Who Obamacare has helped the most

[pb4uski]

....I suggested that what you are advocating is an inadequate suggestion for political and other reasons....

I don't recall advocating anything. What specifically are you referring to?

 

[marko]

All the service providers I know of have a published price sheet and some are higher and lower than others. It's all about how you perceive value as to which one you select.

I wonder if a lot of people take this view:
* I am (or my company)/(or the government) paying big bucks for my HC insurance. If the service is covered by insurance, why do I care if X is cheaper than Y. "Someone else is paying for it"

* It's my health; I want the best for me, not some cut-rate items; who wants to cut corners on major surgery to save $500.

 

[bUU]

I don't recall advocating anything. What specifically are you referring to?

You're correct... I mistook you for another poster.

Rather: You agreed with the essence what I wrote and made it sound like a disagreement, claiming that I was supporting something which instead was something I was saying was impracticable.

Sorry for my confusion about which poster you were.

 

[pb4uski]

Apology accepted. I went back and your post I responded to that you referred to above was as clear as mud . You might have mistaken me for another poster more than once. Whatever.

 

[EastWest Gal]

My nephew came home recently and found his toddler with an open bottle of Tylenol. Taking no chances, he took the kid to ER and they gave the kid a test to see if he had taken any capsules, then kept him overnight for observation. The bill was $55,000.

My point is that even a minor event can have crushing medical expenses attached.

There's a mistake somewhere in that bill. And in the care. You do a acetaminophen level 4 hours post ingestion. If the level is zero he should have gone home.

My son got billed for critical care in ER for a broken arm. I raised a big stink. There are 5 levels of care in the ER. We were charged a level 5. I got it down to a level 3. It would have been a level 2 if they hadn't given him an unnecessary dose of Tylenol with codeine.

There's either a mistake in that bill or there is fraud. If he needed no therapy they charged too much and did too much. If he needed therapy he would have had a 3 day stay for the antidote and more tests.

I hope the family challenges the bill. Up-coding is illegal; it is fraud.


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[pb4uski]

+1 glad to see a pro's view - it smelled very fishy to this layman.

 

[bUU]

Apology accepted. I went back and your post I responded to that you referred to above was as clear as mud . You might have mistaken me for another poster more than once. Whatever.

I think anyone expecting only comments taking a side with regard to what to do would think that my comment was "clear as mud". The reality is that I was commenting on only those things that are reasonable to discuss in this forum, i.e., whether something being suggested has a snowball's chance in hell of being enacted and therefore possibly having an impact (positive or negative). In that context, my comment was clear as glass. But like you said, "Whatever."

 

[pb4uski]

That is clear as mud too.

 

[Totoro]

Writing from a country with universal healthcare (and having lived in another one).

Some observations from across the pond:

• It is very easy to see where a lot of waste is in the US healthcare system: it is in the billing procedures, insurance and administration. The stories here make that very clear. Going universal healthcare is one way to reduce that confusion (not eliminate it mind you).
• In a single payer system the public still worries about high costs, also when your own life is on the line. We realize others are paying for our health, and that it shows up in your own taxes too. People aren't that greedy and self-centered.
• There are no multi-million dollar hospital CEOs or surgeons here. Many still make a million a year though, still nothing to sneeze at.
• Salaries of non-essential procedures are not regulated and free market (cosmetic surgery). The others are, usually through maximum cost of certain procedures.
• Malpractice insurance is virtually a non-issue. This is good as it allows more time and money to go to actual care and improving it. Doctors still lose their license and go to jail when they are negligent.
• Having your life depend on your employment status and your specific employer seems so wrong on every level. Slaves have had better.

From an outsider it is mind boggling and slightly frustrating to see that the best care can be had in the US, but the whole system is so damn inefficient that millions cannot access it.

Whether or not a single payer or universal healthcare system is your best solution, I wouldn't dare say. Fact remains that most countries that have much better outcomes do have such a system.

So if Obamacare helps millions get healthcare and in the long run streamlines the administration a bit, I'd say the whole of the US wins.

Sorry for the rant.

 

[MichaelB]

Teddy Roosevelt said "Politeness is a sign of dignity, not subservience". Let's keep it civil and friendly, even when we don't always agree.

 

[ERhoosier]

So if Obamacare helps millions get healthcare and in the long run streamlines the administration a bit, I'd say the whole of the US wins.

No question that more have HI with ACA. Also no question among most US providers and facilities that ACA has NOT "streamlined the administration" but INcreased it, at least to this point in time. Understandable for a law 974 pages long with implementation regulations spanning approx 10,000+ pages and growing.
How many pages of regulations for ‘Obamacare’? - The Washington Post

IMHO It is best to view US HC reform as a process, not a single law.
https://en.wikipedia.org/wiki/Health_care_reform_in_the_United_States
Only time will tell how much ACA actually increases access to HC in the long run. Many are concerned about long-term financial stability of the laws' provisions, but concerns over funding increasing costs of HC is certainly not unique to the US.
http://www.ecipe.org/media/publicat...e-nature-and-causes-of-the-cost-disease_1.pdf

 

[longranger]

No question about it. Obamacare has helped millions of previously uninsured people.

UNFORTUNATELY!!!!! it has helped insurance companies, companies that provide information technology services, countless regulatory agencies, countless for profit medical corporations, and big pharma to name just a few special interests to a greater degree IMHO as a practicing MD.

In my particular practice environment the combined effect of the past decade of changes is that it cripples my real productivity. I cannot provide quality care to as many patients. I am so busy dealing with regulations, documentation, and navigating terribly cumbersome information technology systems that it forces me to work to the edge of burnout every day.
It wouldn't hurt so much if I didn't love helping patients, the essence of what has driven my practice for 30 years.

The youngsters that have joined our practice the past 5 years appear less stressed. This is all they have known. They have much lower productivity than Geezer Drs like me, have no interest in serving on committees or charity work. Their first questions during interviews are about salary, benefits, vacation and then practice parameters. Each one we have hired and kept are truly nice people. They have had the best training you can get, much better than what I received. Most are highly sub specialized, with limited skill sets that correspond to the most lucrative procedures. If I ever had any doubts in the conclusions of Darwin the transitions I have witnessed in my little microenvironment have extinguished them.

Ironicly Darwin has smiled on me. Myself and a handful of like minded Geezers in my field of practice are in the final stages of forming a megagroup that has the potential to be a dominant player on the west coast in my specialty. Thankfully this may allow us to have enough control to bring down some costs and improve service to our patients. That still remains the goal for my cohort. Hope the culture we create will rub off on the youngsters in the group.

 

[Walt34]

Ironicly Darwin has smiled on me. Myself and a handful of like minded Geezers in my field of practice are in the final stages of forming a megagroup that has the potential to be a dominant player on the west coast in my specialty. Thankfully this may allow us to have enough control to bring down some costs and improve service to our patients. That still remains the goal for my cohort. Hope the culture we create will rub off on the youngsters in the group.

I hope you are successful at this and hope not only that it works for you but is picked up by others. Unfortunately, I am on the east coast.

 

[daylatedollarshort]

A the bottom of this article is a map of Who Remains Uninsured showing where the uninsured rates are still high. Many of the low uninsured rate states are not surprisingly those with expanded Medicaid programs.

Finding out where Obamacare hasn't reached shows just how far it*has

"The Medicaid expansion difference is most starkly portrayed on the map between Kentucky—which expanded—and Tennessee, which did not. Overall, the data shows that states that expanded Medicaid reduced the uninsured rate from 14.9 percent to 9.2 percent, averaged out. In the non-expansion states, the uninsured rate in 2013 averaged 18.2 percent, and has been reduced substantially to 13.8 percent, but these states clearly lag far behind their neighbors."

 

[samclem]

Regarding the ACA as presently experienced here:

So if Obamacare helps millions get healthcare

The jury is still out on this one. "Health care insurance" is very different from "timely, high-quality health care". (e.g. every resident of North Korea or Haiti has health insurance. They have access to free health care as a legal right. Still, I'd bet there's a long wait for coronary bypass surgery in Pyongyang.) Before the ACA there were millions of Americans who got health care who didn't have insurance, and there were many more who technically had health insurance but had poor access to health care (long wait times for Medicaid services, etc). Under the ACA, more people may officially have coverage, but it's not clear if, overall, Americans are receiving better health care services.

and in the long run streamlines the administration a bit

There's not much to indicate that this is happening under the present law.

The overall health care cost issue in the US can be addressed in two ways: Top-down imposed price controls (which invariably lead to shortages, so steps would be needed to allot care in some centralized manner) or market-based competition among health-care insurers, who in turn would put pressure on providers and seek efficiencies to limit costs. Universal care can occur under either model.

 

[gauss]

I wonder what would happen to one's credit rating if there were some late / unpaid medical bills. My car insurance uses my credit rating among other things to determine my rate.

Recently I was considering simply not paying for a $75 medical bill I received. Fortunately, when I called the provider, they said it was their mistake, and to not pay it.

But it seems the ""take to it collections, I don't ever need credit again anyways" tactic may be what many of us will be forced to use against the "gotchas" that are so prevalent in healthcare billing.

In addition to the credit rating impact, remedies could include all those available to unsecured creditors: seizing financial assets, garnishing wages and placing liens on assets depending on state law.

I am no attorney so please correct me if anything is incorrect/misleading.

-gauss

 

[daylatedollarshort]

Whether or not a single payer or universal healthcare system is your best solution, I wouldn't dare say. Fact remains that most countries that have much better outcomes do have such a system.

So if Obamacare helps millions get healthcare and in the long run streamlines the administration a bit, I'd say the whole of the US wins.

Sorry for the rant.

I am always happy when people from outside the U.S. post on this subject. I've never read a single post from anyone in Canada, England, Australia or any English speaking, comparable standard of living country wishing they had our health care system. Here is another comment from a non-U.S. resident:

"Americans have Stockholm syndrome. The rest of the world has efficient and universal health care as the norm, and here you are gushing over the pathetic scraps that you are tossed as a result of the ACA."

From a Reddit thread called thanks Obamacare:
Thanks "Obamacare" : politics

with lot of anecdotal reports of how the ACA has helped people with no insurance, pre-existing conditions, insurance caps, etc.

 

[samclem]

I am always happy when people from outside the U.S. post. Here is another comment from a non-U.S. resident:

Please, don't blame them for their misconceptions. They are just reading the inaccurate accounts of the terrible "dog eat dog, winner-take-all" culture as portrayed in the media. It's the same way with many other issues: I'm sure many outside the US believe every American is packing a gun, works 90 hours per week, takes 2 days of vacation per year, worships 30 hours per week at a church in the woods, and that 50% of us are illiterate. It's what the US media like to report, and it's what the foreign media likes to pass along.

Overall health and health care? Americans have longer life expectancies than our EU friends when adjusted for premature death due to non-health related injuries (we spend a lot more time in cars in the US than people do in Europe. And, there is more violence, but that's hardly a commentary on the US health care system).

 

[daylatedollarshort]

Overall health and health care? Americans have longer life expectancies than our EU friends when adjusted for premature death due to non-health related injuries (we spend a lot more time in cars in the US than people do in Europe. And, there is more violence, but that's hardly a commentary on the US health care system).

Life span is one criteria to measure for ranking country-wide health care systems, but most non-partisian organizations' rankings take into account many factors, including number of uninsured and equitable access to health care among the citizens.

Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally - The Commonwealth Fund -

"The U.S. ranks last of 11 nations overall. Findings in this report confirm many of those in the earlier four editions of Mirror, Mirror, with the U.S. still ranking last on indicators of efficiency, equity, and outcomes." But we're first in cost - Twenty-one graphs that show America's health care prices are ludicrous: http://www.washingtonpost.com/blogs...ow-americas-health-care-prices-are-ludicrous/.

We spend the most by far per capita on health care, but have lower life expectancy than countries like Lebanon and Slovenia: http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

In the last WHO report we were first in cost and 38th in overall performance metrics: World Health Organization ranking of health systems in 2000 - Wikipedia, the free encyclopedia

 

[M Paquette]

Please, don't blame them for their misconceptions. They are just reading the inaccurate accounts of the terrible "dog eat dog, winner-take-all" culture as portrayed in the media. It's the same way with many other issues: I'm sure many outside the US believe every American is packing a gun, works 90 hours per week, takes 2 days of vacation per year, worships 30 hours per week at a church in the woods, and that 50% of us are illiterate. It's what the US media like to report, and it's what the foreign media likes to pass along.

That's OK. Please bear in mind that it is not just the foreigners that are exposed to this.

Plenty of USAians are soaking in the US media reports, too. Add in voluntary memetic filtering ("I get all my news from WND.com/PBS.org/Onion.com, because I don't trust any other source."), and a tendency to form fairly exclusive affinity groups, and we have plenty of folks within the US with their own truthiness baselines, not necessarily bound by outmoded concepts like facts.

It can be interesting. Discussing the effects of policy and practice with some folks who insist on their own reality can also be frustrating. (Mr. Ray is an extreme case, but I seem to run across folks on this road every week. They usually want money...)

I'm not entirely sure that the media's partitioning and polarization around and for exclusive affinity groups is helping our society as a whole. Of course, that could be the whole point...

 

[Mulligan]

Sam, this could be one of my all time favorite threads if we could discuss guns and Obamacare in same thread and Porky not shut it down.


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[gauss]

Gotta agree with Sam on this one.

When I dug into the details on this, I found many of the items that were pulling the US down in the health care ratings were other social problems like infant mortality due to poverty and gun violence.

Don't infer from this that I am satisfied with our current HC system or the price that we pay for it, but a critical reading of the OECD documents shows that they are taking a larger social view on measuring health than we are accustomed to.

-gauss

 

[samclem]

In the last WHO report we were first

We're number one! We're number one!

To talk about quality of health care, we need to do a LOT of parsing out of other conflating issues. Obesity, lack of exercise, "poor health choices" (the US life expectancy numbers will be paying the price for very high US smoking rates through the mid-1980s for decades more to come), wide variances in counting infant mortality, larger number of accidents on the road, etc. The more these non-health care issues are weeded out, the better the US health care system is shown to be.

The point remains: Access to health insurance is not the same as timely access to high-quality health care. There are many people living under "universal care" in highly developed countries that get health care inferior to that delivered, on average, in the US. Really. Tell your foreign pals to spare their tears, we're doing fine. It's true we are paying too much for our health care, but luckily our GDP per capita is also doing fine (another issue--but thank you Mr Free Market. Having resources is a good thing--adding years to lives and life to years).

I am NOT an apologist for the present US health care "system" (pre- or post-ACA), but it is amusing the way some US citizens portray the experiences of real Americans, and how the cross-Atlantic echo-chamber of reinforcement encourages more of the same.

 

[samclem]

Sam, this could be one of my all time favorite threads if we could discuss guns and Obamacare in same thread and Porky not shut it down.

Hey, I squeezed guns, Obamacare and religion in there! If we can get some talk about sex, mortgages, and SS filing strategies in here before the pig shows up we might set some sort of new record.

 

[daylatedollarshort]

Gotta agree with Sam on this one.

When I dug into the details on this, I found many of the items that were pulling the US down in the health care ratings were other social problems like infant mortality due to poverty and gun violence.

Don't infer from this that I am satisfied with our current HC system or the price that we pay for it, but a critical reading of the OECD documents shows that they are taking a larger social view on measuring health than we are accustomed to.

-gauss

The link I posted was from the Commonwealth fund rankings. The U.S scored low on items that were not mainly sociological, such as cost, access to care and efficiency of care.