WatchSeveral years in, it seems to me that the net effect of Obamacare so far has been to do nothing but raise premium costs dramatically.
The core idea of Obamacare is that everyone will be required by law to pay private health insurance companies unlimited premiums.
Sure, health insurers now have to spend 80% of the premiums on medical care, but that just means they have a compelling motive to raise both premiums and medical care payments, so that their 20% profit is 20% of a much bigger number.
Insurers can no longer deny coverage based on pre-existing conditions, but that also means that insurers will both pay out more on medical costs, and raise premiums again to get back to 20% of an even larger premium amount. Their not going to reduce their profits voluntarily.
Insurers have to keep children on their parents' plans to a later age, but yet again, that will raise their payments and therefore raise premiums even more.
So premiums will be too high to pay, and yet we will all be required by law to pay.
Am I misunderstanding something here?
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bob2356 says
I don't know why you keep coming back to me with your sarcastic questions, but I have asked you to leave me out of your straw man arguments. Instead, now you have straw men arguing with each other, yet you continue to insist on involving me for some reason. At the risk of "someone is wrong on the Internet" syndrome, I will answer your questions, but really this is becoming a waste of time.
First of all, you say that childhood leukemia rates are "pretty much stable," when in fact they have been increasing. Next you seem to assume that any connection to the increase in C-T scans must be binary, i.e. all-or-nothing, when in reality I said the two events are not coincidental. Please understand, if one change causes PART of another, they are not coincidental. It isn't necessary that the first change cause 100% of the second. To the contrary, I have provided several articles for you already listing other cancer risks, e.g. the article saying that the average number of childhood X-rays doubles the risk of leukemia. If you don't like those articles, please write to the publishers. If you don't like the facts themselves, then your problem has nothing to do with me.
Sunlight has benefits, personally I wouldn't suggest avoiding it "whenever possible," but if you want to that's your choice. Unnecessary radiation has no known benefits, and the NEJM found tens of millions of unnecessary C-T scans. Your false premise, "avoiding radiation means dying," does not apply at all to the millions of _unnecessary_ C-T scans that confer no benefit to anyone other than the providers who make money off them. (Also, your liability bogeyman is another distraction, http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande.)
You seem to return always to the topic of C-T scans, no matter how many other examples of diagnostic radiation I cite. I don't know why you get so defensive regarding C-T scans, but I can't help thinking it has nothing to do with me.
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Dan, you hit it on the head. Anything short of a nationalized and streamlined system is a bandaid at best. It won't happen any time soon though. The 1% who control both parties in power won't allow it to happen.
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simchaland says
That is crazy. Can you explain to me how such a system would not be swamped.
Once everyone has health insurance everyone is going to be inclined to use their insurance and hence the demand for medical care is going to go through the roof. There are not enough hospitals, doctors, nurses to handle that kind of load.
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curious2 says
Ok I give up, here is the quote from both your article and mine.
"Incidence of childhood leukemias appeared to rise in the early 1980s, with rates increasing from 3.3 cases per 100,000 in 1975 to 4.6 cases per 100,000 in 1985. Rates in the succeeding years have shown no consistent upward or downward trend and have ranged from 3.7 to 4.9 cases per 100,000"
I don't read "shown no consistent upward or downward trend" or "ranging up and down" for the last 25 years as increasing for the last 10. Could you explain how you do?
The term I have been using is invasive radiation, meaning all types of invasive radiation although I sometimes just say cat scan out of lazyness. You were the one who said C-T scans in the first place, look at your original post.
I agreed there are some some excess. What is the straw man in that? If you really think that concerns about medical malpractice doesn't drive a lot of them you don't know anything about medicine or law.
I read the New Yorker article, I quoted the article extensively here at patrick.net years ago. Did you read far enough to get to the parts where they talk about the cleveland and mayo clinic. Those very tightly run organizations aren't doing any excess anything. The average is somewhere between those McAllen and the Cleveland/Mayo clinics.
My bottom line is that there is some unnecessary invasive radiation procedures, but the vast majority are legitimate diagnostic procedures whose value far, far outweighs the small risk of cancer. I don't know how to make that simple statement any clearer. If you feel invasive radiation exists as profit making scam that will give you cancer then you are free to refuse any and all diagnostic radiation. At 30 that's a pretty easy to stand by, so how you hold out at 70.
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bob2356 says
But you never give up, you just keep quoting the same outdated numbers from five years ago despite the fact that diagnoses of radiation-induced cancer can lag exposure by years or even decades. Here's another link for you to ignore:
http://newscenter.berkeley.edu/2010/10/04/x-ray/
It finds C-T scans have increased more than 20-fold in 30 years, now more than 70 million annually. I'm glad you agree finally there is excess. To find the straw men, read the posts where I quoted them. And, you might want to read the New Yorker article over again, because evidently you missed the part where the author specifically refuted the liability bogeyman, pointing out that Texas has had "tort reform" and the problem results from entrepreneurial doctors putting their financial interests ahead of their patients' interests. In fact, with "tort reform," the financial incentives for unnecessary tests and procedures are all in favor, i.e. the entrepreneurial doctor gets the excess revenue but is shielded from the costs of the excess cancers (which in fact lead to more revenue). You mentioned being married to a doctor, perhaps that has something to do with your paradoxical resistance to facts and inability to let the matter go.
In any event, this thread is about ObamaCare, which was signed in 2010, not statistics from 2007. As others have noted, both major parties get their $ from basically the same sources, so they serve basically the same interests. The slogans and details vary but are complementary: Democrats demand more spending, while the Republicans demand less accountability ("tort reform"), with the result that they compromise on more spending and less accountability. ObamaCare mandates nationally policies that include diagnostic radiation (e.g. mammograms) with no co-pay, even in age groups that derive zero net benefit from them. So, the net effect is even more unnecessary radiation, producing even more cancers, and even more spending. The model for ObamaCare was RomneyCare, which has already led to more spending and more hospitalizations. Bottom line, more spending for worse results.
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gromitmpl says
All systems are finite and require allocation of finite resources to users who have infinite demand. If we can manage the Internet, we can manage health care.
A nation-wide health care system does not imply that people don't pay for health care. You are confusing health care reform with the idea of insurance that pays 100% of the costs. A nation-wide health care system does not even require an insurance function. Hell, people buy health insurance not as insurance but simply as a way not to get fucked over by unreasonable overcharging. A $100 bill to an insurance company would be a $10,000 bill to an uninsured person.
Can a national and streamline system be sustained. Of course it can. You have to be an ignorant fool to argue otherwise since such systems do exist and run in other countries like the U.K. and Canada. Will such a system make everybody happy all the time? Of course not. People wouldn't be happy with a health care system unless they never got sick, never aged, and never died. But that doesn't mean you cannot create an optimal system.
Even without any insurance function, a nation-wide single payer system with streamlining of the medical industry would reduce health care costs considerably. Administrative costs alone account for a good chuck of health care costs. Advertisements of drugs accounts for another large chunk, and ads are a zero-sum game that serve no legitimate medical purpose as the doctor, not the patient, should be deciding what drugs to use in a treatment.
Add to those savings the elimination of price gouging -- the real reason people get insurance -- by having fix prices for services at a given location, and the typical American could afford a high level of health care without any freaking insurance. So insurance is just the icing on the cake.
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Pacifica, CA
"This is how it works.
It's a center-right nation."
No, it's a center-right government, the nation is considerably to the left of the politicians.
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monkframe says
Agreed. Most Americans are for gay rights, legalized marijuana, social safety nets, the single payer system, and free speech.
Restricting the freedom of individuals is more of a government interest than a citizen interest.
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The way medicare works is people pay for supplemental policies, that cover premium cost services. I think even if you want bare bones, you pretty much need a minimal supplemental policy.
So "medicare for all" would not have killed the insurance companies. But it would have forced them to limit their business to the supplemental policies.
I do tend to agree that Obama has been a wimp. Politically, the whole Tea Party movement (which was possible because he was a black President with a middle name of Hussein), might have made it impossible. But I would have like to see him try and fail, I think.
Although the preexisting conditions coverage is an important breakthrough.
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monkframe says
I agree too. We drift toward fascism.
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monkframe says
Not sure about that. Is there evidence for that?
Seems our recent national elections have been very close.
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monkframe says
No.
The governments are corporatist serving defense contractors, mortgage bankers, real estate agents, health insurers, the California Correctional Peace Officers Association, the California Federation of Teachers, and other large groups willing to spend money on politicians to furthur their group's common economic interests.
The majority of people are not members of such groups.
"Left" and "right" are more marketing labels than relevant reality.
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drew_eckhardt says
This is true at the same time. The best evidence of this is the fact that the five largest banks not only live, but are taking larger gambles in the markets than ever. They should have been broken up after the collapse, but instead, they got all the money!
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tekkierich says
My former family doctor from Dallas said the exact same thing.
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monkframe says
Yep. I realized all the "free market" talk from the right was bullshit when the bailouts happened.
The reality is that we don't have a "free market" party.
Democrats = socialism for the masses
Republicans = socialism for well-connected Big Banks
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wthrfrk80 says
Democrats = lemon socialism
Republicans = crony capitalism
Bipartisanship = both
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wthrfrk80 says
Right.
Wrong. The Republicans are the bed-wetting liberals. Republican House Speaker Dennis Hastert introduced Medicare Part-D and Republican 41st president George Bush signed it. His son was responsible for America's income tax system becoming the most progressive out of the OECD-24 where the ratio between share of tax burden and share of income among the top earning decile is higher than in Australia, Austria, Belgium, Canada, The Czech Republic, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Japan, Korea, Luxembourg, The Netherlands, New Zealand, Norway, Poland, The Slovak Republic, Sweden, Switzerland, and The United Kingdom.
Wrong. The Democrats are in bed with the bankers with things like the revolving door between Goldman Sachs and the White House. They were responsible for the S&L bailout in the form of the Financial Institutions Reform Recovery and Enforcement Act which created the Resolution Trust Corporation that had "resolved" 747 insolvent banks by 1995 for $394 billion.
A better way of looking at it is that both parties pass legislation to benefit powerful corporatist interests (banking, mortgage, real estate agents, defense contractors, California prison guards, California teachers, etc.) although the rest of us get a few scraps thrown our way like the seniors who benefited from the Medicare Part-D federal funds funnel to the drug companies.
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Ok, I stand corrected:
Both parties = socialism for the rich
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Medicare Part-D doesn't mean shit for everyone below the age of 65. Doesn't mean shit.
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The problems can be summed up like this
1) Any business that has significant profits and significant training will defend itself against reforms. It is natural as to defend amounts
2) As people age more and lifespan grows so do various aliments. Did anyone really know what Alzheimer was 100 years ago?
3) Population expands more so of course that means more coverage and more demands on medical staff.
We cannot make healthcare cheap but subsidizing demand. Nothing is ever made cheaper by subsidizing the demand.
States need to grant more licenses for doctors and nurses. More assistance for those that want to get in those professions.
Outright denials need to be established for government programs to get people off of bad items. If someone is a drug addict they need to enter rehab before medicare. This goes for all illegal and legal substances. If someone is excessively obese as defined by a doctor that would need to be corrected as well.
If we think that somehow habitual actions have no general effect on health then that is wrong. 10% of people in Kentucky have no teeth. When you combine high smoking rates, high chewing tobacco rates, well water (no flouride), high soda consumption, high hard alcohol consumption and poverty and it takes a back seat.
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WillyWanker's website
St. Teresa: 'More tears are shed over answered prayers than unanswered ones'.
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I think the USA just needs to hit the "reset" button.
Not sure how that would ever happen, short of a major meteor/comet impact. Maybe we'll get lucky and the Yellowstone volcano will finally blow...
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wthrfrk80 says
Zombie Apocalypse
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The Obamacare thing was designed to cloward-piven collapse the system to get to single payer. A cursory look at the numbers involved should reveal this. At the end of the day it bread and circus for our dying republic. Prepare to go from middle to lower class or figure out how to be part of the 1%.
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Mick,
Weren't you considering buying a house? Are you really so poor? I remember your internet drama toward Iwog.
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Pacifica, CA
"1) Any business that has significant profits and significant training will defend itself against reforms. It is natural as to defend amounts(.)"
Agreed, and we need the government to defend the people, not the business. I'm so fucking tired of hearing the business interests defended against the people's interest, specifically in regards to health care. Business and its employees need to have this whole subject removed from the debate to a government program like Medicare, and be done with it.
The HMO executives can go have a nice bonfire with their departure bonuses, as they try and find a new career as corporate bloodsuckers.
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I forgot to mention another net effect of ObamaCare, in addition to more spending and worse results. It cost Democrats their House majority in 2010, and looks likely to cost them the Senate in 2012.
Ironically, the statute's namesake may benefit politically from its unpopularity. This is because, with the Republicans taking both houses of Congress, President Obama sounds like the lone voice of sanity. He lied about health insurance, but he isn't crazy like Romney, who anyway signed the same plan in Massachusetts (where it produced more spending and worse results).
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curious2 says
Yes, right up until the House impeaches him. For what? For whatever they can think of. With a Republican Congress and the Tea Party folks pulling the strings, it's very likely.
If you're white, middle class and live in the burbs, hang on tight. Things about to get very bumpy.
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They already have.
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monkframe says
Bankruptcy is not the end of the world. I would prefer a system where the government gets out of insurance regulation and we have a system of private contracts. It is better for a few folks to go BK than to have any of the horrible problems that modern healthcare and insurance regulations have bought us. People have an odd sense of what BK does. It really is not the end of the world. Credit is over-rated, just as mortgaging a house it.
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berational says
Isn't that what got us into this problem?
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drew_eckhardt says
You really don't know what the fuck you're talking about.
For one, Part D was passed in the 2000s (Part C was the late 1990s).
I can't even parse what you're trying to assert about 'progressivity' in the current tax arrangement, but http://motherjones.com/kevin-drum/2012/04/rich-arent-so-different-you-and-me-after-all shows how we already have essentially NO progressivity in the top 4 quintiles.
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wthrfrk80 says
Democrats stand for bullshitting the poor. Republicans stand for liquidating them.
Choose wisely this November!
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berational says
How about we stop doing what we're doing and start doing what the rest of the civilized world is doing wrt health insurance -- heavy government involvement.
The system works well all throughout Europe, Japan, Canada, Oz, NZ.
Your preferred solution works exactly nowhere in the real world; it's perplexing to me why you even think you have proposed a serious idea and not just the typical libertarian reality-challenged bullshit that is so common on the internet.
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berational says
Actually it is more than just a few bankrupcies... Some estimates are around 60% of all bankrupcies in the US.
http://articles.cnn.com/2009-06-05/health/bankruptcy.medical.bills_1_medical-bills-bankruptcies-health-insurance?_s=PM:HEALTH
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American in Japan says
From the article you linked to: "78 percent of them had health insurance...." RomneyCare required everyone to buy insurance and thus led to a 30% increase in 'medical bankruptcies' (bankruptcies with $5k or more of medical bills). Mandatory insurance does not end medical bankruptcies, it increases them. Since ObamaCare is the same as RomneyCare, the net effect will be more bankruptcies.
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The sick and the elderly must become gladiators for our amusement. Have them fight it out in a modern day coliseum. Since our pie is apparently fixed in size, the winner will get treated while the loser will be incinerated in the ocean beach bonfire. This is sure to stimulate the economy. And after a 3 month reprieve, the winner must fight again to remain so.
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dublin hillz says
Apocalpysfuck, you are hilarious.
Whoa whoa...that's not Apocalpysefuck...oops...
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dublin hillz says
No, they must remain profit centers for the medical industrial complex and captive constituencies for politicians. They must neither get well nor die, they must remain on as many pills as possible for as long as possible. It's the economics of ObamaCare: Americans must poison and butcher each other for power and profit, as long as people keep lending us the money to pay for it all.
In the old economy, Americans used to make things. Then, in the new economy, Americans made dot-cons and sold stock to gullible "investors" (speculators). Then, in the housing bubble, Americans sold each other houses with money borrowed from the Chinese. Now, we transition to a Matrix economy, where intubated patients generate revenue and political power.
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curious2 says
God Bless America.
curious2 says
That's the best summary of the last 30 years I've seen so far.