Affordable Care Act Woes (Obamacare)

[Lowe]

@ PS

It sounds like a positive feedback loop leading to higher prices over time.  As more out-of-pocket consumers get priced out, we hear more talk of socialized medicine, of which ACA is the beginning.

It was probably gov't regulations that got the whole thing started.  Do you think the price of a bumper or a car door could've gotten so high if people weren't compelled to sign up for a certain amount of auto insurance?  If not for that, the insurers would all have a great big competitor named no thanks, which would would bid down premiums, and body work prices with them.

[Pointedstick]

@ PS

It sounds like a positive feedback loop leading to higher prices over time.  As more out-of-pocket consumers get priced out, we hear more talk of socialized medicine, of which ACA is the beginning.

It was probably gov't regulations that got the whole thing started.  Do you think the price of a bumper or a car door could've gotten so high if people weren't compelled to sign up for a certain amount of auto insurance?  If not for that, the insurers would all have a great big competitor named no thanks, which would would bid down premiums, and body work prices with them.

Oh of course. I agree with you 100%. I'm just wondering who's benefiting from this cycle of rising prices. Universities and pharmaceutical companies are good candidates, Tyler, but it can't just be them, can it?

[Bean]

@ PS

It sounds like a positive feedback loop leading to higher prices over time.  As more out-of-pocket consumers get priced out, we hear more talk of socialized medicine, of which ACA is the beginning.

It was probably gov't regulations that got the whole thing started.  Do you think the price of a bumper or a car door could've gotten so high if people weren't compelled to sign up for a certain amount of auto insurance?  If not for that, the insurers would all have a great big competitor named no thanks, which would would bid down premiums, and body work prices with them.

Oh of course. I agree with you 100%. I'm just wondering who's benefiting from this cycle of rising prices. Universities and pharmaceutical companies are good candidates, Tyler, but it can't just be them, can it?

I have family in the insurance industry and they always talk about the very slim profit margins.

What if there is no one getting rich, just health care tech and the corresponding expense are just growing faster than everything else around it?

[clacy]

@ PS

It sounds like a positive feedback loop leading to higher prices over time.  As more out-of-pocket consumers get priced out, we hear more talk of socialized medicine, of which ACA is the beginning.

It was probably gov't regulations that got the whole thing started.  Do you think the price of a bumper or a car door could've gotten so high if people weren't compelled to sign up for a certain amount of auto insurance?  If not for that, the insurers would all have a great big competitor named no thanks, which would would bid down premiums, and body work prices with them.

Oh of course. I agree with you 100%. I'm just wondering who's benefiting from this cycle of rising prices. Universities and pharmaceutical companies are good candidates, Tyler, but it can't just be them, can it?

Easy..... Lawyers, politicians and lobbyists.  Just look at the rise in median household income in the Greater DC area since the recession.  The chart looks quite different than that of the US as a whole.

[WiseOne]

@ PS

It sounds like a positive feedback loop leading to higher prices over time.  As more out-of-pocket consumers get priced out, we hear more talk of socialized medicine, of which ACA is the beginning.

It was probably gov't regulations that got the whole thing started.  Do you think the price of a bumper or a car door could've gotten so high if people weren't compelled to sign up for a certain amount of auto insurance?  If not for that, the insurers would all have a great big competitor named no thanks, which would would bid down premiums, and body work prices with them.

Oh of course. I agree with you 100%. I'm just wondering who's benefiting from this cycle of rising prices. Universities and pharmaceutical companies are good candidates, Tyler, but it can't just be them, can it?

Easy..... Lawyers, politicians and lobbyists.  Just look at the rise in median household income in the Greater DC area since the recession.  The chart looks quite different than that of the US as a whole.

1. Pharmaceutical companies.
2. Insurance companies.
3. Medical device manufacturers (though they now face some additional tax - so this is not entirely clear).
4. Hospitals (meaning CEOs - if you work for a hospital chances are you are severely underpaid).
5. Outpatient service companies - but again, the directors not those who work for them.

Doctors are seeing income decline and expenses go up.  Yes, physician reimbursement often does not cover expenses depending on insurance - Medicaid and GHI are the two worst offenders.  Mine is already low since I'm at an academic center with a large Medicaid patient population and has stagnated (no raises x 10 years).  I don't do much clinical work anymore aside from teaching services.  I've chosen to focus on research instead.  Way more interesting, pays just as well, and I have far better control of my time.  Of course it's also very risky, so becoming financially independent is a very important part of that strategy.

I know of many doctors heading for the exits, although there are many who remain out of sheer dedication (and a lack of imagination).  Still, be thankful for those guys.  In a way I'm one of the ones who has sold out.

[Reub]

WiseOne, you have not sold out. There is absolutely nothing wrong with following your own self-interests, whatever they may be (within the law, of course). 

[Tyler]

I have family in the insurance industry and they always talk about the very slim profit margins.

Well the petroleum industry also operates on very thin margins, and they still have huge revenues.  When the margins are that thin, one method to maximize profits is to drive up prices and usage in the system as a whole.  It becomes a game of throughput.  1% of a trillion dollars is a freaking lot of money.

[WiseOne]

Thanks Reub!

Depends what you count as profit.  If profit margins are slim after paying salaries, perks, bonuses, dividends etc, that's doing pretty well in fact.

[WiseOne]

A friend sent me this article.  Nice summary of one of the finer points of the government "quality improvement" mandates.

http://www.forbes.com/sites/kaifalkenbe ... ur-health/

[WiseOne]

The point is that consumer ratings are a poor indicator of health outcomes and cost effectiveness.  It should have caught your attention that both costs and iatrogenic injury (specifically, excess deaths due to unneeded procedures and medications) have increased.  Is this ok given that the patients involved were very happy with their care?  I gather that your answer is "yes" on the theory that the customer is always right.  Then why bother with medical research comparing health outcomes, when said consumer will never read those studies, and performance metrics are based on how willing a doctor is to prescribe Dilaudid?

I think it's perfectly fair for patients to rate doctors and their staff on personability, bedside manner, attentiveness, response to phone calls etc.  But not on choices of treatment.  That presumes that the patient knows at least as much about diagnosis & treatment as the physician, which is absurd.  It's not like picking out a mattress at Sleepy's.  The guy at Sleepy's doesn't need to tell you things you don't want to hear, like "No, an antibiotic won't help your cold", or "You need to stop smoking and lose weight", or "You need to take this medication because if you don't, your risk of <X> increases dramatically."

But yes, we've been aware of how the winds are blowing for quite some time, but there's nothing we (as individuals) can do about it except vote with our feet.

[ns3]

But yes, we've been aware of how the winds are blowing for quite some time, but there's nothing we (as individuals) can do about it except vote with our feet.

And those who are saying it is a good thing that Obamacare frees people from indentured servitude to their employers should have no philosophical problem with you doctors voting with your feet.

[Tyler]

And those who are saying it is a good thing that Obamacare frees people from indentured servitude to their employers should have no philosophical problem with you doctors voting with your feet.

You're absolutely correct.

Freedom of choice is a great thing.  One should not confuse an independent desire to do away with anachronistic rules that distribute health insurance primarily through an employer (and instead allow it to run like every other insurance market) with a financially unsustainable desire to screw up healthcare and doctor choice through tiered subsidies and government (mis)management.  Obamacare is still clearly a bad law, but there are narrow things it addresses in a positive way that I do think need to be looked at if it is ever repealed or rewritten.

[WiseOne]

Well said Tyler!

A good health care reform law IMHO would divorce health insurance from employment, and also keep (or find alternative good solutions for) several of the Obamacare provisions like doing away with pre-existing conditions and finding a way for individuals to get the same insurance plan pricing benefits that big companies get.  And I get PointedStick's critique about over-insurance leading to price inflation, although it's a lot more complicated than that because federal regulations (FDA/JCAHO/OSHA etc) and malpractice lawsuits have more than a small role in the matter.  I see lots of editorials in the NY Times claiming that malpractice has a negligible effect on health care costs, but I expect they are written  by people with a serious vested interest in keeping the malpractice system intact (e.g. malpractice lawyers).  However, I would bet that its impact is dwarfed by that of FDA and JCAHO regulations.

[Reub]

The problem is that these "narrow things that are addressed in a positive way" are not addressed narrowly. In fact they are addressed in the widest way possible and at tremendous cost to this country in treasure and in freedom.

[Tyler]

The problem is that these "narrow things that are addressed in a positive way" are not addressed narrowly. In fact they are addressed in the widest way possible and at tremendous cost to this country in treasure and in freedom.

Yep.  I agree.  I'm confident there are much simpler and more transparent ways to address problems like lack of insurance portability than the legislative monstrosity we're dealing with now.  What it will take for government to let go of the pure politics of it and address these problems reasonably and effectively is beyond me. 

[Libertarian666]

The problem is that these "narrow things that are addressed in a positive way" are not addressed narrowly. In fact they are addressed in the widest way possible and at tremendous cost to this country in treasure and in freedom.

Yep.  I agree.  I'm confident there are much simpler and more transparent ways to address problems like lack of insurance portability than the legislative monstrosity we're dealing with now.  What it will take for government to let go of the pure politics of it and address these problems reasonably and effectively is beyond me.

Oh, that's easy: total collapse of the system!

[Pointedstick]

"Gallup: Few Americans Say Healthcare Law Has Helped Them"

PRINCETON, NJ -- About one month after the new healthcare exchanges closed with over 8 million new enrollees, there has been little substantial change in Americans' perception that the healthcare law has helped them. Most Americans say the law has had no impact on their healthcare situation, while those who do perceive an effect are more likely to say it has hurt them rather than helped them.

http://www.gallup.com/poll/170756/few-a ... elped.aspx

Not a good graph for the president or Democrats more generally.

[MachineGhost]

Another network and another layer of bureaucracy for Obamacare, not to mention the new "mandatory participant" guneia pig layer networks and bureaucry for dual Medicaid-Medicare enrollees, and it just does not look like bureaucracy can ever solve a problem.  So even a conservative philosophy to healthcare will not work if government is involved.