Author Topic: What comes after the ACA?  (Read 102799 times)

NoStacheOhio

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Re: What comes after the ACA?
« Reply #1000 on: February 19, 2017, 10:07:22 AM »
This is only partially true. If an additional DRG is paid it is related to a different diagnosis which may or may not have been a "complication" from the original procedure.  Generally speaking, if it is a known complication (ex pain not controlled requiring an additional day of hospitalization), the hospital is NOT reimbursed for the stay.  Additionally, if a readmission takes place within 30 days related to the previous payment, no additional compensation is paid to the hospital for treatment. 

This is sort of the sledgehammer approach though. A 30-day readmit may or may not be reasonable, or even the hospital's fault. Say the patient is taking longer to recover than what they're willing to pay for post-op inpatient care, so they get turfed to a nursing home, where they can't handle it, and the patient's condition deteriorates. Yep, that's totally on the hospital for sucking. Don't even get me started on nursing staff screwing up insulin (one of the most dangerous drugs around).
The first step is acknowledging you have a problem, right?

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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #1001 on: February 20, 2017, 07:39:13 AM »
Ryancare proposal is

1. Flat subsidies to pay for health insurance regardless of your income. The subsidies would increase with age but it's unclear by how much.
2. The amount you can put in an HSA will increase.
3. Millions will lose their Medicaid.

Are we going to also go back to the bad old days where insurance companies can drop you like a hot potato if you suddenly get sick and need the health insurance?

And to undermine the existing ACA, the tax penalty for not enrolling in insurance  has been suspended - potentially leading to a death spiral in health insurance premiums.

https://www.nytimes.com/2017/02/19/opinion/ryancare-you-can-pay-more-for-less.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-right-region&region=opinion-c-col-right-region&WT.nav=opinion-c-col-right-region&_r=0

protostache

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Re: What comes after the ACA?
« Reply #1002 on: February 20, 2017, 10:58:18 AM »
Ryancare proposal is

1. Flat subsidies to pay for health insurance regardless of your income. The subsidies would increase with age but it's unclear by how much.
2. The amount you can put in an HSA will increase.
3. Millions will lose their Medicaid.

Are we going to also go back to the bad old days where insurance companies can drop you like a hot potato if you suddenly get sick and need the health insurance?

And to undermine the existing ACA, the tax penalty for not enrolling in insurance  has been suspended - potentially leading to a death spiral in health insurance premiums.

https://www.nytimes.com/2017/02/19/opinion/ryancare-you-can-pay-more-for-less.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-right-region&region=opinion-c-col-right-region&WT.nav=opinion-c-col-right-region&_r=0

Congress can't pass a bill that removes the ban on medical underwriting and restrictions on recision without either busting the filibuster or getting 8 more votes in the Senate so those components will likely stick around. As you note, removing the individual mandate (apparently this can be passed in a budget reconciliation bill) will almost certainly lead to death spirals in the individual markets so that point is sort of academic.

infogoon

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Re: What comes after the ACA?
« Reply #1003 on: February 20, 2017, 01:14:45 PM »
President Trump said on Saturday that a plan to replace the Affordable Care Act will come "in a couple of weeks."

Yea, right.  Remember when he said he would release his tax returns "as soon as I win the nomination"?  Remember when he was going to reveal his new tax plan "before inauguration day"?  Remember when he was going to reveal his Obamacare replacement plan "next Wednesday or Thursday"? 

This guy is a serial liar.  He's only buying time, because he knows that giving a fake but specific date gets everyone off his back in the immediate future and then they'll forget or be distracted by some new scandal when his self-imposed deadline actually arrives. 

My golden dream for this election is that he spends four more years doing this exact same thing, and never actually gets around to ruining America.

Still waiting for the amazing secret plan to defeat ISIS his first month in office.

nereo

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Re: What comes after the ACA?
« Reply #1004 on: February 20, 2017, 01:25:18 PM »

Still waiting for the amazing secret plan to defeat ISIS his first month in office.
It's a secret.  If he told anyone it wouldn't be effective.  If ISIS still exists in two years it's someone else's fault.  Probably HRC's.  Somehow.
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NoStacheOhio

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Re: What comes after the ACA?
« Reply #1005 on: February 20, 2017, 01:58:56 PM »

Still waiting for the amazing secret plan to defeat ISIS his first month in office.
It's a secret.  If he told anyone it wouldn't be effective.  If ISIS still exists in two years it's someone else's fault.  Probably HRC's.  Somehow.

She probably gave them the other 80% of our Uranium.
The first step is acknowledging you have a problem, right?

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obstinate

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Re: What comes after the ACA?
« Reply #1006 on: February 20, 2017, 11:22:16 PM »
So many dismiss the advantages that shopping for healthcare will provide using your argument. I believe it will create competition and drive down prices. The experience of shopping for healthcare will eventually become similar to shopping for a tv. If it's not an emergency, I can check amazon, target, walmart, etc, and get the best price on my tv. If it is an emergency and I need a tv right now for super bowl weekend, then I can likely go pick one up at the local walmart and can be confident that I'm not getting gouged too much.
It didn't work before the ACA. There is little reason to believe it will work after the ACA has been repealed. All the other countries that have lower costs than we do? None of them use this "shopping around" system either.

tct

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Re: What comes after the ACA?
« Reply #1007 on: February 22, 2017, 02:02:44 PM »
So many dismiss the advantages that shopping for healthcare will provide using your argument. I believe it will create competition and drive down prices. The experience of shopping for healthcare will eventually become similar to shopping for a tv. If it's not an emergency, I can check amazon, target, walmart, etc, and get the best price on my tv. If it is an emergency and I need a tv right now for super bowl weekend, then I can likely go pick one up at the local walmart and can be confident that I'm not getting gouged too much.
It didn't work before the ACA. There is little reason to believe it will work after the ACA has been repealed. All the other countries that have lower costs than we do? None of them use this "shopping around" system either.

You may need to read more of this thread to better understand the concept of shopping for healthcare. The idea being that healthcare providers must publish prices in order to shop healthcare. When you say "It didn't work before the ACA", That's because as consumers we've never had the option to shop for healthcare, as it was nearly impossible to obtain pricing up front. The proposal is that healthcare providers be required to publish prices so that consumers can shop for the best value. This will create competition and lower cost in healthcare where currently there is no competition.

nereo

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Re: What comes after the ACA?
« Reply #1008 on: February 22, 2017, 07:08:38 PM »
So many dismiss the advantages that shopping for healthcare will provide using your argument. I believe it will create competition and drive down prices. The experience of shopping for healthcare will eventually become similar to shopping for a tv. If it's not an emergency, I can check amazon, target, walmart, etc, and get the best price on my tv. If it is an emergency and I need a tv right now for super bowl weekend, then I can likely go pick one up at the local walmart and can be confident that I'm not getting gouged too much.
It didn't work before the ACA. There is little reason to believe it will work after the ACA has been repealed. All the other countries that have lower costs than we do? None of them use this "shopping around" system either.

You may need to read more of this thread to better understand the concept of shopping for healthcare. The idea being that healthcare providers must publish prices in order to shop healthcare. When you say "It didn't work before the ACA", That's because as consumers we've never had the option to shop for healthcare, as it was nearly impossible to obtain pricing up front. The proposal is that healthcare providers be required to publish prices so that consumers can shop for the best value. This will create competition and lower cost in healthcare where currently there is no competition.

I still have not seen a cohesive explanation regarding how individuals could ever know what health care they needed in order to be able to 'shop around'.  Are you expecting people to go to a clinic, get diagnosed, and then go someplace else for treatment after shopping around? What about all the decisions that are made during an actual procedure?
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accolay

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Re: What comes after the ACA?
« Reply #1009 on: February 22, 2017, 07:29:18 PM »
A cohesive explanation? Well nereo, according to the latest tweet from Paul Ryan, you don't need to know anything when you've got that Freedom.
Quote
Freedom is the ability to buy what you want to fit what you need. Obamacare is Washington telling you what to buy regardless of your needs.

I can't wait for them to unleash all this Freedom for the American consumer.

fuzzy math

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Re: What comes after the ACA?
« Reply #1010 on: February 22, 2017, 09:30:40 PM »


You may need to read more of this thread to better understand the concept of shopping for healthcare. The idea being that healthcare providers must publish prices in order to shop healthcare. When you say "It didn't work before the ACA", That's because as consumers we've never had the option to shop for healthcare, as it was nearly impossible to obtain pricing up front. The proposal is that healthcare providers be required to publish prices so that consumers can shop for the best value. This will create competition and lower cost in healthcare where currently there is no competition.

Just because you repeat an uninformed opinion enough times doesn't make it true. Your idea has been shit on by multiple informed people for a multitude of reasons. There is no publishing because there is no set price. There never has been and there never will be because there are 3 distinct pools of people (public insurance/Medicare/Medicaid , private insurance and the uninsured). Offices, hospitals, providers and others are not just going to publish prices. Drs do not give a shit enough to do this because patients find their way to Drs for a multitude of reasons that have nothing to do with shopping.

Mr Mark

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Re: What comes after the ACA?
« Reply #1011 on: February 22, 2017, 10:49:09 PM »
Most healthcare economists agree that a single payer system is the lowest cost way to provide essential healthcare to everyone, paid through the tax system.

The main options are what level of care does such 'Government insurance' offer, the amount of required co-pay for various treatments, and how you choose to operate the supply side (from free market regulated providers through to a government run system). In many countries people/employers can buy 'top up' insurance that provides extra benefits, such as fast treatment for non-critical conditions, medications, etc.

One thing I'd ask is whatever system for ordinary people the GOP choose to try and replace ACA, it is the same as the one that members of Congress get. Right now they are totally protected by having their own gold plated system.

If it was like that with income taxes I think people would be a lot more angry about it - imagine if the first box on turbotax was "are you a member of Congress?" and a 'Yes' resulted in paying no tax. At least right now the tax loopholes they create for themselves are in theory open to everyone.

Mr. Mark

Lmoot

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Re: What comes after the ACA?
« Reply #1012 on: February 23, 2017, 03:57:32 AM »
Yeah it's serious. Let's keep people with genetic disorders alive so they can reproduce and get rid of natural selection. Sounds dumb for society as a whole.  Don't quite understand how one can say universal healthcare for all BC it's in the best interests of society and avoid the natural selection issue with society.

Think of all of the people with genetic diseases that have contributed greatly to the advancement of the human race. And get back to me. Steven Hawkins is the brain of our time (what little else can he do?). We all have different gifts, and sometimes what seems like a drawback, ends up increasing abilities in other areas. Inventions and medications have been made in trying to solve genetic problems, which benefit others who are not directly affected by those problems.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #1013 on: February 23, 2017, 06:03:37 AM »
A cohesive explanation? Well nereo, according to the latest tweet from Paul Ryan, you don't need to know anything when you've got that Freedom.
Quote
Freedom is the ability to buy what you want to fit what you need. Obamacare is Washington telling you what to buy regardless of your needs.

I can't wait for them to unleash all this Freedom for the American consumer.

OK, I want to pay a dollar for everything. If the hospital billing people don't like it, I'm just going to shout "FREEDOM!" over and over.
The first step is acknowledging you have a problem, right?

https://forum.mrmoneymustache.com/journals/digging-out-of-a-hole/

accolay

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Re: What comes after the ACA?
« Reply #1014 on: February 23, 2017, 08:57:22 AM »
OK, I want to pay a dollar for everything. If the hospital billing people don't like it, I'm just going to shout "FREEDOM!" over and over.
That will only work if you bring a bald eagle in person.

Ryan needs our help to fix his quote:
Quote
Freedom is the ability to buy what you want to fit afford what you need. Obamacare is Washington a law incomplete in scope for a reasonable attempt to curtail cost and improve healthcare standards and outcomes in the United States. I'm sure if we hadn't obstructed and name called this law for seven years we could have written fixes for it and it could have been ready on day one of us having the House, Senate and Presidency after all of that complaining. We understand Obamacare is popular with the American people and we will continue ensure the right to affordable healthcare for every American. what to buy regardless of your needs

Too many characters?

NoStacheOhio

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Re: What comes after the ACA?
« Reply #1015 on: February 23, 2017, 09:05:06 AM »

That will only work if you bring a bald eagle in person.


I think this is reasonable.

On a completely unrelated front: does anyone have a bald eagle I can adopt?
The first step is acknowledging you have a problem, right?

https://forum.mrmoneymustache.com/journals/digging-out-of-a-hole/

infogoon

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Re: What comes after the ACA?
« Reply #1016 on: February 23, 2017, 09:16:03 AM »
OK, I want to pay a dollar for everything. If the hospital billing people don't like it, I'm just going to shout "FREEDOM!" over and over.

There are states where this is a viable platform for a Congressional campaign.

tct

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Re: What comes after the ACA?
« Reply #1017 on: February 23, 2017, 11:14:46 AM »


You may need to read more of this thread to better understand the concept of shopping for healthcare. The idea being that healthcare providers must publish prices in order to shop healthcare. When you say "It didn't work before the ACA", That's because as consumers we've never had the option to shop for healthcare, as it was nearly impossible to obtain pricing up front. The proposal is that healthcare providers be required to publish prices so that consumers can shop for the best value. This will create competition and lower cost in healthcare where currently there is no competition.

Just because you repeat an uninformed opinion enough times doesn't make it true. Your idea has been shit on by multiple informed people for a multitude of reasons. There is no publishing because there is no set price. There never has been and there never will be because there are 3 distinct pools of people (public insurance/Medicare/Medicaid , private insurance and the uninsured). Offices, hospitals, providers and others are not just going to publish prices. Drs do not give a shit enough to do this because patients find their way to Drs for a multitude of reasons that have nothing to do with shopping.

ACA found a way to require every American to obtain health insurance. I'm sure we can find a way to require healthcare providers to publish prices. It's irrelevant that there are different pools of people. Its a sham anyhow that one human being would get charged a different price than another for the same procedure. Try not to be so closed minded.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #1018 on: February 23, 2017, 11:16:03 AM »
Its a sham anyhow that one human being would get charged a different price than another for the same procedure. Try not to be so closed minded.

Except that every single person/procedure interaction has a ton of variables and potential complications.
The first step is acknowledging you have a problem, right?

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sol

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Re: What comes after the ACA?
« Reply #1019 on: February 23, 2017, 11:38:39 AM »
Its a sham anyhow that one human being would get charged a different price than another for the same procedure. Try not to be so closed minded.

Except that every single person/procedure interaction has a ton of variables and potential complications.

Sure, but those could be published too, right?

I understand you can't publish "cost of a heart attack" but you should be able to publish hourly costs of OR and anaesthesiologist and recovery room, along with the options for complications. 

When I take my car to the mechanic for a weird noise he does the same thing, and lays out the costs for diagnosis and each potential repair depending on what he finds.  He doesn't publish "cost to fix that noise" but neither are his prices so fully opaque as are hospital bills.  And if a job takes longer than his estimate because he screws up the repair, he eats that cost instead of passing it on to the customer the way hospitals do.

Price transparency doesn't fix half of the problems with our health care system, but in the absence of a single payer pricing model it would still help.  I'm all for it.
« Last Edit: February 23, 2017, 11:47:35 AM by sol »

goatmom

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Re: What comes after the ACA?
« Reply #1020 on: February 23, 2017, 11:41:46 AM »
The ACA did not have a way to make all Americans get health insurance - I see people everyday that have opted out and just pay the fine.  The plan is something bad happens - they will just quit work and go on Medicaid.  Not the best plan - but they are willing to take the risk rather than pay the high premiums they are being quoted.  Not sure how to "fix" healthcare.  Problem is partisan politics on both sides.  And greed.

AZryan

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Re: What comes after the ACA?
« Reply #1021 on: February 23, 2017, 12:28:56 PM »
The ACA did not have a way to make all Americans get health insurance - I see people everyday that have opted out and just pay the fine.

The fine was the way. It just wasn't strong enough, but it was increasing and could be further improved upon. It could be 'equal to expensive health care'. Then it would be ~100% effective if cheaper plans were available. Just too many people would freak out before we got to universal coverage.

We have a 'way to prevent murder' -go to jail for all (or most) of your life. If the punishment was ~30 days, you'd see a LOT more murders. And we still see some murder 'cuz people either hope to get away with it (i.e. avoid the 'fine' no matter what it is) or they just do it anyway and aren't being rational (unfixable).

Healthcare could be similar and was tilting that direction every year with higher fines.



fuzzy math

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Re: What comes after the ACA?
« Reply #1022 on: February 23, 2017, 02:16:48 PM »


ACA found a way to require every American to obtain health insurance. I'm sure we can find a way to require healthcare providers to publish prices. It's irrelevant that there are different pools of people. Its a sham anyhow that one human being would get charged a different price than another for the same procedure. Try not to be so closed minded.

I don't think you realize how burnt out physicians are and how little it will take a large portion of them to leave medicine overall. I'm sure the few physicians here who are desperate to FIRE like the rest of us could weigh in on it.

Forcing offices and hospitals to publish prices is going to require extra man power and will INCREASE costs passed onto patients due to more ppl in the labor force. It still will not result in people shopping around. If the facility fee is higher at one place, but all your physician care is cheaper at that same hospital (or any other set of A is more expensive here but B is not), then there is no incentive to shop around. This is assuming that you live in an area where you have multiple options and that your insurance is in network with both.

I am not being close minded. You are sticking your fingers in your ear and singing "LALALALLALA I can't hear you!" To everyone who has provided information to you about the system. Your argument at its crux, that multi tiered pricing models is bad, plays into SOL's point that single payer is the way to go. So jump off that HSA bandwagon, and get on the single payer band wagon with the rest of us :p

accolay

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Re: What comes after the ACA?
« Reply #1023 on: February 23, 2017, 02:27:14 PM »
Forcing offices and hospitals to publish prices is going to require extra man power and will INCREASE costs passed onto patients due to more ppl in the labor force.

Maybe at first, but once initial costs are figured out, couldn't new prices be entered into the system at conception?

But....as to single payer, wouldn't one system like that mandate what something should cost like single payer does in other countries? Prices negotiated by the government would be pretty good I think.

Metric Mouse

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Re: What comes after the ACA?
« Reply #1024 on: February 23, 2017, 02:40:55 PM »
Forcing offices and hospitals to publish prices is going to require extra man power and will INCREASE costs passed onto patients due to more ppl in the labor force.

Maybe at first, but once initial costs are figured out, couldn't new prices be entered into the system at conception?

But....as to single payer, wouldn't one system like that mandate what something should cost like single payer does in other countries? Prices negotiated by the government would be pretty good I think.
How could they negotiate prices? There is no way to know what things cost, it's way too complicated, and to even find out would just cost MORE!!! Haven't you been listening?  /s

But seriously, as Sol pointed out, its not a fix all system, but it would be a postive step to take if single payer is not adopted.
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jim555

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Re: What comes after the ACA?
« Reply #1025 on: February 23, 2017, 02:47:55 PM »
Politically the ACA (a plan like it) was the way Republicans would avoid the dreaded (to them) single payer.  Instead of shoring up the ACA (as the least worst alternative to them) they choose to knife it.  So now they risk a backlash (once they piss off millions of people) and may get the (dreaded) single payer as a result.

Metric Mouse

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Re: What comes after the ACA?
« Reply #1026 on: February 23, 2017, 02:50:40 PM »
Politically the ACA (a plan like it) was the way Republicans would avoid the dreaded (to them) single payer.  Instead of shoring up the ACA (as the least worst alternative to them) they choose to knife it.  So now they risk a backlash (once they piss off millions of people) and may get the (dreaded) single payer as a result.
I don't know.  Democrats had the chance to pass single payer and didn't; why would they vote for it now?
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sol

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Re: What comes after the ACA?
« Reply #1027 on: February 23, 2017, 03:04:09 PM »
I don't know.  Democrats had the chance to pass single payer and didn't; why would they vote for it now?

Democrats didn't really have the chance to pass single payer.  Politicians are beholden to lots of different interest beyond trying to compromise with the opposition party.

In this case, Democrats had to get buy in from the AMA and the insurance lobby.  Both of those groups fiercely despise single payer and they own enough Dems that they could have sunk any reforms at all.  This was not a choice between single payer and the ACA, it was a choice between the ACA and doing nothing.

accolay

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Re: What comes after the ACA?
« Reply #1028 on: February 23, 2017, 03:06:50 PM »
If you're interested...

As far as prices on the user end for the nickle and dime cost of consumables, the price of the room in many hospitals generally covers some of the basic supplies. But they also realize that those costs can add up since employees are getting more for certain patients etc. There is a lot of waste too. Epic fucking mountain tons of waste as in never used items thrown/resterilized since they were in a patient room or opened and not needed. Sometime it can't be helped, but a lot of times I would argue that it's due more to not being mindful.

Some places have taken to posting the price of each item in their storeroom tags for workers-RNs/MDs etc to grab, so at least there is some correlation between how many you get for a patient and what it costs in an attempt to make people think about what they're doing. If you need an item, you need it, but maybe you'd think about it more if there was a price/item when grabbing three of whatever if you only really needed one. I don't know if it works or not, but that's the idea. A lot of that shit doesn't cost much, but it adds up. Though some of it is really expensive and we're actually less blasť with those. Some cables for equipment is quite expensive too-i.e. don't throw away.

I hear some hospital supply rooms have a more automated approach where the patient is charged per item removed. Linen is, as far as I know, priced per pound. Also a lot of waste here.

I attempt to control (circle of influence) waste ergo cost by only getting patients what they need at that time. Some waste appears endemic to the environment. There is little if any recycling and not only waste of money, but also landfill type waste.

I sometimes mention when I'm tossing something that when the apocalypse comes whatever item would be used/reused.

obstinate

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Re: What comes after the ACA?
« Reply #1029 on: February 23, 2017, 10:00:19 PM »
The ACA did not have a way to make all Americans get health insurance - I see people everyday that have opted out and just pay the fine.  The plan is something bad happens - they will just quit work and go on Medicaid.  Not the best plan - but they are willing to take the risk rather than pay the high premiums they are being quoted.  Not sure how to "fix" healthcare.  Problem is partisan politics on both sides.  And greed.
Woe is us. How can we fix this? If only there were other countries where healthcare works that we could model our system off of!

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Cranky

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Re: What comes after the ACA?
« Reply #1031 on: February 24, 2017, 05:22:17 AM »
https://www.aol.com/article/news/2017/02/23/john-boehner-who-once-pushed-for-obamacare-repeal-now-says-gop/21720441/

Yeah, and my dd was at the conference where he spoke. She said the health insurance IT professionals who were at the conference were pretty dubious about many things that he said.

I remain interested and horrified about the whole mess.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #1032 on: February 24, 2017, 06:30:50 AM »
If you're interested...

As far as prices on the user end for the nickle and dime cost of consumables, the price of the room in many hospitals generally covers some of the basic supplies. But they also realize that those costs can add up since employees are getting more for certain patients etc. There is a lot of waste too. Epic fucking mountain tons of waste as in never used items thrown/resterilized since they were in a patient room or opened and not needed. Sometime it can't be helped, but a lot of times I would argue that it's due more to not being mindful.

There's also the issue of people discarding regular waste in the biohazard bin, which costs exponentially more to handle than plain old trash. I know we went through a big internal awareness campaign for that a few years back.
The first step is acknowledging you have a problem, right?

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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #1033 on: February 24, 2017, 07:00:40 AM »
I don't think knowing the "retail" price of each and every procedure at every different medical facility is feasible or even comparable.

A better way to drive down health care costs for the system is a mix of prevention and follow up on patients who need urging to take prescribed medicine and improve lifestyle choices.

The ACA was going to initially have a public option, which was essentially Medicare, but 2-4 Democratic senators had to be placated (it took 60 Democratic/Independent Senators because the Republicans were forcing the filibuster and so a simple majority vote wasn't possible).

dragoncar

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Re: What comes after the ACA?
« Reply #1034 on: February 24, 2017, 10:56:08 AM »
https://www.aol.com/article/news/2017/02/23/john-boehner-who-once-pushed-for-obamacare-repeal-now-says-gop/21720441/

Yeah, and my dd was at the conference where he spoke. She said the health insurance IT professionals who were at the conference were pretty dubious about many things that he said.

I remain interested and horrified about the whole mess.

If your designated driver was at the conference, who drove you home?

Metric Mouse

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Re: What comes after the ACA?
« Reply #1035 on: February 24, 2017, 11:05:27 AM »
I don't know.  Democrats had the chance to pass single payer and didn't; why would they vote for it now?

Democrats didn't really have the chance to pass single payer.  Politicians are beholden to lots of different interest beyond trying to compromise with the opposition party.

In this case, Democrats had to get buy in from the AMA and the insurance lobby.  Both of those groups fiercely despise single payer and they own enough Dems that they could have sunk any reforms at all.  This was not a choice between single payer and the ACA, it was a choice between the ACA and doing nothing.
So are we saying single payer is a pipe dream? Since Democrats owned by the healthcare lobby, and Republicans are moving away from ACA instead of towards something else, is there any hope? Or do we save our breath and try to fix the mess we have with the republicans instead of moving towards something good.
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Cassie

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Re: What comes after the ACA?
« Reply #1036 on: February 24, 2017, 12:31:23 PM »
Dragoncar: I heard Boehner speak on the news and what he had to say was very interesting. It sounds like the ACA will be safe.

Classical_Liberal

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Re: What comes after the ACA?
« Reply #1037 on: February 24, 2017, 12:36:00 PM »
I don't think knowing the "retail" price of each and every procedure at every different medical facility is feasible or even comparable.
Yes it is, its called a DRG and it's currently in use on a massive scale called "medicare".
A better way to drive down health care costs for the system is a mix of prevention and follow up on patients who need urging to take prescribed medicine and improve lifestyle choices.
Agree 100% that prevention is key to the major lifestyle diseases we have in the US.  This requires more than just medicine though, it requires a sustanied campaign changing lifestyles. Think smoking.
 
The ACA was going to initially have a public option, which was essentially Medicare, but 2-4 Democratic senators had to be placated (it took 60 Democratic/Independent Senators because the Republicans were forcing the filibuster and so a simple majority vote wasn't possible).
Agreed that a universal/public/single payer option is best.  Create it just like SS/medicare, tax me X% specifically for this service and I'm on board.  Like in most other countries it should be basic care only.  No fancy private suites, no made to order meals, no elective procedures, only generic equivalent drugs when available, procedures completed on a triage ordered basis.  If someone wants more, they can pay extra premiums per their choice.  Current hospitals who wish to remain private can, they would receive the basic DRG type funding and additional funding from the other marketplace optional insurance policies.  They can cater to whatever the marketplace demands for additional coverage.  Hospitals/clinics who are struggling financially (there are many) and wish to become part of the public basic care system can, hence minimizing up front infrastructure costs. 

Everyone receives basic preventative and life saving health care; those who wish to spend more for premium services can and competition can drive down those prices... Problem solved. Vote Classical_Liberal in 2020.

sol

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Re: What comes after the ACA?
« Reply #1038 on: February 24, 2017, 12:41:39 PM »
So are we saying single payer is a pipe dream? Since Democrats owned by the healthcare lobby, and Republicans are moving away from ACA instead of towards something else, is there any hope? Or do we save our breath and try to fix the mess we have with the republicans instead of moving towards something good.

Time heals all wounds.  There was a time in this country when black people voting was a non-starter for any politician, too.

But for the next decade or two?  Yes, I think single payer is dead.  Like everything else in America, our health care systems is  currently set up to be incredibly profitable to a select minority of people, and those people use that money to reinforce the current system.  Why would they want change? 

Democracy is long since dead.  Dollars vote.  Dollars only vote for more dollars.

Quote
Dragoncar: I heard Boehner speak on the news and what he had to say was very interesting. It sounds like the ACA will be safe.

I wouldn't put it past Boehner to be playing the long game.  He's always been a snake, so don't take his words at face value.  It's just as likely that he's trying to suppress public protests against the GOP agenda by reassuring everyone that everything is fine, right up until the concentration camps open their doors.

On the bright side, I think Boehner actually cares about America and wants it to succeed, unlike our current President or his new administration.  He has some disgusting views on how to achieve that success, but he's at least rooting for your team while he cheats and lies.  I think Trump would just as soon burn it all down, if he thought that would make him the most money.

Cassie

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Re: What comes after the ACA?
« Reply #1039 on: February 24, 2017, 01:17:00 PM »
Interesting perspective Sol. I had not thought of that. However, I will continue to be active with Indivisble.

sol

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Re: What comes after the ACA?
« Reply #1040 on: February 24, 2017, 01:51:15 PM »
Wow, the new GOP ACA repeal plan is bonkers.   Someone else already posted this link:  http://www.politico.com/story/2017/02/house-republicans-obamacare-repeal-package-235343

In addition to all of the usual horribleness (kill expanded medicaid, kill all of the taxes, kill guaranteed-issue for people with pre-existing conditions) there is one really killer NEW provision in there:  they want to cut the tax break on employer-sponsored insurance.

So in addition to cutting the new ACA taxes that only apply to the highest-earning people, they're going to ADD new taxes to working stiffs who are otherwise totally unaffected by the ACA.  This is classic Republican tax planning, tax the poor more so that you can tax the rich less.

All of you (us) who currently have jobs, and get our health insurance through our employers, would under this new GOP proposal pay taxes on some ever-rising portion of our health insurance premiums, which are currently tax exempt as a way to encourage employers to offer employees health insurance.

How much is the new tax on working people?  That depends on your current health plan, but union members with better health insurance would pay more.  On average, it looks like about $1,000 of new taxes per employee, to start, and then going up from there (because the exemption isn't inflation adjusted). 

How much is the new tax cut for the wealthiest people?  There are a lot fewer of those folks, so they each get a much larger benefit than each individual worker would pay.  Some estimates suggest the tax breaks would be about $49,000 for people showing more than $200,000 per year of income, which is roughly the same as the national average household income.  Think about that for a second, the Republicans want to give the top 1% a tax break that is larger than the individuals in the 99% make for an entire year of labor.  For ultra-high earners it's maybe even worse, estimated at $195,000 in tax breaks for the top 0.1%, people earning more than about $4 million per year.

jim555

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Re: What comes after the ACA?
« Reply #1041 on: February 24, 2017, 01:59:22 PM »
The proposal is absolute garbage on all levels of measurement. 
Massive tax hike for the middle class, huge tax cut for .1%.

dragoncar

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Re: What comes after the ACA?
« Reply #1042 on: February 24, 2017, 02:51:28 PM »
do they at least make the premiums tax deductible (which would still be regressive to those under the standard deduction)

fuzzy math

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Re: What comes after the ACA?
« Reply #1043 on: February 24, 2017, 03:06:35 PM »
Puke

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #1044 on: February 24, 2017, 05:33:31 PM »

Roland of Gilead

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Re: What comes after the ACA?
« Reply #1045 on: February 24, 2017, 06:02:03 PM »
Actually if you are going to yank back the subsidies I think you *should* remove the employer provided insurance subsidy.

It seems very arbitrary that you get tax free income from your employer to buy insurance but a unemployed person has to use taxed income to buy insurance.

Metric Mouse

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Re: What comes after the ACA?
« Reply #1046 on: February 24, 2017, 06:11:17 PM »
Wow, the new GOP ACA repeal plan is bonkers.   Someone else already posted this link:  http://www.politico.com/story/2017/02/house-republicans-obamacare-repeal-package-235343

In addition to all of the usual horribleness (kill expanded medicaid, kill all of the taxes, kill guaranteed-issue for people with pre-existing conditions) there is one really killer NEW provision in there:  they want to cut the tax break on employer-sponsored insurance.

So in addition to cutting the new ACA taxes that only apply to the highest-earning people, they're going to ADD new taxes to working stiffs who are otherwise totally unaffected by the ACA.  This is classic Republican tax planning, tax the poor more so that you can tax the rich less.

All of you (us) who currently have jobs, and get our health insurance through our employers, would under this new GOP proposal pay taxes on some ever-rising portion of our health insurance premiums, which are currently tax exempt as a way to encourage employers to offer employees health insurance.

How much is the new tax on working people?  That depends on your current health plan, but union members with better health insurance would pay more.  On average, it looks like about $1,000 of new taxes per employee, to start, and then going up from there (because the exemption isn't inflation adjusted). 

How much is the new tax cut for the wealthiest people?  There are a lot fewer of those folks, so they each get a much larger benefit than each individual worker would pay.  Some estimates suggest the tax breaks would be about $49,000 for people showing more than $200,000 per year of income, which is roughly the same as the national average household income.  Think about that for a second, the Republicans want to give the top 1% a tax break that is larger than the individuals in the 99% make for an entire year of labor.  For ultra-high earners it's maybe even worse, estimated at $195,000 in tax breaks for the top 0.1%, people earning more than about $4 million per year.
Isn't this basically the same "Cadillac Tax" that Obama originally fought for and republicans, corporations and union bodies fought against?
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the_fixer

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Re: What comes after the ACA?
« Reply #1047 on: February 24, 2017, 06:36:58 PM »
I think the top 1% starts around $430,000

My work has been warning us for the last 2 years or so about the upcoming Cadillac tax that would apply due to the ACA it was already in the works.

I have a feeling health insurance will make or break my ability to retire.

sol

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Re: What comes after the ACA?
« Reply #1048 on: February 24, 2017, 06:41:35 PM »
Isn't this basically the same "Cadillac Tax" that Obama originally fought for and republicans, corporations and union bodies fought against?

It is an expanded form of the same idea, yes. 

It's the only revenue-generating idea in the Republican plan, and since they are logistically bound by the "no net budget deficits over 10 years" rule if they want to bypass the filibuster, the only way they can make the tax cuts on the rich permanent is if they find a way to increase taxes on everyone else.  This is their way to do that.
 

Metric Mouse

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Re: What comes after the ACA?
« Reply #1049 on: February 24, 2017, 06:49:03 PM »
Isn't this basically the same "Cadillac Tax" that Obama originally fought for and republicans, corporations and union bodies fought against?

It is an expanded form of the same idea, yes. 

It's the only revenue-generating idea in the Republican plan, and since they are logistically bound by the "no net budget deficits over 10 years" rule if they want to bypass the filibuster, the only way they can make the tax cuts on the rich permanent is if they find a way to increase taxes on everyone else.  This is their way to do that.
But doesn't this tax only effect very highly compensated employees (and some union members who have negotiated these ultra-plush plans for themselves). My understanding is that only plans that are in the top 10% of benefits are taxed - so 90% of 'working joes' would be unaffected anyway? Except that their premiums may go down as the risk pools they are in get healthier.
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