UPHELD!

[dgs49]

Doom?

Fact: Rates will go up.

Fact: Some employers (esp. small businesses) will drop insurance coverage for their employees.

Fact: Many, if not most employers will require greater contributions from their employees.

Fact: The demands on the overall medical system in the U.S. will increase, possibly dramatically.

If I predicted "doom," it was inadvertent.

BTW, I would completely support a single payer system if it were feasible in the U.S., but I do not believe that it is. Too many vested interests would be hurt by it, and gazillions of health insurance company employees would be cast adrift.

[Scooter]

Fact: Whatever shit Dave pulls out of his ass and decides to post will be labelled as "fact".

[Joe Guy]

Fact: The demands on the overall medical system in the U.S. will increase, possibly

And what would cause that?

Are you saying that all or most people who have new access to health care will rush to see doctors?

Why? Are all uninsured people sick?

It's possible that this plan has the potential to allow hospitals to focus on real emergencies rather than being forced to treat uninsured people who have the flu or a cold and can only receive treatment if they enter an emergency room.

[Long Run]

I was at a conference where a leading health economist reviewed the state of health care. The first thing is that the rate of health care increases has been declining, and this is not due to the bad economy. Rather, it is largely due to the success after several years of "consumer driven" health care plans -- the so-called high deductible plans where employees pay for their care up to $2,500 or $5,000 (often from a tax-free account set up by their employer).

The reason is that such plans get at the key driver of medical cost increases which has been the administrative complexity. The insurance companies spend a lot of money overseeing the providers to make sure that their protocols and cost-containment models are being followed. This takes a lot of people time if you do so on every single claim that comes in the door. However, if you remove the 95% of claims for routine care for the typical person who never reaches the high deductible, the insurance company can relax its oversight of such claims (at least until the deductible is met) because it is not paying out any funds on those claims. As a result, they have a dramatic drop in their administrative costs which are being passed on to rate payers.

Note that this cost reduction factor continues notwithstanding PPACA. On the other hand, one of the other big drivers of medical care increases, over treatment, is not addressed by PPACA or any other law, yet.

So as to its impact on medical costs, at worst, PPACA will be a one time hit as millions are added to the covered roles, but it will not be a significant factor in the long term costs of medical care as other forces will continue to dwarf its impact.

[rubato]

Doom?

Fact: Rates will go up.
... "

Fact: for the most part we are moving an expense which is already being paid, from column "A" to column "B" and whinging like babies because of it. All of the people whose HC has been paid for by state and local tax dollars (where most HC subsidies come from) will now pay a portion of their own HC costs.

Fact: The demands on the overall medical system in the U.S. will increase, possibly dramatically.

Fact: we will have the same number of sick people we did before which means that the cost to society will not change. But now a woman with cervical cancer will not die because of a lack of treatment; which is the system you want. (Oh, right, you hate women!)


yrs,
rubato

[dgs49]

For those who are not caught in some sort of cave, PEOPLE WHO DO NOT HAVE INSURANCE tend to take care of their own needs when they get a cold or a sprained ankle or a rash. When those people get insurance of the type that is required by OBCR - particularly when they are forced to buy it - they will atart going to their doctor's office to have themselves looked at. It is human nature. They will also go and have annual physicals. And so on. To suppose that the medical industry will not be significantly burdened by tens of millions of additional people who will suddenly get health insurance is...to put it bluntly, stupid.

And although we will have the same number of sick people as before, in the future, a much greater portion of the high-cost care will be dumped on private insurance carriers because they can't turn down high risk clients. Thus the rates for EVERYONE will increase.

It doesn't take a Nobel Prize in Econ to figure this out.

[Scooter]

For those who are not caught in some sort of cave, people who do not have insurance tend to ignore early symptoms of diabetes, high blood pressure, cardiovascular disease, etc. When these people do not have insurance, they will not go to their doctor's office to have themselves looked at. It is human nature. Neither will they go and have annual physicals that can diagnose as yet asymptomatic ailments. To suppose that the medical industry is not significantly burdened by tens of millions of people who are suddenly presenting with advanced disease that is extremely costly to treat, who do not have the insurance to cover it, is...to put it bluntly, stupid.

And since, with greater access to insurance, the number of people who get seriously sick will perforce decrease (because they have accessed appropriate preventive care), a much smaller portion of high cost care will be dumped on the remaining insurance pool, because the fact that people are too high risk to get insurance doesn't mean they aren't accessing care which they will not be able to pay for, and which is therefore being paid for by everyone else. Thus, rates for EVERYONE are higher than they need to be.

It doesn't take a Nobel Prize in Econ to figure this out.

[Long Run]

There is a point to be made that there will likely be more consumers of routine medical care. Some would say that this is a good thing because it might eliminate a percentage of the major problems that can be dealt with in the early stages for a lower cost.

As to major medical problems, these end up in the health care system now anyway. Rate payers pay higher costs since providers have to shift the cost of caring for these "free riders" onto those of us who pay. The payers are either those of us who are insured, or those of us who pay taxes. We are already paying for emergency and major medical issues for the uninsured. This is actually one thing from PPACA that might actually help reduce the rate of health insurance increases (at least for a year or two) as the prior free riders have to pay for some of their major medical care.

[BoSoxGal]

I've known folks with very good medical plans who still avoided the doctor despite clear symptoms of disease - I'm sure many of us know folks who are phobic about medical care.

Men, despite coverage issues, exhibit a far lower rate of voluntary engagement in routine medical care than women.

People have routinely died in this country from lack of access to life saving treatment; emergency rooms are required to treat folks regardless of insurance or ability to pay, but they don't provide organ transplants or chemotherapy, etc. Having those folks in the system will raise costs, but long term more widespread preventative care may reduce costs.

One critical issue not addressed in the ACA is dental treatment; there is a profound need in the US, and poor dental condition is at the root of many disease processes in the human body. Many folks with medical insurance don't have dental insurance that adequately addresses their needs.

We could probably save a great deal in healthcare costs in this country if routine dental care was universally available. Most of that would be work that dental hygienists could do.

[Rick]

I completely with the above post!

[Jarlaxle]

If I was an employer unless absolutley forced to help pay for employees premiums I would pay the fine (read "TAX") and let them all go to the exchange.

It would be cheaper on the employer.

Let me add unless I was an employer that was beyond the break over, I don't exactly know where that is.

I'm sure someone could figger it out though...

Some of the places I go to (I drive a truck and am at small businesses every day) are doing just that! One place laid off two people so they had few enough employees to not fall under the HC rules.

[liberty]

Why not just have a national health care system similar to the one Louisiana has? I will be surprised if this does not mostly benefit insurance companies. Perhaps I am just cynic, but look how well NAFTA and GATT has worked for us.

[Econoline]

Doom?

Fact: Rates will go up. Rates have been going up (for decades).

Fact: Some employers (esp. small businesses) will drop have been dropping insurance coverage for their employees.

Fact: Many, if not most employers will now require greater contributions from their employees.

Fact: The demands on the overall medical system in the U.S. will increase, possibly have been increasing, dramatically.

Predicting the present is so much easier than predicting the future.

[rubato]

For those who are not caught in some sort of cave, PEOPLE WHO DO NOT HAVE INSURANCE tend to take care of their own needs when they get a cold or a sprained ankle or a rash. ... "

But when they get a treatable form of cancer they discover that they will die because hospitals &c are not required to treat chronic, but lethal, diseases.

But if they get diabetes or high blood pressure they will have strokes, blindness and amputations because no one is required (or reimbursed) for providing preventive care.



yrs,
rubato

[Joe Guy]

We could probably save a great deal in healthcare costs in this country if routine dental care was universally available. Most of that would be work that dental hygienists could do.

I have often wondered why dental care is not a part of "Medical Care" and is instead a separate entity.

Studies have shown there is a link between gum disease and heart disease, yet, dental coverage is not included in the medical coverage that most people receive when they retire from their employment, unless the retiree chooses to pay the full cost of a separate premium.

Even without a link between gum disease and heart disease the separation of dental and "health" care makes little sense to me. Dental problems are medical problems. Eye problems are medical problems too, but we have to pay a separate premium for regular eye examinations.

Why are they not all linked?

A "primary care physician" should be able to make a referral to a dentist or optometrist for an exam within the same plan.

Why, for example, can a PCP make a referral to a proctologist but not a dentist?

Is it about all doctors individual enrollment in a specific Health Plan that just allows them a restricted amount of referrals to specialists - and leaves those approvals ultimately to clerical workers who use cheat sheets to guide them on what to deny or approve - probably based on cost effectiveness?

[loCAtek]

Meanwhile, those unemployeed will be bitten further by not having insurance, nor paying out for the outragous COBRA care.

[Gob]

[dales]

Meanwhile, those unemployeed will be bitten further by not having insurance, nor paying out for the outragous COBRA care.

You should qualify for "extended Medi-Cal".

I do.