patrick.net

Dan8267 says

all software contractors are going to get royally butt-fucked by this law because it assumes that everyone is either a jobless bum on the government teat or has a steady job that lasts years and immediately provides benefits. This is not even remotely close to the realities of working in IT.

It's not that I don't understand the law. It's that you don't understand the realities of the "flexible job market" in IT. And that "flexible job market" where gigs are very short-term

Arbitrarily raising taxes to pay for a government program, be it Obamacare or Romneycare or even (god forbid!) deficit reduction is small potatoes compared to the problem behind the situation you describe: how we have allowed our society to keep the facade of the gig going with all kinds of cost reduction gimmicks.

It looks to me like what you are describing is a plain and simple pay cut disguised as the state of the working conditions in that field, kind of like the Stealth Inflation of the price-steady, but incredibly shrinking portion size of the items in the supermarket; or the (for the rich who can afford to fly) bait-and-switch "bargain" flight prices that are loaded with all kindza "fees".

B.A.C.A.H. says

how we have allowed our society to keep the facade of the gig going with all kinds of cost reduction gimmicks.

The only way to maintain or improve health care quality and reduce its costs is to do the following:

1. Eliminate all administrative costs by streamlining and automating all administration. Of course, this means that the bureaucrats will be out of jobs.

2. Limiting lawsuits and damages awarded for malpractice. You can still discourage malpractice by taking away the right to practice from doctors who are incompetent or do deliberate harm. However, limits must be placed so that doctors don't have to spend a lot on malpractice insurance.

3. Eliminating all economic profit from health insurance. The best way to do this is to nationalize health care like it is in the U.K.

4. Streamlining the legal structure and limiting the corporate power of hospitals.

lostand confused says

Are you joking or for real?? I did give you a link and you come back and say it is a silly video, not connected to what we are talking about. It is a basic outline of all the taxes that Obamacare is going to bring on us-as I mentioned-very basic analysis. Nothing too detailed-there is plenty of that too.

Another lie. I said you gave no explanation of how it relates. And you still haven't. This is the simplicity of your mind at work - I make a very specific point about how you don't have to pay this penalty if you already have health insurance, and you just link to a video - "Golly gee willikers, there's gonna be all kinds of taxes". Do you even know what they are and who they would apply to? Doubtful.

pre existing conditions while part of Obamacare could have been passed separately. It is a good part, but it could have been easily passed as stand alone. Then there is nothing for costs for people making a decent income? It is not like Medicare where the premiums are fixed. If he bought a single payer or a fixed cost alternative-with reasonable increases- instead of this jumbled mess/corporate giveaway- I am all for it. But this is just the republican plan-nothing else. They got him to take ownership of their plan and implement it. Some parts are good-but not the whole.

Again, I have no idea what you're talking about. "Pre existing conditions could have been passed seperately" What do you mean by that?

A big reason for passing this law was guaranteed issue. People were being denied health insurance because of pre-existing conditions (and still are). Starting in 2014, these people can not be denied insurance anymore. Why would we want to leave that out of the law? That would defeat the whole purpose.

I'm willing to listen to you, even though you have been less than civil in this thread. So please, explain exactly how "pre-existing conditions could be passed seperately", because it is a meaningless sentence as it stands.

Dan8267 says

2. Limiting lawsuits and damages awarded for malpractice. You can still discourage malpractice by taking away the right to practice from doctors who are incompetent or do deliberate harm. However, limits must be placed so that doctors don't have to spend a lot on malpractice insurance.

The "tort reform" myth is a red herring, actual malpractice liability amounts to only 2% of spending, and tort reform has caused disastrous consequences in Texas and California. But, no doctor should ever be required to carry malpractice insurance. The current system charges the same premium to every doctor in the same area, so the careful surgeon pays as much as the butcher across the street and the careful prescriber pays as much as the poisoner who prescribes whatever the drug companies are promoting. Obviously this system results in the careful doctors subsidizing the reckless, incentivizes mass production and carelessness. A proficient doctor who has the courage to practice without insurance, i.e. taking personal responsibility instead of offloading it to an insurer, ought to be respected not punished.

curious2 says

The MLR accounting tool was never intended as a measure of quality.

We're discussing COST, not quality. It was brought up by Lost and Confused, who wrongly said there are NO cost controls. This is not true. There are cost controls. It's a simple fact. You cannot say there are NO cost controls. If you want to debate the merits of the provision, that's fine, but still, Lost and Confused's claim is false.

curious2 says

The largest insurers are already buying hospital corporations and corporate practice groups so they can shift profits from the insurance side to the medical side, within the same corporate umbrella. This results in higher prices, not savings.

What is your proof that this results in higher premium prices?

Homeboy says

You cannot say there are NO cost controls.

The MLR is not a cost control. As I explained, the insurers are simply buying hospitals and corporate practice groups, so they can shift the profits from the insurance side to the hospital side of the same business. It does not reduce costs in any way. In fact, since they overcharge "out of network" patients, it increases costs.

Homeboy says

What is your proof that this results in higher premium prices?

Premiums are already increasing, contrary to Obama's promise that they would decrease. One reason is because when an insurer buys a hospital, it can overcharge "out of network" emergency patients. If those patients have insurance, then their premiums increase to reflect the higher cost.

curious2 says

Premiums are already increasing, contrary to Obama's promise that they would decrease. One reason is because when an insurer buys a hospital, it can overcharge "out of network" emergency patients. If those patients have insurance, then their premiums increase to reflect the higher cost.

They already are not increasing as fast as they were under the Bush administration, and not all of the provisions of the law are in effect. Don't you think it's a bit premature to declare the law a failure when it isn't fully in effect yet? I would say that's more an indictment of the PREVIOUS system.

I will grant you that Obama made a number of promises that he did not keep, just like EVERY president in history. What's your point?

curious2 says

The MLR is not a cost control. As I explained, the insurers are simply buying hospitals and corporate practice groups, so they can shift the profits from the insurance side to the hospital side of the same business.

O.K., I'm listening. If they buy hospitals, but are still limited to 15% overhead, then they have expanded their operation, so while they may have the same expenses, that would be a smaller percentage of the total operation. If they manage a larger business on the same budget, how is that not a cost savings?

Homeboy says

Don't you think it's a bit premature to declare the law a failure when it isn't fully in effect yet?

It's been in effect in Massachusetts for five years, where it's resulted in the highest premiums in the nation. Just like Obama, Romnesia promised that RomneyCare would reduce premiums, but of course it increased them. "Medical bankruptcies" have also increased in Massachusetts.

Homeboy says

I will grant you that Obama made a number of promises that he did not keep, just like EVERY president in history. What's your point?

At the federal level, ObamneyCare is unprecedented. It's the Democrats' worst blunder since the Viet Nam draft. But there is no point communicating with you, you're not interested in learning anything you just want to fight. I'll stop now, have the last word here, voters will have the last word next month. I can attest to one thing though: your trolling worked halfway, because I had decided to forgive Obama for ObamneyCare and vote for him again, but you've persuaded me that I can't vote for him again. This is also why he lost the first debate: they didn't talk about his popular stuff, but they did talk about healthcare, so he got clobbered. ObamneyCare polls at -10% nationally, which is an enormous weight for Democrats to carry into the election. Good luck with your mandatory subsidized insurance, but I suspect you will find that it isn't worth what it costs.

Homeboy says

If they buy hospitals, but are still limited to 15% overhead, then they have expanded their operation, so while they may have the same expenses, that would be a smaller percentage of the total operation. If they manage a larger business on the same budget, how is that not a cost savings?

The hospitals are not limited to 15% overhead. There is no limit on hospital overhead or profit. The combined company makes more money on a larger budget.

The only fair solution would be to take a percentage based fee for every person for the total of money received, be it wages, capital gains or anything else for ALL of their life. Either make it impossible to opt out (by referendum), or let people opt out and pay back in for all the payments they have missed plus averaged interest if they suddenly want to use the health care system again, or they have to pay cash. The fees would be estimated based on the avg. income so that the "earning" can subsidize for the people who currently don't make any money. If you let people opt out any time you obviously have the risk of them blowing all their money and then being unable to pay back their fair share which they could have paid while they were making money, in which case you either let them be on their own or give them a "loan" that has to be paid by raising everybody else's payments. Insurance is something you pay all your life for bad times, or something you pay at increased rates, the more expensive the later you enter. Forcing insurance companies - no matter how 'evil' they may be - to take on insurance for an already burning house at the same premium is just plain stupid and won't work, unless the penalty for opting out is equal to the insurance premium, but then why bother having the penalty? I'd be fine with the mandatory fee bound to being used exclusively for healthcare (no tax that goes into the general fund) if they would ease up in turn on all other taxes such as capital gains and income taxes (or any other tax).

My previous post was regarding how a so called public option or covered (basic) healthcare for all does work. It was not an endorsement, it comes down on whether a particular society prefers it or not and the people should be asked. But there are countries where this concept works relatively well and the avg. quality of care is similar to the US and those countries do not have an opt-out option unless you want to get (add-on or full) coverage from a private insurance company, but you have to show proof that you are covered or pay into the general pool.

curious2 says

The "tort reform" myth is a red herring, actual malpractice liability amounts to only 2% of spending, and tort reform has caused disastrous consequences in Texas and California. But, no doctor should ever be required to carry malpractice insurance.

That's a good point about lawsuits amounting to only 2% of spending, and my research confirms that. I'm not sure about letting doctors carry no malpractice insurance though, as how would a victim get emergency corrective treatment and some kind of compensation if the doctor doesn't have assets.

However, the requirement for malpractice insurance is definitely expensive in itself. Here are a few good articles on it.

Medical Malpractice System Breeds More Waste

The direct costs of malpractice lawsuits — jury awards, settlements and the like — are such a minuscule part of health spending that they barely merit discussion, economists say. But that doesn’t mean the malpractice system is working.

The fear of lawsuits among doctors does seem to lead to a noticeable amount of wasteful treatment. Amitabh Chandra — a Harvard economist whose research is cited by both the American Medical Association and the trial lawyers’ association — says $60 billion a year, or about 3 percent of overall medical spending, is a reasonable upper-end estimate.

The problem is that just about every incentive in our medical system is to do more. Most patients have no idea how much their care costs. Doctors are generally paid more when they do more. And, indeed, extra tests and procedures can help protect them from lawsuits.

An excerpt from
The Medical Malpractice Myth

[T]he real problem is too much medical malpractice, not too much litigation. Most people do not sue, which means that victims—not doctors, hospitals, or liability insurance companies—bear the lion’s share of the costs of medical malpractice.

Second, because of those same studies, we know that the real costs of medical malpractice have little to do with litigation. The real costs of medical malpractice are the lost lives, extra medical expenses, time out of work, and pain and suffering of tens of thousands of people every year, the vast majority of whom do not sue. There is lots of talk about the heavy burden that “defensive medicine” imposes on health costs, but the research shows this is not true.

Third, we know that medical malpractice insurance premiums are cyclical, and that it is not frivolous litigation or runaway juries that drive that cycle.

Rural Health News, Vol. 9, No. 1
Spring-Summer 2002, High Insurance Premiums Jeopardize Rural OBs

Malpractice insurance rates are on the rise, particularly in high-risk specialties like obstetrics, and that is creating a crisis in some rural communities.

The American College of Obstetricians and Gynecologists (ACOG) concurs with Jenkins’s dire assessment. At a May 6 press conference, ACOG named nine "Red Alert" States where the medical liability insurance situation threatens the availability of physicians to deliver babies.

"Across the country, liability insurance for obstetrician-gynecologists is becoming unaffordable or even unavailable," said ACOG President Thomas Purdon, MD.

The situation is particularly worrisome for rural areas, where physicians and care are often already in short supply. "Hospitals, public health clinics, and medical facilities in medically underserved areas begin to lose prenatal and delivery care. The impact on rural women and Medicaid patients is most acute," said Dr. Purdon.

Dan8267 says

I'm not sure about letting doctors carry no malpractice insurance though, as how would a victim get emergency corrective treatment and some kind of compensation if the doctor doesn't have assets.

That's an argument for single payer emergency care, or for carrying true emergency medical insurance (which ObamneyCare prohibits), or for saving for a rainy day, or for choosing doctors who have sufficient insurance or assets, or avoiding doctors whenever possible. It isn't an argument for requiring malpractice insurance though, especially because the insurers' greatest expertise is in not paying. Ron Paul delivered thousands of babies in his career as a doctor, never got sued. As far as I know he never dropped a kid, but a malpractice insurer would charge him the same premium as butterfingers across the hall.

curious2 says

That's an argument for single payer emergency care, or for carrying true emergency medical insurance (which ObamneyCare prohibits)

True. I agree that implementing a single payer system could eliminate the need for doctors to carry any malpractice insurance. The single payer system could have a malpractice repair and compensation policy built into it.

Lazy incompetence can still be deterred by banning workers from the medical field if they screw up, for instance, by mixing up the blood types as in the Jesica Santillan case sited in the second article above. All medical workers, not just doctors, could be held to this standard. It would also encourage double-checking of work.

Dan8267 says

Lazy incompetence can still be deterred by banning workers from the medical field if they screw up...

But the opposite happens because it's much more lucrative. Hospitals profit from their mistakes, insurers use "runaway jury" stories to scare doctors into paying for more insurance, etc. As Noam Chomsky would say, it isn't a deliberate conspiracy in the usual sense of that word, it's only the inevitable result of executives in large organizations pursuing their own self interest.

curious2 says

But the opposite happens because it's much more lucrative. Hospitals profit from their mistakes, insurers use "runaway jury" stories to scare doctors into paying for more insurance, etc.

A properly implemented single payer system would eliminate both those problems and provide the transparency necessary to detect and correct mistakes.

I suspect 90% of those that have been Okeydoking Obamacare the most, running around calling it a Healthcare SYSTEM, will be the most vocal critics when that mandate kicks in. People are confusing this with some government stewardship of the Nations citizens and their well being. This is only a measure to make sure that all of the people investing in medicine, hospitals, insurance all gets paid.

My Mom 72 just informed me this week she no longer has Insurance since this passed. Well she does, but for the health problems she may have at this stage in life, she might as well not have. The out of pocket prices and expenses have never been higher, and no Doctor will see her now, with out her paying her part up front first. And this is a disabled little old lady. Do these people really think they will fare better under Obamacare.

CaptainShuddup says

I suspect 90% of those that have been Okeydoking Obamacare the most, running around calling it a Healthcare SYSTEM, will be the most vocal critics when that mandate kicks in.

I'd have no problem with the individual mandate if we got single payer, a public option, and a divorce of health insurance from employment in exchange. Otherwise it's a giveaway to already too-powerful insurance companies and it's going to backfire.

Of course, I'd have sponsored a real health care reform bill like the one I described above if I were in the Senate.

CaptainShuddup says

Do these people really think they will fare better under Obamacare.

Most people see through it and know they won't fare better, but partisans believe whatever their party tells them. For example, Homeboy refuses to acknowledge that insurers are buying hospitals, which enables them to sidestep the MLR rules by shifting profit from the insurance side to the hospital side within the same parent company. Most people, on both sides, just want to believe.

Dan8267 says

Of course, I'd have sponsored a real health care reform bill like the one I described above if I were in the Senate.

...which is why you aren't. Legislation isn't drafted by public spirited engineers. It is drafted by self-interested politicians and lobbyists whose patronage networks demand payback and offer opportunities, for example Billy Tauzin and Max Baucus. When you look at how a legislative body actually works, and the product that emerges when the inputs have been digested all the way through the system, it becomes a powerful argument for limited government.