Obamacare cost...

[VirginiaCougar]

Plus, that great BBYYYYAAAAAAHH!! moment of his.

LOL, indeed!

[calicoug]

Nothing of substance to respond to here. I'm not going to come back and clean up after you each time you rip apart a straw man. I'll let you know if you come close to addressing anything I actually said.

What's the point of that? When I respond you will just change your mind and say you never said it anyways.

[calicoug]

Actually there are quite a few people on the right arguing that we get rid of that implicit mandate. Some quite directly others through the complete market argument you mention. Now, that isn't what Cardiac is arguing, but I've heard it many, many times.

When you say "implicit mandate," are you referring to the obligation to give care to those with life threatening conditions? If anyone is seriously making that argument, they are waaaaaay outside of the mainstream.

[calicoug]

And there are some on both sides who fear that we will do away with that mandate through the single-payer system.

Are you talking about the mandate to care for those with life threatening conditions? Because if so, VA Coug is right. This makes zero sense.

[All-American]

I'll let you know if you come close to addressing anything I actually said.

What's the point of that?

How telling.

[imanihonjin]

Admits what? That as corporate profits increase higher and higher, they refuse to help employees get health care? They would rather screw over their employees than make somewhat lower profits? For all its faults, Obamacare has not "forced" business to cut hours.

Careful....your liberal is showing. Let us not forget that an employers principal purpose for going into business is to make a profit. If an employee is no longer profitable to him/her why in the world would he/she continue to employ them. If you keep asking business owners to receive less and less of a return on investment because of some ridiculous notion that an employer owes an employee more than the value of the employee's labor, then of course employers will stop investing and figure out something else to do.

I also found it interesting that you focus only on corporations.....what about the colleges that were mentioned in the opening comments of the article? You fat cats in education have been increasing tuition and unbelievable rates yet you can't figure out how to stop padding your benefits and retirements systems enough to stop screwing over the janitors who clean your floors and empty your trash?

[CardiacCoug]

We do. Lasik isn't cancer, nor is it even a bad childhood virus. I am well taken care of with the eye glasses I am currently wearing. Lasik would not only be purely voluntary for me, it is also an unnecessary and somewhat vain fluff given other options. Most health care doesn't fit the model of lasik and thus completely misses the point of inelasticity.

Are you attempting to argue that we are not more market oriented than Europe or Japan? I would strongly disagree with you there - we have powerful market mechanisms in place, always have. The data is pretty clear on this. Inelasticity causes health care technology to increase in price - not following the model of TVs and computers. We also know what happens in an even more pure market system, what happened to the elderly before Medicare is horrific.

Of course we have some market forces at work, more than Europe and Japan. But the fact remains that consumers don't generally have any "skin in the game" when seeking out health care. They don't pay directly for their care and so it's not a free market.

Now I'm obviously not in favor of getting rid of EMTALA. I primarily take care of heart attack patients who obviously are brought to the nearest ER and obviously like you're saying can't shop for their care in that situation.

But we also take care of outpatients who have chest pain and would have time to shop around and act like real consumers in their search for a stress test and subsequent angiogram. This charges for a single patient to come and have a stress test and then an angiogram with stents is often well over $20K. Can the consumer look on the internet and compare costs and quality of care at different hospitals, different doctors? Nope. It's like purchasing a new car where you just trust the car dealer and go into the purchase having no idea ahead of time whether he will charge you $10K or $40K for the new car. And you don't really care because the new car is covered by your insurance anyway.

Sorry that's not a free market.

If you reformed the system for outpatients that would trickle down to the people who come to the ER in an ambulance with a heart attack. Surgeries and cancer treatment really aren't that different. There are emergencies, sure, but here in SLC for example there are four different hospital systems and the vast majority of care could be shopped for if there were real cost and quality transparency.

[Color Me Badd Fan]

Of course we have some market forces at work, more than Europe and Japan. But the fact remains that consumers don't generally have any "skin in the game" when seeking out health care. They don't pay directly for their care and so it's not a free market.

Now I'm obviously not in favor of getting rid of EMTALA. I primarily take care of heart attack patients who obviously are brought to the nearest ER and obviously like you're saying can't shop for their care in that situation.

But we also take care of outpatients who have chest pain and would have time to shop around and act like real consumers in their search for a stress test and subsequent angiogram. This charges for a single patient to come and have a stress test and then an angiogram with stents is often well over $20K. Can the consumer look on the internet and compare costs and quality of care at different hospitals, different doctors? Nope. It's like purchasing a new car where you just trust the car dealer and go into the purchase having no idea ahead of time whether he will charge you $10K or $40K for the new car. And you don't really care because the new car is covered by your insurance anyway.

Sorry that's not a free market.

If you reformed the system for outpatients that would trickle down to the people who come to the ER in an ambulance with a heart attack. Surgeries and cancer treatment really aren't that different. There are emergencies, sure, but here in SLC for example there are four different hospital systems and the vast majority of care could be shopped for if there were real cost and quality transparency.

These guys have also completely missed your point regarding catastrophic insurance. Point is, if you have a heart attack or get cancer, you're going to be paying $10k but you're still going to get treatment. For non emergency care, people will shop around and the pricing will come down accordingly to gain a competitive edge. The limits on deductibles along with the way the employer mandate was written, was the dumbest part of Obamacare

[VirginiaCougar]

These guys have also completely missed your point regarding catastrophic insurance. Point is, if you have a heart attack or get cancer, you're going to be paying $10k but you're still going to get treatment. For non emergency care, people will shop around and the pricing will come down accordingly to gain a competitive edge. The limits on deductibles along with the way the employer mandate was written, was the dumbest part of Obamacare

Actually, I addressed that point of his directly:

http://www.cougarstadium.com/showthr...=1#post1004738

[VirginiaCougar]

When you say "implicit mandate," are you referring to the obligation to give care to those with life threatening conditions? If anyone is seriously making that argument, they are waaaaaay outside of the mainstream.

Yes, that is what I meant. Perhaps not the best term to use given that "mandate" has a very specific meaning in ACA. That individual mandate is another one of those previously and originally conservative ideas (to avoid the real problem of free-riders in a market based health care system where everyone invariably will use the system) that they now call "Socialist-Marxism with the tinge of Fascism."

[Eddie]

The drag of health care on the economy LONG precedes Obamacare. While deeply flawed, it is not the primary problem. Cost increases that have occurred are not outside of long-standing historical norms.

For me, the issue with Obamacare is precisely that the issue of health care costs (the drag of health care on the economy, if you will) HAS been around for a long time. We've known that there was need for reform for a long time. How many years ago did Hillary Clinton try to dive in? And obviously few if any improvements have been made since that time.

However, the more we learn about Obamacare the more it seems like this is a law that actually increases the drag of health care on the economy at a much greater rate than was previously there.

[Color Me Badd Fan]

Actually, I addressed that point of his directly:

http://www.cougarstadium.com/showthr...=1#post1004738

By saying demand is inelastic? Sorry, that doesn't cut it. You said nothing about monopoly pricing and the current system that indirectly passes on costs to employers. Not surprisingly, employers started dropping coverage en masse around 10 years ago because premiums were too high. As more people had to pay for their own care the rate of growth came down.

What I'm not arguing is that the current system is any good. It's awful. Single payer would be better than the current system. What I'm arguing is that Obamacare does nothing to improve the current system and in fact makes some things about the current system worse.

The US needs to shit or get off the pot. Either disengage insurance by promoting catastrophic or go to single payer. We're already all paying at least the equivalent of what single payer would cost with the current bastardized system whereby employers pay premiums and pass on the costs to everyone else. Since there's little incentive for those actually receiving care to shop around, they don't.

[ERCougar]

Yes, that is what I meant. Perhaps not the best term to use given that "mandate" has a very specific meaning in ACA. That individual mandate is another one of those previously and originally conservative ideas (to avoid the real problem of free-riders in a market based health care system where everyone invariably will use the system) that they now call "Socialist-Marxism with the tinge of Fascism."

No one is seriously advocating dropping emtala, so I'm honestly not sure what your point is.

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[ERCougar]

By saying demand is inelastic? Sorry, that doesn't cut it. You said nothing about monopoly pricing and the current system that indirectly passes on costs to employers. Not surprisingly, employers started dropping coverage en masse around 10 years ago because premiums were too high. As more people had to pay for their own care the rate of growth came down.

What I'm not arguing is that the current system is any good. It's awful. Single payer would be better than the current system. What I'm arguing is that Obamacare does nothing to improve the current system and in fact makes some things about the current system worse.

The US needs to shit or get off the pot. Either disengage insurance by promoting catastrophic or go to single payer. We're already all paying at least the equivalent of what single payer would cost with the current bastardized system whereby employers pay premiums and pass on the costs to everyone else. Since there's little incentive for those actually receiving care to shop around, they don't.

I honestly believe that there are some within healthcare reform circles, even among the aca crafters, who are going to create such a cluster with all of this that Americans will be begging for single payer. It's already worked with you.

Insured Americans were spoiled with really fantastic healthcare, to the point where they never would have accepted the constraints necessary to a single payer system that would be sustainable.

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[CardiacCoug]

By saying demand is inelastic? Sorry, that doesn't cut it. You said nothing about monopoly pricing and the current system that indirectly passes on costs to employers. Not surprisingly, employers started dropping coverage en masse around 10 years ago because premiums were too high. As more people had to pay for their own care the rate of growth came down.

Yep, and there really is some significant elasticity to the demand as well. The incentives in health care are so perverse -- doctors have incentives to do as much as possible. Once patients have met their deductible they also have an incentive to do as much as possible now that the care has become "free."

A great example of totally elective cardiac care is radiofrequency ablation for atrial fibrillation. This is a very expensive procedure (charges often $40K+) with limited efficacy for a condition where it has been shown that most patients don't even benefit from being back in normal sinus rhythm versus anticoagulated and rate controlled. I think this procedure is totally analogous to LASIK surgery -- people prefer to be back in normal sinus rhythm but ablation for atrial fibrillation specifically (as opposed to other types of arrhythmia) is truly an optional luxury. If there were a truly free market the cost would plummet down to $3K or so I would think.