(no subject)

[enders-shadow.livejournal.com]

So the other day I was hanging out with some of my liberal-leftist-commie-pinko-socialist-anarchist friends. (You decide if that's the appropriate adjective for one of my friends, all of them, or each friend has some combination of those. Enjoy.)

One of them was all happy about John Roberts (he went so far as to call him a "hunk") going to bat for the ACA. According to my buddy, the ACA is indeed going to help Americans, long term, by essentially eliminating for-profit healthcare in the US.

What what what? My ears perked up as he spoke. I'm in favor of single-payer, UHC, cause nobody, no matter how poor or irresponsible, should die cause they can't see a doctor or get the needed meds or required surgery, cause they can't afford it. Life is more important than money. Full stop.


So, he said that the ACA would bring about (essentially) the end of for-profit healthcare in the US. He says this because of the part of the bill that requires a specific % of money collected by spent on actual patient healthcare. This %, iirc, is around 80%. Which means if a company pulls in $100M, it MUST spend $80M on patient healthcare, OR--it must REFUND the money over that %.

That does, to me anyway, sound like a cap on the profitability of healthcare. That sounds like a good start.

My friend was explaining that yes, they can make a little on the top, but such a small amount that it's not terribly profitable and eventually, the healthcare market will be able (and willing, cause there won't be monied interests fighting against it) to collapse into a single-payer style system.


Now, I'm no expert on the ACA, healthcare or insurance. But this sounds good to me. This sounds right. And it sounds like one reason I should actually THANK Obama for this HCR. There were moments when I viewed it as a gigantic handout to the insurance companies--requiring us all to go buy their shit. But with this requirement about spending a certain % on patient care, I no longer see it as a corporate handout.

I'm curious: do you see the mandate regarding a certain % being spent on patient care or else there must be a refund as a good thing or a bad thing? (c'mon you greedy fucks free market libertarians, explain why companies should be allowed to make 80% profit off my illness)
Also, do you see this as being the slow road to the elimination of for-profit healthcare in the US?

And finally, on the whole, are you happy or unhappy with Obama for his HCR? What, specifically would you want done different?

Comments

[badlydrawnjeff.livejournal.com]

I'm curious: do you see the mandate regarding a certain % being spent on patient care or else there must be a refund as a good thing or a bad thing?

A bad thing. It assumes administrative costs are static, assumes "non-care" costs are actually not going toward care, and puts bureaucracy ahead of running a business.

(c'mon you greedy fucks free market libertarians, explain why companies should be allowed to make 80% profit off my illness)

There's no reason why they shouldn't.

Also, do you see this as being the slow road to the elimination of for-profit healthcare in the US?

I'm hesitant to outright say that it was the overarching goal even if it was the goal of some (http://www.youtube.com/watch?v=QLm9t9j-qKM). There are many reasons to repeal the bill, and this is one of them.

And finally, on the whole, are you happy or unhappy with Obama for his HCR? What, specifically would you want done different?

Obviously unhappy. The necessity is for the government to get out of the way, as they're driving the costs upward more than anyone else is. Less government involvement and fewer government incentives would be better on a whole.

[enders-shadow.livejournal.com]

"There's no reason why they shouldn't."

Yes there is.
It's called morality.
Are you familiar with the concept?

[enders-shadow.livejournal.com]

Specifically, how does the govt drive up costs?
Let's use two examples:

If I need a root canal, how does govt drive up costs?
If I need surgery, as I did once, because I had a pilo-nydal cyst and abscess, how does the govt drive costs up?

These are two real world examples, not terribly far fetched, so I'm sure you'll be able to explain how these things are more expensive because of the govt involvement, right?

[chron-job.livejournal.com]

> It assumes administrative costs are static

Why do you think it assumes that?

> assumes "non-care" costs are actually not going toward care

That's the definition of non-care costs, yes. I often find myself assuming that words mean what they are supposed to mean. Of course, I'm sure many insurers would like to cover every dime they spend as going toward care. There is explicit language in the ACA to 1) Create a process for Insurance providers to appeal to if they feel a certain expenditure is a care cost, and should not count in the Medical Loss Ration, and 2) Unlike most state definitions of MLR, the ACA's overtly exempts some non-care activities under the heading of "Quality Improvement", e.g. "improvement activities must lead to measurable improvements in patient outcomes or patient safety, prevent hospital readmissions, promote wellness, or enhance health information technology in a way that improves quality, transparency, or outcomes." that's pretty inclusive.

> and puts bureaucracy ahead of running a business.

No. It USES bureaucracy to put CARE ahead of running a business.

> There's no reason why they shouldn't. [make unfettered profit off of illness]

The current state of affairs argues otherwise. Market forces are already distorted in this arena by federal legislation mandating care for those in need. If you want market forces to control medical costs, you must repeal the "Emergency Medical Treatment and Active Labor Act" of 1986 (passed under Regan, a Republican Senate, and a Democratic House), and convince the U.S. voting population that it is ethically acceptable for hospitals to throw people on the street to die, if they can't make the bill. Most consider that a reprehensible abandonment of moral values. But, until that abandonment can be 'sold' to the American people, medical costs will continue to be distorted and will require regulatory correction.

[fizzyland.livejournal.com]

The irony being that America's health care services cost(hospital billings, pharmaceuticals, etc.) are extremely high, putting the lie to your claims that government needs to get out of the way.

Where is an example of your privatized, low-cost health care system?

[kylinrouge.livejournal.com]

I always wonder in these kinds of arguments what's so unique about the US government that drives prices up that's not seen in any other government.

[policraticus.livejournal.com]

Why is profit bad?

[enders-shadow.livejournal.com]

Why do the poor deserve to die?

[fizzyland.livejournal.com]

When it leads to spending more money for poorer outcomes. As in the American health care system. We already spend more per-capita in government funding than our competitors, who somehow manage to not only spend less but cover all their citizens.

[dexeron.livejournal.com]

Thing is, it's not as simple as "PROFIT BAD, ALTRUISM GOOD". It's a little more nuanced.

There's a reality show that has people pitch ideas to venture capitalists. Long story short: Guy had a great idea for a product. EVERYONE liked it. But his one "will not budge" line was that it HAD to be made in the U.S.

No one would bite. In fact, one of the capitalists expressed regret; he wanted to fund it, but couldn't figure out a way for HIM to make it profitable. However, the other capitalists could have made a profit off of it. . But none wanted to. See, in the U.S.. they couldn't make as BIG a profit as they would if it were manufactured in China. So they passed on a profitable venture because it wasn't EXPLOSIVELY profitable.

This is kind of what we're getting at: profit is not enough anymore. It has to be OBSCENE PROFIT. It's not enough to make money. To make a profit. It has to be SUPER PROFIT. EVERY QUARTER has to be higher than the last. Bubble after bubble. Stocks must go up up up up, or the board/shareholders/whatever will get angry!

It's not sustainable. SOMETHING has to give. And right now, what's giving are the people whose backs this house of cards is being built upon.

Metaphor: Farmers know how to plant and till the land. How to care for food animals. They know not to OVERUSE the soil. They know how to manage their herds so they don't run OUT of animals. Lumber companies know to cut a certain amount of trees, plant a certain amount, because working in an unsustainable fashion will bite them in the ass when they run out of trees. Pursuit of short term profits above all will lead to greater losses down the road.

What we're complaining about here is that there is no such concern for sustainability in the economy (be it healthcare, banking, etc) when it comes to profit.

At some point, yes, PROFIT IS BAD. And heaven help me, I know someone is going to call me a freaking communist for daring to say: "What the hell, what they're doing may be legal; there might be nothing 'objectively' wrong with it; but for crying out loud, it's so obviously irresponsible in its ripple effects outwards - and in terms of long term sustainability."

Responses about "punishing success" are missing the point. And it's not a matter of "this is the prescribed upper limit on how much profit any one person can make". But at some point, people have to stop falling back on the same old tired defense of "why is profit bad?" and look at the aforementioned profit IN CONTEXT. In terms of morality, self-interest (beyond the short term) and sustainability.

[yes-justice.livejournal.com]

Because it leads to those who cannot afford basic needs clogging up the streets with their diseased and deceased bodies.

Consider those Chinese girls being forcibly aborted - instead their homeless, starving and/or sick. They cannot afford to line your pockets so their basic needs are unmet. Isn't that worse than that other earlier but perhaps more merciful death?

[kylinrouge.livejournal.com]

What, specifically would you want done different?

Well, a public option would've been nice.

[enders-shadow.livejournal.com]

OK, I can see that. I'd have liked that too. But as it stands, do you see the % cap as being a big deal as my friend does?

I mean, he was going on and on about how the ACA is going to, in the long run, completely transform the US healthcare system. What's your take on that part of it?

[fizzyland.livejournal.com]

Congress to Waste Everyone’s Time by Repealing Obamacare Again (http://www.npr.org/2012/07/09/156474493/gop-to-make-31st-attempt-to-repeal-obamacare-act)

According to NPR, this will be the 31st time that the Republican-controlled House has attempted to repeal Obamacare in since January of 2011. That seems like a lot of time and taxpayer money to waste on symbolic votes. It almost seems like we're paying these guys to run 2-year-long reelection campaigns consisting of meaningless grandstanding on CSPAN and interrupting the State of the Union.

It's a good thing America doesn't have any real problems right now!

[enders-shadow.livejournal.com]

Well, obviously.

This is why my cat would be a better congressman than some 30% of congress.
I'm hesitant to say more than 30%, cause my cat does have a habit on pissing on things.
At least most of congress doesn't DIRECTLY piss and shit on things. Only indirectly.

[badlydrawnjeff.livejournal.com]

Maybe if the Democrats would pass the repeal, the Republicans wouldn't have to keep offering it.

[devil-ad-vocate.livejournal.com]

Clearly, they need to be spending more time naming post offices.

[caerbannogbunny.livejournal.com]

My thoughts on the 80% limit...

It makes scale very important, both in market size and in time. You can't build a business on a small scale--both short time-frame to their cycle or small overall scale--that can reflexively handle it's entire administrative budget being radically changed based on what people's health outcomes are this week. This means--to be functional--any insurance company in that market needs to be huge--where it can afford to soak up periods of running in the red without failing--built on a very long cycle--to absorb the variability from the "market"--or be part of a larger business that can kick funds in when needed. So, essentially, you've just pruned off the ability for smaller companies to compete with larger companies.

However, that all changes when you can control the costs of healthcare in terms of prices etc. At that point, the 80% is meaningless beyond a reporting number. Which--in old-school terms--is called a monopoly. And--while monopolies have an advantage on the administrative side of the house--on the purely economic side of the house, they function as a pump controlling where the money goes.

Which means--as a universal healthcare system--you could actually rein in healthcare costs nationally except for one small problem...

You're depending on a relatively small cadre of professionals with a lot of options as to what they want to do and where they want to practice. We already have a huge problem with getting enough general practitioners and primary care physicians--to the point of bleeding off a pretty sizable number of nurses who are also in demand to be trained as nurse practitioners and/or physician's assistants. The reason why is medical students have an option of choosing a specialty--which pays more under the current system--or general practice and they are more often opting to spend more money and time to become specialists.

By artificially manipulating the amount of money in the healthcare system through a single-payer monopoly, the opportunity to recoup such expenses to become doctors or the profitability of the profession overall decreases and doctors (or potential doctors) are much more likely to apply themselves to either another line of work or to move somewhere with a reasonable expectation of income. Compensating for this shift can be done, but generally by either supplementing the amount of healthcare funds going towards medical training and staff (i.e. supporting the profitability of the medical profession) or by creating a system that requires less doctors and more reliance on other medical decision-makers. Either way, compensating means increased competition in the healthcare budget between paying doctors and things like medical infrastructure (clinics, etc.), medical logistics (supplies, medications, etc.), and non-doctor provided medical care.

So, overall, I think the primary beneficiaries of such a limitation are going to be the large mega-corporations with insurance arms, scientific research (a potential alternative to medical practice for medical students/doctors), and the healthcare systems that still have a competitive market for medical providers. Although, medical research--especially pharmaceuticals--under a "non-profit" healthcare system will likely stagnate or shift off-shore with the profits in that industry being more driven by identification and marketing of new drugs/treatments. (Can't really price fix what you can't buy.)

The downside, of course, is we'll get the healthcare system we pay for...

[caerbannogbunny.livejournal.com]

What what what? My ears perked up as he spoke. I'm in favor of single-payer, UHC, cause nobody, no matter how poor or irresponsible, should die cause they can't see a doctor or get the needed meds or required surgery, cause they can't afford it. Life is more important than money. Full stop.

The problem with the logic is it depends on available doctors and medication which is where the problems in many of the universal healthcare systems come from. Especially in those countries that try to supplement their number of doctors by offsetting the cost of medical school only to lose them to countries that pay physicians better. In that case, unless the conscript medical professionals and/or assign them to be doctors, train them, and make severe consequences if they do not practice, you're still competing in a free society with other professions that might allow a person with those skills and aptitudes more profit in terms of money and quality of life.

What your friend is ignoring--in other words--is the incentives for the people forming critical elements in the system.

[737-700.livejournal.com]

A single payer universal system doesn't mean taking the profit it out of healthcare. Canada is single payer(government acts as the insurance company) but the doctors are mostly in private practice, most of the labs are private companies, the pharmacies (prescription drug coverage is largely not covered by the universal system, so you pay cash or have private insurance to off set the costs out of pocket, but there is some gov't assistance.).

There is plenty of profit to be made in a single payer system, but atleast the entire population is covered regardless of how much money one has.

I dunno, but for me when I was living in Canada, it was super nice not paying hundreds a month in healthcare related expenses. My medication alone in the US is pushing 300 a month (120 in Canada).

[enders-shadow.livejournal.com]

When I say single-payer, I suppose I use it as short-hand for "govt payed for healthcare for any citizen who wants to see a doctor"

And thus there is a single payer for the doctor. The govt. The one that is of the people, by the people, for the people.

I don't get all this UHC is socialism/anti-american. Why don't we want to heal our neighbors? What sort of absurd sickness do we as a country have? Let the poor die? God aught strike you dead for such blasphemy, oh Christian nation! /rant

But I do understand that single-payer does not outlaw, nor should it outlaw, private practice of medicine. And private practice can make LOTS of money.

And if you got the money and WANT to cut the waiting list line, go see your private doc. If not, wait with all the other patients who need the thing you are waiting for--and, of course, if your situation becomes DIRE and you NEED it sooner, you get it sooner.

[merig00.livejournal.com]

http://www.bloomberg.com/news/2012-01-05/health-insurer-profit-rises-as-obama-s-health-law-supplies-revenue-boost.html

Basically it's another rent-seeking law. The health care law guarantees private insurance companies millions of new customers--and billions of dollars in government subsidies for those customers. But it doesn't guarantee that insurers will provide adequate coverage to those who buy mandated policies.

[yes-justice.livejournal.com]

This was my perception as well but it DID cover more people and does have other tangible benefits.

I have had no health insurance and I am still paying for it. Sucky is still better than nothing.

[gunslnger.livejournal.com]

yes, they can make a little on the top, but such a small amount that it's not terribly profitable and eventually, the healthcare market will be able (and willing, cause there won't be monied interests fighting against it) to collapse into a single-payer style system.

More like it'll just collapse, and then we all get nothing. Brilliant plan.

[yes-justice.livejournal.com]

Is that a prediction?

[yes-justice.livejournal.com]

According to my buddy, the ACA is indeed going to help Americans, long term, by essentially eliminating for-profit healthcare in the US.



I am skeptical of the power of the ACA to so thoroughly limit profits. These boys are pros.

[underlankers.livejournal.com]

Honestly, I'd find GOP protestations on the evils of this idea more sincere if they hadn't invented this supposed gateway drug to the Gulag and Stalinist Hell themselves first. This says nothing about the idea itself, however.

[merig00.livejournal.com]

And that was an idea at Heritage Foundation some 20 years ago which was since abandoned.
http://www.usatoday.com/news/opinion/forum/story/2012-02-03/health-individual-mandate-reform-heritage/52951140/1

[factotum666.livejournal.com]

I pretty much stopped at "life is more important than money". A statement with exactly zero meaning, and designed only to rouse various groups of rabble, that is people who, like the author do not, or can not think carefully.

What does important mean? Who judges that? How is it measured?
What does life mean? whose life? what kind of life?
Money? Whose money?

Still do not get it? Ok... Contrary to the views of the author, we live in a world of finite resources, and one can not address any situation without the use of those resources. Also we are all going to die, it is just a matter of when, and what happens before then. The statement "life is more important than money" says nothing about the above facts of the situation. Nor does it address responsibility.

How much money should be spent replacing the liver of an alcoholic who has never been self supporting?
How much money should be spent saving the life of a 90 year old with terminal cancer? 10K/day for an ICU?
How much medical resources should be devoted to treating a person who is 200 lbs overweight, and has diabetes, but really really likes to eat?

Given our current technology, it really is possible to have 1/2 the gdp devoted to "health care" We will just neglect the fact that above a level that is about 1/3 of what we now spend, the more that a community spends on health care, the less healthy are its residents.

And I have not begun to discuss the mess that is our food/gov/industrial complex, or the disaster that is the FDA in regulating drugs and making us all "safer"

(frozen) (no subject)

[enders-shadow.livejournal.com]

this comment is painfully dumb.
and the author of it should............

your welcome, mods.