Obamacare cost...

[ERCougar]

I understand that the demand for Lasik is more elastic than many MRIs. But everyone needs to buy milk yet we don't have the same kind of problems. As you said the problem is really the fact that those who consume the good/service usually don't directly pay for it. The costs are instead spread out to employers who have no control over the health care decisions of their employees. Unlike private individuals who would have to pay for their own health care, health insurance providers can always just incrementally increase their premiums -- of course they are limited to what prices are being charged by other companies. But the reality in the health insurance industry is they all have to increase their premiums ever year or else they can't continue functioning. One can't break from the pack and dramatically slash their prices to gobble up market share because they'll be out of business quickly (and I believe there are also laws on how much they can increase their premiums from year to year).

So overall there's a lack of control over prices. If everyone had to pay for the first, say, $5,000 of their medical care every year then I can guarantee that more people would be satisfied with the no frills MRI machines that they apparently use in Japan if they had to pay half as much. The demand for the machines that also provide what presumably must be a "happy ending" (judging by how much they cost, good hell) would lessen. MRI facilities that offer cheaper imaging would come into being -- and that would be good enough for a large share of those that want or need an MRI. I imagine in larger communities there would be more price competition between different large health care facilities. Potentially smaller facilities pop up that can provide cost savings but service that is "good enough."

This is a short list of things I would change:

1. Employers must stop providing health insurance. Health Insurance must have a $5,000 deductible. Co-pays are only allowed for one doctor visit for each family member per year.

2. Patent reform. The length of a patent should be dependent on the level and cost of testing required by the federal regulatory agencies. 20 years is still proper for many pharmaceuticals due to the massive amount of money that goes into getting the drug approved by the FDA. I'm not sure if medical devices receive the same amount of scrutiny -- if they don't then the patent term should be shortened to 10 years or even 5 years depending on the cost to wrangle with regulators.

3. Tort reform. I don't think we need to necessarily limit the amounts of med mal verdicts. What we do need to do is incorporate the British system of shifting legal costs to the losing party in litigation.

By far the most important thing is #1. Much more than blood-sucking med mal lawyers and too-lengthy patents, the shifting of costs from consumer to parties that have almost no control over those costs is the main problem.

I'm sure most people read this article from Time and it doesn't begin to address the real problems: http://swampland.time.com/2013/02/21...too-damn-high/

I've only read the excerpt here and in typical journalist fashion they simply point out the massive amounts of money going into the medical industry and seem to infer the simple conclusion that everyone involved are a bunch of greedy bastards. My argument is everyone, if given the opportunity, will be greedy bastards. So the examination should then focus on how they are given the opportunities to extract 20% of this country's GDP. In my post above I mentioned (perhaps improperly) the concept of rent-seeking. The best definition I can give of rent-seeking is parties seek to extract a premium through government laws and regulation. George Will wrote a column a few months ago on restrictions in Louisiana placed on monks that were producing and selling coffins. Basically in order to sell a coffin in Louisiana, you have to be a licensed funeral home. Not surprisingly, funeral homes in Louisiana charge an arm and a leg for coffins. The monks were undercutting the funeral homes, so the funeral homes then went to the state government to crack down on the monks.

I don't think the medical industry had the resources 30-40 years ago to build these compounds described in the Time article that seem to be reminiscent of something Rockefeller or Carnegie would have built when they were alive. I think when something like that is built it connotes that they have more money then they know what to do with. Something changed and it didn't happen overnight. Rent seeking may not be the correct term to describe the behavior engaged in by health insurance companies and hospitals. Health insurance was at first voluntarily provided by employers in order to attract employees. Then it started receiving favorable tax treatment which started putting it in the realm of a rent seeking (it should be noted, that most employers are small businesses and the people who run the business obviously want health insurance so naturally they decide to get the insurance through their business). Employer provided health insurance worked fine for the first few decades after WWII but things started spiraling out of control in the 1980s. Medical device manufacturers, pharmaceutical companies, and hospitals eventually found out that you could start charging more and more and the insurance companies discovered that they could just continually raise premiums and the employers would pay it. So, there has been a massive transfer of capital from employers all over the country to the medical industry. That 20% GDP figure should shock the conscience.

I almost completely agree with you and have been championing high deductible plans, even a nationalized high-deductible coverage, with the deductible based on income, for a long time.
The problem is, as much sense as this type of solution makes, most studies have found that high deductible plans won't have all that large of an effect on health care costs. I don't know a lot of the specific methodologies and I assume that they ignore some eventualities (prices come down as they're actually *gasp* published), but I assume that the fact that a large proportion of healthcare costs attributed to an individual come in the last few months of life, when that deductible is presumably already exhausted, plays into the lack of efficacy.

[Color Me Badd Fan]

I almost completely agree with you and have been championing high deductible plans, even a nationalized high-deductible coverage, with the deductible based on income, for a long time.
The problem is, as much sense as this type of solution makes, most studies have found that high deductible plans won't have all that large of an effect on health care costs. I don't know a lot of the specific methodologies and I assume that they ignore some eventualities (prices come down as they're actually *gasp* published), but I assume that the fact that a large proportion of healthcare costs attributed to an individual come in the last few months of life, when that deductible is presumably already exhausted, plays into the lack of efficacy.

If the portion of health care that is provided to people outside of the last few months of life comes down, I just can't imagine that it doesn't spill over to the health care provided on peoples' death beds. While it does present a question as to whether high deductible plans would solve that much of the problem, it also just reiterates the point that health insurance footing the bill is a huge part of the problem.

I'm sure medicare covers a lot of these expenses and medicare limits the amount it's going to pay. So on one hand, you'd have younger and healthy people forking out up to $5k per year for their own health care before insurance covers anything. And on the other hand, you'd have essentially a single payer system covering the lion's share of those extensive deathbed medical expenses and the single payer system can dictate what they're going to pay.

My point about the high deductible plans are that younger and healthy people will get out of the habit of engorging themselves on health care they don't need. Also when there is much more of a question about everyone but Medicare's patients ability to pay (not just the uninsured), then pricing is going to have come in line with what people can afford to pay for the service, and inevitably patients will start shopping around for everything except emergency health care. A prime example is my run of the mill anesthesiologist being able to charge $1,000 for essentially 15 minutes of his time (on a procedure that he's performed hundreds if not thousands of times -- an epidural in labor and delivery -- and supposedly $1,000 is cheap). Why is there only one anesthesiology group available? Obviously the answer is because the hospital contracted with that anesthesiology group so they can then charge monopoly prices and share the enormous profits. So, what happens if a competing hospital (perhaps instead of 10 miles away, it's 30 miles away) allows patients to hire their own anesthesiologist -- especially patients that have the time to shop around prior to going to the hospital? Does anyone really think that competing anesthesiolgist groups would be able to get away with charging the equivalent of $4,000 an hour?

Why isn't this already the case? While there may be some malpractice issues involved (again, tort reform and I would add that a statute could be passed that a hospital is not responsible for acts of a third party), there are enough people with low deductible group coverage that simply don't give a shit. When I had my first child, I had a group plan and the epidural cost $200. When I had my second and third I had individual coverage and each epidural cost $1,000. If hospitals weren't automatically profitable and had to compete for business, then one would separate from the pack and find new ways to get market share. Right now, a critical mass of people have group health insurance and they just don't give a shit, $200 isn't that big of a deal. So not surprisingly hospitals don't see a need to be cost competitive.

[Color Me Badd Fan]

Max Baucus is jumping ship on Obamacare. He's up for reelection next year. He describes the legislation as heading for a "train wreck."

Well, no shit Sherlock. You guys should have thought about that before cramming through an enormous bill with virtually no deliberation on the topic. You own it now.

Baucus won't be the first one to do this.

http://www.greatfallstribune.com/vie...ly-implemented

[il Padrino Ute]

Max Baucus is jumping ship on Obamacare. He's up for reelection next year. He describes the legislation as heading for a "train wreck."

Well, no shit Sherlock. You guys should have thought about that before cramming through an enormous bill with virtually no deliberation on the topic. You own it now.

Baucus won't be the first one to do this.

http://www.greatfallstribune.com/vie...ly-implemented

Let's hope the good people of Montana have the good sense to vote Baucus out of office.

[Indy Coug]

Max Baucus is jumping ship on Obamacare. He's up for reelection next year. He describes the legislation as heading for a "train wreck."

Well, no shit Sherlock. You guys should have thought about that before cramming through an enormous bill with virtually no deliberation on the topic. You own it now.

Baucus won't be the first one to do this.

http://www.greatfallstribune.com/vie...ly-implemented

But they had to do SOMETHING to address the problems with healthcare...

[venkman]

Screw Max Baucus. Oh yeah, he'll vote to repeal, knowing damn well Obama would veto anything that passed. I'm so sick of these faux blue-dog congressassholes. Wake up people of Montana and quit falling for his schtick.

[Uncle Ted]

Max Baucus is jumping ship on Obamacare. He's up for reelection next year. He describes the legislation as heading for a "train wreck."

Well, no shit Sherlock. You guys should have thought about that before cramming through an enormous bill with virtually no deliberation on the topic. You own it now.

Baucus won't be the first one to do this.

http://www.greatfallstribune.com/vie...ly-implemented

[Uncle Ted]

I just found out that health insurance for my family is going up about 10% this year. It was going up about 15% this year but by moving into the city from the suburbs saved me about 5% for some reason. I can't wait until these Obamacare health insurance exchanges are in place so I can just drop my health insurance, pay the rather inexpensive tax penalty, and only pick up insurance when we actually need it. Thanks Obama!

[Indy Coug]

I just found out that health insurance for my family is going up about 10% this year. It was going up about 15% this year but by moving into the city from the suburbs saved me about 5% for some reason. I can't wait until these Obamacare health insurance exchanges are in place so I can just drop my health insurance, pay the rather inexpensive tax penalty, and only pick up insurance when we actually need it. Thanks Obama!

Ahhh... the election of anti-selection.

[All-American]

You are all mistaken. Magic Johnson says Obamacare is working.

http://www.breitbart.com/Breitbart-T...are-is-Working

[SCcoug]

Max Baucus is jumping ship on Obamacare. He's up for reelection next year. He describes the legislation as heading for a "train wreck."

Well, no shit Sherlock. You guys should have thought about that before cramming through an enormous bill with virtually no deliberation on the topic. You own it now.

Baucus won't be the first one to do this.

http://www.greatfallstribune.com/vie...ly-implemented

Looks like he'll retire rather than seek reelection.
http://www.washingtonpost.com/blogs/...s=rss_politics

[Surfah]

Washington State exploring the possibility of pushing part-time stake workers into ACA exchange. If they do it, every other state and local muni will follow suit.

http://apnews.myway.com/article/20130424/DA5RP7302.html

My favorite line of the article:

The plan threatens to affect the federal budget and the pocketbooks of some part-time workers, as it would push a group of employees out of their current health care plans and into an exchange developed under the Affordable Care Act.

Observers say the shift seems to run counter to the intent of the new health care law.....
A spokeswoman with the Department of Health and Human Services declined comment, and it's unclear whether the federal government accounted for this possible outcome.

LOL. Counter to the intent? What is the intent? That everyone wouldn't try to save as much money as possible? Who didn't predict workers getting hours cut? My state is at the front of that. 29 hour work weeks, but you get Obamacare. Congrats.

[Omaha 680]

Washington State exploring the possibility of pushing part-time stake workers into ACA exchange. If they do it, every other state and local muni will follow suit.

http://apnews.myway.com/article/20130424/DA5RP7302.html

My favorite line of the article:



LOL. Counter to the intent? What is the intent? That everyone wouldn't try to save as much money as possible? Who didn't predict workers getting hours cut? My state is at the front of that. 29 hour work weeks, but you get Obamacare. Congrats.

The government planners always conceive grand plans to structure society in a just way. But one thing those geniuses never fail to account for is individual will and that humans will make decisions for their own benefit wherever they are allowed. "Unintended consequences" are entirely predictable but always missed by planners who rely on "intent" of laws to order society. It would be comical if the results weren't so disastrous.

[Color Me Badd Fan]

http://www.reuters.com/article/2013/...93L04620130422

I thought this article was relevant. Employers are switching to high deductible plans and, shockingly, people aren't making as much hospital visits as they used to.

BTW, softness in earnings is a good thing. The rational response to soft earnings is to cut back on costs and look at innovative ways to increase market share. So, no more shimmering Rockefeller-esque medical complexes in Texas and other areas of the country.

[Uncle Ted]

http://www.reuters.com/article/2013/...93L04620130422

I thought this article was relevant. Employers are switching to high deductible plans and, shockingly, people aren't making as much hospital visits as they used to.

I have been on a high deductible health care plan for about five years. It seems like it has been about five years since I have been to the doctor too (with the exception of preventive care). When I am paying the high deductible I just tell my kids to rub some dirt on their "owie".

BTW, softness in earnings is a good thing. The rational response to soft earnings is to cut back on costs and look at innovative ways to increase market share. So, no more shimmering Rockefeller-esque medical complexes in Texas and other areas of the country.