concluding that CGI has not been effective enough in fixing the intricate computer system underpinning the federal Web site, according to a person familiar with the decision who spoke on the condition of anonymity in order to discuss private negotiations.

Accenture, one of the world’s largest consulting firms, has extensive experience with computer systems on the state level and built California’s large new health-insurance exchange. But it has not done substantial work on any Health and Human Services Department program.
http://www.washingtonpost.com/politi...a3b_story.html

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01-11-2014, 04:41 PM
  #915
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http://www.washingtonpost.com/blogs/...3Fp%253D74854/

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The Obama administration is set to announce Friday an ambitious health-care experiment that will make Maryland a test case for whether aggressive government regulation of medical prices can dramatically cut health spending.

Under the experiment, Maryland will cap hospital spending and set prices — and, if all goes as planned, cut $330 million in federal spending. The new plan, which has been under negotiation for more than a year, could leave Maryland looking more like Germany and Switzerland, which aggressively regulate prices, than its neighboring states. And it could serve as a model - or cautionary tale - for other states looking to follow in its footsteps.
One of the most interesting things about the ACA will be seeing what happens as more states start to experiment with using ACA funding to control healthcare costs. Vermont and Maryland are going to be interesting states to watch over the next several years.

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01-11-2014, 08:07 PM
  #916
PredsV82
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Originally Posted by Sevanston View Post
http://www.washingtonpost.com/blogs/...3Fp%253D74854/



One of the most interesting things about the ACA will be seeing what happens as more states start to experiment with using ACA funding to control healthcare costs. Vermont and Maryland are going to be interesting states to watch over the next several years.
On the face of it, this looks mighty draconian. What the hell is going to happen if a hospital has spent all it is allowed to for the year before december 31? Close? Tell employees they are all volunteers for the rest of the year?
Not pay the electric bill?

the other problem will be narrow networks... if one hospital is on everyones network and another isnt, you could see the first hospital running out of money and being forced to turn away patients who would then have to pay more because only the out of network facility still had the ability to see them

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01-11-2014, 08:13 PM
  #917
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On the face of it, this looks mighty draconian. What the hell is going to happen if a hospital has spent all it is allowed to for the year before december 31? Close? Tell employees they are all volunteers for the rest of the year?
Not pay the electric bill?

the other problem will be narrow networks... if one hospital is on everyones network and another isnt, you could see the first hospital running out of money and being forced to turn away patients who would then have to pay more because only the out of network facility still had the ability to see them

The plan was negotiated and works in other countries. Shouldn't we give it a go.

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01-11-2014, 08:21 PM
  #918
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The plan was negotiated and works in other countries. Shouldn't we give it a go.
Its not the same as other countries. Its basically rationed care, which is fair if everyone is on equal footing, but in this country people are still paying for insurance, sometimes a hell of a lot, and if they then cant get care because their hospital has already spent its yearly limit, thats a double whammy of fuck you

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01-11-2014, 08:28 PM
  #919
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Its not the same as other countries. Its basically rationed care, which is fair if everyone is on equal footing, but in this country people are still paying for insurance, sometimes a hell of a lot, and if they then cant get care because their hospital has already spent its yearly limit, thats a double whammy of fuck you
I'm mobile getting ready for Sharks game, but the quote specifically days like Germany. I'll read it later, but I'm guessing you don't know the details and are being your usual negative self about anything Obama does with health-care.

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01-12-2014, 01:45 AM
  #920
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Its not the same as other countries. Its basically rationed care, which is fair if everyone is on equal footing, but in this country people are still paying for insurance, sometimes a hell of a lot, and if they then cant get care because their hospital has already spent its yearly limit, thats a double whammy of fuck you
It's a solid method of moving away from fee-for-service healthcare. Hospitals will no longer be reimbursed based on how many procedures they do, so now they have to work to make sure their procedures are actually necessary, and even work to encourage community health outside of their walls.

The spending cap, assuming its set correctly, would only be an issue for poorly-managed hospitals or else if there was some kind of emergency spike in demand. The former would encourage more efficient hospital spending, and the latter is a nonissue because it'd be easy to raise the cap to respond to an emergency.

The issue you raise with narrow networks might be a problem, but since all health services cost the same in every hospital in Maryland, thanks to strict government price controls, I'm not really sure how serious of a problem narrow networks are in Maryland to begin with.

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01-12-2014, 04:20 PM
  #921
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I'm mobile getting ready for Sharks game, but the quote specifically days like Germany. I'll read it later, but I'm guessing you don't know the details and are being your usual negative self about anything Obama does with health-care.
I read the whole article and it doesnt specify that it is exactly like Germany just more like Germany.
And I am pointing out what appears to be a potential flaw. It is a Maryland pilot project so it has little to do with Obama directly


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It's a solid method of moving away from fee-for-service healthcare. Hospitals will no longer be reimbursed based on how many procedures they do, so now they have to work to make sure their procedures are actually necessary, and even work to encourage community health outside of their walls.

The spending cap, assuming its set correctly, would only be an issue for poorly-managed hospitals or else if there was some kind of emergency spike in demand. The former would encourage more efficient hospital spending, and the latter is a nonissue because it'd be easy to raise the cap to respond to an emergency.

The issue you raise with narrow networks might be a problem, but since all health services cost the same in every hospital in Maryland, thanks to strict government price controls, I'm not really sure how serious of a problem narrow networks are in Maryland to begin with.
The network problem would be as much an issue with physicians as hospitals. If your doctor works at the popular hospital and they have reached their quota for elective surgery for the year, your choices are wait til next year or go somewhere else. It almost seems like it is designed to punish the good hospitals who are busier because they get better results.

I would really like to see a more detailed explanation of how the limits for each hospital is determined

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01-13-2014, 12:29 AM
  #922
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I read the whole article and it doesnt specify that it is exactly like Germany just more like Germany.
And I am pointing out what appears to be a potential flaw. It is a Maryland pilot project so it has little to do with Obama directly
I know that kind of all-payer model where everyone negotiates uniform prices is also used also done in Germany, the Netherlands, France, and Japan.

Except it sounds like Maryland has had that model for 40 years, and I have no idea which other country sets spending caps. Germany reimburses hospitals mainly based on the length of a patient's stay. Maybe Switzerland caps hospital spending?

Quote:
The network problem would be as much an issue with physicians as hospitals. If your doctor works at the popular hospital and they have reached their quota for elective surgery for the year, your choices are wait til next year or go somewhere else. It almost seems like it is designed to punish the good hospitals who are busier because they get better results.

I would really like to see a more detailed explanation of how the limits for each hospital is determined
Yeah, more details are definitely necessary. I could imagine them setting limits based on a hospital's expected usage. I'm sure a Baltimore hospital sees way more patients than a rural hospital, so it'd be kind of weird to give them the same cap.

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01-13-2014, 02:10 PM
  #923
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I think setting fixed prices for services across all payors is extremely rational and reasonable. The problem is, it would bankrupt Medicaid if they had to pay the same price as other payors, and if all payors were reduced to paying Medicaid rates there would be no one willing to go into the medical business because everyone would lose money.

I think a system like what happens at an auto garage is applicable to medicine... the rate for "labor" is fixed based on what is done regardless of how long it actually takes to do the job. the charge for materials is also predetermined.

So if I schedule a patient for a tonsillectomy, the hospital will know how much money its getting regardless of whether I do it efficiently or wastefully. If I can get both good results and be efficient, the hospital is going to reward me financially. Physicians who cant practice efficiently and still get good results will end up being less attractive to employers or will be compensated less.

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01-13-2014, 02:24 PM
  #924
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I think setting fixed prices for services across all payors is extremely rational and reasonable. The problem is, it would bankrupt Medicaid if they had to pay the same price as other payors, and if all payors were reduced to paying Medicaid rates there would be no one willing to go into the medical business because everyone would lose money.

I think a system like what happens at an auto garage is applicable to medicine... the rate for "labor" is fixed based on what is done regardless of how long it actually takes to do the job. the charge for materials is also predetermined.

So if I schedule a patient for a tonsillectomy, the hospital will know how much money its getting regardless of whether I do it efficiently or wastefully. If I can get both good results and be efficient, the hospital is going to reward me financially. Physicians who cant practice efficiently and still get good results will end up being less attractive to employers or will be compensated less.
The fixed prices would also have to vary from state to state due to differences in prices.

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01-13-2014, 02:47 PM
  #925
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The fixed prices would also have to vary from state to state due to differences in prices.
yeah that is true but all payors in a given geographic area paying the same for the same service is what I am getting at.

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