Author Topic: What comes after the ACA?  (Read 1916344 times)

EnjoyIt

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Re: What comes after the ACA?
« Reply #2500 on: May 31, 2017, 03:02:47 PM »
I'm saying that I don't care if there was some ties between Russia and the Trump campaign.  The only reason why people are upset is because "Russia is evil."  Politicians have ties with people from foreign countries all the time.  I would care if we saw Trump creating policy that somehow gives Russia a significant upper had.  I would prefer that politicians can't be bought regardless of it being foreign countries or rich corporations.  All of it is bad, but, it seams to me like standard practice in today's political environment.

Again, it makes no difference to the US or its people. Its just one more scandal that everyone is talking about. Personally I believe he likes scandal.  He once said in an interview regarding a hotel he was building in NYC that he liked the publicity and did not want to squash it when some scandalous event occurred regarding its construction. I believe he has even created scandal just for the sake of getting news coverage. Personally I think he thrives on it, but that is just an opinion. I bet if we go for a few weeks without some new tirade about him, Trump will lay out some tweets or do an interview just to bring attention back on him.

nereo

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Re: What comes after the ACA?
« Reply #2501 on: May 31, 2017, 03:46:55 PM »
I'm saying that I don't care if there was some ties between Russia and the Trump campaign.  The only reason why people are upset is because "Russia is evil."  Politicians have ties with people from foreign countries all the time.  I would care if we saw Trump creating policy that somehow gives Russia a significant upper had.  I would prefer that politicians can't be bought regardless of it being foreign countries or rich corporations.  All of it is bad, but, it seams to me like standard practice in today's political environment.


I would disagree with your premises  that 1) the only reason people are upset is because "Russia is evil" & 2) this involvement with foreign countries is standard practice.

1) Distrust of Russia is certainly one aspect, but what also is deeply disturbing is the lack of transparency, promises that there is nothing going on and (later) realizations that this was utter crap and a great deal has been going on. Flynn lied about his contacts regarding Russia and payment recieved. Manafort was paid to lobby for the Russians (and payments weren't disclosed). Sessions said, under oath, that he did not have contact with Russian government officials during the campaign (and later recanted). Kushner sought to set up a private channel while he was a private citizen.
It goes on and on... multiple upper-echilon members have said they have had no dealings with Russia, yet that's repeatedly turned out to be untrue. Maybe this is a case where there's a coverup or no crime - but why the steady denial of contacts.

2) it simply isn't standard practice to have back-door channels set up as a private citizen (ie..g before DJT took office). I could go on but it's getting late and I need to go to the store - perhaps I'll finish this later.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2502 on: May 31, 2017, 04:36:41 PM »
Moreover Russia hacked emails from both the Trump and Hillary campaigns and tried to influence the election in favor of Trump by releasing Hillary campaign's emails.

There are policy changes, there's a promise by Trump campaign to get rid of sanctions imposed by Obama on Russian officials and Russian banks for tampering with the election.
In fact have those sanctions now been removed?

Trump won't release his tax returns and there may very well be Russian bank lending to Trump's various businesses.

Mr. Green

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Re: What comes after the ACA?
« Reply #2503 on: May 31, 2017, 05:44:54 PM »
Is this a thread about healthcare? I can't really tell anymore.

nereo

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Re: What comes after the ACA?
« Reply #2504 on: May 31, 2017, 06:08:56 PM »
Is this a thread about healthcare? I can't really tell anymore.
Healthcare occasionally comes up...

Davnasty

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Re: What comes after the ACA?
« Reply #2505 on: May 31, 2017, 08:45:17 PM »
Sorry, It's the "Godwin's Law" of Trump.


EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #2506 on: May 31, 2017, 09:09:15 PM »
Sorry, It's the "Godwin's Law" of Trump.

And, I daresay, if Trump somehow accidentally gives Russia (or any other Super-Power) the location of one US nuclear submarine (he's already apparently indicated to the Philippine PM that two are in proximity of North Korea) then healthcare should be the least of our worries.  I have a feeling Trump doesn't understand the concept of 'deterrents' and diplomacy, life is very black and white to that Billionaire 70 y.o..  So, in this case at least, I'd actually say the internet is getting it right and has evolved vs. calling out Godwin's Law - but maybe this is just me using my MMM optimism gun.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2507 on: May 31, 2017, 09:15:01 PM »
I'm saying that I don't care if there was some ties between Russia and the Trump campaign.  The only reason why people are upset is because "Russia is evil."  Politicians have ties with people from foreign countries all the time.  I would care if we saw Trump creating policy that somehow gives Russia a significant upper had.  I would prefer that politicians can't be bought regardless of it being foreign countries or rich corporations.  All of it is bad, but, it seams to me like standard practice in today's political environment.


I would disagree with your premises  that 1) the only reason people are upset is because "Russia is evil" & 2) this involvement with foreign countries is standard practice.

1) Distrust of Russia is certainly one aspect, but what also is deeply disturbing is the lack of transparency, promises that there is nothing going on and (later) realizations that this was utter crap and a great deal has been going on. Flynn lied about his contacts regarding Russia and payment recieved. Manafort was paid to lobby for the Russians (and payments weren't disclosed). Sessions said, under oath, that he did not have contact with Russian government officials during the campaign (and later recanted). Kushner sought to set up a private channel while he was a private citizen.
It goes on and on... multiple upper-echilon members have said they have had no dealings with Russia, yet that's repeatedly turned out to be untrue. Maybe this is a case where there's a coverup or no crime - but why the steady denial of contacts.

2) it simply isn't standard practice to have back-door channels set up as a private citizen (ie..g before DJT took office). I could go on but it's getting late and I need to go to the store - perhaps I'll finish this later.

All this stuff happened, sure, I'm not sure what it all means, and maybe we will find out in the future.  Either way I still don't think anything will come of this. None of it will affect our lives in any way.

Ohh and to keep on topic.  I hope no one repeals the pre-existing condition clause.


Sorry, It's the "Godwin's Law" of Trump.


I had to google that.  Funny.

nereo

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Re: What comes after the ACA?
« Reply #2508 on: June 01, 2017, 06:09:12 AM »

All this stuff happened, sure, I'm not sure what it all means, and maybe we will find out in the future.  Either way I still don't think anything will come of this. None of it will affect our lives in any way.


I just can't understand your conclusion, EnjoyIt. With all that has already happened it seems far too late to say nothing will come of this. Perhaps the fire will be tamped out and the structure will be saved but the scorch-marks will remain. As for whether htis 'affects our lives in any way' depends partly on an unknowable (what would life be like if there were no "Russia thing"), but I'm still deeply skeptical of the notion. We're talking about it for one, and I think this rip-current has kept a new president from moving on many things that he otherwise should be able to champion with ease with GOP control of both houses. Instead, most of the energy of both houses are being spent on hearings, investigations, subpoenas and 'lawyering up'. That's got to be an immense drag.

Quote

Ohh and to keep on topic.  I hope no one repeals the pre-existing condition clause.

Yes, back onto topic.  I, too, hope no one repeals the pre-existing condition clause (Kaiser's white paper says that as many as 52MM people can be considered to have
pre-existing conditions).  I'll go one furhter and say that I hope people with pre-existing conditions can get easily affordable health care which covers their condition.  This will certainly mean that the rest of us will help subsidize it (unless we can get Mexico to pay for it), but that seems preferable to the alternatives.
I have two close family members with costly pre-existing conditions who would be unable to afford non-subsidized health insurance.

radram

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Re: What comes after the ACA?
« Reply #2509 on: June 01, 2017, 06:54:32 AM »
Also disagree that the Paris accord is just symbolic and that experts say it will be ineffective. The scientific community (which I consider myself a member) is pretty clear that its a good step.  No, it probably won't keep us below the +2ºC threshold on its own but it will slow it down. The broadscale hope is that the Paris accord holds and then more ambitious targets emerge in another 5-10 years.  Saying its ineffective just because it isn't a complete solution is akin to saying "well, I'm 40 with no savings and despite my resolution to fund my IRA every year I've learned that this will not be enough, so I won't even do that."
 
This is not saving 10% of income after 40 and hoping to do better later.  This is more like stopping drinking coffee as a symbolic commitment to funding retirement, except if stopping drinking coffee actually caused you to make less money going forward. 
I don't get this analogy. Are you suggesting that limiting carbon emissions will increase the temperature of the planet?

Or that you could not TRIPLE the average retirement savings of a 50 year old by doing NOTHING ELSE other than simply saving the cost of a daily cup of coffee at Starbucks? You would have $130,000 in 30 years ($3.25 average cost of coffee at Starbucks daily, 3% inflation, 7% growth,EDIT: start at 18)
« Last Edit: June 01, 2017, 07:04:08 AM by radram »

EnjoyIt

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Re: What comes after the ACA?
« Reply #2510 on: June 01, 2017, 11:24:09 AM »

Yes, back onto topic.  I, too, hope no one repeals the pre-existing condition clause (Kaiser's white paper says that as many as 52MM people can be considered to have
pre-existing conditions).  I'll go one furhter and say that I hope people with pre-existing conditions can get easily affordable health care which covers their condition.  This will certainly mean that the rest of us will help subsidize it (unless we can get Mexico to pay for it), but that seems preferable to the alternatives.
I have two close family members with costly pre-existing conditions who would be unable to afford non-subsidized health insurance.

There it goes again talking about who will pay for healthcare instead of how to fix the problem :)
If we cut the cost of healthcare by 25% that would solve many of the issues we are talking about right now. And believe me 25% is very doable if we as a country are willing to agree on somethings.

We keep confusing health insurance as healthcare.  Health insurance is just a middle man that pays for goods and services. Health care is provided by health care professionals in a setting such as an office or a hospital. The friction between providing the care and getting paid for it is extremely costly.  The friction alone is worth over 25%

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2511 on: June 01, 2017, 12:18:06 PM »


There it goes again talking about who will pay for healthcare instead of how to fix the problem :)
If we cut the cost of healthcare by 25% that would solve many of the issues we are talking about right now. And believe me 25% is very doable if we as a country are willing to agree on somethings.

We keep confusing health insurance as healthcare.  Health insurance is just a middle man that pays for goods and services. Health care is provided by health care professionals in a setting such as an office or a hospital. The friction between providing the care and getting paid for it is extremely costly.  The friction alone is worth over 25%

If we were to start the whole system from scratch then you're right we wouldn't have health insurance middlemen. But politically the Republican party will never allow a single payer government run system of health care - it goes against their ideology that the market is always perfect and right.
So now we have a potential system that accommodates health insurance companies, limits their profits, provides them with more customers who receive premium subsidies to afford the health insurance.

You can still cut the cost of health care, there's a million in one ways to do it, that everyone would get on board with.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2512 on: June 01, 2017, 06:53:55 PM »


There it goes again talking about who will pay for healthcare instead of how to fix the problem :)
If we cut the cost of healthcare by 25% that would solve many of the issues we are talking about right now. And believe me 25% is very doable if we as a country are willing to agree on somethings.

We keep confusing health insurance as healthcare.  Health insurance is just a middle man that pays for goods and services. Health care is provided by health care professionals in a setting such as an office or a hospital. The friction between providing the care and getting paid for it is extremely costly.  The friction alone is worth over 25%

If we were to start the whole system from scratch then you're right we wouldn't have health insurance middlemen. But politically the Republican party will never allow a single payer government run system of health care - it goes against their ideology that the market is always perfect and right.
So now we have a potential system that accommodates health insurance companies, limits their profits, provides them with more customers who receive premium subsidies to afford the health insurance.

You can still cut the cost of health care, there's a million in one ways to do it, that everyone would get on board with.

I'm not fully for or against a single payer system but it should only cover catastrophic health care. There is absolutely no need for even a single payer middle man for simple healthcare related transactions.  You should not have to pay $400 for a month's insurance premiums and then a $30 copay to see your GP. It should cost a flat fee with no one else involved. Same for simple imaging or lab tests.  On the other hand if someone ends up with cancer or some other expensive medical condition insurance should be able to step in and take over. Just making that change would cut the friction on much of our healthcare expenditure, and buy having transparency in prices, costs will go down for all simple outpatient care.  Emergencies are a whole other story where catastrophic insurance can come in.  I would also go so far as to say there is no need to have a prescription from your doctor for refills on your medications. Very expensive chronic conditions should also be covered by some form of insurance.  Those who can not afford it based on income or disability should get subsidies or vouchers to help pay for their care.  Subsidies/vouchers are given out on a sliding scale based on income as opposed to an all or nothing distribution ideally incentivizing employment. 

protostache

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Re: What comes after the ACA?
« Reply #2513 on: June 01, 2017, 07:38:43 PM »
The California Senate passed SB 562 today which would enact single payer healthcare for all California residents. A study released yesterday finds that single payer in California would cut overall spending by 18% and would cost an additional $106 billion to implement on top of the current $225 billion that taxpayers currently contribute to healthcare in the state via Medicare, Medicaid, and the ACA premium and cost sharing reduction subsidies. Notably this legislation would cover every resident of California regardless of their immigration status.

The Senate version of the bill does not contain any actual funding provisions, other than stipulating that California would seek all waivers necessary for all Federal health care money to be paid into a state trust fund. The study referred to above proposes two alternatives for generating the $106 bill in additional revenue: a 2.3% gross receipts tax on businesses (with an exemption for the first $2 mil in revenue) plus a 2.3% sales tax (with a broad swath of exemptions) OR a 6.6% payroll tax plus the 2.3% sales tax.

The bill now passes to the Assembly, who can either pass it and kick the funding can down the road, or they can work up a funding plan and send it back to the Senate where it would require a 2/3 majority (I think? I'm don't know much about CA legislative workings.) Today's bill passed 23-14.
« Last Edit: June 01, 2017, 07:47:24 PM by protostache »

Lagom

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Re: What comes after the ACA?
« Reply #2514 on: June 01, 2017, 08:07:42 PM »
The California Senate passed SB 562 today which would enact single payer healthcare for all California residents. A study released yesterday finds that single payer in California would cut overall spending by 18% and would cost an additional $106 billion to implement on top of the current $225 billion that taxpayers currently contribute to healthcare in the state via Medicare, Medicaid, and the ACA premium and cost sharing reduction subsidies. Notably this legislation would cover every resident of California regardless of their immigration status.

The Senate version of the bill does not contain any actual funding provisions, other than stipulating that California would seek all waivers necessary for all Federal health care money to be paid into a state trust fund. The study referred to above proposes two alternatives for generating the $106 bill in additional revenue: a 2.3% gross receipts tax on businesses (with an exemption for the first $2 mil in revenue) plus a 2.3% sales tax (with a broad swath of exemptions) OR a 6.6% payroll tax plus the 2.3% sales tax.

The bill now passes to the Assembly, who can either pass it and kick the funding can down the road, or they can work up a funding plan and send it back to the Senate where it would require a 2/3 majority (I think? I'm don't know much about CA legislative workings.) Today's bill passed 23-14.

Huh, I'm actually surprised it passed given what I had read on it earlier, but I have not been closely following the subsequent debate. I would love to see some analysis beyond handwavy supposition on how much reduced healthcare costs would offset a tax increase for the average Californian.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2515 on: June 01, 2017, 08:20:05 PM »
The California Senate passed SB 562 today which would enact single payer healthcare for all California residents. A study released yesterday finds that single payer in California would cut overall spending by 18% and would cost an additional $106 billion to implement on top of the current $225 billion that taxpayers currently contribute to healthcare in the state via Medicare, Medicaid, and the ACA premium and cost sharing reduction subsidies.

The Senate version of the bill does not contain any actual funding provisions, other than stipulating that California would seek all waivers necessary for all Federal health care money to be paid into a state trust fund. The bill now passes to the Assembly, who can either pass it and kick the funding can down the road, or they can work up a funding plan and send it back to the Senate where it would require a 2/3 majority (I think? I'm don't know much about CA legislative workings.) Today's bill passed 23-14.

I hope this goes through. This would be a great experiment to see if the government can have a single payer system.  California will need to provide reasonable healthcare without running out of money, while not overtaxing their population into moving out, and still keep the doctors around. We have a few docs here from California who fled for better pay and a better lifestyle and that is under the current system. I'm not sure how spending an extra 45% on healthcare will save 18% in the long run unless hat 45% one time fee will cut spending by 18% in the long run. Again, I am very curious to see this experiment in action.  This should put to rest the controversy if we can have a single payer system in the United States. I'm also currently glad I don't live or work in California because I would hate to be a part of that experiment. More reason to get myself FI cause who knows what will come next.

protostache

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Re: What comes after the ACA?
« Reply #2516 on: June 01, 2017, 08:25:39 PM »
The California Senate passed SB 562 today which would enact single payer healthcare for all California residents. A study released yesterday finds that single payer in California would cut overall spending by 18% and would cost an additional $106 billion to implement on top of the current $225 billion that taxpayers currently contribute to healthcare in the state via Medicare, Medicaid, and the ACA premium and cost sharing reduction subsidies.

The Senate version of the bill does not contain any actual funding provisions, other than stipulating that California would seek all waivers necessary for all Federal health care money to be paid into a state trust fund. The bill now passes to the Assembly, who can either pass it and kick the funding can down the road, or they can work up a funding plan and send it back to the Senate where it would require a 2/3 majority (I think? I'm don't know much about CA legislative workings.) Today's bill passed 23-14.

I hope this goes through. This would be a great experiment to see if the government can have a single payer system.  California will need to provide reasonable healthcare without running out of money, while not overtaxing their population into moving out, and still keep the doctors around. We have a few docs here from California who fled for better pay and a better lifestyle and that is under the current system. I'm not sure how spending an extra 45% on healthcare will save 18% in the long run unless hat 45% one time fee will cut spending by 18% in the long run. Again, I am very curious to see this experiment in action.  This should put to rest the controversy if we can have a single payer system in the United States. I'm also currently glad I don't live or work in California because I would hate to be a part of that experiment. More reason to get myself FI cause who knows what will come next.

The estimate is $106 billion per year on top of the current payments from the Federal government of all types. The study has a breakdown of where that money comes from. Remember that nobody will be paying premiums or copays for health or dental care. It will all be paid for with Federal money and the addition of a sales tax and either a gross receipts tax or a payroll tax (assuming the final legislation hews close to the study).  The 18% overall savings comes from a broad swath of friction reduction, as you put it earlier, plus price controls in the same vein as the Medicare price list. For purposes of the study they assume Healthy California would adopt the Medicare price list exactly, but that's probably not how it would shake out in the end.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2517 on: June 01, 2017, 08:46:03 PM »
The California Senate passed SB 562 today which would enact single payer healthcare for all California residents. A study released yesterday finds that single payer in California would cut overall spending by 18% and would cost an additional $106 billion to implement on top of the current $225 billion that taxpayers currently contribute to healthcare in the state via Medicare, Medicaid, and the ACA premium and cost sharing reduction subsidies.

The Senate version of the bill does not contain any actual funding provisions, other than stipulating that California would seek all waivers necessary for all Federal health care money to be paid into a state trust fund. The bill now passes to the Assembly, who can either pass it and kick the funding can down the road, or they can work up a funding plan and send it back to the Senate where it would require a 2/3 majority (I think? I'm don't know much about CA legislative workings.) Today's bill passed 23-14.

I hope this goes through. This would be a great experiment to see if the government can have a single payer system.  California will need to provide reasonable healthcare without running out of money, while not overtaxing their population into moving out, and still keep the doctors around. We have a few docs here from California who fled for better pay and a better lifestyle and that is under the current system. I'm not sure how spending an extra 45% on healthcare will save 18% in the long run unless hat 45% one time fee will cut spending by 18% in the long run. Again, I am very curious to see this experiment in action.  This should put to rest the controversy if we can have a single payer system in the United States. I'm also currently glad I don't live or work in California because I would hate to be a part of that experiment. More reason to get myself FI cause who knows what will come next.

The estimate is $106 billion per year on top of the current payments from the Federal government of all types. The study has a breakdown of where that money comes from. Remember that nobody will be paying premiums or copays for health or dental care. It will all be paid for with Federal money and the addition of a sales tax and either a gross receipts tax or a payroll tax (assuming the final legislation hews close to the study).  The 18% overall savings comes from a broad swath of friction reduction, as you put it earlier, plus price controls in the same vein as the Medicare price list. For purposes of the study they assume Healthy California would adopt the Medicare price list exactly, but that's probably not how it would shake out in the end.

Currently Medicare/Medicaid is a major source of friction and cost. They are the ones who have created much of the expensive regulations providers and doctors must now follow.  They also have some rules regarding documentation and billing making the process much more costly as compared to some private insurance companies. At least they are not looking for a profit like private insurance.  Maybe there is a possibility at cost cutting though I think the 18% is overzealous.

California has 12.2% of the US population.  We currently spend $ 3.4 trillion dollars in the US on healthcare every year. Based on population alone California therefor spends $414 Billion and apparently looking to add another $106 billion and increase spending by 25% in the hopes of saving 18%.  I probably am still not quite getting it which is fine. I have always been skeptical of a single payer system in the US because of how expensive the cost of care is. I am truly eager to see if this can be accomplished in California without detrimental consequences. I would be completely content to be proven wrong because we really need some big changes in our healthcare industry.
« Last Edit: June 01, 2017, 08:54:21 PM by EnjoyIt »

protostache

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Re: What comes after the ACA?
« Reply #2518 on: June 02, 2017, 03:54:26 AM »
At least read the first page or two of the study. It explains how the math works in the summary.

nereo

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Re: What comes after the ACA?
« Reply #2519 on: June 02, 2017, 05:32:16 AM »
-EnjoyIt: I (mostly) follow your numbers but I do not understand your conclusion regarding single-payer. If we are already spending this amount on health-care in the US in all our various forms (e.g. Individual, employer, out-of-pocket, Medicare/caid etc) why would *cost* be the reason single-payer cannot work here?  Are you suggesting that a single-payer system would cause costs to increase further (seems?to be your argument regarding Medicare and its "friction and cost")?

jim555

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Re: What comes after the ACA?
« Reply #2520 on: June 02, 2017, 07:09:46 AM »
Medicare fee for service is very efficient.  No insurance company slice between payer and provider.  Insurance companies should be closed down they just add a layer of expense for no reason.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2521 on: June 02, 2017, 09:16:17 AM »
This is why we can't have cheap drug prices:

https://finance.yahoo.com/m/4f84226f-c898-3c1a-b4e9-ffcd1406a194/endocyte-stock-plummets-30%25.html

A billion dollars of investor money down the drain.

OurTown

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Re: What comes after the ACA?
« Reply #2522 on: June 02, 2017, 11:04:01 AM »
Okay, this should be popular:  https://www.wsj.com/articles/gop-senators-weigh-taxing-employer-health-plans-1496350662

I thought the Rs were going to cut my taxes!  Instead, they are talking about taxing health premiums for employer plans and Roth-ifying the 401(k). 


jim555

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Re: What comes after the ACA?
« Reply #2523 on: June 02, 2017, 11:18:05 AM »
And large employers would no longer have a mandate to provide coverage at all. 

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2524 on: June 02, 2017, 01:12:53 PM »
Okay, this should be popular:  https://www.wsj.com/articles/gop-senators-weigh-taxing-employer-health-plans-1496350662

I thought the Rs were going to cut my taxes!  Instead, they are talking about taxing health premiums for employer plans and Roth-ifying the 401(k).

Actually taxing compensation that is used to buy your health insurance is completely fair.

Why should a person get to use pre-tax dollars to get health insurance if an unemployed person has to buy the same insurance with post-tax dollars?

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2525 on: June 02, 2017, 01:43:45 PM »
I guess this thread is just a free for all discussing anything Trump related.

How about that Kathy Griffen thing?   Publicity stunt to try and stay relevant or just an idiot with poor impulse control?

sol

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Re: What comes after the ACA?
« Reply #2526 on: June 02, 2017, 01:56:15 PM »
I guess this thread is just a free for all discussing anything Trump related.

How about that Kathy Griffen thing?   Publicity stunt to try and stay relevant or just an idiot with poor impulse control?

Why not both?

Lagom

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Re: What comes after the ACA?
« Reply #2527 on: June 02, 2017, 01:58:25 PM »
I guess this thread is just a free for all discussing anything Trump related.

How about that Kathy Griffen thing?   Publicity stunt to try and stay relevant or just an idiot with poor impulse control?

Inconsequential political commentary made in poor taste that has been thoroughly punished worse than what happened to Ted Nugent, for example. Not worth discussing tbh, but if you care to, I would recommend the Political Current Events thread.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2528 on: June 02, 2017, 02:05:08 PM »

sol

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Re: What comes after the ACA?
« Reply #2529 on: June 02, 2017, 02:12:21 PM »
Parliamentarian MacDonough is going to decide which parts of the AHCA need 50 votes versus 60 votes in the Senate to pass.

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/05/30/the-health-202-meet-the-referee-in-the-gop-effort-to-replace-obamacare/592cad88e9b69b2fb981dbe1/?utm_term=.52e29c57d0cc

Any bets on just how strongly worded Trumps conversation with her was, when he "really hoped she could see the right thing to do, because if not someone else will"?  Having watched the way the administration works, I'd lay 10:1 odds they've already tried to strongarm her.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2530 on: June 02, 2017, 02:17:43 PM »
Parliamentarian MacDonough is going to decide which parts of the AHCA need 50 votes versus 60 votes in the Senate to pass.

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/05/30/the-health-202-meet-the-referee-in-the-gop-effort-to-replace-obamacare/592cad88e9b69b2fb981dbe1/?utm_term=.52e29c57d0cc

Any bets on just how strongly worded Trumps conversation with her was, when he "really hoped she could see the right thing to do, because if not someone else will"?  Having watched the way the administration works, I'd lay 10:1 odds they've already tried to strongarm her.

Trump's immorality will likely happen here too abetted by the Republican Senate Majority Leader McConnell

protostache

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Re: What comes after the ACA?
« Reply #2531 on: June 02, 2017, 02:25:57 PM »
Parliamentarian MacDonough is going to decide which parts of the AHCA need 50 votes versus 60 votes in the Senate to pass.

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/05/30/the-health-202-meet-the-referee-in-the-gop-effort-to-replace-obamacare/592cad88e9b69b2fb981dbe1/?utm_term=.52e29c57d0cc

Any bets on just how strongly worded Trumps conversation with her was, when he "really hoped she could see the right thing to do, because if not someone else will"?  Having watched the way the administration works, I'd lay 10:1 odds they've already tried to strongarm her.

Trump's immorality will likely happen here too abetted by the Republican Senate Majority Leader McConnell

McConnell doesn't have anything to do with it, but Mike Pence as President of the Senate can overrule the Parliamentarian for purposes of the Byrd rule.

jim555

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Re: What comes after the ACA?
« Reply #2532 on: June 02, 2017, 02:32:54 PM »
If the Republicans had the will they could blow up the Senate rules and pass a full repeal, sending everything back to 2009.  This is what they ran on. 
I don't know why they aren't doing this.  Could it be that the "free market" just doesn't work?

Mr. Green

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Re: What comes after the ACA?
« Reply #2533 on: June 02, 2017, 04:49:10 PM »
If the Republicans had the will they could blow up the Senate rules and pass a full repeal, sending everything back to 2009.  This is what they ran on. 
I don't know why they aren't doing this.  Could it be that the "free market" just doesn't work?
I don't think anyone would survive the fallout of this, despite it being what they ran on. Ironically, politicians always seem more interested in preserving their own position than fulfilling their fiduciary duties as a representative of the people.

stoaX

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Re: What comes after the ACA?
« Reply #2534 on: June 02, 2017, 05:52:21 PM »

[/quote]
politicians always seem more interested in preserving their own position than fulfilling their fiduciary duties as a representative of the people.
[/quote]

Shocking!   And as a footnote, "their own position" includes health insurance.   


EnjoyIt

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Re: What comes after the ACA?
« Reply #2535 on: June 04, 2017, 07:35:47 AM »
-EnjoyIt: I (mostly) follow your numbers but I do not understand your conclusion regarding single-payer. If we are already spending this amount on health-care in the US in all our various forms (e.g. Individual, employer, out-of-pocket, Medicare/caid etc) why would *cost* be the reason single-payer cannot work here?  Are you suggesting that a single-payer system would cause costs to increase further (seems?to be your argument regarding Medicare and its "friction and cost")?

Great question.
1) Medicaid pays less than what it costs to treat the patient. If the reimbursement rates are all Medicaid rates then this is unsustainable. This is the reason why so many providers just don't take on Medicaid patients. Medicare pays better but also very poorly to providers although it does allow for a small profit.

2) Many single payer systems in the world outsource to insurance companies to manage payments. These infact do take a profit. BTW, this practice also occurs in the US as well.

3) CMS, the guys who run Medicare/Medicaid are the ones who have created some of the rediculous regulations that are putting small practices out of business. CMS is also the reason why costs are so high in the hospital settings as well.

4) I can promise you that if tomorrow my pay got cut to just Medicaid reimbursement, I would probably just quit. Just not worth going into work. The reason why physicians take Medicare/Medicaid patients is that they hope it will also bring insured patients as well. Without the insured there just isn't a point to keeping the doors open.

5) Think about it from the physician standpoint. They graduate at about 30 years old with about $350K in debt. Very very few docs are mustachiane and buy their first home right out of residency at 3x income.  Now all of a sudden their pay is cut by 25%. For many that equals bankruptcy. Sad but true.

6) Why have insurance private or public of any kind interfere with low cost health expenditures. It is an added step, and a waste of time and money.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2536 on: June 04, 2017, 07:14:17 PM »
Regarding the bloated costs of medical care in this country, it sounds like the specialty physicians are a major factor here.

Every specialist wants to run a bunch of tests on you, most not needed, and a primary care doctor could have prevented this waste.


"The Specialists' Stranglehold on Medicine", by Jamie Koufman, Otolaryngologist (you have to get really good grades in Med school in order to get an Otolaryngology residency program)

https://nyti.ms/2rDTDI1


NESailor

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Re: What comes after the ACA?
« Reply #2537 on: June 05, 2017, 08:04:26 AM »
-EnjoyIt: I (mostly) follow your numbers but I do not understand your conclusion regarding single-payer. If we are already spending this amount on health-care in the US in all our various forms (e.g. Individual, employer, out-of-pocket, Medicare/caid etc) why would *cost* be the reason single-payer cannot work here?  Are you suggesting that a single-payer system would cause costs to increase further (seems?to be your argument regarding Medicare and its "friction and cost")?

Great question.
1) Medicaid pays less than what it costs to treat the patient. If the reimbursement rates are all Medicaid rates then this is unsustainable. This is the reason why so many providers just don't take on Medicaid patients. Medicare pays better but also very poorly to providers although it does allow for a small profit.

2) Many single payer systems in the world outsource to insurance companies to manage payments. These infact do take a profit. BTW, this practice also occurs in the US as well.

3) CMS, the guys who run Medicare/Medicaid are the ones who have created some of the rediculous regulations that are putting small practices out of business. CMS is also the reason why costs are so high in the hospital settings as well.

4) I can promise you that if tomorrow my pay got cut to just Medicaid reimbursement, I would probably just quit. Just not worth going into work. The reason why physicians take Medicare/Medicaid patients is that they hope it will also bring insured patients as well. Without the insured there just isn't a point to keeping the doors open.

5) Think about it from the physician standpoint. They graduate at about 30 years old with about $350K in debt. Very very few docs are mustachiane and buy their first home right out of residency at 3x income.  Now all of a sudden their pay is cut by 25%. For many that equals bankruptcy. Sad but true.

6) Why have insurance private or public of any kind interfere with low cost health expenditures. It is an added step, and a waste of time and money.

The first bolded part - I'm going to go with no, it's not that simple.  It's part of it, but not nearly all or even the largest part of the problem.  The second bolded part illustrates why.  The entire system - literally from the pre-Med program up through the company that does the laundry for the hospital is bloated because we've managed to obfuscate what things cost and who pays them.   If Colleges didn't think they can enrich themselves (admins, professors, subcontractors, etc etc.), you wouldn't graduate with 350K in debt.  Then you wouldn't expect to make 250K out of the gate.  So on and so forth.  This setup does motivate some of the best and brightest to pursue medical care careers - that's good.  But it comes at a cost, obviously. 

Somehow, very bright students all around the world choose to become doctors without the expectation of a 500K salary ...ever.  You know how I know? My ex is an MD in Prague.  Probably makes a fraction of what I make in the US as a CPA.   As does her now hubby.  Both are brilliant.  Neither paid any tuition at a great med school in Prague.

Same story with pharma, equipment manufacturers and so on.  Everyone knows that price is secondary in the US.  Someone will foot the bill and as long as the bill keeps getting footed we are seeing rates of cost increases outpace inflation. 

You are right, Medicaid does reimburse at rates below cost...but it's not a Medicaid problem - you've identified it pages ago as a cost problem.   Medicare, as I've also noted a few pages back, is actually a pretty good payer.  If even a small hospital didn't need an army to deal with coding and insurance reimbursement issues (i.e.: they only dealt with a few players and 1 common price list), costs would surely be saved.  As a first step. 

I could ramble on...which is what I'm already doing...but I've gotta get some work done :)


nereo

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Re: What comes after the ACA?
« Reply #2538 on: June 05, 2017, 08:08:45 AM »
-EnjoyIt: I (mostly) follow your numbers but I do not understand your conclusion regarding single-payer. If we are already spending this amount on health-care in the US in all our various forms (e.g. Individual, employer, out-of-pocket, Medicare/caid etc) why would *cost* be the reason single-payer cannot work here?  Are you suggesting that a single-payer system would cause costs to increase further (seems?to be your argument regarding Medicare and its "friction and cost")?

Great question.
1) Medicaid pays less than what it costs to treat the patient. If the reimbursement rates are all Medicaid rates then this is unsustainable. This is the reason why so many providers just don't take on Medicaid patients. Medicare pays better but also very poorly to providers although it does allow for a small profit.

2) Many single payer systems in the world outsource to insurance companies to manage payments. These infact do take a profit. BTW, this practice also occurs in the US as well.

3) CMS, the guys who run Medicare/Medicaid are the ones who have created some of the rediculous regulations that are putting small practices out of business. CMS is also the reason why costs are so high in the hospital settings as well.

4) I can promise you that if tomorrow my pay got cut to just Medicaid reimbursement, I would probably just quit. Just not worth going into work. The reason why physicians take Medicare/Medicaid patients is that they hope it will also bring insured patients as well. Without the insured there just isn't a point to keeping the doors open.

5) Think about it from the physician standpoint. They graduate at about 30 years old with about $350K in debt. Very very few docs are mustachiane and buy their first home right out of residency at 3x income.  Now all of a sudden their pay is cut by 25%. For many that equals bankruptcy. Sad but true.

6) Why have insurance private or public of any kind interfere with low cost health expenditures. It is an added step, and a waste of time and money.
This is a long list of problems with our medical system, but none of it really addressed the question about why a single-payer system would not work.  The closest it comes is talking about how medicaid pays less for treatment than what doctors bill.

Jrr85

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Re: What comes after the ACA?
« Reply #2539 on: June 05, 2017, 09:47:30 AM »
-EnjoyIt: I (mostly) follow your numbers but I do not understand your conclusion regarding single-payer. If we are already spending this amount on health-care in the US in all our various forms (e.g. Individual, employer, out-of-pocket, Medicare/caid etc) why would *cost* be the reason single-payer cannot work here?  Are you suggesting that a single-payer system would cause costs to increase further (seems?to be your argument regarding Medicare and its "friction and cost")?

Great question.
1) Medicaid pays less than what it costs to treat the patient. If the reimbursement rates are all Medicaid rates then this is unsustainable. This is the reason why so many providers just don't take on Medicaid patients. Medicare pays better but also very poorly to providers although it does allow for a small profit.

2) Many single payer systems in the world outsource to insurance companies to manage payments. These infact do take a profit. BTW, this practice also occurs in the US as well.

3) CMS, the guys who run Medicare/Medicaid are the ones who have created some of the rediculous regulations that are putting small practices out of business. CMS is also the reason why costs are so high in the hospital settings as well.

4) I can promise you that if tomorrow my pay got cut to just Medicaid reimbursement, I would probably just quit. Just not worth going into work. The reason why physicians take Medicare/Medicaid patients is that they hope it will also bring insured patients as well. Without the insured there just isn't a point to keeping the doors open.

5) Think about it from the physician standpoint. They graduate at about 30 years old with about $350K in debt. Very very few docs are mustachiane and buy their first home right out of residency at 3x income.  Now all of a sudden their pay is cut by 25%. For many that equals bankruptcy. Sad but true.

6) Why have insurance private or public of any kind interfere with low cost health expenditures. It is an added step, and a waste of time and money.
This is a long list of problems with our medical system, but none of it really addressed the question about why a single-payer system would not work.  The closest it comes is talking about how medicaid pays less for treatment than what doctors bill.

It's not that single payer won't work, it's that single payer may be politically impossible without addressing the cost side first.  The costs for single-payer at the prices the U.S. currently pays would be an immediate deal killer politically.  Even if you ignored the politics of getting it passed, there are a lot of fixed costs in the system (both for buildings and other capital goods and for things like student debt), that just enacting single payer and trying to use monopsony power to bring costs down to something politically acceptable would cause the healthcare industry to look like the housing industry in 2008.  It's just a big complex system and people are loss averse, so it's going to be difficult to make meaningful change. 

NESailor

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Re: What comes after the ACA?
« Reply #2540 on: June 05, 2017, 10:12:27 AM »


It's not that single payer won't work, it's that single payer may be politically impossible without addressing the cost side first.  The costs for single-payer at the prices the U.S. currently pays would be an immediate deal killer politically.  Even if you ignored the politics of getting it passed, there are a lot of fixed costs in the system (both for buildings and other capital goods and for things like student debt), that just enacting single payer and trying to use monopsony power to bring costs down to something politically acceptable would cause the healthcare industry to look like the housing industry in 2008.  It's just a big complex system and people are loss averse, so it's going to be difficult to make meaningful change.

#truth.  That's what I was saying.  Changing how we pay for healthcare still doesn't really address how much.  We first have to admit that we have a problem - that's a political non-starter.  The clowns who run the show can't be honest and expect to get elected.  Mainly because we run around pretending that somehow we can solve all the issues without any pain.  Lowering costs is abstract and sounds great.  Cutting salaries by XYZ% for everyone from the groundskeeper at a med school to a brain surgeon is a different story. 

EnjoyIt

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Re: What comes after the ACA?
« Reply #2541 on: June 05, 2017, 12:31:40 PM »
NeSailor,
You are spot on for many of the items you described in your last two posts. Just a few items that CMS (Medicare/Medicaid) have control over.  The documentary and regulatory burdens hospitals, doctors, and offices have to deal with to just even be allowed to bill CMS for the services provided is very time consuming and very expensive. The amount of people that are hired to keep up with all this costs a significant amount.  That doesn't even include the equipment and technology required to keep up with these ever changing regulations.  For example CMS has pulled out a new payment scheme called MACRA. Providers who do not comply 100% with MACRA will have a 9% cut in reimbursement by 2020 while those who do will get a 9% increase.  Despite the 9% on each side of the equation the total will be a cut in reimbursement across the board (A method to control cost.)  The people who will be hit the hardest are the small practices 1-9 providers who will be unable to easily fund the technology needed to meet MACRA's demands. This 9% cut could be the difference between staying in business or being forced to close the doors. Also, our government has had plenty of opportunity to prove that it can do a good job on paying for healthcare.  The VA is 1 example of the government doing a half ass job. Although the VA is able to control cost the care is extremely delayed, and most VA patients I work with prefer to never have to go back to the VA hospital.  The other example is CMS which has done a piss poor job of controlling costs. Because of this I am just skeptical that our government, is physically able to do a good job with the 1 payer model. I would be thrilled to be proven wrong if California could pull it off, but again I'm very skeptical and glad I do not live in California.

Just wanted to point out.  Medicare pays hospitals decently.  Not great, but definitely enough to make some profit on the transaction.  That is not the case for physicians.  For example Medicare will pay a surgeon $667 to remove an appendix.  Although this may seam like a terrific deal, let me elaborate.  The $667 covers the pre-op, surgery, as well as post op in the hospital followed by an office visit.  About 2% of appendix surgeries can have complications but that $667 is included. Also the surgeon has overhead.  They must pay the coder, the biller, the IT guy, the nurse and secretary in his/her office, also keep the lights on and the rent the surgeon must pay.  For a cumulative of about 4 hours of work the surgeon might get to keep $200-$250 pre-tax. I'm sorry but all that education including 5 years of residency plus accrued debt should pay a little more that $50-$65/hr.  Also, the average salary for physicians is about $250k/yr not $500k as you specified.

Jrr85,
I think you are 100% correct.  As long as the US population continues to expect everything regardless of cost or necessity while the actual cost is hidden through the veil of insurance, there is no hope in controlling how much we spend on healthcare.  It can only go up just like higher education.

Nereo,
You are correct I pointed out how medicaid pays very little.  You must understand that if a physician or hospital does not make even some profit they might as well close the shop and find something else to do.  Currently Medicaid pays about 80% of the cost of providing the care which means everyone involved loses money on the transaction.  For everyone to have Medicaid either the cost pf providing care must go down by 25-30% or reimbursement must go up by 30%-35% or some combination of both. You can't expect people to work for free can you?  Another interesting fact for you.  Since ACA has come out, more people have health insurance, but more people with insurance don't bother to pay their deductibles and therefor hospitals are either much less profitable or even loosing money.  Around the country hospitals are cutting costs and laying off people. Again, you can't expect a hospital to keep its doors open and loose money every year.

protostache

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Re: What comes after the ACA?
« Reply #2542 on: June 05, 2017, 01:40:49 PM »
What if we, as a society, decide to pay off all of your medical debt? I realize that this is a pie in the sky scenario, but stick with me here.

The mean medical school debt for a fresh graduate in 2014 was $180,000 (pdf). In 2015 there were 18,705 medical school gradates in the entire country. That comes to about $3.3 billion per year which would fundamentally change the calculus of how much doctors need to charge to sustain a living. I know that doesn't fundamentally change your cost structure, EnjoyIt, but it would definitely make that $65/hr more attractive, and $3.3 billion per year is a rounding error in the Federal budget.

Of course with this loan forgiveness plan or straight tuition subsidy there would have to be cost controls in place so colleges don't start inflating prices more than they already are, and you'd probably have to agree to work in the US for a certain number of years, but it seems like a fair trade: society pays for you to become a doctor because that means society can pay less for appendectomies.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2543 on: June 05, 2017, 04:52:04 PM »
What if we, as a society, decide to pay off all of your medical debt? I realize that this is a pie in the sky scenario, but stick with me here.

The mean medical school debt for a fresh graduate in 2014 was $180,000 (pdf). In 2015 there were 18,705 medical school gradates in the entire country. That comes to about $3.3 billion per year which would fundamentally change the calculus of how much doctors need to charge to sustain a living. I know that doesn't fundamentally change your cost structure, EnjoyIt, but it would definitely make that $65/hr more attractive, and $3.3 billion per year is a rounding error in the Federal budget.

Of course with this loan forgiveness plan or straight tuition subsidy there would have to be cost controls in place so colleges don't start inflating prices more than they already are, and you'd probably have to agree to work in the US for a certain number of years, but it seems like a fair trade: society pays for you to become a doctor because that means society can pay less for appendectomies.

That is a great question but I do not think it is reasonable because:
1) I still don't think $65/hr is worth 4 years of college, 4 years of medical school and 5 years of residency for a surgeon or really anyone else who is responsible for the life of another human being.  Especially if they take on the liability of those decisions as well.  Sorry Protostache, but for $65/hr I think I would have stuck with my other degree in college and been a programmer at 22 instead of a practicing physician at 30.
2) What about all those people that have created their lifestyles on $250k/yr are you just going to say, sorry docs sell your houses and pull your kids out of school.  Starting next year your being downgraded.
3) How about the people who are already out and paid down their debt. Do you tell them, "sucks to be you."

One of the issues plaguing physicians today is this trend in decreasing reimbursement and increasing regulations (at least that is what they/we will tell you.)  Keep in mind most physicians are horrible with money.  Because of their awesome income and job security in conjunction with banks throwing money at them, they end up creating a life for themselves that is close to paycheck to paycheck.  Eventually decreasing reimbursement hits them and their only way to respond is to just work more (remember horrible with money and not mustachian.) Then some added bureaucracy makes them work harder to accomplish the same task. This puts an incredible stress on the physician and his/her family which often leads to divorce and sometimes suicide. That is with small cuts and regulations every few years.  Can you imagine what a 50% cut would do as you propose? On top of this burned out doctors become very bad at their jobs putting lives at risk.  I have seen this scenario played out so many times over the years.

tct

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Re: What comes after the ACA?
« Reply #2544 on: June 05, 2017, 05:06:26 PM »


I'm not fully for or against a single payer system but it should only cover catastrophic health care. There is absolutely no need for even a single payer middle man for simple healthcare related transactions.  You should not have to pay $400 for a month's insurance premiums and then a $30 copay to see your GP. It should cost a flat fee with no one else involved. Same for simple imaging or lab tests.  On the other hand if someone ends up with cancer or some other expensive medical condition insurance should be able to step in and take over. Just making that change would cut the friction on much of our healthcare expenditure, and buy having transparency in prices, costs will go down for all simple outpatient care.  Emergencies are a whole other story where catastrophic insurance can come in.  I would also go so far as to say there is no need to have a prescription from your doctor for refills on your medications. Very expensive chronic conditions should also be covered by some form of insurance.  Those who can not afford it based on income or disability should get subsidies or vouchers to help pay for their care.  Subsidies/vouchers are given out on a sliding scale based on income as opposed to an all or nothing distribution ideally incentivizing employment.


EnjoyIt, i agree.. Insurance should be for catastrophic care only, not routine care.

Nightwatchman9270

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Re: What comes after the ACA?
« Reply #2545 on: June 06, 2017, 06:18:32 AM »
As another physician-member I have to agree with most of what EnjoyIt said.  At 47, I have decided to partially retire.  The profession sucks the life out of you and is bad for relationships/family as well as my own physical and mental health.  I have partners who, inexplicably are living paycheck-to-paycheck.  Unbelievable.  Fortunately for me, that has enabled me to sell off my weekend calls (at a pretty hefty premium but oh well).  If I lived the way some of my partners do, I wouldn't be able to do that.  It really has helped trmendously.

Most doctors I know have done all kinds of financial bone-head moves.  Bad investments,  multiple homes, multiple wives.  Flipping cars every other year.  Solar panels (Yes! I said it!  for 90% of folks solar panels are a stupid financial investment).

And $65/hour?  Really?  For that level of risk and responsibility and education?  If that's what it paid I would do something else.  As it is I don't really bring home much more than that when you consider I'm at the hospital 60-80 hours a week now.

My auto shop charges $75/hr for labor.  If you think your car is worth more than your life so be it, but I wouldn't want to live in a country where I had a $65/hr doctor operating on me!

NESailor

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Re: What comes after the ACA?
« Reply #2546 on: June 06, 2017, 07:50:14 AM »
Currently Medicaid pays about 80% of the cost of providing the care which means everyone involved loses money on the transaction.  For everyone to have Medicaid either the cost pf providing care must go down by 25-30% or reimbursement must go up by 30%-35% or some combination of both. You can't expect people to work for free can you?  Another interesting fact for you.  Since ACA has come out, more people have health insurance, but more people with insurance don't bother to pay their deductibles and therefor hospitals are either much less profitable or even loosing money. Around the country hospitals are cutting costs and laying off people. Again, you can't expect a hospital to keep its doors open and loose money every year.

I'm glad we agree.  I didn't repost all of it but both you and the other Doc point to a structural issue that's not really the consumer's fault.  Doctors too, have what appear to be unreasonable expectations.  I certainly value my life more than my car - but the fact that some doctor bought 3 homes and 4 cars and has 3 ex-wives is not good enough of a reason for me not to push for lower costs - that includes your salary.

You've earned it, no doubt.  Imagine that the no med school debt proposal somehow happened.  Perhaps 65/hr is not enough.  How about a 100?  And better regulations as to working hours so you DON'T have to work 60-80/week.  Maybe 40 would do.  Better work-life balance would probably see you with a higher perceived quality of life.  At a lower salary and lower total cost to the system.

Regarding the bits I quoted.  They're not general truths.  Everyone does not lose money.  As long as the provider and facility (hospital) pay 100% of their costs - all the subs make money.  It's only those who get reimbursed by Medicaid that lose money.  Not good - but not everyone loses.

The bit about ACA is not quite universal either.  My local providers estimate that the current repeal effort will hurt the bottom line by a pretty significant margin.  I'm not making these things up.  Full disclosure - I'm a CPA who sits on the board of a small mental health provider group and work in a financial management capacity at a 400 mUSD hospital network. 

Oh...and I'm aware the average physican does not make 500K.  I said they hope to make that ;)  If my physician friends took my financial advice they could all take a 20% pay cut and still be millionaires by 40.  C'est la vie.

nereo

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Re: What comes after the ACA?
« Reply #2547 on: June 06, 2017, 08:39:02 AM »
As another physician-member I have to agree with most of what EnjoyIt said.  At 47, I have decided to partially retire.  The profession sucks the life out of you and is bad for relationships/family as well as my own physical and mental health.  I have partners who, inexplicably are living paycheck-to-paycheck.  Unbelievable.  Fortunately for me, that has enabled me to sell off my weekend calls (at a pretty hefty premium but oh well).  If I lived the way some of my partners do, I wouldn't be able to do that.  It really has helped trmendously.

Most doctors I know have done all kinds of financial bone-head moves.  Bad investments,  multiple homes, multiple wives.  Flipping cars every other year.  Solar panels (Yes! I said it!  for 90% of folks solar panels are a stupid financial investment).

And $65/hour?  Really?  For that level of risk and responsibility and education?  If that's what it paid I would do something else.  As it is I don't really bring home much more than that when you consider I'm at the hospital 60-80 hours a week now.

My auto shop charges $75/hr for labor.  If you think your car is worth more than your life so be it, but I wouldn't want to live in a country where I had a $65/hr doctor operating on me!

I come from a medial family (dad, mom, sister, grandfather are all medical professionals), and I've experienced a lot of the same regarding physicians who are barely living within their means.  When I was in HS my dad had to restructure his practice, and every doctor in the practice had to take a 8% salary reduction for 2 years.  Several of the doctors (none of whom were "new" doctors) went through bankruptcy.  His partner had been living paycheck-to-paycheck (with a salary >>$100k) for 20+ years. They were doing what you said - huge houses, 7-series BMWs (leased), tropical vacations. Growing up I kinda assumed that my dad must make much less than them since we lived in a modest house and drove to the beach for our vacation.
I think that was my first real awakening that regardless of your salary one can always get into serious financial distress in the US.

I inherently disagree about not wanting someone earning $65/hr operating on me - the amount someone is paid doesn't correlate very well with the job they do (and I think it's a huge mistake to assume more pay = better outcome).  To extend the analogy on cars, dealerships are often the most expensive but that doesn't mean they do the best job.  For physicians, I wouldn't reject a surgeon from the UK or Canada or any other developed nation, even though they earn 1/2 to 2/3 of what their US counterparts do.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2548 on: June 06, 2017, 08:44:27 AM »
Just like other professions, not all physicians are the same.

Do you know what they call you when you finish residency at backwoods medical center after graduating with a C average from po dunk U?

Doctor.

nereo

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Re: What comes after the ACA?
« Reply #2549 on: June 06, 2017, 08:57:56 AM »
Just like other professions, not all physicians are the same.

Do you know what they call you when you finish residency at backwoods medical center after graduating with a C average from po dunk U?

Doctor.
ha!
Reminds me of something a building inspector told me once:
do you know what they call buildings that are one point above "condemned"?
Spoiler: show
Up to code.