Obamacare: Say goodnight, Gracie...

[Libertarian01]

The frightening thing is I've heard and read politicians show-casing the fact that the healthcare industry is experiencing record growth in employment and in some areas is the largest employer. I even heard one clueless liberal on NPR saying healthcare was the new manufacturing and people should retrain to seek jobs there. Healthcare manufactures nothing and adds nothing to the economic bottom line, it is only a drag on the overall economy (though a somewhat necessary one). No one seems aware (or at least willing to admit) that there is a hard upper limit to the share of the economy that health care can absorb before it all comes off the rails

Sometimes, in my more cantankerous moments, I think it should be turned into a regulated monopoly like water and electricity. The 'all the traffic will bear' mentality for something everyone will need eventually bothers me.

I can see where the NPR guy was coming from. Is it "manufacturing" per se? No. But is it the industry that has replaced manufacturing for high paying, large growth jobs? Yes. So in that sense he is correct.

The problem is that we could do much more with much less. The drivers for cost are not the standard issue free market supply & demand. Their fees have nothing to do with their costs or the supply. Their costs are based upon a bloated inefficient system that is unsustainable in the long run, yet no one wants to see that.

In a normal manufacturing business the company makes a widget for $X, and may add a very small percentage for profit, so let's say $X+5%. If someone wants to come along and negotiate a large scale purchase the manufacturer can reduce the cost to $X. If someone wants a really large purchase the manufacturer can go to his accountant, do some math, and maybe come up with $X - 3% and still make a small profit, but that is as far as he can go.

The same basic principle can apply to large segments of the service industry. In landscaping the normal charge might be $X / hour to mow and landscape a yard. However, if a large building complex comes along the landscaper may be able to reduce the cost to $X - 10% due to the fact that he is staying in the area longer and reducing other costs, but the landscaper STILL is aware of his fixed and variable expenses to the point that he should know where he will begin to lose money.

The health care industry has no real idea of the $X to charge for any procedure or service. Only in those areas like laser eye surgery or lab tests which have become more free market does supply and demand begin to exert strength, and thus de facto price controls without government interference or regulation. Laser eye surgery has their costs down to a science as most of it isn't covered by insurance, thus patients shop around.

Someday the bubble will burst on the health care industry. They will no longer require damned degrees for a variety of tasks, but go to certificates that are cheaper and shorter to attain. This will then drop the cost of services and labor prices will fall as well.

The same thing will go when we finally start allowing the import of prosthetic devices. When foreign competition will do to Warsaw Indiana what the foreign automotive industry did to Detroit when gas prices rose in the 70's. Only with outside pressure did true innovation begin and a free market system begin to take place.

Until we get real reform the health care industry has in a sense replaced the manufacturing industry of the 50's as the field to get into for good pay and good benefits. The problem is I want that to end, and right quick.

Regards,

Doug

 

[PaulF]

I think people on the "Right" are (now) aware of the fustercluck we're in. Justice Roberts hosed us. What's going to take more time, is for Liberals to realize how badly they're screwed.

Liberals are going to spend 6 months celebrating non-repeal of the law, another year anticipating the midterms, then the next two years searching for a "Bernie" candidate to promise them Single-Payer. It will be at least 4 years before they reach the conclusion I've / we've reached: that Obamacare is an entrenched government-industry partnership designed to create revenue flows to insurance companies. And the Republicans now have 4 years of full control, with lobbyists knocking on their office doors every day, to entrench the arrangement.

"Coverage for the Poor" was the bait used to lure Progressives in. Afterward, Conservatives spent 6 years thinking "We'll get Repeal." Liberals will now spend another 4 thinking, "We'll get Single-Payer." We will be a full decade into entrenchment of this Military-Industrial complex, before both sides fully realize that absolutely nothing can be done about it. "Everybody" will have coverage, Insurance Companies will be the Government Contractors for implementation, and all the damages of that promise/arrangement will accrue to the National Debt. Once everybody's "nut is covered," there will not be any one single constituency with enough pull to successfully push for Single-Payer.

So don't celebrate too hard, Liberals. It turns out your last hope for the system you wanted, was the same as Conservatives': Justice Roberts striking the current law down. He was a reliable vote for corporate oligarchy. While you were celebrating Obama's historic Supreme Court victory, he was laying the final brick of a new Military-Industrial complex right under your noses. Obamacare isn't going to be the downfall of your much-hated enemy, the Insurance Companies; to the contrary, it's going to ensure their existence forever.

You and I have bumped heads on other topics, I think.

Not here, not one bit.

I think you see the issue with clarity, and your post speaks to one of the main pillars of this issue.

I think there is an argument to be made for government-provided healthcare insurance. Removing the burden of providing health insurance from the employer would also remove a siginificant competitive disadvantage for that employer, especially when compared to other parts of the global labor market with lower wages and public heathcare...

...however, I think the Federal government is the poorest place imaginable to impliment this. I think that if the citizens of any given State wish to find a way to solve the healthcare question, they should be free to do so as they wish, but the idea that one system will fit every American lifestyle sounds....well, like folly.

I would like to see the states spearhead the solutions. Some might choose to lean heavily on the existing insurers, others might opt for a full single-payer model. Others might come up with something better than any option we see before us today.

Obamacare stuck us with a Master/Puppet relationship between the Government and Big Insurance with no clear way of telling what strings are being pulled, or by whom. It is a lose/lose/lose...unless you are a large shareholder or beureacrat.

Meanwhile, I got my coverage through the marketplace, and I am terrified of what the next few months will bring.

 

[BugI02]

I cited the idea of health care as future employment center for two reasons that concern me

1) As I stated, health care is essentially a service industry. It creates no product of intrinsic value that can be marketed around the world (with a few exceptions). Thus it is a drag on the companies that do produce such hard value products

2) I see no one addressing the inefficiencies developing as these providers are consolidating. My current home city is of modest size, 1 million people or so in the metro area. We have no less than three 'keiretsu' developing in competing medical conglomerates, and they all feel their group needs to offer everything. Thus we (because 'we' always pay for everything, eventually) are left to pay for 3 level 1 trauma centers, 3 stroke centers, 3 heart hospitals, 3 cancer centers and on and on (the latest is a brain and spine center which I'm sure the others will want to duplicate). So far no one has proposed a medical proton accelerator complex, but I'm sure it is on the drawing board.

I am unsure when it became déclassé to have to travel to another (larger) city to receive expensive and esoteric medical treatment but apparently it has. Multiply our situation by however many cities exist of similar size and it's no wonder health care is one of the fastest growing employment areas. Salaries are equally bloated. One of the three I'm familiar with pays its CEO $1.8million and its Director of Nursing well over $500k

Since consumers are limited in the amount that they can control demand (can't really shop around for treatment while in the throes of anything acute such as a heart attack or stroke), this monster will run out of air at the supply end when its boundlessly escalating costs finally 'break the bank'

 

[Alpo]

The frightening thing is I've heard and read politicians show-casing the fact that the healthcare industry is experiencing record growth in employment and in some areas is the largest employer. I even heard one clueless liberal on NPR saying healthcare was the new manufacturing and people should retrain to seek jobs there. Healthcare manufactures nothing and adds nothing to the economic bottom line, it is only a drag on the overall economy (though a somewhat necessary one). No one seems aware (or at least willing to admit) that there is a hard upper limit to the share of the economy that health care can absorb before it all comes off the rails

Sometimes, in my more cantankerous moments, I think it should be turned into a regulated monopoly like water and electricity. The 'all the traffic will bear' mentality for something everyone will need eventually bothers me.

When I was a kid, there was a gas station on every corner (it seemed). Now there is a drug store on every corner. Health care has become a major component of GDP.

 

[Libertarian01]

I cited the idea of health care as future employment center for two reasons that concern me

1) As I stated, health care is essentially a service industry. It creates no product of intrinsic value that can be marketed around the world (with a few exceptions). Thus it is a drag on the companies that do produce such hard value products

2) I see no one addressing the inefficiencies developing as these providers are consolidating. My current home city is of modest size, 1 million people or so in the metro area. We have no less than three 'keiretsu' developing in competing medical conglomerates, and they all feel their group needs to offer everything. Thus we (because 'we' always pay for everything, eventually) are left to pay for 3 level 1 trauma centers, 3 stroke centers, 3 heart hospitals, 3 cancer centers and on and on (the latest is a brain and spine center which I'm sure the others will want to duplicate). So far no one has proposed a medical proton accelerator complex, but I'm sure it is on the drawing board.

I am unsure when it became déclassé to have to travel to another (larger) city to receive expensive and esoteric medical treatment but apparently it has. Multiply our situation by however many cities exist of similar size and it's no wonder health care is one of the fastest growing employment areas. Salaries are equally bloated. One of the three I'm familiar with pays its CEO $1.8million and its Director of Nursing well over $500k

Since consumers are limited in the amount that they can control demand (can't really shop around for treatment while in the throes of anything acute such as a heart attack or stroke), this monster will run out of air at the supply end when its boundlessly escalating costs finally 'break the bank'

I agree entirely. I think you and I are griping about the same thing in different ways.

If the free market were allowed more into the healthcare industry then we wouldn't have hospitals building massive redundancies all across the board. Just like there are only so many landscaping businesses, pet groomers, criminal defense lawyers etc that can earn a living in certain areas so too would we have it with medical services IF ONLY there were the free market.

And I know we can never apply the free market 100% to healthcare, as it is our lives on the line. If we're involved in an auto accident and critically injured we don't want the free market, we want the closest place to get critical care as time becomes the prevailing factor in survival. The same thing if we are diagnosed with certain stage 3 cancers. We don't have days or weeks to shop for the cheapest and best oncology treatment, we need to get our radiation or chemo started ASAP as time again is the prevailing factor in our survival. But we could inject the free market into a heckofa lot more into healthcare than we currently allow.

You and I have bumped heads on other topics, I think.

Not here, not one bit.

I think you see the issue with clarity, and your post speaks to one of the main pillars of this issue.

I think there is an argument to be made for government-provided healthcare insurance. Removing the burden of providing health insurance from the employer would also remove a siginificant competitive disadvantage for that employer, especially when compared to other parts of the global labor market with lower wages and public heathcare...

...however, I think the Federal government is the poorest place imaginable to impliment this. I think that if the citizens of any given State wish to find a way to solve the healthcare question, they should be free to do so as they wish, but the idea that one system will fit every American lifestyle sounds....well, like folly.

I would like to see the states spearhead the solutions. Some might choose to lean heavily on the existing insurers, others might opt for a full single-payer model. Others might come up with something better than any option we see before us today.

Obamacare stuck us with a Master/Puppet relationship between the Government and Big Insurance with no clear way of telling what strings are being pulled, or by whom. It is a lose/lose/lose...unless you are a large shareholder or beureacrat.

Meanwhile, I got my coverage through the marketplace, and I am terrified of what the next few months will bring.

One of the primary problems often missed with the ACA is that large chunks of it have NOT been allowed to be enforced. The republicans don't want to because it would hurt (very true imo), and the democrats don't want to because it will show huge problems with the ACA (again, very true imo). Therefore, the liberals who love it are loving a product that has been severely limited on how much it will hurt.

What I believed the republicans should have done is pressed like hell to enforce EVERY aspect of the ACA as soon as it was to do so by law. They should have said, "We hated it, but you wanted it so bad HERE IT IS!" Watch as companies and municipalities go bankrupt trying to keep up. Watch as millions pay extra for not having insurance. Watch as the the system begins to buckle under the weight of this thing.

But that isn't what happened. Huge chunks have been ignored or kicked down the road by both parties for different reasons. So liberals who aren't aware of all the crap that should be happening but isn't get to keep their rose coloured glasses and see this thing for what it is not. It's like a giant monster in disguise that has invaded our society with its stench being covered up by perfume. Most everyone would know how horrible it really is if only the thing were allowed to show all of its flaws.

The liberals are living in a bubble created by BOTH democrats and republicans. They will continue to do so unless & until the ACA is fully implemented.

Regards,

Doug

 

[Leadeye]

I don't see a comparison to manufacturing considering the amount of dollars coming from tax money, companies manufacturing drugs or equipment maybe, but again how much purchased with tax money. How large an industry is it if you remove all revenue that comes from tax money like medicare, medicaid, obiecare etc, etc, etc. Connected companies and individuals are cashing in on a health/industrial complex that is increasingly being underwritten by the federal reserve.

Always follow the money

 

[Ericpwp]

What about those producers that produce for heathcare? An MRI is really complex to keep running, let alone to build. What about the producers that get a few more years of production because of heathcare?

The .gov knows to follow the money too. As the boomers start dying off, there will be more and more money spent on heathcare.

 

[Twangbanger]

Think the ACA exchanges are "doomed to fail?"

An analysis of why they're not:

The Little Death Spiral That Couldn?t | RealClearHealth

"...For better or for worse, it is nearly impossible for the ACA’s insurance exchanges to implode to the extent that its detractors have long predicted. To understand why, it is important to understand how the subsidies and regulations in the ACA work. The ACA employs “price-linked subsidies.” That is, the premium subsidy consumers receive is based on the actual prices for insurance on the exchanges. In addition, the ACA’s regulatory framework caps the out-of-pocket expenses faced by consumers.This works as follows. For those who purchase insurance on the exchange and have incomes below 400 percent of the poverty level (nearly $100,000 for a family of four), the ACA limits how much of your income you can spend on premiums. This amount ranges from 2 percent to 9.5 percent of income depending on the level of said income, under the assumption that you are purchasing the second-cheapest silver plan. Once you contribute this portion of your income towards premiums, the federal government picks up the rest of the tab. That means that even if premiums rise, once you have hit the contribution cap, you do not have to contribute more. Critically, a full 83 percent of exchange enrollees receive these subsidies. All of those enrollees are effectively shielded from future premium increases.

"...A true death spiral – one that leaves a market bereft of sellers and buyers – relies on increasing prices driving more and more consumers from a market. But what if consumers don’t actually pay those higher prices?..."

 

[ATM]

Think the ACA exchanges are "doomed to fail?"

An analysis of why they're not:

The Little Death Spiral That Couldn?t | RealClearHealth

"...For better or for worse, it is nearly impossible for the ACA’s insurance exchanges to implode to the extent that its detractors have long predicted. To understand why, it is important to understand how the subsidies and regulations in the ACA work. The ACA employs “price-linked subsidies.” That is, the premium subsidy consumers receive is based on the actual prices for insurance on the exchanges. In addition, the ACA’s regulatory framework caps the out-of-pocket expenses faced by consumers.This works as follows. For those who purchase insurance on the exchange and have incomes below 400 percent of the poverty level (nearly $100,000 for a family of four), the ACA limits how much of your income you can spend on premiums. This amount ranges from 2 percent to 9.5 percent of income depending on the level of said income, under the assumption that you are purchasing the second-cheapest silver plan. Once you contribute this portion of your income towards premiums, the federal government picks up the rest of the tab. That means that even if premiums rise, once you have hit the contribution cap, you do not have to contribute more. Critically, a full 83 percent of exchange enrollees receive these subsidies. All of those enrollees are effectively shielded from future premium increases.

"...A true death spiral – one that leaves a market bereft of sellers and buyers – relies on increasing prices driving more and more consumers from a market. But what if consumers don’t actually pay those higher prices?..."

The force backing the theft is all that props it up.

 

[ArcadiaGP]

Assuming it's a forgone conclusion... What would you be willing to trade for an American NHS system? (Ideally, 50/50 private/public)

A few decade truce for hands-off 2A?
A 100% guarantee that abortion would not be allowed within it?
Something else?

Just a thought experiment.

 

[jamil]

Assuming it's a forgone conclusion... What would you be willing to trade for an American NHS system? (Ideally, 50/50 private/public)

A few decade truce for hands-off 2A?
A 100% guarantee that abortion would not be allowed within it?
Something else?

Just a thought experiment.

Nothing.

 

[PaulF]

I'm not interested in a National Health Service here.

I am not impressed with the way our Federal Government conducts itself generally, and I have serious doubts about their ability to craft a system that serves the average American better than it serves the average partisan lobbyist.

The only place the Federal government has in the equation, in my opinion, is in acting as an arbiter should a conflict arise between the states or the people. I would like to see the individual states pursue whatever course of action seems most appropriate to their own citizens, based on what the realities of the healthcare situation are locally.

I think the burden of providing heath insurance should not fall to the employer. One of the reasons our system is in such bas shape is too many of us have grown accustomed to someone else paying for our health insurance. I think the system might look different if each citizen had to shop and purchase their own policy judged against a risk pool comprised of the entire State, and allow that citizen to use pre-tax dollars to buy it (payroll deduct). I also think its crazy that health providers are allowed to play the pricing games they are.

Example:
I have been having problems with my lower back (something about inflammation in a pelvic joint), and my "Sports" doctor (I put that in quotes because I don't watch sports, let alone play any) sent me to physical therapy. I went through my first session and asked how much the bill would be. Neither the therapist nor the manager (?) could give me a straight answer...but they did want me to commit to 12 more sessions.

How can I make an informed decision about my health and my finances when I can't even price the services I need accurately?

So, like Jamil said...

Nothing.

 

[churchmouse]

Nothing.

Ditto.

The feds do "Nothing" well. They are not in the health care business. They are actually not supposed to be in any business.

And Paul makes some really good points.

 

[Twangbanger]

The force backing the theft is all that props it up.

...and it is a strong "force," indeed, with the power to lay and collect income taxes being the one Constitutional principle we can depend on the aholes carrying out with unerring precision.

 

[HoughMade]

Not a fan of the healthcare legislation, generally, but is the pursuit of the more ideologically pure going to cost us a step in the right direction?

 

[jamil]

Not a fan of the healthcare legislation, generally, but is the pursuit of the more ideologically pure going to cost us a step in the right direction?

I don't think it's possible to get a clean repeal through both the House and Senate. And I'm not all that sure Trump would sign it if they did. But if they started the conversation with repeal, I think what would end up as the negotiated product, would be much closer to what I want than what there is now. It's like they started this negotiation with the price they thought they could get, instead of starting with more than what they'd want.

 

[ATM]

I don't think it's possible to get a clean repeal through both the House and Senate. And I'm not all that sure Trump would sign it if they did. But if they started the conversation with repeal, I think what would end up as the negotiated product, would be much closer to what I want than what there is now. It's like they started this negotiation with the price they thought they could get, instead of starting with more than what they'd want.

Always start with YOU'LL GET NOTHING AND LIKE IT!



This leaves room for negotiation on the LIKE IT part.

 

[actaeon277]

So many people in America (Democrat AND Republican) have completely forgotten what liberty is. It's just a word they say now.

I have little hope any of these non-constitutional programs will be eliminated. Only increased over time.

 

[ArcadiaGP]

Coming out now...

BREAK: House leadership now open to changes to the AHCA after learning new info about EHBs/the reconciliation process, per leadership aide. House leaders are now talking to the White House and members about the idea - this would be a big step forward w/ the Freedom Caucus.

Up to this point EHBs had been left out of the bill out of concern that they wouldn't be Byrd Rule compliant. While adding this into the bill would still certainly result in a Byrd rule challenge, info suggests it wouldn't be fatal to overall bill. Of note: no deal has been made yet, but this is now in play - and a big reason Freedom Caucus folks are preaching "optimism" now

 

[bwframe]

Happy to see the Freedom Caucus standing ground for us.

This bill or any bill that gets branded as "Trump Care," "Ryan Care" or "American Healthcare" needs to be defeated. Our healthcare does not belong to the government.