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I am sorry, but you are SO ill informed about the ACA, it's intent, it's provisions, and who has been effected how, and how many, that I don't have the time or inclination to correct you.. Besides, I know an immovable object when I run into one.
Most, even the supporters of the ACA do not feel it is an answer to all of our problems and acknowledge it's short comings, but most would say it certainly is an improvement over what we had before. Obviously, not for you, but then I suspect there is a great deal that you may be unaware of. Also, Medicare is a very good example of a similar "second tier health system. People without means are forced to purchase an Advantage Plan, which in most cases is a HMO, and even if it isn't, it is very restrictive, and often times you can not see the doctor you want to if he/she is out of network, and or to get him/her paid in a timely manner without a hassle.
Now if you have money, you can afford to purchase a good medigap policy like the F policy that I carry that costs me an additional $259 a month, plus a Part D policy, that costs another $50 mo. for my prescription drugs, then again another $104.27 for Part B. So, I pay an additional $415 a month in order to have good coverage without restrictions as to what doctor I can see, what hospital I can go to, and what state I can go to for treatment.
So, the "second tier health system" is well and alive in Medicare, ACA policies, and while they still exist non compliant insurance policies.
Also, if I were you, I would expect that your employer will continue to downgrade your policy in future years, because as of yet no substantial measures have been taken to stop the continued growth in health care costs. It is slowing, but I'm afraid most would agree that is not good enough.
It's an improvement to what we had in the same way the AT&T monopoly was an improvement. It cost the US decades in set backs and technology so that one company could benefit and have complete control over the telecommunications market.
If you get a chance watch Genius on Hold and you can see just how destructive monopolies can be.
In my layman's opinion, morbid obesity is much more costly, long-term, than smoking. Heart/blood pressure issues, joint replacements, it runs the gamut. A smoker can counteract, to some degree, the bad effects of smoking with good diet and exercise. Many smokers live to an active ripe old age without disability, possibly only experiencing disability a couple of years before death. I don't think the same can be said for morbidly obese who can often be disabled early in life. I see too many in the scooters in the grocery store, for starters.
We were in an ER this weekend with my father (age 96). The rolling beds there now are rated to 700 pounds. Good grief! Robyn
The ACA's purpose was to make health insurance available to a greater number of people, specifically those with pre-existing conditions, those not covered by an employer, and those whose income prevented them from qualifying for Medicaid but who could not afford individual health insurance policies.
There was a lot of opposition to Medicare before it became law. Many warned that a government run program would lead to socialism in the U.S.
"If you don't (stop Medicare) and I don't do it, one of these days you and I are going to spend our sunset years telling our children and our children's children what it once was like in America when men were free." -Ronald Reagan in 1961
And now Medicare is the largest unfunded obligation of the US. "Welfare" now takes up 66% of the federal budget and is expected to grow by 60% to 8% of GDP by 2039 from 5% because of SS, Medicare, CHIP and ACA subsidies.
Quote:
Mandatory programs have accounted for a rising share of the federal government’s noninterest spending (that is, spending excluding interest payments) over the past few decades, averaging 60 percent in recent years. (Funding for those programs is generally determined by rules for eligibility, benefit formulas, and other parameters rather than by appropriating specific amounts each year.) Most of the growth in mandatory spending has involved the three largest programs—Social Security, Medicare, and Medicaid. Federal outlays for those programs together made up more than 40 percent of the government’s noninterest spending, on average, during the past 10 years, compared with less than 30 percent four decades ago.
Most of the anticipated growth in spending (beside interest payments) as a share of GDP over the long term is expected to come from the government’s major health care programs: Medicare, Medicaid, the Children’s Health Insurance Program, and the subsidies for health insurance purchased through the exchanges created under the Affordable Care Act (ACA). CBO projects that, under current law, total outlays for those programs would grow much faster than the overall economy, increasing from just below 5 percent of GDP now to 8 percent in 2039 (net of Medicare premiums and certain other offsetting receipts).
In succeeding years, however, deficits would become notably larger under current law. The pressures stemming from an aging population, rising health care costs, and an expansion of federal subsidies for health insurance would cause spending for some of the largest federal programs to increase relative to GDP. Moreover, CBO expects interest rates to rebound in coming years from their current unusually low levels, raising the government’s interest payments. That additional spending would contribute to larger budget deficits—equaling close to 4 percent of GDP—toward the end of the 10-year period spanned by the baseline, CBO anticipates. Altogether, deficits during that 2015–2024 period would total about $7.6 trillion.
1.all working people pay into Medicare over their working lives to fund Medicare. There is no immediate benefit. Under ACA, you can get immediate benefit without having paid into the system.
2. Under Medicare you pay taxes to receive a federal govt product (or federal govt endorsed product such as advantage care plan). Under ACA you are mandated to pay a tax to purchase a plan from a PRIVATE company that has no federal govt endorsement.
3. Under Medicare your premiums are based on your income, under ACA your premiums are based on income AND WHICH ENTITY YOU PURCHASED THAT PLAN FROM. To get a subsidy or tax credit you need to purchase the plan off an exchange, even though the plan is identical in nature and definition to a plan sold directly by the insurance company.
Proponents of ACA have repeatedly stamped their feet and said this is not govt controlled/run healthcare. So how could it be compared to Medicare then?
And now Medicare is the largest unfunded obligation of the US. "Welfare" now takes up 66% of the federal budget and is expected to grow by 60% to 8% of GDP by 2039 from 5% because of SS, Medicare, CHIP and ACA subsidies.
Disagree with you on that one. And don't blame that all on Medicare.
"As for Medicare, there's distinctly good news. The continuing drop in healthcare expenses has made Medicare healthier -- the estimated date of its trust fund's depletion has been moved out by four years, to 2030. If you're keeping track, that date has been moved off by a total of 13 years since enactment of the Affordable Care Act." Good news and warnings in the Social Security and Medicare reports - LA Times
Disagree with you on that one. And don't blame that all on Medicare.
"As for Medicare, there's distinctly good news. The continuing drop in healthcare expenses has made Medicare healthier -- the estimated date of its trust fund's depletion has been moved out by four years, to 2030. If you're keeping track, that date has been moved off by a total of 13 years since enactment of the Affordable Care Act." Good news and warnings in the Social Security and Medicare reports - LA Times
Or you could go read the Medicare Trustees Report yourself. The 2014 report came out July 28th.
"Indeed, the Trustees have revised down their projections for near term Medicare expenditure growth in response to the recent favorable experience. In addition, the methodology for projecting Medicare finances had already assumed a substantial long-term reduction in per capita health expenditure growth rates relative to historical experience, to which the ACA’s cost-reduction provisions would add substantial further savings. Notwithstanding recent favorable developments, both the projected baseline and current law projections indicate that Medicare still faces a substantial financial shortfall that will need to be addressed with further legislation."
So long as things don't go like they have historically everything looks rosy. I think that's fatally flawed because it used decreased expenditures during the Great Recession. Also, it's highly unlikely to achieve that rosy scenario seeing how the Baby Boomers are retiring and that is without precedent in the history of the program.
Anyways, when welfare consumes 60+ percent of the federal budget it's hard to argue that it's not going to consume the vast majority of the US' budgets. It might not be "socialism" in the textbook form but when $2.3 trillion of the US economy is dependent on wealth transfers it's not all that far off from government controlling the means of production and being centrally planned.
Anyways, when welfare consumes 60+ percent of the federal budget it's hard to argue that it's not going to consume the vast majority of the US' budgets. It might not be "socialism" in the textbook form but when $2.3 trillion of the US economy is dependent on wealth transfers...
A completely separate issue. Medicare is not welfare. (And if you want to call the ACA or Medicare "socialism," then address the institution of public education. You would not want to live in a society that does not take care of its elderly, educate its public, or assist with the health needs of its society. (But that's a topic for another forum.)
A completely separate issue. Medicare is not welfare. (And if you want to call the ACA or Medicare "socialism," then address the institution of public education. You would not want to live in a society that does not take care of its elderly, educate its public, or assist with the health needs of its society. But that's a topic for another forum.)
Agreed but just for the record I didn't bring up the socialism thing. Another poster linked to ThinkProgress did that.
It was a payback scheme, a quid pro quo, for the politicians that passed it who saw massive investments in their campaigns from the American Hospital Association. Just look at section 6001 of the ACA that pretty much bans physician owned hospitals from starting or expanding. The AHA and the FAH don't like the competition from the POHs. You can read about that in the major hospital's operating statements.
The ACA did nothing to cut the cost of health care. It was simply a quid pro quo scheme to politicians so that monopoly hospital cartels could keep power indefinitely. That scheme was to pay politicians million upon millions of dollars for unfettered and unquestionable access to 16% of the US economy without any chance of having to compete against any other viable options.
In the end it's going to hurt the American economy tremendously just a monopolies always do.
BibJon, First, thank you for the recommendation on the documentary concerning Bell Labs. I watched it last night and enjoyed learning more about it. It was very sad what happened to the Bell Lab employee. I am fervently opposed to monopolies, and the continued proliferation of them today without any real restraints imposed.
I have also read some material previously of POH and the concept scares me, as I fear it will eventually only perpetuate the current problem of promoting health care for profit and gives an even larger incentive to doctors and surgeons to perform additional testing and unnecessary procedures. It appears the jury is still out on this count however.
I did read ACA section 6001, and it deals more with requirement for medicare patients. However, it appears that these POH's catter to patients who have higher re-imbursment rates anyway and few medicare patients are directed there by their financially involved physician.
"Section 6001 of the Patient Protection and Affordable Care Act (ACA)
The movement against POHs gained substantial ground in May 2010 when President Obama signed the ACA into law, substantially restricting POHs [5]. Section 6001 of the ACA modified the “whole hospital exception” of the Stark law in three key ways, adding (a) limits on the growth of POHs in the medical marketplace, (b) requirements to disclose investment terms and investor identities, and (c) requirements to provide emergency services [5]. Notably, the ACA measures are somewhat narrow in their impact and scope—they apply only to facilities seeking reimbursement for Medicare services that were Medicare certified after December 31, 2010. They do not affect POHs’ ability to seek reimbursement from self-pay patients or private insurance [19-21]. To the extent that POHs rely on Medicare reimbursements, however, their growth and development are substantially curtailed.
(a) Prohibitions expanding existing or establishing new POHs. Section 6001 prohibits expanding the capacity of existing Medicare-certified POHs as of March 23, 2010, unless they meet one of two exceptions. The law also placed a moratorium on the establishment of new Medicare-certified POHs after March 23, 2010. For the 60-65 POHs that were already being developed in March 2010, the ACA set a deadline of December 31, 2010 to obtain Medicare certification [22, 23].
(b) Disclosure requirements. The ACA imposes reporting requirements and restrictions on physician investments. POHs must report to HHS and disclose to their patients the identity of their investors and investment terms and post their POH status on websites and in public advertising. Moreover, the percentage of the aggregate value of investments owned by physicians (as opposed to nonphysicians) in a given POH was capped at its March 23, 2010, level. The act also limits the terms of physician investment to prevent inappropriate behavior, prohibiting, for example, lending money to finance physician investment in POHs or requiring physician-investors to meet referral quotas [24].
(c) Emergency services. Also included in the ACA are regulations addressing patient safety concerns regarding insufficient emergency services in POHs. POHs that lack 24-hour physician availability are required not only to disclose this fact to their patients but also to obtain written acknowledgment that the patient understands. Moreover, POHs must “provide assessment and initial treatment for medical emergencies and have the capacity to refer and transfer patients to full-service hospitals, if necessary to treat a patient’s emergent condition” [20"
I do not think any of the above requirements are unreasonable. In fact I agree with them. They also restrict the percentage that a doctor can hold in investment in the hospital, which seems like a good idea also. The problem appear to be that these small hospitals are really only interested in the higher paying insurance policies and healthier patients, and in performing high cost operations. So they have created a rather unfair competition against hospitals in their favor, as hospitals can not discriminate in this fashion.
The ACA law also lifted the patient bed room to proceedure rooms by 200% if the hospital would include a percentage of medicaid patients, which they to date have not embraced.
I think the question remains in your argument, was the ACA trying to prevent additional escalation of health care costs by physician ownership in future years, or were they merely trying to protect the larger hospitals, or even perhaps a little of both, which is what I would wager on.
The intent is the real argument here. If the small specialty hospitals are allowed to take the cream of the crop of the patients who produce the largest financial renumeration away from the hospitals, while leaving hospitals with the uninsured and less costly procedures - is this really allowing for a monopoly in the true sense? As long as we must have for profit health care, competition is good I agree, but it appears unrestricted, these "preferred" physician owned hospitals could destroy the financial viability of hospitals, which could have a large negative impact on citizens. I don't really have the answers. So much is conjecture now.
Unfortunately, if you have read any of my previous posts you know that I am against medical care for profit. Not only do I feel that it does nothing to contain costs, but it is a unique commodity unlike any other that should not be run for profit. So obviously I am biased in this area.
Patients and families don't really care about the numbers, they seek quality. If you have specially trained MD's and RN's who are better at what they do, they will be recommended to those people who can afford it. These doctors typically are either very good and or smart and have better outcomes than say an urban hospital.
While you are "against medical care for profit" bear in mind when the profit is taken out of the equation in many cultures, not all, but many, the financial incentive is gone. This means that when you enter a hospital in England on the weekend with a ruptured appendix you will be operated on by a 2nd year intern. On Monday it will be the supervising MD. The supervising MD is not coming in on his weekend. Here its' quite different because the MD is Paid for showing up and most surgeries will be guided by an attending fully fledged MD as the interns assist with surgery. The outcomes can be quite different. In Alaska where managed care HMO does not exist each MD is paid the full amount for a procedure. In taking care of many who are medvaced off shipping and fishing boats who live in other parts of the world including Canada, the care provided here according to loved ones is just simply better. Now bear in mind that is for emergency procedures. In other countries for routine care Canada France Japan and others do better at both serving the patients and keeping costs down, both fixed costs and costs of service. Kaiser here in the US emulated that model and for long term disease management they do well. Something to consider in your thinking perhaps. Finally, keep in mind that patients don't give a rat's ass* about who when and where. They want to survive and be well. That is the true shame of the ACA that it really does not touch on the education of patients pre hospitalization. Still the equation is build a hospital at the bottom of this cliff NOT a fence on the edge of it. You can blame the profit motive but the paradigm is deeper economically than that. Your argument is valid about the problems with for profit with the caveat above as stated. However in the long term you are talking about economic substitution and when one wants a burger you have many choices. Typically you have one maybe two for a hospital. That is where the rub comes. Why should people get paid more for a procedure at hospital A than hospital B when a patient has no options. You MUST see a surgeon. So yes valid on paper, but in the real world of talent, infection and outcomes paying more for success has impact on one's life not just potentially getting a better burger. In the former you might die and in the latter that is not so much the case.
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