Author Topic: ACA challenged again  (Read 25573 times)

MoonShadow

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Re: ACA challenged again
« Reply #50 on: September 14, 2015, 04:46:20 PM »
All private plans "tax" you, if you're healthy, so that unhealthier people are covered.  Other insurance does this too.  If your house never burns down, your payments go to fund people whose houses do burn down.  You are either subsidizing others or the one being subsidized.  In health care, all of us will probably be both — the subsidizers when we're young, and the subsidized when we're older and have health problems.  (Because however healthy and responsible we are, very few of us get to our last day without any health problems.)  Some people subsidizing other people is how insurance systems work.

To one degree or another, yes they do.  But I had, and still have, an HSA; so the majority of my premiums before the ACA taking effect were to fund the risk pool of my family needing more than $6500 in actual medical costs in a year.  After the ACA taking effect, roughly $100 per month of my premium costs were to cover the regulatory costs of the plan; in other words, to subsidize people who receive federal subsidies.  The basic principle of insurance, that all members within a risk pool share the costs equally, has been undermined by law; because those people that qualify for subsidies are protected from the full risk of equal sharing by the letter of the ACA itself.  That actually has much to do with the lawsuit that this thread starts with.  Furthermore, I'm not just risk sharing with other families that use HSA's anymore, because I'm now paying more to subsidize plans that are better than my own; i.e. silver and higher quality plans.

To put it bluntly, the burden of risk is no longer even across the risk pool, and that is not fair to those of us who actually had insurance to begin with.  As happens so often with the complex laws that come out of Washington, DC these days; the greatest long term effects that the ACA will have will be it's unintended consequences on the economy.
« Last Edit: September 14, 2015, 07:18:55 PM by MoonShadow »

Exflyboy

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Re: ACA challenged again
« Reply #51 on: September 14, 2015, 05:01:53 PM »
Or maybe it will be so painful that we finally realize that HC just costs too much and there might finally be the political will to stop providers for behaving like cartels and gouging all of us.

Then maybe we'll finally get to a medicare for all plan and pay the same rate the rest of the Western world does.. i.e HALF or less than what we pay.

forummm

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Re: ACA challenged again
« Reply #52 on: September 14, 2015, 05:19:25 PM »
Socialized medicine is sure popular with those not paying the bills.

I don't understand you socialists, forcing me to pay for other people's problems. What's up with that? Get your dam' hands out of my pockets!

Your sig says you have six mini mustaches.   If that means kids, I wonder if you put them through private school?  If not, get your hands out of MY pocket, as I went to a private school and we have no children ourselves.

And all those tax deductions and credits I'm paying for!

MoonShadow

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Re: ACA challenged again
« Reply #53 on: September 14, 2015, 05:27:44 PM »
Or maybe it will be so painful that we finally realize that HC just costs too much and there might finally be the political will to stop providers for behaving like cartels and gouging all of us.

Then maybe we'll finally get to a medicare for all plan and pay the same rate the rest of the Western world does.. i.e HALF or less than what we pay.

Almost certainly not.  The insurance system in the US is pretty screwed up, but it's still not the main reason that health care insurance is expensive here.  The VA is pretty much the closest thing to a single payer system in the US, and it costs about as much as the private system does and is lucky to provide equal quality of care. 

LAGuy

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Re: ACA challenged again
« Reply #54 on: September 14, 2015, 05:28:40 PM »
Or maybe it will be so painful that we finally realize that HC just costs too much and there might finally be the political will to stop providers for behaving like cartels and gouging all of us.

Then maybe we'll finally get to a medicare for all plan and pay the same rate the rest of the Western world does.. i.e HALF or less than what we pay.

Is that why healthcare costs so much? All of us providers that are getting fantastically wealthy? From my own view here on the ground, one of the big reasons why healthcare costs so much is the same reason that conservatives often rave about our own system versus the "evils" of single payer. Namely that you have to wait oh so long for a procedure in that terrible bastion of communism, aka Canada, whereas in America you can often have your procedure done the same day. Isn't America great?! Yeah, until you realize that you're basically paying a guy like me to sit around and play video games on his phone until some work comes across his plate. Sure I'm busy sometimes, but Americans don't like to wait, so somebody is always on duty when maybe they don't necessarily need to be.

wordnerd

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Re: ACA challenged again
« Reply #55 on: September 14, 2015, 05:30:00 PM »
Apparently if you link to a Yahoo! article, the comments section comes with it.

Literal LOL.

Exflyboy

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Re: ACA challenged again
« Reply #56 on: September 14, 2015, 05:43:58 PM »
Or maybe it will be so painful that we finally realize that HC just costs too much and there might finally be the political will to stop providers for behaving like cartels and gouging all of us.

Then maybe we'll finally get to a medicare for all plan and pay the same rate the rest of the Western world does.. i.e HALF or less than what we pay.

Almost certainly not.  The insurance system in the US is pretty screwed up, but it's still not the main reason that health care insurance is expensive here.  The VA is pretty much the closest thing to a single payer system in the US, and it costs about as much as the private system does and is lucky to provide equal quality of care.

This to my mind is one GOOD thing about the ACA.. Its PAINFUL.. Yes, but it gets us talking about the cost of care!

So whatever the reason.. lets sit down and find out why the UK spends $3500 per person and the US $10,000.. We (ordinary folks) simply can't afford this and it (was) rising at least double the rate of inflation.

When I say ordinary folks can't afford it.. of course they can't that's why there are massive subsidies.. Either we put up with the subsidies (like RE taxes that go to schools even though I don't have kids).. Or we take care of the root cause find out WTF is going and who is gouging who.. Cus somebody sure as hell is!

The US is a WONDERFUL place to be.. I wouldn't go back to the UK, too many other problems... BUT.. the UK and almost EVERYBODY else has figured the problem of high cost HC out.. Why can't we?

Argyle

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Re: ACA challenged again
« Reply #57 on: September 14, 2015, 05:47:13 PM »
Our country pays 17% of GDP for healthcare; that is far and away much higher than the vast majority of developed countries, which pay 11% on down.  (Canada 10.9%, Denmark 10.6%, Iceland 9.1%, Germany 11.3%, New Zealand 9.7%, Australia 9.4%, UK 9.1% — http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS).  Much of this excess is due to our bewildering excessive bureaucracy, where a typical doctors' practice will have two or three people on staff whose full-time job it is to sort out the claims between the myriad health insurance companies.  Add the insurance companies' own bureaucracies, including the entire floors dedicated to finding ways to deny people's claims.  (I have posted before about how I used to work for an insurance company.)  Then the fact that they are for-profit companies, as are many hospitals, and have to take a slice off every transaction for the shareholders.  Then also the fact that the set-up means many people, such as the insured and those who have trouble paying deductibles, don't get preventive health care.  Then add the cost of treating the uninsured when they have health emergencies and rely on emergency room care for when the abcess, infection, etc. has finally gotten out of control.  It all adds costs that single-payer or centrally organized not-for-profit systems don't have.

So first let's look at the fact that 35% of health care costs (17% instead of 11% of GPD) is spent on this crazy for-profit bureauracy.  All our premiums and healthcare expenses could be 35% cheaper if we had a sane system.

The other issue is that under ACA (as actually under all current insurance systems) some people are subsidizing the healthcare of others.  Yup.  That's how it works.  That's how schooling works, that's how the highway system works, that's how national defense works, that's how paying for all infrastructure and law enforcement and all of it works.  Those who can afford more are asked to pay more.  I get that those who can afford more don't always like it.  There are arguments as to why those with more should contribute more, and how those with more have benefited from the system in invisible ways, and how there should be a safety net because even those with lots of money can lose it.  But I get that some people just want to hang on to their dollars.

To me, it's crazy that we've developed this system around healthcare rather than around schooling.  Healthcare is more essential than schooling.  Why not assure free healthcare for everyone, and let people's schooling have deductibles and fees, and depend on their parents' jobs (some jobs will subsidize it, some not), and whether they can afford schooling to pay the $10,000 per year themselves or get some corporation or group to do it for them, and when they lose jobs they have to give up their kids' right to free schooling until they get another job, unless they can pay for COBRA.  And poor people have a harder time affording schooling, but that's their problem; at least people who have worked and saved don't have to pay for other people's schools.  At least then nobody would die from this system.  But somehow we accept that schooling should be available at no cost for all citizens, but not treatments to keep them healthy and alive. Beats me.

Hank Sinatra

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Re: ACA challenged again
« Reply #58 on: September 14, 2015, 06:27:05 PM »
Quote
At what point does Atlas shrug? 


Atlas isn't bearing the burden. If he shrugs, it's out of boredom.

Exflyboy

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Re: ACA challenged again
« Reply #59 on: September 14, 2015, 06:32:59 PM »
Our country pays 17% of GDP for healthcare; that is far and away much higher than the vast majority of developed countries, which pay 11% on down.  (Canada 10.9%, Denmark 10.6%, Iceland 9.1%, Germany 11.3%, New Zealand 9.7%, Australia 9.4%, UK 9.1% — http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS).  Much of this excess is due to our bewildering excessive bureaucracy, where a typical doctors' practice will have two or three people on staff whose full-time job it is to sort out the claims between the myriad health insurance companies.  Add the insurance companies' own bureaucracies, including the entire floors dedicated to finding ways to deny people's claims.  (I have posted before about how I used to work for an insurance company.)  Then the fact that they are for-profit companies, as are many hospitals, and have to take a slice off every transaction for the shareholders.  Then also the fact that the set-up means many people, such as the insured and those who have trouble paying deductibles, don't get preventive health care.  Then add the cost of treating the uninsured when they have health emergencies and rely on emergency room care for when the abcess, infection, etc. has finally gotten out of control.  It all adds costs that single-payer or centrally organized not-for-profit systems don't have.

So first let's look at the fact that 35% of health care costs (17% instead of 11% of GPD) is spent on this crazy for-profit bureauracy.  All our premiums and healthcare expenses could be 35% cheaper if we had a sane system.

The other issue is that under ACA (as actually under all current insurance systems) some people are subsidizing the healthcare of others.  Yup.  That's how it works.  That's how schooling works, that's how the highway system works, that's how national defense works, that's how paying for all infrastructure and law enforcement and all of it works.  Those who can afford more are asked to pay more.  I get that those who can afford more don't always like it.  There are arguments as to why those with more should contribute more, and how those with more have benefited from the system in invisible ways, and how there should be a safety net because even those with lots of money can lose it.  But I get that some people just want to hang on to their dollars.

To me, it's crazy that we've developed this system around healthcare rather than around schooling.  Healthcare is more essential than schooling.  Why not assure free healthcare for everyone, and let people's schooling have deductibles and fees, and depend on their parents' jobs (some jobs will subsidize it, some not), and whether they can afford schooling to pay the $10,000 per year themselves or get some corporation or group to do it for them, and when they lose jobs they have to give up their kids' right to free schooling until they get another job, unless they can pay for COBRA.  And poor people have a harder time affording schooling, but that's their problem; at least people who have worked and saved don't have to pay for other people's schools.  At least then nobody would die from this system.  But somehow we accept that schooling should be available at no cost for all citizens, but not treatments to keep them healthy and alive. Beats me.

And your numbers are per unit of GDP.. have a look at the same data that lists costs per person... Its much worse than 17% vs 9.1% example for the UK.

Hank Sinatra

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Re: ACA challenged again
« Reply #60 on: September 14, 2015, 06:36:18 PM »
http://www.cnbc.com/2015/09/11/expatriates-choosing-to-leave-the-us-rather-than-pay-taxes.html

Thanks Obamacare.

The fumes are getting to you. That stuff causes leukemia ya know. Obamacare has nothing to do with this. It's been going on a long time. And ya know what?  I know about a dozen of these people who have either done it or are always talking about doing it. They always expat to countries like Germany, UK, Canada, Switzerland, Ireland etc. NONE of these sorest of winners and pants-crappers ever move to Sudan or Yemen or some other place that has a weak small government you can drown in the bathtub and likes he-Man "Achievers". NO WAY!  They always go to evil, socialist, communist, dictatorships that take away their freedom with universal healthcare! And don't allow every swingin' law-abiding citizen to carry a gun everywhere. What a bunch of lying losers.    Now, how can they be truly free and safe with healthcare and no guns?
« Last Edit: September 14, 2015, 06:42:10 PM by Hank Sinatra »

MoonShadow

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Re: ACA challenged again
« Reply #61 on: September 14, 2015, 07:13:28 PM »
Our country pays 17% of GDP for healthcare...

The costs of the bureaucracy aside for a moment, I recently heard (on Freakonomics Radio podcast,Are You Ready for a Glorious Sunset? on Aug 26th, to be precise) that roughly 40% (iirc) of medical expenses are incurred in the last 2 years of life.  The argument there is, are we doing this the right way?  The US system basicly tries to save everyone's life to whatever extent is possible with current technology, and the costs of doing so (both in terms of actual monetary fees, and quality of life during those final years) are actually a secondary consideration.  Whereas it is much more common in Europe for elder Europeans to enter into 'hospice' style care at a much earlier stage in many terminal conditions.  Said another way, is it really in the best interests of grandpa, or his grandchildren, to spend $500K to have even an 80% chance that grandpa can suppress that cancerous tumor for another 2 years?
« Last Edit: September 14, 2015, 07:15:25 PM by MoonShadow »

LAGuy

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Re: ACA challenged again
« Reply #62 on: September 14, 2015, 07:18:00 PM »
Our country pays 17% of GDP for healthcare...

The costs of the bureaucracy aside for a moment, I recently heard (on Freakonomics Radio podcast,Are You Ready for a Glorious Sunset? on Aug 26th, to be precise) that roughly 40% (iirc) of medical expenses are incurred in the last 2 years of life.  The argument there is, are we doing this the right way?  The US system basicly tries to save everyone's life to whatever extent is possible with current technology, and the costs of doing so (both in terms of actual monetary fees, and quality of life during those final years) are actually a secondary consideration.  Whereas it is much more common in Europe for elder Europeans to enter into 'hospice' style care at a much earlier stage in many terminal conditions.  Said another way, is it really in the best interests of grandpa, or his grandchildren, to spend $500K to have even an 80% chance that grandpa can suppress that cancerous tumor for another 2 years?

The ACA tried to do something about that. But then somebody started to literally scream bloody murder about death panels.

It's already well known that the way to save money in healthcare is rationing. But Americans love their all you can eat healthcare buffet, in sparkling healthcare palaces, and equal access for all at all times of day and night.

Argyle

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Re: ACA challenged again
« Reply #63 on: September 14, 2015, 08:24:12 PM »
Certainly the insurance companies want rationing.  Until now they've done it by disallowing pre-existing conditions.  Now they'll be looking for other ways to cut costs.  But the profits won't go.  That's how we could really cut healthcare costs — by switching to a system that is not full of for-profit insurance companies and for-profit hospitals and all of that.  But in effect Americans would rather have a for-profit system than cheaper healthcare, and would rather have the "death panel" decisions of the insurance companies than cheaper non-profit healthcare.

LAGuy

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Re: ACA challenged again
« Reply #64 on: September 14, 2015, 08:56:29 PM »
Certainly the insurance companies want rationing.  Until now they've done it by disallowing pre-existing conditions.  Now they'll be looking for other ways to cut costs.  But the profits won't go.  That's how we could really cut healthcare costs — by switching to a system that is not full of for-profit insurance companies and for-profit hospitals and all of that.  But in effect Americans would rather have a for-profit system than cheaper healthcare, and would rather have the "death panel" decisions of the insurance companies than cheaper non-profit healthcare.

I'm all on board with cutting out the insurance companies, but I'm with Moonshadow on this one. It's not going to be a panacea either...just look at the VA. And just how far down the rabbit hole do  you want to go to cut out the profit motivation? Pharmaceutical companies? Medical device companies? How about clinical laboratories? That's my line of work. Constantly chasing down the fat reimbursement cash from the endlessly changing and schizophrenic Medicare. Sure, Medicare has way lower overhead then the profit driven insurance companies. But then you have to put up with a booming business in motorized medical scooters. And in the meantime the good old hospital based CBC hasn't seen a reimbursement increase in like 15 years.

The real problem in healthcare costs are the expectations of Americans. And the ACA is just a reflexive result of that. It's just an attempt to find a way to pay for everything that's been either mandated or expected of healthcare since pretty much Saint Ronald Reagan past the Emergency Medical Treatment Act requiring everybody that shows up at an ER is to receive care. But didn't provided a means to pay for that care. When Americans are ready to compromise on the quality, timeliness, or access of the care they receive, then we can talk cost. Otherwise, be ready to pay up.

MoonShadow

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Re: ACA challenged again
« Reply #65 on: September 14, 2015, 09:28:14 PM »
Certainly the insurance companies want rationing.  Until now they've done it by disallowing pre-existing conditions.  Now they'll be looking for other ways to cut costs.  But the profits won't go.  That's how we could really cut healthcare costs — by switching to a system that is not full of for-profit insurance companies and for-profit hospitals and all of that.

We had such a system of non-profit hospitals and health care institutions once upon a time, but they were slowly undermined because most of them were associated with religious groups, which could not receive federal funding due to separation of church and state issues.

MoonShadow

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Re: ACA challenged again
« Reply #66 on: September 14, 2015, 09:35:06 PM »
. And just how far down the rabbit hole do  you want to go to cut out the profit motivation? Pharmaceutical companies? Medical device companies? How about clinical laboratories? That's my line of work. Constantly chasing down the fat reimbursement cash from the endlessly changing and schizophrenic Medicare.

Also, while cutting out the bureaucratic fat from the industry is a fine goal in it's own right, using the hammer of government regulation and legislation is the least effective way to do this.  Such regulatory bureaucracies, if not outright captured by the industry players they are intended to regulate; are always reactionary in nature, always responding to the latest crisis of the system and never accurately predicting the full effects of changes in regulatory policy.

okonumiyaki

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Re: ACA challenged again
« Reply #67 on: September 14, 2015, 10:04:02 PM »
Our country pays 17% of GDP for healthcare...

The costs of the bureaucracy aside for a moment, I recently heard (on Freakonomics Radio podcast,Are You Ready for a Glorious Sunset? on Aug 26th, to be precise) that roughly 40% (iirc) of medical expenses are incurred in the last 2 years of life.  The argument there is, are we doing this the right way?  The US system basicly tries to save everyone's life to whatever extent is possible with current technology, and the costs of doing so (both in terms of actual monetary fees, and quality of life during those final years) are actually a secondary consideration.  Whereas it is much more common in Europe for elder Europeans to enter into 'hospice' style care at a much earlier stage in many terminal conditions.  Said another way, is it really in the best interests of grandpa, or his grandchildren, to spend $500K to have even an 80% chance that grandpa can suppress that cancerous tumor for another 2 years?

True.  One of the reasons the UK NHS is good value for money is that is is pretty ruthless in spending money on what has best bang for the buck - in terms of "QOL" (Quality of Life Years)

So prenatal care is a big focus
Healthy lifestyle education is a big  focus.
A&E (ER in US speak) is a big focus.
But a cancer drug that cost 90,000 pounds, but only extended patients' lives six months hasn't been approved. 
If you are over 55, you don't get a kidney transplant, only dialysis.

My father died a few years ago, and had dementia in the end.  The NHS were fantastic in helping my mother look after him at home.  Subsidies for adapting the bathroom, a "dementia day care" centre where he could go to give my mother a break, weekly visits from district nurse, financial help for things like adult diapers, loan of an electric seat (so he could get up unaided), an inflatable cushion device (and training) that made it much easier to get him up after falling down etc, panic buttons etc.   

But when he finally went into hospital, following a silly accident (swallowing his dentures) frankly, he was allowed to die of the pneumonia he then caught in hospital.  He probably could have been saved, but it wouldn't have been worth it.  Allowing him to die in peace, with his family around him, recognising some of us now and again, and in no pain, vs putting him into a very expensive intensive care unit for, maybe, a few months more?  It was the right decision.

A couple of days in the ICU would have cost as much, if not more, than all the relatively cheap help he had got before that.  And things like building a disabled friendly bathroom had much more impact on his (and my mother looking after him!) QOL than trying to extend his life.

So, yeah, death panels are a thing.  But they are rational.

Argyle

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Re: ACA challenged again
« Reply #68 on: September 14, 2015, 10:16:48 PM »
We're acting like we have to reinvent the wheel here.  Every developed country in the world except us has universal health care, and all of them do it at significantly lower cost.  They don't do it through happenstance and private enterprise, either, but through national laws and national coordination.  There are a number of different systems out there.  Pick which one you like and see how they do it.  And what do we get for our extra 35% in costs?  To quote Forbes, "The U.S. ranks last overall [of the ten countries studied] with poor scores on all three indicators of healthy lives — mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60."  (http://www.forbes.com/sites/danmunro/2014/06/16/u-s-healthcare-ranked-dead-last-compared-to-10-other-countries/).  And we act as if we just don't have any choices about it.  But of course we have choices.  If we want to get what other countries have — better outcomes, universal coverage, and lower costs — we're going to have to do something differently.  Many ways of doing it differently and well are already out there.   

I'll just add one anecdote that will undoubtedly not change anyone's mind, but will illustrate the ways in which Americans have just automatically regarded some options as unthinkable.  You know how you can be incredibly ill and miserable, and yet you're supposed to drag yourself into the doctor's office, potentially spreading your germs around, when it finally opens in the morning?  In the UK, when you're having a bad problem in the middle of the night or on a weekend, you call a central number and a professional assesses your situation.  If it warrants it, a doctor phones and talks to you.  If you're in an emergency, of course an ambulance comes and gets you.  (At no charge to you, let's remember.)  But if you're just in a bad way and need attention, the doctor comes to you.  When I had food poisoning, the doctor came twice in the middle of the night.  Of course I was all panicking, "Oh my God, how am I going to pay for this?"  Then I remembered.  I pay through my taxes.  Not the $1000 per month I pay for healthcare when I live in the States, but some.  So I don't have to pay any more.  I don't have to forgo healthcare because I'm scared of the cost.  It's safe to call the doctor. 

They all, of course, think our wild-west healthcare system is insane.

Telecaster

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Re: ACA challenged again
« Reply #69 on: September 14, 2015, 10:27:37 PM »
We had such a system of non-profit hospitals and health care institutions once upon a time, but they were slowly undermined because most of them were associated with religious groups, which could not receive federal funding due to separation of church and state issues.

That's a giant load of horse shit.   

I realize you have a political agenda, but please pay us the courtesy of making your lies sort of plausible.   Otherwise it you just come across as both across as both condescending and dishonest.  One or the other is bad enough, but both at the same time is just too much. 

MoonShadow

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Re: ACA challenged again
« Reply #70 on: September 14, 2015, 10:46:54 PM »
We had such a system of non-profit hospitals and health care institutions once upon a time, but they were slowly undermined because most of them were associated with religious groups, which could not receive federal funding due to separation of church and state issues.

That's a giant load of horse shit.   

I realize you have a political agenda, but please pay us the courtesy of making your lies sort of plausible.   Otherwise it you just come across as both across as both condescending and dishonest.  One or the other is bad enough, but both at the same time is just too much.

We all have an agenda, but that is not what this is about.  While I did really over-simplify the causes; as they are complex and not just due to separation of church and state issues, that is certainly one contributing factor to the overall trend...

http://usatoday30.usatoday.com/money/economy/2003-09-16-nonprofits2_x.htm

"But for possibly the first time since Ronald Reagan attacked the public welfare state, non-profits face the very real prospect of significant, continuing declines in government funding, their second-largest source of revenue. Many state and local governments, facing budget shortfalls, have already pared back. Congress, staring down $500-billion-plus annual deficits, is beginning to debate cuts or slower spending in some social programs."

http://www.medicarenewsgroup.com/news/medicare-faqs/individual-faq?faqId=31a98723-ad91-4801-9bd8-1f968a7c0f1b

"But in recent years, investor-owned hospitals have expanded nationally, purchasing often financially distressed facilities or stand-alone hospitals that are in need of access to capital for expansion. Depending on economic conditions, for-profit hospitals can have better access to capital than nonprofits that expand by issuing debt through tax-exempt bonds."

(Non-profit hospitals cannot issue tax-exempt bonds)

http://www.hcpro.com/MSL-307899-871/Nonprofit-hospitals-income-continues-to-decline.html

"According to the report of 383 hospitals and health systems, the median revenue growth was just 3.9%. The low rate can be partially attributed to the fact that nonprofit hospitals have had difficulty negotiating higher payment rates from insurers and are receiving smaller federal payments."

https://www.aeaweb.org/assa/2006/0106_0800_0204.pdf

"  In
1960, U.S. nonprofit hospitals maintained on average
more than three times as many beds per hospital as
their for-profit counterparts; following a monotonic
decline in relative size, by 2000, the average
nonprofit hospital was only 32% larger than the typical
 for-profit hospital. Hospital level data indicate
that this convergence was driven primarily by en
try, exit and ownership conversions, rather than
expansions or downsizing of existing hospitals. Th
ese findings suggest that hospitals may in fact
strategically choose their ownership type and hence,
their regulatory environment
"


LAGuy

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Re: ACA challenged again
« Reply #71 on: September 14, 2015, 10:54:09 PM »
We had such a system of non-profit hospitals and health care institutions once upon a time, but they were slowly undermined because most of them were associated with religious groups, which could not receive federal funding due to separation of church and state issues.

That's a giant load of horse shit.   

I realize you have a political agenda, but please pay us the courtesy of making your lies sort of plausible.   Otherwise it you just come across as both across as both condescending and dishonest.  One or the other is bad enough, but both at the same time is just too much.

Yeah, I was wondering about that too, lol. I worked for a non-profit Catholic hospital at one point and we received all sorts of government cheese.

Gin1984

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Re: ACA challenged again
« Reply #72 on: September 15, 2015, 07:07:08 AM »
We had such a system of non-profit hospitals and health care institutions once upon a time, but they were slowly undermined because most of them were associated with religious groups, which could not receive federal funding due to separation of church and state issues.

That's a giant load of horse shit.   

I realize you have a political agenda, but please pay us the courtesy of making your lies sort of plausible.   Otherwise it you just come across as both across as both condescending and dishonest.  One or the other is bad enough, but both at the same time is just too much.

We all have an agenda, but that is not what this is about.  While I did really over-simplify the causes; as they are complex and not just due to separation of church and state issues, that is certainly one contributing factor to the overall trend...

http://usatoday30.usatoday.com/money/economy/2003-09-16-nonprofits2_x.htm

"But for possibly the first time since Ronald Reagan attacked the public welfare state, non-profits face the very real prospect of significant, continuing declines in government funding, their second-largest source of revenue. Many state and local governments, facing budget shortfalls, have already pared back. Congress, staring down $500-billion-plus annual deficits, is beginning to debate cuts or slower spending in some social programs."

http://www.medicarenewsgroup.com/news/medicare-faqs/individual-faq?faqId=31a98723-ad91-4801-9bd8-1f968a7c0f1b

"But in recent years, investor-owned hospitals have expanded nationally, purchasing often financially distressed facilities or stand-alone hospitals that are in need of access to capital for expansion. Depending on economic conditions, for-profit hospitals can have better access to capital than nonprofits that expand by issuing debt through tax-exempt bonds."

(Non-profit hospitals cannot issue tax-exempt bonds)

http://www.hcpro.com/MSL-307899-871/Nonprofit-hospitals-income-continues-to-decline.html

"According to the report of 383 hospitals and health systems, the median revenue growth was just 3.9%. The low rate can be partially attributed to the fact that nonprofit hospitals have had difficulty negotiating higher payment rates from insurers and are receiving smaller federal payments."

https://www.aeaweb.org/assa/2006/0106_0800_0204.pdf

"  In
1960, U.S. nonprofit hospitals maintained on average
more than three times as many beds per hospital as
their for-profit counterparts; following a monotonic
decline in relative size, by 2000, the average
nonprofit hospital was only 32% larger than the typical
 for-profit hospital. Hospital level data indicate
that this convergence was driven primarily by en
try, exit and ownership conversions, rather than
expansions or downsizing of existing hospitals. Th
ese findings suggest that hospitals may in fact
strategically choose their ownership type and hence,
their regulatory environment
"
One in six hospital beds in the United States is affiliated with a Catholic health system, so no, none of your statements agree with facts.  And I am betting that if I went through your sources I would find that you cherry picked enough to be inaccurate, just like every other time I have. 

In December 2013, the ACLU published a report on the rise of Catholic health systems and the impact on reproductive health nationwide. In 2011, about one in nine hospital beds was affiliated with a Catholic health system. As of February 2015, that figure is one in six.

Between 2001 and 2011, the number of Catholic-affiliated or -sponsored acute care hospitals increased by 16%, a far greater increase than any other type of non-profit hospital. In 2011, the 10 largest Catholic-sponsored health systems together controlled 330 acute-care hospitals — about one-third of all the hospitals and beds in the 25 largest systems. According to the ACLU, if these 10 Catholic systems were viewed as one, they would make up the largest health system in the country.

Argyle

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Re: ACA challenged again
« Reply #73 on: September 15, 2015, 07:42:54 AM »
I don't have a dog in this fight about the trajectory of non-profit hospitals, apart from the fact that I think they should all be non-profit.  This article (http://www.huffingtonpost.com/dr-andrew-agwunobi/catholic-hospitals-versus_b_3567095.html) says that there are "over 630" Catholic hospitals in the U.S., and 5724 hospitals in total.  Figuring 640 Catholic hospitals, that means 11.18% are Catholic.  However, according to this article (healthnetpulse.com/broker/2013/10/11/did-you-know-for-profit-versus-nonprofit-hospitals/), "According to the AHA, about 18 percent of U.S. hospitals are private, for-profit hospitals, while 23 percent are owned by state and local governments. The rest are private, nonprofit facilities." 

That doesn't say what percentage of beds are at for-profit hospitals, but I imagine it's similar.

An interesting corollary question is what's happened to non-profit insurance companies, of which I believe Blue Cross/Blue Shield is the giant.  They have given up their non-profit status in a number of markets.  Wikipedia says: "In 1994, BCBS changed to allow its licensees to be for-profit corporations.[4] During 2010, Health Care Service Corporation, the parent company of BCBS in Texas, Oklahoma, New Mexico, Montana and Illinois, nearly doubled its income to $1.09 billion in 2010, and began 4 years of billion-dollar profits."  California BCBS lost its tax-exempt non-profit status this year. 

Again, I don't know why healthcare is regarded as a for-profit business and K-12 schooling is not.  Maybe because people could just opt out of schooling, but beyond a certain point they're compelled to get healthcare?  But that doesn't seem like a good reason.

infogoon

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Re: ACA challenged again
« Reply #74 on: September 15, 2015, 07:54:23 AM »
We'll never see means testing. Do you have any idea what it will cost in additional man hours to process all that information? I have $1,000 that says the number of people who are "taking advantage" of the system because it isn't means tested costs less than the amount of money it would take to implement means testing. And that's why it'll never happen.

The fact that it's wildly impractical is no guarantee it won't happen. How many states have spent more money on drug testing the recipients of social programs than they've saved in denying benefits to those who fail?

Mr. Green

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Re: ACA challenged again
« Reply #75 on: September 15, 2015, 08:08:32 AM »
Once I left the Corporate Teet, I was uninsurable pre-ACA (Tourette's Syndrome).  I used an "indemnity plan" as a stop gag substitute but was very exposed to something major like MS or Parkinson's.  Now I have insurance that only costs about 20% more than my indemnity plan and has no lifetime limit.  I do not qualify for subsidies and am plenty happy with ACA.
Interesting. I have Tourette's as well but never heard of it causing insurance issues before. I'm quite surprised because everything I learned about Tourette's made it seem like other than the nervous ticks there are no health effects like shortened longevity or increased risks of developing other health problems.

Mr. Green

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Re: ACA challenged again
« Reply #76 on: September 15, 2015, 08:16:48 AM »
Or maybe it will be so painful that we finally realize that HC just costs too much and there might finally be the political will to stop providers for behaving like cartels and gouging all of us.

Then maybe we'll finally get to a medicare for all plan and pay the same rate the rest of the Western world does.. i.e HALF or less than what we pay.

Almost certainly not.  The insurance system in the US is pretty screwed up, but it's still not the main reason that health care insurance is expensive here.  The VA is pretty much the closest thing to a single payer system in the US, and it costs about as much as the private system does and is lucky to provide equal quality of care.

This to my mind is one GOOD thing about the ACA.. Its PAINFUL.. Yes, but it gets us talking about the cost of care!

So whatever the reason.. lets sit down and find out why the UK spends $3500 per person and the US $10,000.. We (ordinary folks) simply can't afford this and it (was) rising at least double the rate of inflation.

When I say ordinary folks can't afford it.. of course they can't that's why there are massive subsidies.. Either we put up with the subsidies (like RE taxes that go to schools even though I don't have kids).. Or we take care of the root cause find out WTF is going and who is gouging who.. Cus somebody sure as hell is!

The US is a WONDERFUL place to be.. I wouldn't go back to the UK, too many other problems... BUT.. the UK and almost EVERYBODY else has figured the problem of high cost HC out.. Why can't we?
You can start right here.

http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/

If you take the time to read the article in its entirety as I did when it first came out, you'll likely find yourself shocked and fairly disgusted. While the article isn't dealing with the insurance industry directly, it's pretty eye opening regarding the shenanigans that are going on at hospitals across the country, particularly where companies own numerous hospitals and operate them all under the auspices of "saving money by sharing overhead costs."

Bob W

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Re: ACA challenged again
« Reply #77 on: September 15, 2015, 08:21:15 AM »
The simplest solution is to just hire Japan,  Germany, the UK or Canada to run our health system.   It is a no brainer.  We obviously can't run it half as good as them. 

We are losers in the sickness care business. 

And just for something to chew on ---- All the Medicaid clients I work with pay zero in premiums and have zero deductible.   I literally have to be creative to make sure they don't go above the cap for liquid assets that would exempt them.  So they take vacations,  eat out lots and have closets full of clothes. 

My guess is that many of the "liberal" readers of this forum are looking forward to the day when their none asset tested FIRE allows them to pay $25 in premiums.

So yeah, those with lots of assets and no earned income and those "poor" folks with low earned income can have their golden insurance paid for by the working poor middle class.

As far as Trump's proposal.  The only thing I've heard from him is that he will open the state borders and allow bidding across state. lines.   It is a complete joke that this isn't already happening.   

Regarding the rate of medical inflation --- it appears that since most people's annual deductible are now in the stratosphere that the use of medical care of people with actual money will continue to decrease.   Thus demand down,  price down.   I hope this turns into a virtuous cycle and prices continue to decrease.

forummm

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Re: ACA challenged again
« Reply #78 on: September 15, 2015, 09:39:47 AM »
Or maybe it will be so painful that we finally realize that HC just costs too much and there might finally be the political will to stop providers for behaving like cartels and gouging all of us.

Then maybe we'll finally get to a medicare for all plan and pay the same rate the rest of the Western world does.. i.e HALF or less than what we pay.

Almost certainly not.  The insurance system in the US is pretty screwed up, but it's still not the main reason that health care insurance is expensive here.  The VA is pretty much the closest thing to a single payer system in the US, and it costs about as much as the private system does and is lucky to provide equal quality of care.

Provide your evidence for this.

forummm

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Re: ACA challenged again
« Reply #79 on: September 15, 2015, 09:40:58 AM »
Certainly the insurance companies want rationing.  Until now they've done it by disallowing pre-existing conditions.  Now they'll be looking for other ways to cut costs.  But the profits won't go.  That's how we could really cut healthcare costs — by switching to a system that is not full of for-profit insurance companies and for-profit hospitals and all of that.

We had such a system of non-profit hospitals and health care institutions once upon a time, but they were slowly undermined because most of them were associated with religious groups, which could not receive federal funding due to separation of church and state issues.

Provide your evidence for this. The random links you provided upthread when others called you on this were not evidence at all. Non-profit hospitals issue bonds all the time, and get tax benefits for investors of those bonds. And "non-profit" hospitals are insanely profitable, and get probably most of their revenue from the government in most states.
« Last Edit: September 15, 2015, 09:45:00 AM by forummm »

Mr. Green

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Re: ACA challenged again
« Reply #80 on: September 15, 2015, 11:50:24 AM »
LOL. I just got my company's open enrollment letter for this year and my premium is going up 45%.

Gin1984

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Re: ACA challenged again
« Reply #81 on: September 15, 2015, 12:16:52 PM »
LOL. I just got my company's open enrollment letter for this year and my premium is going up 45%.
Your premium went up 45%, how did the COBRA cost change (aka the real cost of your insurance).

MoonShadow

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Re: ACA challenged again
« Reply #82 on: September 15, 2015, 01:03:52 PM »

One in six hospital beds in the United States is affiliated with a Catholic health system, so no, none of your statements agree with facts.  And I am betting that if I went through your sources I would find that you cherry picked enough to be inaccurate, just like every other time I have. 

In December 2013, the ACLU published a report on the rise of Catholic health systems and the impact on reproductive health nationwide. In 2011, about one in nine hospital beds was affiliated with a Catholic health system. As of February 2015, that figure is one in six.


While you make some good points here that have forced me to reconsider my position, there are still some mitigating factors you have 'cherrypicked' yourself.  For example, while a for-profit hospital is certainly not supported by or ran by religious institutions; the fact that a non-profit hospital identifies with a particular religion is not a certain fact that they actually are.  Often-times those religious affiliations are simply historical in nature, and have little or no effect on the actual nature of the hospital itself.  For example; Jewish founded and inspired hospitals have numbered over 100 in the history of the United States, but only 22 still retain a Jewish identity across the country, and most of those are simply in name only....

http://www.ncbi.nlm.nih.gov/pubmed/22450187

Likewise among Catholic founded hospitals, "in 1968, there were 770 religious CEOs and only 26 lay CEOs running Catholic hospitals. Today, four religious CEOs and 626 lay CEOs lead those institutions.

http://ncronline.org/news/peace-justice/challenges-ahead-catholic-health-care-keehan-says

And despite much evidence of a resurgence of Catholic hospitals nationwide, even the Catholic church itself acknowledges that the religious nature of health care is either declining, or simply being diluted by regulatory directives as well as the diverse and generally non-secular culture of employees of these hospitals...

"As their efforts to care for the sick expanded, the sisters invested in the construction of hospitals, where they served as nurses and administrators. They integrated explicit religious practice into clinical care, and their habits were reminders of their Catholicity. In these times, no one questioned what made their institutions Catholic. The Catholic identity engrained and sustained through the presence of the sisters was so obvious that it was not a topic of conversation.

Today, the Catholic health ministry has grown to include 642 hospitals and 1,600 continuing care facilities in all 50 states. One sixth of the patients in U.S. health care are treated in Catholic systems. With this expansion, the proportion of non-Catholic patients and employees has grown dramatically, and far fewer vowed religious hold leadership positions. Fifty years ago, religious women led 98 percent of Catholic hospitals. Currently, only four Catholic hospitals have religious CEOs. Meanwhile, structural dimensions of U.S. health care have pushed Catholic systems to embark on more partnerships and collaborative endeavors with non-Catholic organizations and their employees.

The rise of lay leadership, growing proportions of non-Catholic employees, and an increasingly interdependent and collaborative health care system create a question that the early sisters did not face: What does it mean for a health care organization to hold a “Catholic identity”?"

http://www.uscatholic.org/articles/201503/what-makes-catholic-hospital-catholic-29861

Furthermore, the actual not-for-profit nature of non-profit hospitals has been challenged as a "legal fiction" in our modern world, which is arguablely true to some degree or another with all of them.

http://nonprofitquarterly.org/2015/07/07/judge-terms-modern-nonprofit-hospitals-a-legal-fiction/

Gin1984

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Re: ACA challenged again
« Reply #83 on: September 15, 2015, 01:11:22 PM »

One in six hospital beds in the United States is affiliated with a Catholic health system, so no, none of your statements agree with facts.  And I am betting that if I went through your sources I would find that you cherry picked enough to be inaccurate, just like every other time I have. 

In December 2013, the ACLU published a report on the rise of Catholic health systems and the impact on reproductive health nationwide. In 2011, about one in nine hospital beds was affiliated with a Catholic health system. As of February 2015, that figure is one in six.


While you make some good points here that have forced me to reconsider my position, there are still some mitigating factors you have 'cherrypicked' yourself.  For example, while a for-profit hospital is certainly not supported by or ran by religious institutions; the fact that a non-profit hospital identifies with a particular religion is not a certain fact that they actually are.  Often-times those religious affiliations are simply historical in nature, and have little or no effect on the actual nature of the hospital itself.  For example; Jewish founded and inspired hospitals have numbered over 100 in the history of the United States, but only 22 still retain a Jewish identity across the country, and most of those are simply in name only....

http://www.ncbi.nlm.nih.gov/pubmed/22450187

Likewise among Catholic founded hospitals, "in 1968, there were 770 religious CEOs and only 26 lay CEOs running Catholic hospitals. Today, four religious CEOs and 626 lay CEOs lead those institutions.

http://ncronline.org/news/peace-justice/challenges-ahead-catholic-health-care-keehan-says

And despite much evidence of a resurgence of Catholic hospitals nationwide, even the Catholic church itself acknowledges that the religious nature of health care is either declining, or simply being diluted by regulatory directives as well as the diverse and generally non-secular culture of employees of these hospitals...

"As their efforts to care for the sick expanded, the sisters invested in the construction of hospitals, where they served as nurses and administrators. They integrated explicit religious practice into clinical care, and their habits were reminders of their Catholicity. In these times, no one questioned what made their institutions Catholic. The Catholic identity engrained and sustained through the presence of the sisters was so obvious that it was not a topic of conversation.

Today, the Catholic health ministry has grown to include 642 hospitals and 1,600 continuing care facilities in all 50 states. One sixth of the patients in U.S. health care are treated in Catholic systems. With this expansion, the proportion of non-Catholic patients and employees has grown dramatically, and far fewer vowed religious hold leadership positions. Fifty years ago, religious women led 98 percent of Catholic hospitals. Currently, only four Catholic hospitals have religious CEOs. Meanwhile, structural dimensions of U.S. health care have pushed Catholic systems to embark on more partnerships and collaborative endeavors with non-Catholic organizations and their employees.

The rise of lay leadership, growing proportions of non-Catholic employees, and an increasingly interdependent and collaborative health care system create a question that the early sisters did not face: What does it mean for a health care organization to hold a “Catholic identity”?"

http://www.uscatholic.org/articles/201503/what-makes-catholic-hospital-catholic-29861

Furthermore, the actual not-for-profit nature of non-profit hospitals has been challenged as a "legal fiction" in our modern world, which is arguablely true to some degree or another with all of them.

http://nonprofitquarterly.org/2015/07/07/judge-terms-modern-nonprofit-hospitals-a-legal-fiction/
Actually I did not cherry pick.  The counsel of Bishops is quite clear on what a Catholic hospital must do (and what religious rules they must follow).  Including refusal of basic medical care based on Catholic beliefs.   The CEO does not matter in this case, the rules they operate under do. 

MoonShadow

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Re: ACA challenged again
« Reply #84 on: September 15, 2015, 01:17:26 PM »
Non-profit hospitals issue bonds all the time, and get tax benefits for investors of those bonds.
This time you need to show your evidence.  I never claimed that religious non-profit hospitals can't issue bonds, only that they cannot be tax exempt.  Tax exempt bonds are tax exempt because they fund the construction of public (municipal) infrastructure, and government funding of a religious institution, even something as generally beneficial as a hospital, is certainly a violation of separation of church and state, and would be challenged in court.  So either the hospitals don't actually get state support (i.e. a tax exempt status for their construction bonds) or their religious affiliation is in name or history only.
Quote

 And "non-profit" hospitals are insanely profitable, and get probably most of their revenue from the government in most states.

That true, and I'd wager that the majority of those same 'non-profit' hospitals are religious in name or history only, and are not a present fact.  When I said above that non-profit hospitals were in decline, I should have said that religious non-profit hospitals, with actual religiously motivated employees, volunteers and sponsorship, have been in decline.  I believe that this statement, corrected, is likely still true; although I can't prove it.  The age that a Catholic hospital in the US actually staffed nuns as nurses, with a religious conviction for caring for the sick rather than a registered nurse with a personal profit motive, is a bygone concept.  I literally can't remember the last time I saw an actual nun working as a nurse in a Catholic hospital, nor the last time I saw a nun working as a teacher in a Catholic school.  How about yourself?

forummm

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Re: ACA challenged again
« Reply #85 on: September 15, 2015, 04:33:41 PM »
Non-profit hospitals issue bonds all the time, and get tax benefits for investors of those bonds.
This time you need to show your evidence.  I never claimed that religious non-profit hospitals can't issue bonds, only that they cannot be tax exempt.  Tax exempt bonds are tax exempt because they fund the construction of public (municipal) infrastructure, and government funding of a religious institution, even something as generally beneficial as a hospital, is certainly a violation of separation of church and state, and would be challenged in court.  So either the hospitals don't actually get state support (i.e. a tax exempt status for their construction bonds) or their religious affiliation is in name or history only.

Instead of providing any evidence you ask for some from me? You don't make it easy to have a useful conversation. I literally googled catholic hospital and this one popped up first.
http://www.upmc.com/locations/hospitals/mercy/about/Pages/catholic-health-care.aspx

Quote
What Does It Mean to be a Catholic Hospital?

There is one fundamental commandment for a Catholic hospital: All life, from conception to the moment of natural death, is profoundly sacred. All life must therefore be treated with awe, respect, and dignity. This fundamental commandment comes without a “but,” “if,” or “however.” There is no qualification, no exception.

To put that into practice, a Catholic hospital operates according to the directives established by the United States Conference of Catholic Bishops. Directives for Catholic Heath Care Services are contained in a 12-page document that interested readers may read.

The Catholic understanding of health care is rooted in the basic scriptural understanding, outlined in the bishops’ document, that the healing mission of Jesus “touched people at the deepest level of their existence: He sought their physical, mental, and spiritual healing.” Throughout its history, the church has dedicated herself in service to the sick and all those in need.

The social responsibility of Catholic health care services is guided by five essential principles outlined in the bishops’ document:

To promote and defend human dignity: The right to life of every human being means the right as well to adequate health care and must be basic to every Catholic institution involved in medical service and science.
To care for the poor: No one can ever be turned away from a Catholic hospital because of an inability to pay. This attention to the poor, the underinsured, and the uninsured must be paramount at a Catholic hospital.
To contribute to the common good: Catholic health care services are meant for the entire community. These services should be instigators of social change that lead to a greater respect for fundamental human rights and for the economic, social, political, and spiritual health of the entire community.
To exercise responsible stewardship: As the bishops state, “Catholic health care ministry exercises responsible stewardship of available health care resources. A just health care system will be concerned both with promoting equity of care – to assure the right of each person to basic health care is respected – and with promoting the good health of all within the community.”
Adherence to the moral teachings of the Church: In our society today, any Catholic health care service will be approached, or even pressured, to provide medical procedures that are contrary to Catholic teaching. But by refusing to provide or permit such medical procedures, Catholic health care affirms what defines it: a commitment to the sacredness and dignity of human life from conception until death.
Reprinted with permission by Catholic Diocese of Pittsburgh, 2008

The hospital exists to provide "faith based care". And they are nonprofit (also googled nonprofit hospital tax exempt religious).

http://www.stltoday.com/business/columns/jim-doyle/dispute-grows-over-tax-exemptions-for-nonprofit-hospitals/article_f3ff8917-8b17-5edd-85fc-c1e7ab1ce30c.html

Why do you so frequently assert as fact stuff that you have no basis in fact to support? Not cool.

Where's your evidence about your VA claim (which I also know is not true)?

Rezdent

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Re: ACA challenged again
« Reply #86 on: September 15, 2015, 05:00:02 PM »

snip...

That true, and I'd wager that the majority of those same 'non-profit' hospitals are religious in name or history only, and are not a present fact.  When I said above that non-profit hospitals were in decline, I should have said that religious non-profit hospitals, with actual religiously motivated employees, volunteers and sponsorship, have been in decline.  I believe that this statement, corrected, is likely still true; although I can't prove it.  The age that a Catholic hospital in the US actually staffed nuns as nurses, with a religious conviction for caring for the sick rather than a registered nurse with a personal profit motive, is a bygone concept.  I literally can't remember the last time I saw an actual nun working as a nurse in a Catholic hospital, nor the last time I saw a nun working as a teacher in a Catholic school.  How about yourself?

The number of nuns visible in hospitals and schools may not be related to this discussion at all.

  -  http://www.pewresearch.org/fact-tank/2014/08/08/u-s-nuns-face-shrinking-numbers-and-tensions-with-the-vatican/
"Globally, the number of nuns also is declining, but not nearly as fast as it is in the U.S. In 1970, U.S. nuns represented about 16% of the world’s religious sisters; now, American nuns are about 7% of the global total (just over 700,000), also according to CARA."

MoonShadow

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Re: ACA challenged again
« Reply #87 on: September 15, 2015, 05:38:09 PM »
Actually I did not cherry pick.  The counsel of Bishops is quite clear on what a Catholic hospital must do (and what religious rules they must follow).  Including refusal of basic medical care based on Catholic beliefs.   The CEO does not matter in this case, the rules they operate under do.

I guess we are done here, then.  You asked for more support, and I provided it.  Apparently you don't consider my perspective valid, and I consider yours to be as debatable as my own.  Carry on with your belief that the CEO doesn't actually matter.

MoonShadow

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Re: ACA challenged again
« Reply #88 on: September 15, 2015, 05:51:07 PM »
Non-profit hospitals issue bonds all the time, and get tax benefits for investors of those bonds.
This time you need to show your evidence.  I never claimed that religious non-profit hospitals can't issue bonds, only that they cannot be tax exempt.  Tax exempt bonds are tax exempt because they fund the construction of public (municipal) infrastructure, and government funding of a religious institution, even something as generally beneficial as a hospital, is certainly a violation of separation of church and state, and would be challenged in court.  So either the hospitals don't actually get state support (i.e. a tax exempt status for their construction bonds) or their religious affiliation is in name or history only.

Instead of providing any evidence you ask for some from me? You don't make it easy to have a useful conversation. I literally googled catholic hospital and this one popped up first.
http://www.upmc.com/locations/hospitals/mercy/about/Pages/catholic-health-care.aspx

Quote
What Does It Mean to be a Catholic Hospital?

There is one fundamental commandment for a Catholic hospital: All life, from conception to the moment of natural death, is profoundly sacred. All life must therefore be treated with awe, respect, and dignity. This fundamental commandment comes without a “but,” “if,” or “however.” There is no qualification, no exception.

To put that into practice, a Catholic hospital operates according to the directives established by the United States Conference of Catholic Bishops. Directives for Catholic Heath Care Services are contained in a 12-page document that interested readers may read.

The Catholic understanding of health care is rooted in the basic scriptural understanding, outlined in the bishops’ document, that the healing mission of Jesus “touched people at the deepest level of their existence: He sought their physical, mental, and spiritual healing.” Throughout its history, the church has dedicated herself in service to the sick and all those in need.

The social responsibility of Catholic health care services is guided by five essential principles outlined in the bishops’ document:

To promote and defend human dignity: The right to life of every human being means the right as well to adequate health care and must be basic to every Catholic institution involved in medical service and science.
To care for the poor: No one can ever be turned away from a Catholic hospital because of an inability to pay. This attention to the poor, the underinsured, and the uninsured must be paramount at a Catholic hospital.
To contribute to the common good: Catholic health care services are meant for the entire community. These services should be instigators of social change that lead to a greater respect for fundamental human rights and for the economic, social, political, and spiritual health of the entire community.
To exercise responsible stewardship: As the bishops state, “Catholic health care ministry exercises responsible stewardship of available health care resources. A just health care system will be concerned both with promoting equity of care – to assure the right of each person to basic health care is respected – and with promoting the good health of all within the community.”
Adherence to the moral teachings of the Church: In our society today, any Catholic health care service will be approached, or even pressured, to provide medical procedures that are contrary to Catholic teaching. But by refusing to provide or permit such medical procedures, Catholic health care affirms what defines it: a commitment to the sacredness and dignity of human life from conception until death.
Reprinted with permission by Catholic Diocese of Pittsburgh, 2008

The hospital exists to provide "faith based care". And they are nonprofit (also googled nonprofit hospital tax exempt religious).


And this is evidence of what?  That Catholics prefer that Catholic hospitals act like Catholics?  Is this actual evidence that even a majority, much less all, such Catholic hospitals actually follow such rules and guidelines in practice?  But this is already deep into 'inside baseball' territory.  I'm not debating with you what percentage of Catholic hospitals actually run like Catholic hospitals.  My comment was about the decline of real religiously based non-profit hospitals, and the idea that separation of church and state issues contributed to such a decline.  I have already been shown evidence that this trend has reversed, but not any evidence contradicting the second half of that statement.  Were you able to find any evidence that faith-based non-profit hospitals can issue tax-exempt municipal bonds?

MoonShadow

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Re: ACA challenged again
« Reply #89 on: September 15, 2015, 06:07:04 PM »

Where's your evidence about your VA claim (which I also know is not true)?

From the Obamafacts website...

http://obamacarefacts.com/single-payer/

Quote
"Defining Single Payer

The term “single payer” describes the funding mechanism (health care financed by a single public body from a single fund) not specify the type of delivery, or for whom doctors work. Given this there are many different examples of single payer systems throughout the world that employ different tactics in terms of insurance, delivery of services, and funding. Some of these systems look a lot like the mix of private and public systems we find in “ObamaCare”, while others use both public insurance and public healthcare.

FACT: A true single payer system eliminates private insurance, but in most countries they haven’t actually implemented a true single payer system. Keep reading to understand different ways different types of single payer systems have been implemented around the world and how supplemental coverage, cost sharing, and tiered systems can remain in place in a single payer system.The US already has a number of Government run health care systems such as: Medicare, Medicaid, Veterans Affairs, military, federal employee benefits, state and local government benefits.  That hasn’t stopped us from spending more per-capita on healthcare than any other nation on earth and suggests single payer won’t magically solve our health care spending problems alone."

<snip>
What Would A Single Payer System Look Like In America?

A universal single payer health care system would be paid for in part through taxes based on income replacing insurance premiums, copays, deductibles, etc. All plans would have the same benefits and networks and would eliminate our current multi-tiered system (our current system rewards income with quality).

<snip>

The US already has a number of Government run health care systems such as: Medicare, Medicaid, Veterans Affairs, military, federal employee benefits, state and local government benefits.  That hasn’t stopped us from spending more per-capita on healthcare than any other nation on earth and suggests single payer won’t magically solve our health care spending problems alone."

So the website put up to promote Obamacare, which is obviously not some right wing rag, gives the VA as an example of a (limited in scope) single payer system, that single payer being the government.  It also describes Medicare as being such a (also limited in scope) system.

So, Forummm; are you about to prove the Obamafacts website to be false?

forummm

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Re: ACA challenged again
« Reply #90 on: September 15, 2015, 06:31:07 PM »
Yes, I've found Obamacarefacts to be wrong on multiple occasions. It's just a website put up by some anonymous people who want web traffic so they can direct people to buy health insurance outside the Marketplace (presumably higher cost plans). And what you provided wasn't proof of anything.

You said :
Quote
The VA is pretty much the closest thing to a single payer system in the US, and it costs about as much as the private system does and is lucky to provide equal quality of care.
First off, we do have an actual single-payer system: Medicare. People love it. And it's run much more inexpensively than private insurance. The VA is just a place that people can go to get some care, and the levels of benefits they are eligible for varies, but it's frequently not a comprehensive benefits package. The VA has limited funding and they just provide as much care as they get an appropriation for each year. And the people eligible to go there commonly have another source of insurance and just get some care at the VA because the VA provides that service better or is cheaper or more inviting in some way. So it's not a single payer system--it's like a public health clinic with limited access and a much broader service portfolio.

And you also provided no evidence that it "costs about as much as the private system". Which of course you can't because it's not really comparable to a private insurer due to the operating model.

MoonShadow

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Re: ACA challenged again
« Reply #91 on: September 15, 2015, 06:47:37 PM »
And you also provided no evidence that it "costs about as much as the private system". Which of course you can't because it's not really comparable to a private insurer due to the operating model.

If you were at all concerned about context, Forummm; you would have noticed I said that in the context of medical care costs in the United States compared to other countries.  So while the VA care might actually be somewhat cheaper than in the US private system (which I actually don't doubt, because the quality of care is of a lower standard, in addition to being delayed, which is one reason I don't really bother going to the VA myself) that is still not evidence that privately funded care is the root cause of the generally higher costs of American health care.  I think you would have a hard time showing that the VA, or even Medicare, is as cheap per capita as the British single payer system, as an example.  The growing medical tourism industry alone is likely enough to undercut the idea that the VA is cheaper than any private health care system.

Gin1984

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Re: ACA challenged again
« Reply #92 on: September 15, 2015, 06:58:10 PM »
Actually I did not cherry pick.  The counsel of Bishops is quite clear on what a Catholic hospital must do (and what religious rules they must follow).  Including refusal of basic medical care based on Catholic beliefs.   The CEO does not matter in this case, the rules they operate under do.

I guess we are done here, then.  You asked for more support, and I provided it.  Apparently you don't consider my perspective valid, and I consider yours to be as debatable as my own.  Carry on with your belief that the CEO doesn't actually matter.
Actually no.  I corrected your incorrect statement, you now have made another one.  This is not about opinions, or perspectives, this is about basic facts.  The counsel of bishops controls the actions of the hospitals under their control.  Period. 
http://www.propublica.org/article/catholic-bishops-weigh-tightening-rules-for-health-care-partnerships

Mr. Green

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Re: ACA challenged again
« Reply #93 on: September 15, 2015, 08:00:06 PM »
If you read the article I posted a link to you'll find that in general hospitals are masking their huge profit margins by building new buildings and in some cases buying new equipment, not necessarily because it'w worth it but because they have money to spend. After all, they're nonprofit so they have to do something with this money to keep it from looking bad. I don't know whether Catholic hospitals are in on the game too, but I would venture to guess many of them are.

Bob W

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Re: ACA challenged again
« Reply #94 on: September 16, 2015, 09:38:26 AM »
If you read the article I posted a link to you'll find that in general hospitals are masking their huge profit margins by building new buildings and in some cases buying new equipment, not necessarily because it'w worth it but because they have money to spend. After all, they're nonprofit so they have to do something with this money to keep it from looking bad. I don't know whether Catholic hospitals are in on the game too, but I would venture to guess many of them are.

Why yes they are.   

Trudie

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Re: ACA challenged again
« Reply #95 on: September 16, 2015, 11:25:56 AM »
This just in, number of uninsured in America drops by 8.8 million:
http://www.nytimes.com/2015/09/17/us/politics/census-bureau-poverty-rate-uninsured.html?hp&action=click&pgtype=Homepage&module=first-column-region&region=top-news&WT.nav=top-news&_r=0

I went to grad school (health policy) back in 1994 and the uninsured was somewhere around 36 million at the time.  Despite all the hand wringing, Hillary's health care council (under Pres. Clinton), and political discourse the needle never moved in a positive direction and, in fact, just continued getting worse -- until now.

I think the gains for society will accrue, steadily, over time.  The ship doesn't turn quickly, but I have to say that this is an impressive step.

BTDretire

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Re: ACA challenged again
« Reply #96 on: September 16, 2015, 11:33:17 AM »

So first let's look at the fact that 35% of health care costs (17% instead of 11% of GPD) is spent on this crazy for-profit bureauracy.  All our premiums and healthcare expenses could be 35% cheaper if we had a sane system.

1) I don't believe there is 35% going to shareholders.
2) We have greater access to procedures and equipment (this where part of that 35% goes)
3) Private business is more efficient than government, so,
if you cut out profit, you will gain inefficiency, waste and fraud.
4) you add another layer of government to monitor, regulate generaly F%^& around with
providers and hospitals.
  Point being some of those extra costs bring us benefits.
       

Hank Sinatra

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Re: ACA challenged again
« Reply #97 on: September 16, 2015, 11:58:44 AM »
Quote
3) Private business is more efficient than government, so,
if you cut out profit, you will gain inefficiency, waste and fraud.

Maximum shibboleth.  Saying or believing this is on the same level as "masturbation causes hair to grow on the palm of one's hand".

BTDretire

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Re: ACA challenged again
« Reply #98 on: September 16, 2015, 12:00:34 PM »
This just in, number of uninsured in America drops by 8.8 million:
http://www.nytimes.com/2015/09/17/us/politics/census-bureau-poverty-rate-uninsured.html?hp&action=click&pgtype=Homepage&module=first-column-region&region=top-news&WT.nav=top-news&_r=0

I went to grad school (health policy) back in 1994 and the uninsured was somewhere around 36 million at the time.  Despite all the hand wringing, Hillary's health care council (under Pres. Clinton), and political discourse the needle never moved in a positive direction and, in fact, just continued getting worse -- until now.

I think the gains for society will accrue, steadily, over time.  The ship doesn't turn quickly, but I have to say that this is an impressive step.
  It is just in, but from what I gleen from it, it is all 2013 and 2014 data written up and released Sept. 2015.
I did see it, so I wonder if the data included those that went on Medicaid.

protostache

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Re: ACA challenged again
« Reply #99 on: September 16, 2015, 02:17:02 PM »
This just in, number of uninsured in America drops by 8.8 million:
http://www.nytimes.com/2015/09/17/us/politics/census-bureau-poverty-rate-uninsured.html?hp&action=click&pgtype=Homepage&module=first-column-region&region=top-news&WT.nav=top-news&_r=0

I went to grad school (health policy) back in 1994 and the uninsured was somewhere around 36 million at the time.  Despite all the hand wringing, Hillary's health care council (under Pres. Clinton), and political discourse the needle never moved in a positive direction and, in fact, just continued getting worse -- until now.

I think the gains for society will accrue, steadily, over time.  The ship doesn't turn quickly, but I have to say that this is an impressive step.
  It is just in, but from what I gleen from it, it is all 2013 and 2014 data written up and released Sept. 2015.
I did see it, so I wonder if the data included those that went on Medicaid.

You can read the full report yourself, if you like, right here:

http://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-253.pdf

On page 4 there's a graphic with a breakdown between the different types of medical coverage and percentage-point change from 2013 to 2014. The number of people covered by Medicare went up a little less than two points, while people covered by direct purchase plans (both from the exchange and off-exchange) went up about three. I think each percentage point represents about 3 million people (page 3 first column "In 2014, the percentage of people without health insurance coverage for the entire calendar year was 10.4 percent or 33.0 million").

Edit: There's a table on page 5. Medicaid-covered people went from 54.9 million to 61.6 million, a difference of 6.7 million people, with a ~0.9 million margin of error on both years.
« Last Edit: September 16, 2015, 02:22:56 PM by protostache »

 

Wow, a phone plan for fifteen bucks!