Will Obamacare affect risk perception?

[photoguy]

Midpack/Samclem -- thanks for your response. I do understand that if coverage is being expanded to a greater percentage of Americans there is significant possibility of overall additional costs which may have to be paid by expanded taxes. Still as an individual/couple with modest assets I think I will benefit significantly from PPACA.

People recognize that:
--The PPCA does almost nothing to limit the growth of spending on medical care (expressed as a percent of GDP, if you choose).

Do you not consider the creation of Accountable Care Organizations (ACOs) part of attempt to limit medical spending? or tying of reimbursement to medicare star ratings? Or do you see this as too little?

Stephen

 

[samclem]

Do you not consider the creation of Accountable Care Organizations (ACOs) part of attempt to limit medical spending? or tying of reimbursement to medicare star ratings? Or do you see this as too little?

No one has seen an ACO yet, it's just a concept put into the legislation. Normally one would recommend pilot studies, maybe a single-state test, etc. Instead, we'll get to see it on a national basis. Maybe it'll work.
I'm more optimistic about the health care exchanges in general, especially if there's some mechanism by which health care consumers benefit when their overall healthcare expenses are low. It can't be so much that folks put off needed care, but I want Mr Smith to at least ask the Doc why he needs an MRI for his sprained ankle.

 

[MichaelB]

I'm more optimistic about the health care exchanges in general, especially if there's some mechanism by which health care consumers benefit when their overall healthcare expenses are low. It can't be so much that folks put off needed care, but I want Mr Smith to at least ask the Doc why he needs an MRI for his sprained ankle.

I'm hoping that is the case, and higher deductibles should lead people to question a little more rigorously when tests are prescribed. Still, I remember the last time I tried that on behalf of DW - the doctor's office said they had no idea of the cost, the hospital agreed only to give me the list price of the test, and the insurance company said the 'agree" price was not my concern and that I should plan to pay the deductible amount. Multiple calls and efforts to escalate (ineffective) only resulted in hard feelings and a scolding (by them to me) by the insurance co reps that I was wasting their time.

 

[obgyn65]

The decision from SCOTUS should be known any day now. I am getting anxious.

 

[Mulligan]

The decision from SCOTUS should be known any day now. I am getting anxious.

I admit that I am too as I have followed it with interest. Though I don't really know of the ramifications either way for me, since I purposely got an individual HI plan prior to its initial implementation to avoid the mandates and costs.

 

[samclem]

The amazing part, to me, is that we've heard no "leaks" regarding the deliberations and back-and-forth of the Justices. There are lots of clerks involved in the research needed to write the opinions that will accompany this decision, and I haven't read anything resembling a hint of the outcome. Surely some folks are getting rubbed the wrong way, and that normally (in politics, business, etc) results in disgruntled folks talking to their pals. Apparently this effective secret-keeping is the norm--the SCOTUS has a good record for keeping their work under wraps until the designated official unveiling.
A little advance notice of the ruling could make somebody a LOT of money via the options market.

 

[BigNick]

Medicare in six months; DW five months after that (sorry, don't care about U; we have our own life to live).

If Obamacare passes, and people learn to live with it -- my guess is that after a couple of years of operation, anyone trying to repeal it would be lynched, cf. those wonderful pictures of people holding placards saying "Keep Government out of Medicare" -- then presumably at some point the US Government will wake up to the fact that it has its finger in the healthcare pie in multiple ways, and perhaps some merging will take place.

The most shocking thing for me is that the US Government already spends about as much on health care as European governments (what with military, federal employees, Medicare etc) and yet doesn't leverage that to get better value. When the French Health Minister calls Pfizer or Roche to tell them how much he's prepared to pay for tablet X, they listen.

 

[marko]

The OP was about the 'risk' aspect. I suspect that most employers have already figured out what they'll do.

If it remains as is, many have told me that they'll drop their current coverage and 'allow (send) the employees out to get their own' i.e. discontinue the benefit.

The 'risk' seems to be not so much over Obamacare but in the lack of clarity in general business regulations.

Again, most employers I know are holding off from hiring because they don't know what that employee will cost them, what their corporate taxes will be and what the cost of added (and yet to be defined) regulations are.

 

[travelover]

.......... When the French Health Minister calls Pfizer or Roche to tell them how much he's prepared to pay for tablet X, they listen.

When Pfizer or Roche call up our politicians to tell them how much they will contribute to their endless campaigns, they listen.

 

[eridanus]

I'm hoping that is the case, and higher deductibles should lead people to question a little more rigorously when tests are prescribed. Still, I remember the last time I tried that on behalf of DW - the doctor's office said they had no idea of the cost, the hospital agreed only to give me the list price of the test, and the insurance company said the 'agree" price was not my concern and that I should plan to pay the deductible amount. Multiple calls and efforts to escalate (ineffective) only resulted in hard feelings and a scolding (by them to me) by the insurance co reps that I was wasting their time.

Yes, there definitely needs to be price transparency. Price shopping is impossible even when you explain that you're self pay.

Another way to decrease health care costs is graduating more physicians. The US has too few doctors, especially GPs, when compared to western European countries. Too few doctors means longer waits and higher costs.

Also, non-emergency may well decrease when there are better options for the current un- or barely insured.*

"The Effect of Insurance on Emergency Room Visits: An Analysis of the 2006 Massachusetts Health Reform"

New Jersey Demonstration Reduces Non-Emergency ER Visits By 22% | Capacity Management


*8-27% of ER visits are non-emergencies. We already pay for these visits even though they're not a line item on the 1040.

 

[easysurfer]

The decision from SCOTUS should be known any day now. I am getting anxious.

Shhhh! I'm waiting too with bated breath, but know we shouldn't talk to loudly about this.

 

[FinanceDude]

SCOTUS must like the breathless anticipation of the Obama administration..........

 

[rescueme]

Shhhh! I'm waiting too with bated breath...

Ever try Listerine?

 

[2B]

The amazing part, to me, is that we've heard no "leaks" regarding the deliberations and back-and-forth of the Justices. There are lots of clerks involved in the research needed to write the opinions that will accompany this decision, and I haven't read anything resembling a hint of the outcome. Surely some folks are getting rubbed the wrong way, and that normally (in politics, business, etc) results in disgruntled folks talking to their pals. Apparently this effective secret-keeping is the norm--the SCOTUS has a good record for keeping their work under wraps until the designated official unveiling.
A little advance notice of the ruling could make somebody a LOT of money via the options market.

Look at what happens if some clerk leaks and gets caught. They would almost certainly be dismissed in the middle of their assignment unless "approved" by one of the justices. If a justice leaks the original vote, I personally think it would be grounds for impeachment plus it would be dangerous. The other justices would never trust that justice again. It is also not unknown for the final vote to change after justices read the minority opinions. It's rare but still possible.

These clerking positions are coveted by every law student. Getting dismissed in the middle of their assignment would mark them with a legal version of an incurable STD. Their legal career prospects would probably be greatly diminished. One need to remember that the Brits loved to have Benedict Arnold turncoat but they never trusted him afterwards either.

 

[samclem]

Look at what happens if some clerk leaks and gets caught.

Yes, clearly. But we have very big penalties for disclosure of national security information, and look how often that gets out (always). And this is a topic of greater interest to far more people. Anyway, whatever they are doing seems to be working.

 

[BigE]

OTOH, it got to have some moderation. We already have a lot of health care consumption and a significant health care labor force in this country. In a purely hypothetical (worst) case scenario, if everyone in US is employed in health care industry, and everyone has insurance and just keeps perpetually providing & consuming medical services, will this system be healthy? Having an affordable health insurance is one thing, staying healthy to keep the overall system cost down is another factor we can not ignore.[/QUOTE]

I work in healthcare and see it first hand every weekday and most weekends. Even though I have easy access to colleagues in other specialties and easier access to meds, I worry a great deal about the ability to afford healthcare and retiring early. We have an amazing advanced system that is unsustainable because of over consumption and the inability to say "no". Most modern therapies, research and major medical breakthroughs are coming from the good old USA. But this is going to change, and probably sooner than we think. Bob doesn't wear and helmet and gets on the ole motor scooter after a few beers. Who pays for the hip replacements, 6 month rehab, 3 month ICU stay, and now lifetime on SSDI?? Granny has multiple medical problems and is 93 but the family refuses to give up and she lives 6 months in the ICU. Who pays for this? Bob drinks very heavy, his liver is shot and needs a transplant...who pays for this? The default position for this excess is government run healthcare where everyone gets less. And I think we are going to be shocked at how much "less" is. The inability to say "no" to anyone in the setting of our advanced medical system has allowed this to become a massive GDP eating monster and it is unsustainable. There is no wrong or right answer, it is what it is. And it is very a facet of our humanity.

 

[BigNick]

The inability to say "no" to anyone in the setting of our advanced medical system has allowed this to become a massive GDP eating monster and it is unsustainable. There is no wrong or right answer, it is what it is. And it is very a facet of our humanity.

That, plus the fact that we now mostly get to live to an age where we have chronic conditions that cost $$$ multiplied by years, rather than good old acute infectious diseases whose medical costs (regardless of the outcome) are measured in tens of dollars.

I don't believe that it's unsustainable, but it will require people to dig into their pockets. That may mean choosing between health care and the fifth family iPad for some, or it could be an altogether less comfortable choice for others.

 

[clifp]

I would think that ObamaCare as written would probably reduce my uncertainty about future health care costs. I have been purchasing an individual plan from Kaiser since I moved to Hawaii a dozen years ago. Overall my insurance cost have slightly more than doubled (I don't track spending that closely) I am currently paying $290/month which doesn't seem bad when I read all of the forum members paying $800-1,000+ (although I assume this is mostly families) . I am figuring that will more double again before I am eligible for Medicare, having a cap of 10% of my income will certainly help.

In theory ObamaCare should help me, especially in years like 2008/9 when market losses cause my income to drop making me eligible for subsidized insurance. On the other hand I am very skeptical that system will (or certainly should) provide subsidies to multimillionaire early retirees like myself. I suspect I will be best case unaffected and worse case be forced to buy insurance plans covering more than I need or want.

 

[donheff]

Re: why no leaks - I don't remember ever hearing leaks about an impending SC decision. Speculation sure but no intimation of leaks. All the books say they take great pride in keeping the info secret.

 

[marko]

Leaks have been implied via liberal newpaper editorials that opine "the SCOTUS rulings should not necessarily be the final word" and claims of agendas on the part of the justices.

 

[MichaelB]

Let's try to keep political views out of the thread.

 

[marko]

Sorry.

My response was to donheff re: 'leaks'; my focus was on the media's anticiaption.

Didn't mean it to be political...

 

[Semiretired2008]

I'm hoping that is the case, and higher deductibles should lead people to question a little more rigorously when tests are prescribed. Still, I remember the last time I tried that on behalf of DW - the doctor's office said they had no idea of the cost, the hospital agreed only to give me the list price of the test, and the insurance company said the 'agree" price was not my concern and that I should plan to pay the deductible amount. Multiple calls and efforts to escalate (ineffective) only resulted in hard feelings and a scolding (by them to me) by the insurance co reps that I was wasting their time.

Each company negotiates their own agreed upon price and agreed upon procedures and it is a lot lower than what you would be charged if you did not have that insurance - in some cases it seems that even the agreed upon items do not match.

What I am battling right now is a doctor is trying to charge me the difference between what the insurance company paid and what he wants to collect. He is not arguing the agreed upon price - he is arguing that he performed procedure B (let's say laser method) and the insurance company will only pay for procedure A (manual method) - so I pay the difference - since the procedure B cost more than A to perform. The insurance company will not help... When I got the breakdown summary in the mail - they had a note to that point in the small print...

 

[rescueme]

(I don't track spending that closely)

Regardless of thread subject, I found this statement "interesting", especially in a "high value" (I assume) monthy expense.

Heck, I/DW are a bit more than FI, but we still track spending, closely ...

You don't know where you are going unless you know were you've been...

 

[Bestwifeever]

Leaks have been implied via liberal newpaper editorials that opine "the SCOTUS rulings should not necessarily be the final word" and claims of agendas on the part of the justices.

Maybe a link to the editorials you've read and a snippet of them without defining their political incliniation would be helpful and illuminating (e.g., do the editorial imply that leaked information has been obtained)?