Oklahoma Doctors vs. Obamacare

[sappstuf]

An article well worth reading.

Is a top-down approach to healthcare really the way to go?


Three years ago, Dr. Keith Smith, co-founder and managing partner of the Surgery Center of Oklahoma, took an initiative that would only be considered radical in the health care industry: He posted online a list of prices for 112 common surgical procedures. The 51-year-old Smith, a self-described libertarian, and his business partner, Dr. Steve Lantier, founded the Surgery Center 15 years ago, after they became disillusioned with the way patients were treated at St. Anthony Hospital in Oklahoma City, where the two men worked as anesthesiologists. In 1997, Smith and Lantier bought the shell of a former surgical center with the aim of creating a for-profit facility that could deliver first-rate care at a fraction of what traditional hospitals charge.

The major cause of exploding U.S. heath care costs is the third-party payer system, a text-book concept in which A buys goods or services from B that are paid for by C. Because private insurance companies or the government generally pick up most of the tab for medical services, patients don’t have the normal incentive to seek out value.

The Surgery Center’s consumer-driven model could become increasingly common as Americans look for alternatives to the traditional health care market—an unintended consequence of Obamacare. Patients may have no choice but to look outside the traditional health care industry in the face of higher costs and reduced access to doctors and hospitals.

The Surgery Center demonstrates that it’s possible to offer high quality care at low prices. "It's always been interesting to me,” says Dr. Jason Sigmon, “that in any other industry, tons of attention is devoted to making systems more efficient, but in health care that's just completely lost." Sigmon, an ear, nose, and throat surgeon, regularly performs procedures at both the Surgery Center and at Oklahoma City's Integris Baptist Medical Center, which is the epitome of a traditional hospital. It's run by a not-for-profit called Integris Health, which is the largest health care provider in Oklahoma serving over 700,000 patients a year.

Sigmon says he can perform twice as many surgeries in a single day at the Surgery Center than at Integris. At the latter institution, he spends half his time waiting around while the staff struggles with the basic logistics of moving patients from preoperative care into the operating room. When the patient arrives, Sigmon will sometimes wait even longer for the equipment he needs.

Except for the clerical staff, every employee at the Surgery Center is directly involved in patient care. For example, both human resources and building maintenance are the responsibility of the head nurse. "One reason our prices are so low," says Smith, "is that we don't have administrators running around in their four or five thousand dollar suits."

In 2010, the top 18 administrative employees at Integris Health received an average of $413,000 in compensation, according to the not-for-profits' 990 tax form. There are no administrative employees at the Surgery Center.Because bills charged by Integris are paid primarily by insurance companies or the government, the hospital gets away with gouging for its services. Reason obtained a bill for a procedure that Dr. Sigmon performed at Integris in October 2010 called a “complex bilateral sinus procedure,” which helps patients with chronic nasal infections. The bill, which is strictly for the hospital itself and doesn't include Sigmon's or the anesthesiologist's fees, totaled $33,505. When Sigmon performs the same procedure at the Surgery Center, the all-inclusive price is $5,885.

The Integris bill for the same nasal procedure went to Blue Cross of Oklahoma, so the patient had no compelling reason to question its outrageous markups. They included a $360 charge for a steroid called dexamethasone, which can be purchased wholesale for just 75 cents. Or the three charges totaling $630 for a painkiller called fentanyl citrate, which all together cost the hospital about $1.50.

While patients and their insurance companies rarely pay the full price on a hospital bill, the bigger the bill, the more the hospital gets. Uninsured patients at Integris generally get a 50 percent discount, while private insurance companies pay closer to 60 percent of the full bill, which is still greater by orders of magnitude than what the Surgery Center collects.

Integris Health declined to make a spokesperson available to be interviewed for this story. But in a statement, the company defended its outrageous bills on the grounds that it needs a way to cover losses on services offered free. Whatever the merits of that argument, Integris must also cover overhead costs and bureaucratic inefficiencies that the Surgery Center has managed to abolish.

The rising cost of health insurance has been driving companies to look for ways to cope with the third-party payer system. Health maintenance organizations, or HMOs, have been one approach. Today, a growing number of firms are dumping their health insurance providers and becoming “self-funded,” meaning they pay their employees' health care costs directly out of their revenues. This model was virtually nonexistent 30 years ago, and today an estimated 60 percent of Americans work for “self-funded” companies.

Self-funded companies, like individual patients, can negotiate directly with hospitals for lower prices. Recently a handful of self-funded Fortune 500 companies struck deals directly with major hospitals to care for their patients for a negotiated fee.

In Oklahoma City, there’s an alternative health care market taking shape in which hospitals offers competitive flat fee prices to self-funded companies. And it’s all modeled after the Surgery Center.

This was the brainchild of Jay Kempton, who is the president of The Kempton Group, which administers health care plans for self-funded companies. When Kempton met Keith Smith, he had been looking for a way to help his clients deal with their exploding health care costs. "Cutting edge procedures are justifiably expensive," Kempton concedes. "But what we also see are soaring increases in relatively garden-variety procedures, like a knee resurfacing or a carpal tunnel release. Those things should not be experiencing 10 or 15 percent inflation every year."

So Kempton and Smith came up with a cost-saving arrangement: If their employees agreed to be treated at the Surgery Center instead of a traditional hospital, they would be spared the cost of all co-pays and deductibles.

Almost immediately, Kempton was approached by other surgical centers and hospitals. There are now four health care facilities participating in his flat-fee consortium, and more are on the verge of coming onboard.

June Wietzikoski is a typical patient benefiting from this alternative health care market. She works as a loan officer for a community bank in Groesbeck, Texas, which is a client of the Kempton Group. She had carpal tunnel release procedure done at the Surgery Center for the all-inclusive price of $2,775, which was covered by her employer. Had she gone to a traditional hospital run by Integris the discounted bill would have come to about $7,452 and she would have been personally responsible for the first $5,299, since she hadn’t met her deductible.
"It makes me mad that people are bankrupted by our current health care system when many times the costs are completely unjustified," says Smith.

Is Kempton's model replicable in other places? There are obstacles. Oklahoma has an unusually entrepreneurial health care sector, which stems from a 1989 decision to roll back the state's Certificate of Need (CON) laws. CON laws, which are still on the books in 35 states, require all medical facilities to get permission from a planning board before opening, which in practice provides a way for traditional hospitals to use political influence to keep new entrants out of the market.

A new provision buried in Obamacare effectively prohibits doctors from starting their own hospitals or expanding the hospitals they already own, which has been widely interpreted as a give-away to the American Hospital Association.

The Surgery Center is exempt from this statue, since it's technically not a hospital and it doesn't accept Medicaid or Medicare. So Smith and Lantier are considering expanding to accommodate their growing clientele.

Smith believes that despite the obstacles, market-driven facilities like his will thrive and proliferate as consumers catch on to costly collusion between big government and big health care.

Says Smith: "Everyone can see what the prices are at the Surgery Center, and that affordable health care is possible. So the jig is up.”

http://reason.com/archives/2012/11/15/the-obamacare-revolt-oklahoma-doctors-fi

[yermom]

like everything else, it's going to **** so some guy in a suit can get more zeros on his paycheck today rather than tomorrow

[TUSooner]

Nice article. I may actually know Keith Smith from way back in the day, though it's a fairly common name. I hope deals like that can survive Obamacare and the "Health Care Cabal" of insurance companies and hospitals. Wish that idea had gotten rolling sooner.

[pphilfran]

The price list... http://surgerycenterok.com/pricing.php

A sample

Arthroscopy
Knee $ 3,740.00

Knee with lateral release or microfracture $ 4,510.00

Shoulder $ 5,720.00

Elbow $ 3,740.00

Wrist $ 4,300.00

Hip $ 5,575.00

Ankle $ 3,740.00

[picasso]

Costs are crazy but when you start dumbing down the price, just like anything, you get ****tier service.
Anyone who has dealt with Indian Health knows whats coming. People will not be happy but hey, sometimes you get what you ask for.

[sappstuf]

Tonsillectomy $ 3,050.00
Adenoidectomy $ 2,695.00
Tonsillectomy and Adenoidectomy $ 3,695.00

Bundle and save!

[pphilfran]

Tonsillectomy $ 3,050.00
Adenoidectomy $ 2,695.00
Tonsillectomy and Adenoidectomy $ 3,695.00

Bundle and save!

Treat you body like you do your car...

If you change your water pump you change your hoses and belts at the same time... :)

[cleller]

Please let this be the trend of the future.

Maybe it could be translated to the public school system.

[rock on sooner]

The price list... http://surgerycenterok.com/pricing.php

A sample

Arthroscopy
Knee $ 3,740.00

Knee with lateral release or microfracture $ 4,510.00

Shoulder $ 5,720.00

Elbow $ 3,740.00

Wrist $ 4,300.00

Hip $ 5,575.00

Ankle $ 3,740.00

Is that shoulder price for shoulder replacement? I had my worn out right
should replaced and the itemized bill was a little over $41000. Insurance
paid nearly all of it, I had a small deductible to be met, then there was four
months of rehab/therapy. But, holy cow...

[pphilfran]

Is that shoulder price for shoulder replacement? I had my worn out right
should replaced and the itemized bill was a little over $41000. Insurance
paid nearly all of it, I had a small deductible to be met, then there was four
months of rehab/therapy. But, holy cow...

Those prices are for an arthroscopy

[rock on sooner]

Those prices are for an arthroscopy

'K, thanks.

[sappstuf]

'K, thanks.

But you can get a penile prosthesis for $15k! ;)

[pphilfran]

But you can get a penile prosthesis for $15k! ;)

I am in need of a penile reduction...cost?

[sappstuf]

I am in need of a penile reduction...cost?

I don't see "delusion" as a covered procedure... :)

[pphilfran]

I don't see "delusion" as a covered procedure... :)

lol

[SoonerorLater]

Our family doctor has mentioned several times about something like this. He would like to go to a cash only type system and forego insurance altogether. He once told me that between medicare (he doesn't accept new Medicare Patients) and all the various insuranace filings and staff required to do the paperwork, he could reduce costs to patients by at least 50% and probably more.

[KantoSooner]

Costs are crazy but when you start dumbing down the price, just like anything, you get ****tier service.
Anyone who has dealt with Indian Health knows whats coming. People will not be happy but hey, sometimes you get what you ask for.

I've dealt with Indian Health, Cherokee version. I was pretty happy with it.

In any event, it's nice to see someone, albeit on a local scale only, trying to attack costs rather than just finding a bigger shovel with which to hurl money at the beast.

[TUSooner]

I don't see "delusion" as a covered procedure... :)
That made me laugh.

[StoopTroup]

Nice article. I may actually know Keith Smith from way back in the day, though it's a fairly common name. I hope deals like that can survive Obamacare and the "Health Care Cabal" of insurance companies and hospitals. Wish that idea had gotten rolling sooner.
Lots of Doctors were trying this and many other ideas to try and cope with all of the issues they were bombarded with. We lost lots of Doctors when many of them moved to practices like that. I know how we were having to deal with section 8 Patients back in the 80's. It's when I decided to find something else like Accounting and Business Management rather than end up as an employee of some Super Practice driven by nothing but profit. It sounds good but it misses the basic reason that Doctors should concentrate on and that's never turning away a patient that needs care and especially specialty care that they couldn't ever pay back even if you gave them an 80% discount.

[stoops the eternal pimp]

I've dealt with Indian Health, Cherokee version. I was pretty happy with it.

In any event, it's nice to see someone, albeit on a local scale only, trying to attack costs rather than just finding a bigger shovel with which to hurl money at the beast.

I deal with local tribal health and it is amazing..but i did work statewide for IHS that showed that for the most part, it is a miserable experience with horrible service for the most part across the state.

[Midtowner]

This story is more of an indication as to why we need ObamaCare--to drive these inflated costs down by force. If the hospital needs 18 administrators with salaries in excess of $400K to run, then I think there's some fat to cut somewhere.

[TVKaleen]

This story is more of an indication as to why we need ObamaCare--to drive these inflated costs down by force. If the hospital needs 18 administrators with salaries in excess of $400K to run, then I think there's some fat to cut somewhere.

Yep. I'm sure that is what government bureacracy does best... drive down costs that is. Eliminate the need for administrators and paper pushers.

Yep. Sounds like a job for government.

[Curly Bill]

Yep. I'm sure that is what government bureacracy does best... drive down costs that is. Eliminate the need for administrators and paper pushers.

Yep. Sounds like a job for government.

Even Mid knows what he typed is wrong, but ya got to follow those talking points.

[Midtowner]

Yep. I'm sure that is what government bureacracy does best... drive down costs that is. Eliminate the need for administrators and paper pushers.

Yep. Sounds like a job for government.

The beauty of ObamaCare is that it actually is not a lot of government bureaucracy. It is mostly relying on the free market. It is restructing things there to help get control of costs, especially administrative costs and other factors to deliver a better healthcare product at a lower price.

[Curly Bill]

The beauty of ObamaCare is that it actually is not a lot of government bureaucracy. It is mostly relying on the free market. It is restructing things there to help get control of costs, especially administrative costs and other factors to deliver a better healthcare product at a lower price.

It sure is a hit with the folks that actually hire people and stuff! LOL

[Midtowner]

It sure is a hit with the folks that actually hire people and stuff! LOL

It forces us to all play by the same rules and do something we should have been doing anyway. Now we can provide our employees health insurance and still remain competitive. The Papa John's founder is a huge ****** in that regard. He could have been providing health insurance to his employees to five cents a pie all this time.

[cleller]

Yep. I'm sure that is what government bureacracy does best... drive down costs that is. Eliminate the need for administrators and paper pushers.

Yep. Sounds like a job for government.


The beauty of ObamaCare is that it actually is not a lot of government bureaucracy. It is mostly relying on the free market. It is restructing things there to help get control of costs, especially administrative costs and other factors to deliver a better healthcare product at a lower price.

I do hope something like this happens, but I can think of no reason to expect it, given the history of programs created by the feds. I just hope Obamacare does not discourage setups like this Surgery Center place. One of the few good trends I've seen in health care.

[agoo758]

It forces us to all play by the same rules and do something we should have been doing anyway. Now we can provide our employees health insurance and still remain competitive. The Papa John's founder is a huge ****** in that regard. He could have been providing health insurance to his employees to five cents a pie all this time.

You do realize he will probably just cut employees?

Just like how everyone loves raising the minimum wage until they found out they got laid off as a result of that.

[TVKaleen]

The definition of insanity is doing the same thing over and over and over again and expecting a different result. I've studied enough history to know that when government becomes involved in something, paperwork increases and bureaucracy becomes the catch phrase of the day. Sometimes this is a necessary evil. Regulation isn't always bad. But maybe the system might not be as broken as it is if we hadn't given the medical profession a blank check in the '60s in order to get them into Medicare. Or maybe it would be worse

If you had said, it would make people safer.. it would make things fairer... Maybe I could believe that. The first more than the second. But cheaper? Government doesn't make things cheaper. It just tries to redistribute the assets already on the table.

[jkjsooner]

At the best their argument is that our current system is a failure. This sure isn't an endorsement for the pre-Obamacare status quo.

A big complaint is related to having a 3rd party insurance but what's the solution to that? People not having insurance and going bankrupt when they have a serious health issue?


The biggest problem I see is the complete lack of transparency in the health care industry. You doctor may send you to an untrasound and you have no way to know that that is some kind of special ultrasound that costs $5000 and isn't covered by your insurance. (Been there done that when my wife was pregnant.)

It's not like people are in the mindset to start haggling services and prices when they're in an emergency situation...

I know this group is trying to be transparent and that is great. That needs to be the norm although as complicated as modern medicine is it could be a lot easier said than done.

[KantoSooner]

The beauty of ObamaCare is that it actually is not a lot of government bureaucracy. It is mostly relying on the free market. It is restructing things there to help get control of costs, especially administrative costs and other factors to deliver a better healthcare product at a lower price.

Okay, I'll bite. I have not read the ACA. Although I'm a bit guilty feeling on that score, I just remind myself that no one in congress has, either, and I feel better.
How does it do those things? Can you explain the mechanism(s) to me? How does it cut admin costs? How does it deliver a better product?
I'm a big fan of national health services, but so far the ACA supporters' bund has been long on telling us how good things were going to be and short on telling us how we'd get from A to B.

[Midtowner]

How does it cut admin costs?

The ACA requires that 80 to 85% depending on your group of expenses paid out by insurance companies actually go to healthcare. While this really doesn't help at the hospital level, it certainly will force the insurance companies themselves to tighten their belt administratively. I can tell you I'll feel a little better about my insurance premium when I know it's not being used to fund the CEO's yacht or a corporate jet.


How does it deliver a better product?

If we're to believe the old capitalist maxim that an expanded marketplace leads to a more competitive and better product, then you'd have to at least have some faith that a dramatic expansion of the number of folks in the healthcare market will lead to a better product.


I'm a big fan of national health services, but so far the ACA supporters' bund has been long on telling us how good things were going to be and short on telling us how we'd get from A to B.

With healthcare, it's kind of insane not to take advantage of some of the economies of scale which only governments have access to. Restructuring the marketplace to lead to greater competition and more consumers within the system will hopefully be a free-market solution which works. If not, the next step is single payer or a nationalized system.

[jkjsooner]

You do realize he will probably just cut employees?

Just like how everyone loves raising the minimum wage until they found out they got laid off as a result of that.

If he can cut employees and still deliver the same amount of product (pizzas) then why didn't he do it a long time ago? Isn't that what a business does already - deliver product which meets the demand with as few costs (employees) as possible?

I can see a company going out of business because their business model doesn't work with the extra cost. I can see them raising prices (especially since all competitors are under the same pressure).

What I can't see is an argument that they will cut employees unless 1) they weren't running efficiently to begin with or 2) they are willing to cut quality or service. If they choose the second route they probably made the wrong choice.


Edit: If you want to argue that a company will move to offshore employees then you might have a point but that doesn't apply to a pizza restaurant (except for a few corporate workers).

[pphilfran]

The beauty of ObamaCare is that it actually is not a lot of government bureaucracy. It is mostly relying on the free market. It is restructing things there to help get control of costs, especially administrative costs and other factors to deliver a better healthcare product at a lower price.

This is a key point...all it takes is one company to not supply heathcare and it squeezes the others that do....

My take is the part time limit was set too high...drop it to 20 hours per week and we would see companies doing an about face and hiring far more full time (40 hour) workers to save costs...

[jkjsooner]

But this talk about cutting employees brings up something I've mentioned several times.

If your company is like mine, you've seen benefits go down year after year. With globalization and ever-decreasing employee power, it becomes less of an incentive for employees to provide those benefits. Assuming the government let them, I think the days of employee provided benefits are waning.

I believe that in 20 years without a mandate for health insurance very few companies would still offer health insurance. Once that happened we would end up with a government run system. In that respect Obamacare might be a blessing.


I've worked for my company for 18 years and I can't remember a single year where some benefit wasn't reduced - worse health insurance, less 401k matching, no more pension plan, no more PTO rollovers, reduction in maximum amount of PTO you can accrue per year as you become more senior, etc., etc. It's been a slow drip and my company is by no means unique.

[Midtowner]

This is a key point...all it takes is one company to not supply heathcare and it squeezes the others that do....

My take is the part time limit was set too high...drop it to 20 hours per week and we would see companies doing an about face and hiring far more full time (40 hour) workers to save costs...

It'll be a few years before we can start tweaking it. The Republicans are going to have to get over the fact that ObamaCare is here to stay and come on board to do real problem solving once things are up and running. So long as their only goal is repealing it, what we've got is what we've got.

The next big issue will be whether our companies can compete with this mandate in place when their foreign competitors don't have to worry about healthcare costs at all since the government provides those services at nominally at least no cost to the companies.

[pphilfran]

It'll be a few years before we can start tweaking it. The Republicans are going to have to get over the fact that ObamaCare is here to stay and come on board to do real problem solving once things are up and running. So long as their only goal is repealing it, what we've got is what we've got.

The next big issue will be whether our companies can compete with this mandate in place when their foreign competitors don't have to worry about healthcare costs at all since the government provides those services at nominally at least no cost to the companies.

True, a lot of implications down the road...

[SoonerorLater]

It forces us to all play by the same rules and do something we should have been doing anyway. Now we can provide our employees health insurance and still remain competitive. The Papa John's founder is a huge ****** in that regard. He could have been providing health insurance to his employees to five cents a pie all this time.

"It forces us to all play by the same rules" and that is the problem, being co-opted into a system that you don't want to be part of. When did this kind of government intrusion become palatable to the U.S. citizens? I've heard the term "healthcare system" bantied around a lot. Where do we come up with the idea that's it's a given we need a healthcare system anymore than we need a grocery store system or automobile purchasing system? We've managed to reach this point in the history of civilization without government planned healthcare.

[rock on sooner]

It'll be a few years before we can start tweaking it. The Republicans are going to have to get over the fact that ObamaCare is here to stay and come on board to do real problem solving once things are up and running. So long as their only goal is repealing it, what we've got is what we've got.

The next big issue will be whether our companies can compete with this mandate in place when their foreign competitors don't have to worry about healthcare costs at all since the government provides those services at nominally at least no cost to the companies.

In 2014 most provisions go into effect and as the effect of more healthy, younger
participants come on board and the overall costs begin to drop, I think, by 2015
you'll see some tweaking and by 2018 the program will have stablized. You'll see
visible effects on health care costs...e.g. what insurance companies offer and pay
for, you'll see the caregivers begin to be more comfortable with one or two tests,
as opposed to 4 or 5, also driving down costs. When the insurance companies get
more fully on board, many caregivers will reenter the Medicare market.

One of the tweaks, imo, will be regarding malpractise caps. Now, so many tests
are extraneous just to cover the caregiver's liabilities.

[KantoSooner]

Midtowner,
Requiring X% go to 'healthcare' rather than 'admin costs' is not going to change much. One of those 'suits' simply slides the dollars over into a different column and off we go.

Improved quality and lower cost in a competitive market are produced by expanded competition between the suppliers, not between the consumers. Getting more people into the system might, arguably contribute to lowering costs by allowing for economies of scale, but something that consumes 17% or so of the largest economy on earth doesn't seem to be gasping for volume in order to cover overhead. I might be wrong; just sayin'.

'Restructuring the marketplace to lead to greater competition and more consumers within the system...' ...How? How restructured? What greater competition? What more consumers? Right now 100% of our population has a plan. It might be a crappy plan (ie, plan: "if sick, go to ER, get treated, go home stiffing hospital."), but it's a plan. The rest of us have some sort of insurance and carry the balance by ourselves. Does ACA fundamentally change this? I don't see it.

A Parable.
There once was a man, let's call him 'Dad'. He had knee replacement surgery. It didn't go so well. He got a staph infection in his femur. Knee had to be replaced several times. Upshot: 'Dad' doesn't walk anymore. He is wheelchair bound.
The wheelchair is interesting. Medicare bought it. (you're limited to 2 per lifetime. Glad to know 'Dad's' got one more coming in case he wears this one out.) Here's the deal. To buy a wheelchair costs about $400. If you pay yourself. To get Medicare to pay for it, you are billed $100 a month (with $100 up front) for 12 months. 100% of which is covered by Medicare. Then, if you want to keep the chair, you pay $100 more (also covered by Medicare) and it's yours. Notice what happened? A chair with some sort of market value of $400 becomes a thing that is billed to the government at $1400. 'Dad', being a bluff old traditionalist, suggested that perhaps he could just buy it for $400 and then submit the bill to Medicare. No go, said medstore guy, Medicare must be billed by the provider. Hmm, Okay, says 'Dad', how about I take it for 4 months, get Medicare to cover those months and then 'return' the chair, but actually keep it. Medistore gets $400, I get a chair and we don't rip off the public. Medistore guy: "We've thought of that but it would be Medicare 'fraud' and we'd go to jail."
Moral of the story? Our system is run by people who live in a parallel universe in which money grows in the little boxes in Monopoly sets. It has no meaning to them. To think that these people are somehow going to being able to keep up with insurance companies and hospitals who do, god help them, both understand and really, REALLY love money, and somehow use their purchaing power to reduce costs is to believe in, oh, the big rock candy mountain.

So far, no one has been able to explain to me why the ACA will work. Not why national health can't work. It does, in lots of countries around the world. But our system aborning. No idea why it will work at all. Kind of interested to see how BamBam deals with it now that it's his baby for four more.

[Midtowner]

Except in this case, we're not going through government bureaucracy to pay for costs outside of Medicare, we're allowing folks to sign up based on a presentation of price and benefits for various plans at the exchange and paying through private insurance.

[Turd_Ferguson]

Except in this case, we're not going through government bureaucracy to pay for costs outside of Medicare, we're allowing folks to sign up based on a presentation of price and benefits for various plans at the exchange and paying through private insurance.Who is We, and how are they Allowing?

[Midtowner]

"It forces us to all play by the same rules" and that is the problem, being co-opted into a system that you don't want to be part of. When did this kind of government intrusion become palatable to the U.S. citizens?

Driving back from court in Shawnee today, I'm pretty sure most folks who saw the 70 MPH speed limit sign didn't yell WAAAARRRGGHHHH!! TYRANNY AND OPPRESSION!!! The fact is that just like the fact that everyone on the public roads is participating in a government regulated system of highways and has to follow certain rules, we're all going to be a part of the healthcare economy at some point, and we've decided through the process of democracy and the Constitution, utilizing all 3 branches of government and arriving at what we have. We could decide on a grocery store or auto system, but we haven't. It makes sense that we have chosen to regulate healthcare because we are basically the last first world country to do something like this. It'll be an interesting experiment, but this will be the last chance for any sort of free market healthcare system to function before we either go single payer or totally nationalize things.

[Midtowner]

Who is We, and how are they Allowing?

The United States of America is still a "we," ain't it?

[SoonerorLater]

Midtowner,
Requiring X% go to 'healthcare' rather than 'admin costs' is not going to change much. One of those 'suits' simply slides the dollars over into a different column and off we go.

Improved quality and lower cost in a competitive market are produced by expanded competition between the suppliers, not between the consumers. Getting more people into the system might, arguably contribute to lowering costs by allowing for economies of scale, but something that consumes 17% or so of the largest economy on earth doesn't seem to be gasping for volume in order to cover overhead. I might be wrong; just sayin'.

'Restructuring the marketplace to lead to greater competition and more consumers within the system...' ...How? How restructured? What greater competition? What more consumers? Right now 100% of our population has a plan. It might be a crappy plan (ie, plan: "if sick, go to ER, get treated, go home stiffing hospital."), but it's a plan. The rest of us have some sort of insurance and carry the balance by ourselves. Does ACA fundamentally change this? I don't see it.

A Parable.
There once was a man, let's call him 'Dad'. He had knee replacement surgery. It didn't go so well. He got a staph infection in his femur. Knee had to be replaced several times. Upshot: 'Dad' doesn't walk anymore. He is wheelchair bound.
The wheelchair is interesting. Medicare bought it. (you're limited to 2 per lifetime. Glad to know 'Dad's' got one more coming in case he wears this one out.) Here's the deal. To buy a wheelchair costs about $400. If you pay yourself. To get Medicare to pay for it, you are billed $100 a month (with $100 up front) for 12 months. 100% of which is covered by Medicare. Then, if you want to keep the chair, you pay $100 more (also covered by Medicare) and it's yours. Notice what happened? A chair with some sort of market value of $400 becomes a thing that is billed to the government at $1400. 'Dad', being a bluff old traditionalist, suggested that perhaps he could just buy it for $400 and then submit the bill to Medicare. No go, said medstore guy, Medicare must be billed by the provider. Hmm, Okay, says 'Dad', how about I take it for 4 months, get Medicare to cover those months and then 'return' the chair, but actually keep it. Medistore gets $400, I get a chair and we don't rip off the public. Medistore guy: "We've thought of that but it would be Medicare 'fraud' and we'd go to jail."
Moral of the story? Our system is run by people who live in a parallel universe in which money grows in the little boxes in Monopoly sets. It has no meaning to them. To think that these people are somehow going to being able to keep up with insurance companies and hospitals who do, god help them, both understand and really, REALLY love money, and somehow use their purchaing power to reduce costs is to believe in, oh, the big rock candy mountain.

So far, no one has been able to explain to me why the ACA will work. Not why national health can't work. It does, in lots of countries around the world. But our system aborning. No idea why it will work at all. Kind of interested to see how BamBam deals with it now that it's his baby for four more.

If you want to make healthcare affordable just do away with insurance altogether. Immediately health services could only charge what the market would bear. No more $100.00 aspirins etc. Every patient would have the incentive to go over each bill with a fine tooth comb. To me the U.S Pharmaceutical Industry is little more than organized crime.

[SoonerorLater]

Driving back from court in Shawnee today, I'm pretty sure most folks who saw the 70 MPH speed limit sign didn't yell WAAAARRRGGHHHH!! TYRANNY AND OPPRESSION!!! The fact is that just like the fact that everyone on the public roads is participating in a government regulated system of highways and has to follow certain rules, we're all going to be a part of the healthcare economy at some point, and we've decided through the process of democracy and the Constitution, utilizing all 3 branches of government and arriving at what we have. We could decide on a grocery store or auto system, but we haven't. It makes sense that we have chosen to regulate healthcare because we are basically the last first world country to do something like this. It'll be an interesting experiment, but this will be the last chance for any sort of free market healthcare system to function before we either go single payer or totally nationalize things.

I'd say that logic is a bit of a stretch, comparing traffic laws to mandated healthcare. The first difference is that states set the speed limit (some Federal guidlines apply & that is a problem too). As we all know by faithfully adhereing to the words of the constitution that this is the type of thing that would fall under the powers of the State. So traffic laws are constitutionally sound.

Secondly empirical evidence would tell us that we can not operate without traffic laws. However it wouldn't suggest we can't operate without mandated federal healthcare since we are operating under that system now and have been since we became a country.

[sappstuf]

In 2014 most provisions go into effect and as the effect of more healthy, younger
participants come on board and the overall costs begin to drop, I think, by 2015
you'll see some tweaking and by 2018 the program will have stablized. You'll see
visible effects on health care costs...e.g. what insurance companies offer and pay
for, you'll see the caregivers begin to be more comfortable with one or two tests,
as opposed to 4 or 5, also driving down costs. When the insurance companies get
more fully on board, many caregivers will reenter the Medicare market.

One of the tweaks, imo, will be regarding malpractise caps. Now, so many tests
are extraneous just to cover the caregiver's liabilities.

Not for those healthy, younger participants... Their insurance costs are set to skyrocket because they are being forced to buy more insurance than they need.

Obamacare is a huge transfer of wealth from the poor(young) to the rich(old). This will keep younger workers from building wealth at the exact time that saving and investing will do the most long term good.

[rock on sooner]

Not for those healthy, younger participants... Their insurance costs are set to skyrocket because they are being forced to buy more insurance than they need.

Obamacare is a huge transfer of wealth from the poor(young) to the rich(old). This will keep younger workers from building wealth at the exact time that saving and investing will do the most long term good.

Hey, Sapp, don't you think there'll be programs tailored to fit most every need.
E.G. the auto industry with liability, high deductions , comprehensive and collisions
choices. I haven't seen any programs written yet but, it seems to me, to be a pretty
straightforward approach.

[KantoSooner]

On the tweaking side of things, note that National Health in the UK has been popular for only about the last 10-15 years. It was utterly despised for the first 35 years or so of its existence.
On that model, we're going to have a bubbling national screaming match until something like 2050.

Yee Ha.

[Midtowner]

Not for those healthy, younger participants... Their insurance costs are set to skyrocket because they are being forced to buy more insurance than they need.

Obamacare is a huge transfer of wealth from the poor(young) to the rich(old). This will keep younger workers from building wealth at the exact time that saving and investing will do the most long term good.

We already have a huge transfer of wealth with Medicare.

I'm not really that concerned. I'll be old eventually and at that point, the whipper snappers can subsidize my decadent lifestyle.

[sappstuf]

Hey, Sapp, don't you think there'll be programs tailored to fit most every need.
E.G. the auto industry with liability, high deductions , comprehensive and collisions
choices. I haven't seen any programs written yet but, it seems to me, to be a pretty
straightforward approach.

They are absolutely not tailored.. One size fits all. This has been admitted by the Obama administration and Dems. Their only response is the younger people will be "paid back" when they get older by other younger folks paying for their health care.

What could possibly go wrong? Cough, cough... Social security.

[rock on sooner]

They are absolutely not tailored.. One size fits all. This has been admitted by the Obama administration and Dems. Their only response is the younger people will be "paid back" when they get older by other younger folks paying for their health care.

What could possibly go wrong? Cough, cough... Social security.

Respectfully, I disagree. I think this will be part of the tweaking in the next
few Congresses. It only stands to reason that flaws now be fixed then...
and, I think the GOP, in particular, as they come to grips with the fact that
the ACA is here to stay, are going to be right up front trying to put their "
see, I fixed this" for you during the neverending political seasons to come.

[sappstuf]

We already have a huge transfer of wealth with Medicare.

I'm not really that concerned. I'll be old eventually and at that point, the whipper snappers can subsidize my decadent lifestyle.

Then please explain by what mechanism Medicare has worked to keep costs down? I mean if we are talking about expanding it, it must have been a huge success in that area.... Right?

Right?

[sappstuf]

Respectfully, I disagree. I think this will be part of the tweaking in the next
few Congresses. It only stands to reason that flaws now be fixed then...
and, I think the GOP, in particular, as they come to grips with the fact that
the ACA is here to stay, are going to be right up front trying to put their "
see, I fixed this" for you during the neverending political seasons to come.

It isn't a flaw. It is one of the major parts of the design. It is what makes Obamacare appear more financially sound. Take away that portion and it will collapse under its on weight.

[rock on sooner]

It isn't a flaw. It is one of the major parts of the design. It is what makes Obamacare appear more financially sound. Take away that portion and it will collapse under its on weight.

I guess we can agree to disagree because I believe that a number of
things will be fiddled with over the next few years and the ACA will
be viable going forward...

[okie52]

Driving back from court in Shawnee today, I'm pretty sure most folks who saw the 70 MPH speed limit sign didn't yell WAAAARRRGGHHHH!! TYRANNY AND OPPRESSION!!!

Obamas War on drivers!!!

[rock on sooner]

Obamas War on drivers!!!

What about that section of highway in Texas aka Lone Star Autobahn
where the limit is 85 mph? Then there's section of Montana where
it used to be "Reasonable and Prudent".

[sappstuf]

I guess we can agree to disagree because I believe that a number of
things will be fiddled with over the next few years and the ACA will
be viable going forward...

Well the healthcare exchanges are supposed to be up and running October of next year. The Obama administration just gave the states another month to decide if they are going to do it themselves or just leave it to the federal government. The problem is that the states don't know what all the rules are or the costs because the rules haven't even been written yet.

Less than a year out and no one knows what the hell is going on.

Not really a comforting sign is it?

[TitoMorelli]

I guess we can agree to disagree because I believe that a number of
things will be fiddled with over the next few years and the ACA will
be viable going forward...

The old white Republicans will work to lower the cost of ObamaCare to all those youngsters who voted for a hip president and free stuff. Not called the party of stupid for nothing.

[rock on sooner]

Well the healthcare exchanges are supposed to be up and running October of next year. The Obama administration just gave the states another month to decide if they are going to do it themselves or just leave it to the federal government. The problem is that the states don't know what all the rules are or the costs because the rules haven't even been written yet.

Less than a year out and no one knows what the hell is going on.

Not really a comforting sign is it?

There is a LOT of cause for concern. Interesting that a number of
GOP governors are getting on board. The nutjob here in IA sits
are whith his thumb up his azz.

[KantoSooner]

Yeah, what's up with Iowa politically? Your Gov is insane, Gassley is on a single handed jihad against American companies engaged in international business (as though we have a choice) and every four years you kick up a bunch of zipper head candidates who'll never garner a serious vote in any other state in the union.


I'm thinking of revoking your man cards.

[sappstuf]

There is a LOT of cause for concern. Interesting that a number of
GOP governors are getting on board. The nutjob here in IA sits
are whith his thumb up his azz.

The number isn't that big and the "nutjob" is wise to wait. Why would anyone make a decision that is going to cost the state millions without knowing what they are getting into?

The WaPo had a good story on this.


“These are systems that typically take two or three years to build,” says Kevin Walsh, managing director of insurance exchange services at Xerox. “The last time I looked at the calendar, that’s not what we’re working with.” …

These marketplaces often get described as a Travelocity or Expedia for health benefits. While that might be the case for the consumer experience, experts say the underlying technology is hugely more complex, a maze of interconnecting computer systems meant to deliver health insurance to 30 million Americans.

“The reality is, states and the federal government are building something new,” says Pat Howard, who runs state health issues for consulting firm Deloitte. “There’s a rough blueprint in terms of federal regulations, but there’s still a number of decisions that need to happen to operationalize this.”

http://www.washingtonpost.com/blogs/wonkblog/wp/2012/11/12/is-obamacare-too-much-work-for-the-obama-administration/

A lot of states are probably going to say no because they see it for the clusterfark it is going to be beginning October 1st. Why take the blame when you can pass it off to the Feds? Of course if the Feds have to set up exchanges for the majority of the states that is going to be a bureaucrat's wet dream not to mention a total fiasco.

Bureaucratic wet dream don't really lend themselves to cost saving do they?

[rock on sooner]

Yeah, what's up with Iowa politically? Your Gov is insane, Gassley is on a single handed jihad against American companies engaged in international business (as though we have a choice) and every four years you kick up a bunch of zipper head candidates who'll never garner a serious vote in any other state in the union.


I'm thinking of revoking your man cards.

When I first moved to Iowa, Grassley was okay, a moderate who was willing
to work with Dems and get One stuff done. Now, he's just a grumpy old white
guy that seems to suck up to the Far Right (nee Far Side) to get along. Our
gov, when I got here was much the same, now, as our Attorney General said,
when I met him at our state convention, that he is harder to work with than
before. The AG and the gov have been in office a long time..Branstad was
gov for 16 years then out for a while and now back, the AG never left.

Our gov has overstayed, imo. Hard to understand how Iowans can be so
forward thinking/looking and still elect a dinosaur.

IA's senators are in a race to see who can live in office longer, both are in
their 70's and need to step aside for younger, fresher ideas. Now keep in
mind that I'm only 5 er 6 years younger. One's a Dem and then Grassley.
Hell, our state Congress is one of only three in the country that is split. No
damn wonder we're a tossup state.

[FaninAma]

Physician owned surgery centers rarely accept Medicaid or Medicare. That fact alone cuts administrative costs significantly. They also do not accept self-pay(unless you pay up front) and thus have a very low rate of non-payers. But I agree, the biggest cost saver is jettisoning the dead wood in administration.

[FaninAma]

Midtowner, how is Obamacare paying for the 18 million(25+ million by some estimate) new enrollees in Medicaid?

[pphilfran]

Midtowner, how is Obamacare paying for the 18 million(25+ million by some estimate) new enrollees in Medicaid?


Who pays for those 18 million (25+ million by some estimates) under the current system?

Do you think they completely do without care? Do they wait until their symptoms are serious and then head to the ever cheap emergency room?

[pphilfran]

I am not a fan of the current system....I am also not a fan of the ACA...but it is imperative that we get 100% of the population in at least basic, catastrophic coverage...

I have said it many times before...I am partial to the Swiss system...

[soonercruiser]

This story is more of an indication as to why we need ObamaCare--to drive these inflated costs down by force. If the hospital needs 18 administrators with salaries in excess of $400K to run, then I think there's some fat to cut somewhere.

Really, really dumb!
Who has more high paying administrators....the government!
And they are usually appointed, not elected or accountable to anyone!
Duh!

[soonercruiser]

In 2014 most provisions go into effect and as the effect of more healthy, younger
participants come on board and the overall costs begin to drop, I think, by 2015
you'll see some tweaking and by 2018 the program will have stablized. You'll see
visible effects on health care costs...e.g. what insurance companies offer and pay
for, you'll see the caregivers begin to be more comfortable with one or two tests,
as opposed to 4 or 5, also driving down costs. When the insurance companies get
more fully on board, many caregivers will reenter the Medicare market.

One of the tweaks, imo, will be regarding malpractise caps. Now, so many tests
are extraneous just to cover the caregiver's liabilities.

By 2014, I predict that all the **** will have begun to hit the Wall,
When all the younger folks, seniors, etc. see all the increased costs, can't find a job, and can't find a doctor that will take Medicare or Medicaid ther will be public outrage.

[soonercruiser]

Who pays for those 18 million (25+ million by some estimates) under the current system?

Do you think they completely do without care? Do they wait until their symptoms are serious and then head to the ever cheap emergency room?

Maybe you have missed it Phil, but most of these folks are treated by charity clinics run by churches and non-profits.

Catholic Hospitals turn noone away. That will change as they close, or limit care to Catholics only!

Even OK County runs the OK Co. Pharmacy, where overstocks or excess are collected in a warehouse, and distributed at no cost throught the county.

Our ministry's phone system rings off the hook when needy patients are calling in.
Many just "show up" mad at clinics when they can't get through on the phone.
The "Left wing line" that everyone shows up at hospital emergenct rooms is extremely inaccurate at best!

Anyone else out there involved in free or reduced-fee healthcare clinics?
Our lines will only grow longer in future years.
:neglected:

[FaninAma]

Who pays for those 18 million (25+ million by some estimates) under the current system?

Do you think they completely do without care? Do they wait until their symptoms are serious and then head to the ever cheap emergency room?

You have no clue about utilization rates of health care. Medicaid patients utilize services at a rate almost 3 x that of insured patients and 5 times of self-pay. Part of my locums work is with the IHS. That population also pays
nothing, including no co-pays, for their health care service has a utilization rate approaching 6x that od self-pay.

You also need to educate yourself about the ER utilization
rate of Medicaid patients. It is much higher tham self-pay and insurance patients. Now you are moving 25 million more patients on to the Medicaid rolls. Do you really think private doctors are going to magically open up their practices to these patients when Medicaid is
already cutting reimbursement rates?

So tell me again how moving all of these self-paid and insurance patients onto Medicaid rolls is going to save us money?

Liberals......always thinking with their hearts and not their brains.

[FaninAma]

Oh, and BTW, there are 30k+ physicians retiring yearly and that is expected to increase to 50k+ by 2018. There are 22k new physicians entering the market from residency programs. You do the math.

Right now the average age of urologists in this country is 56. Lots af other specialities have similiarly aging populations.

Same goes for nurses.

http://www.washingtonpost.com/wp-dyn/content/article/2010/06/13/AR2010061304096.html

[bluedogok]

Tonsillectomy $ 3,050.00
Adenoidectomy $ 2,695.00
Tonsillectomy and Adenoidectomy $ 3,695.00

Bundle and save!
Mine were done at the same time, back in 1970 at Deaconess in OKC.


What about that section of highway in Texas aka Lone Star Autobahn
where the limit is 85 mph? Then there's section of Montana where
it used to be "Reasonable and Prudent".
There was a financial incentive in the toll road contract for the 85 mph speed limit. The State of Texas gets a higher percentage of revenue from Cintra/Zachry with the 85 mph speed limit in effect. That put pressure on the legislature to approve the new speed limit, since to do pretty much anything in Texas requires legislative action.

[RUSH LIMBAUGH is my clone!]

The beauty of ObamaCare is that it actually is not a lot of government bureaucracy. It is mostly relying on the free market. It is restructing things there to help get control of costs, especially administrative costs and other factors to deliver a better healthcare product at a lower price.Yes, of course. what a crock!

[RUSH LIMBAUGH is my clone!]

"It forces us to all play by the same rules" and that is the problem, being co-opted into a system that you don't want to be part of. When did this kind of government intrusion become palatable to the U.S. citizens? I've heard the term "healthcare system" bantied around a lot. Where do we come up with the idea that's it's a given we need a healthcare system anymore than we need a grocery store system or automobile purchasing system? We've managed to reach this point in the history of civilization without government planned healthcare.Get with the program. Your team(Freedom and American laws)lost. You will learn to conform over time.

[pphilfran]

Maybe you have missed it Phil, but most of these folks are treated by charity clinics run by churches and non-profits.

Catholic Hospitals turn noone away. That will change as they close, or limit care to Catholics only!

Even OK County runs the OK Co. Pharmacy, where overstocks or excess are collected in a warehouse, and distributed at no cost throught the county.

Our ministry's phone system rings off the hook when needy patients are calling in.
Many just "show up" mad at clinics when they can't get through on the phone.
The "Left wing line" that everyone shows up at hospital emergenct rooms is extremely inaccurate at best!

Anyone else out there involved in free or reduced-fee healthcare clinics?
Our lines will only grow longer in future years.
:neglected:

I understand that...but there is still a cost to the country when they go to a charitable organization...it is not free...

[pphilfran]

You have no clue about utilization rates of health care. Medicaid patients utilize services at a rate almost 3 x that of insured patients and 5 times of self-pay. Part of my locums work is with the IHS. That population also pays
nothing, including no co-pays, for their health care service has a utilization rate approaching 6x that od self-pay.

You also need to educate yourself about the ER utilization
rate of Medicaid patients. It is much higher tham self-pay and insurance patients. Now you are moving 25 million more patients on to the Medicaid rolls. Do you really think private doctors are going to magically open up their practices to these patients when Medicaid is
already cutting reimbursement rates?

So tell me again how moving all of these self-paid and insurance patients onto Medicaid rolls is going to save us money?

Liberals......always thinking with their hearts and not their brains.

I do not care what the utilization rate is....people will go to see the doctor when sick and if they are unable to pay then everyone else pays the uninsureds fee through higher premiums and higher medical costs...

Insurance or no insurance we still pay x amount a year in the US for heath coverage and care...

I too have concerns about the physician shortage and possible overload...little doubt in my mind that is going to happen...I also understand that some physicians will stop taking medicare/medicaid patients due to lowered compensation coming out of the ACA...

As stated earlier, I am not a fan of the current system or the ACA...I firmly believe that we will never get a handle on our healthcare problems when a significant portion of our population does not have at least catastrophic insurance and uses high cost emergency room service for the normal care...

One last point...I am anything but a liberal and take offense to your crap azz, pizz ant, mindless statement about me when I have been nothing but civil in my discussion...

[LiveLaughLove]

We're heading to single payer. It was the plan all along. Our people chose socialism over free market (yes I know ObamaCare isn't socialist). They will go through fits and starts toward single payer. Say ObamaCare doesn't work well enough, and move "forward" to single payer.

Good news: Everyone will be covered.

Bad news: Rationing.

So if you stay healthy until you keel over, well guess it's great. If you get old and want to live longer. Well, good luck with that if you aren't rich.

Of course, it will be another "hate the rich" thing down the road, so there is that.

All of this prelude to single payer is just noise.

[rock on sooner]

We're heading to single payer. It was the plan all along. Our people chose socialism over free market (yes I know ObamaCare isn't socialist). They will go through fits and starts toward single payer. Say ObamaCare doesn't work well enough, and move "forward" to single payer.

Good news: Everyone will be covered.









Bad news: Rationing.

So if you stay healthy until you keel over, well guess it's great. If you get old and want to live longer. Well, good luck with that if you aren't rich.

Of course, it will be another "hate the rich" thing down the road, so there is that.

All of this prelude to single payer is just noise.

LLL, elaborate on your point about rationing, please. Are you saying
that individuals only get so much health care?

[pphilfran]

I think he going along the lines that once you hit a certain age you might not get all of the treatment available...

I will use my Dad as an example...he is 90...dementia, Alzheimer, can't hear but he can still get up and move around and see well...he has been in the VA nursing home facility in Lawton fr about a year...

A couple of months ago he fell and broke his hip...I have power of attorney and total control of everything that goes on....

My choices were to do nothing...but he would probably never walk again and would more than likely be in some amount of pain at all times...pain that could be controlled by medication..

Or I could have him operated on and have pin placed and he would have a slim chance at being able to walk again and have less pain over the long run..however long run is considering he is 90....

Doctors put the chance of him even surviving the surgery at around 50/50...

After talking with my sisters and various doctors we chose to go ahead and do the operation...

He did well, even though he had an infection and stayed in the OKC vet hospital for about a week...he is now able to get up and move around...little pain that we can tell...

Down the road this operation might/probably wouldn't be allowed due to age and his overall limitations and quality of life...

About a month ago he started bleeding from his penis during urination...the urologist ordered a bunch of tests to determine the cause...no pain....not sure of cause...again my sisters and various doctors held a pow wow and went over the choices...

Do nothing and keep him as comfortable as possible...
Do the tests and again have a 50/50 chance of losing him...

In this case we elected to do nothing since it was not affecting his quality of life...another possibility of nothing being done (rationed) down the road due to age, cost, and future quality of life...

In our current system both of these calls were on me...cost was not really an concern and only quality of life for my Dad...

Down the road it may not be me making the decision...it could be a panel weighing costs of these high dollar procedures on a 90 year old...

[FaninAma]

I do not care what the utilization rate is....people will go to see the doctor when sick and if they are unable to pay then everyone else pays the uninsureds fee through higher premiums and higher medical costs...

Insurance or no insurance we still pay x amount a year in the US for heath coverage and care...

I too have concerns about the physician shortage and possible overload...little doubt in my mind that is going to happen...I also understand that some physicians will stop
taking medicare/medicaid patients due to lowered compensation coming out of the ACA...h

As stated earlier, I am not a fan of the current system or the ACA...I firmly believe that we will never get a handle on our healthcare problems when a significant portion of
our population does not have at least catastrophic insurance and uses high cost emergency room service for
the normal care...


One last point...I am anything but a liberal and take
offense to your crap azz, pizz ant, mindless statement about me when I have been nothing but civil in my discussion...

I am shocked I tell you that can't grasp a pretty simple concept. If a patient has no out of pocket obligation to use helath care services their utilization rates go up.
When utilization rates go up so do costs. If you cover even more people with Medicaid their utilization of
healthcare services will go up including utilization of
emergency rooms and urgent cares. Medicaid pays about 20 to 30 cents on the dollar. So guess what? Insured
patients are still subsidizing them and now we will have even more patient visits to subsidize.
http://townhall.com/columnists/philkerpen/2012/07/20/medicaid_patients_not_uninsured_crowd_emergency_ro oms/page/full/


As far as labeling you, if the shoe fits....... If you're going to regurgitate faulty liberal talking points then don't be suprised when somebody groups you together with the progressives. The faulty talking point is that it is people without any insurance overutilizing emergency rooms.
That is false. It is people on Medicaid and other low reimbursement plans that over utilize emergency room services.

http://townhall.com/columnists/philkerpen/2012/07/20/medicaid_patients_not_uninsured_crowd_emergency_ro
oms/page/full/

And it doesn't take much to punch your emotional buttons. So quick to lash out emotionally. Pizz ant? Are you serious?

The bottom line is that the more government becomes involved the higher health care costs will become until they become so exhorbitant that there will no other option but to ration.

And your insinuation that ER utilization rates by patients covered by taxpayer supported plans will do anythibg but go up is mis-informed.

[LiveLaughLove]

I think he going along the lines that once you hit a certain age you might not get all of the treatment available...

I will use my Dad as an example...he is 90...dementia, Alzheimer, can't hear but he can still get up and move around and see well...he has been in the VA nursing home facility in Lawton fr about a year...

A couple of months ago he fell and broke his hip...I have power of attorney and total control of everything that goes on....

My choices were to do nothing...but he would probably never walk again and would more than likely be in some amount of pain at all times...pain that could be controlled by medication..

Or I could have him operated on and have pin placed and he would have a slim chance at being able to walk again and have less pain over the long run..however long run is considering he is 90....

Doctors put the chance of him even surviving the surgery at around 50/50...

After talking with my sisters and various doctors we chose to go ahead and do the operation...

He did well, even though he had an infection and stayed in the OKC vet hospital for about a week...he is now able to get up and move around...little pain that we can tell...

Down the road this operation might/probably wouldn't be allowed due to age and his overall limitations and quality of life...

About a month ago he started bleeding from his penis during urination...the urologist ordered a bunch of tests to determine the cause...no pain....not sure of cause...again my sisters and various doctors held a pow wow and went over the choices...

Do nothing and keep him as comfortable as possible...
Do the tests and again have a 50/50 chance of losing him...

In this case we elected to do nothing since it was not affecting his quality of life...another possibility of nothing being done (rationed) down the road due to age, cost, and future quality of life...

In our current system both of these calls were on me...cost was not really an concern and only quality of life for my Dad...

Down the road it may not be me making the decision...it could be a panel weighing costs of these high dollar procedures on a 90 year old...

Yeah except as costs skyrocket on ObamaCare and single payer (once we get it) the age's will drop and drop to offset those costs.

BTW, rich people will still be just fine, same as they are today. Hate on (not you personally phil).

[Soonerjeepman]

older couple in Arizona, brother's neighbors...the doctor is giving FREE flu shots because the new reimbursement for medicare is .04$ (yes 4 CENTS, pennies)...guess it's one way of "getting rid of the old people".

[pphilfran]

I am shocked I tell you that can't grasp a pretty simple concept. If a patient has no out of pocket obligation to use helath care services their utilization rates go up.
When utilization rates go up so do costs. If you cover even more people with Medicaid their utilization of
healthcare services will go up including utilization of
emergency rooms and urgent cares. Medicaid pays about 20 to 30 cents on the dollar. So guess what? Insured patients are still subsidizing them and now we will have even more patient visits to subsidize.
http://townhall.com/columnists/philkerpen/2012/07/20/medicaid_patients_not_uninsured_crowd_emergency_ro oms/page/full/


As far as labeling you, if the shoe fits....... If you're going to regurgitate faulty liberal talking points then don't be suprised when somebody groups you together with the progressives. The faulty talking point is that it is people without any insurance overutilizing emergency rooms.
That is false. It is people on Medicaid and other low reimbursement plans that over utilize emergency room services.

http://townhall.com/columnists/philkerpen/2012/07/20/medicaid_patients_not_uninsured_crowd_emergency_ro oms/page/full/

And it doesn't take much to punch your emotional buttons. So quick to lash out emotionally. Pizz ant? Are you serious?

The bottom line is tht the more government becomes involved the higher health care costs will become until they become so exhorbitant that their will no other option but to ration.

And your insinuation that ER utilization rates by patients covered with taxpayer supported plans will do anythibg but go up is mis-informed

I never stated that there should be no out of pocket expense...everyone should pay something for each visit...

The current system is broken and has a rate of increase that is unsustainable...I refuse to believe that we cannot come up with a system that controls costs and still has 100% of the population with catastrophic care...

We pay a fortune for heath care costs with the current system....we will continue to pay a fortune with the ACA....

My suggestion has always been to move to a system similar to the Swiss system...

I have seen no suggestions from you about what should be done to decrease costs and have every person with catastrophic coverage...

[pphilfran]

Yeah except as costs skyrocket on ObamaCare and single payer (once we get it) the age's will drop and drop to offset those costs.

BTW, rich people will still be just fine, same as they are today. Hate on (not you personally phil).

I don't disagree....

[pphilfran]

FA, instead of your rant you could have easily asked if I supported no co payment on visits...

My bad for not including it in my initial post...

[FaninAma]

I never stated that there should be no out of pocket expense...everyone should pay something for each visit...

The current system is broken and has a rate of increase that is unsustainable...I refuse to believe that we cannot come up with a system that controls costs and still has 100% of the population with catastrophic care..

We pay a fortune for heath care costs with the current system....we will continue to pay a fortune with the
ACA....

My suggestion has always been to move to a system similar to the Swiss system...

I have seen no suggestions from you about what should
be done to decrease costs and have every person with catastrophic coverage...


My first recommendation would be to make sure
everybody has some skin in their own health care decisions. In New Zealand everybody pays a $25 copay to see their primary care physician. They are educated about what will be covered and what will not be covered, in other words they have defined benefits that are set in stone.They have malpractice tort reform and fewer lawsuits. They don't pay hospital administrators hundreds to housands of dollars a year. They reimburse health care providers who actually take care of patients very well, especially those in primary care.

Their per capita expenditures are abot 1/3 of ours and they have a longer average longevity.

And I apologize about the tone of my previous posts. It was overboard. I am frustrated by the fact that there are lots of examples of better ran healthcare systems in the world but neither party cares to implement them because it would upset one of their special interests....lawyers
insurance companies, those who want health care without
ANY financial obligation. All of the claims about uninsured patients being the reason costs are so high is bogus. Over-utilization and parasites(non-productive administrators and insurance companies trying to squeeze a profit out of the system) on the system are the primary causes.

[LiveLaughLove]

There's absolutely no way that EVERYBODY will pay.

[pphilfran]

I have looked at the NZ system but still prefer the Swiss...

IF I remember correctly the majority of the NZ system is paid for by the government...75% or so....I would rather not have the money going to our DC leadership since they tend to do the wrong things with the money....

They also have a secondary system of insurance offered by public companies that covers expensive procedures due to long wait times with the fed systems

Expenditures are closer to 1/2 of US cost...even less then the Swiss system I favor..

The Swiss system sets a basic, catastrophic policy standard...various insurance companies can compete for the coverage but are not allowed a profit on the basic coverage...they profit on coverage for extra benefits like private room...

Everyone pays for their coverage...up to 7 or 8% of their wages...the government will subsidies those where coverage exceeds that 7 or 8%...

[FaninAma]

Phil, I could go for that. Again it will be hard to convince those that have been getting totally free healthcare that they are going to have to pay something even if it is a $10 copay. You wouldn' t believe how parents of children on Medicaid and in the IHS system ask me to write prescriptions for Tylenol.

[Midtowner]

Yeah except as costs skyrocket on ObamaCare and single payer (once we get it) the age's will drop and drop to offset those costs.

BTW, rich people will still be just fine, same as they are today. Hate on (not you personally phil).

Why will costs skyrocket?

Also, apostrophes don't turn things into plurals. They make words possessive.

[soonercruiser]

Why will costs skyrocket?


Duh!
Costs are already up $4,000 per family since the bill passed!!!
Businesses cutting back on hours and healthcare insurance?
Businesses closing because of increasing healthcare costs to the employer?
Doctors quitting?
Forget the facts.....they don't fit the Left's narrative.

[LiveLaughLove]

Why will costs skyrocket?

Also, apostrophes don't turn things into plurals. They make words possessive.


I'm going to assume that's a serious question. Name one government program where costs haven't skyrocketed.

This program alone was sold as $900 billion, but the cbo has already upped that to $2.7 trillion. That already skyrocketing and it hasn't even really started.

If you like the program that's fine, we can disagree, but don't play or be dumb on what its going to cost. Its going to be staggering.

And no, not EVERYONE will pay. Are we going to deny healthcare to those that can't afford it? I thought that was the point of it. Its our new human right isn't it? (human right is code for free to most, paid by the "rich")

As for my punctuation, thanks, I use my phone mostly on here and it autocorrects my words. The only punctuation I put in myself are periods usually. But I may have posted that on my laptop, I don't recall.

[Midtowner]

I'm going to assume that's a serious question. Name one government program where costs haven't skyrocketed.

I assume you're talking about federal government, 'cuz we seem to handle state and local projects just fine for whatever reason. I'm sure they're out there, but costs really don't "skyrocket" with most government programs, they just keep growing incrementally, every single one of them by a few percentage points per year for no good reason. Government works differently from business--there is incentive to spend every available dollar rather than turning money back to the general fund. Even at the state level, we don't get that. My father was first assistant in a major state department back in the early 80s. He claims that they were the only administration to ever turn money back to the general fund from their budget--all while raising all kinds of hell.

It should also be noted that ObamaCare isn't really a government program--it's forced capitalism. We're going to have everyone participating in the marketplace and we've reshaped the market to encourage costs to decrease. If they don't, we'll see real socialism, but we're nowhere close to it yet.


As for my punctuation, thanks, I use my phone mostly on here and it autocorrects my words. The only punctuation I put in myself are periods usually. But I may have posted that on my laptop, I don't recall.

It's one of the most common mistakes I see smart people make. Hell.. there are even business signs around town which make this error. If you're ever on Boulevard and around Edwards in Edmond, check out "The Corner's" apartments.

--of course they could be owned by Dave and Sue Corner, but then it'd be The Corners'. Maybe the owner is single?

[FirstandGoal]

Phil, I could go for that. Again it will be hard to convince those that have been getting totally free healthcare that they are going to have to pay something even if it is a $10 copay. You wouldn' t believe how parents of children on Medicaid and in the IHS system ask me to write prescriptions for Tylenol.

Oh I see it every day. That and Claritin. What's funny is that they're only allowed 1 rx for acetaminophen and 1 rx for ibuprofen every 6 months and those parents will holler like stuck pigs if you try to tell them they've exceeded their limits and will actually have to pay out of pocket for fever reducer for their sick child. LOL, most of them play it smart though and just have me run it on one of their other 6 kids' (oh hey, is this proper punctuation?) profiles and find a way to wrangle the system into paying for it.

[sappstuf]

I assume you're talking about federal government, 'cuz we seem to handle state and local projects just fine for whatever reason. I'm sure they're out there, but costs really don't "skyrocket" with most government programs, they just keep growing incrementally, every single one of them by a few percentage points per year for no good reason. Government works differently from business--there is incentive to spend every available dollar rather than turning money back to the general fund. Even at the state level, we don't get that. My father was first assistant in a major state department back in the early 80s. He claims that they were the only administration to ever turn money back to the general fund from their budget--all while raising all kinds of hell.

It should also be noted that ObamaCare isn't really a government program--it's forced capitalism. We're going to have everyone participating in the marketplace and we've reshaped the market to encourage costs to decrease. If they don't, we'll see real socialism, but we're nowhere close to it yet.



It's one of the most common mistakes I see smart people make. Hell.. there are even business signs around town which make this error. If you're ever on Boulevard and around Edwards in Edmond, check out "The Corner's" apartments.

--of course they could be owned by Dave and Sue Corner, but then it'd be The Corners'. Maybe the owner is single?

So if it isn't a government program, but by your own admission it is being "forced" then who is doing the forcing and do they have a program for that?

[Midtowner]

So if it isn't a government program, but by your own admission it is being "forced" then who is doing the forcing and do they have a program for that?

If you don't buy, you're taxed.

[RUSH LIMBAUGH is my clone!]

FORCED CAPITALISM!!!...NOT a government program! yeeehaaah!

[LiveLaughLove]

If you don't buy, you're taxed.

That would be you're taxed if you aren't one of the poor, correct?

So not EVERYBODY is forced to buy it really.

Also so much for not taxing the middle class as somebody named Obama had said he wouldn't.

[sappstuf]

If you don't buy, you're taxed.

Taxed by whom, if this is not a government program? Who will enforce that you pay this tax if not the government?

[Midtowner]

Taxed by whom, if this is not a government program? Who will enforce that you pay this tax if not the government?

The IRS. We don't need additional infrastructure to tax.

[Soonerjeepman]

well at least the dems created some new jobs...

According to Brady, a new analysis by the Joint Economic Committee and the House Ways & Means Committee staff estimates up to 6,500 new IRS personnel will be necessary to collect, examine and audit new tax information mandated on families and small businesses as a result of the Affordable Care Act.

http://www.examiner.com/article/irs-geared-up-for-the-obamacare-individual-mandate-tax

[FirstandGoal]

well at least the dems created some new jobs...

According to Brady, a new analysis by the Joint Economic Committee and the House Ways & Means Committee staff estimates up to 6,500 new IRS personnel will be necessary to collect, examine and audit new tax information mandated on families and small businesses as a result of the Affordable Care Act.

http://www.examiner.com/article/irs-geared-up-for-the-obamacare-individual-mandate-tax

Woo hoo!
Isn't that Obama such a hero for creating new jobs?

Just gives me the warm fuzzies.

[pphilfran]

The IRS. We don't need additional infrastructure to tax.

Well, ****...I want to fold the IRS and here we are giving them more opportunity and power...

[TitoMorelli]

Well, ****...I want to fold the IRS and here we are giving them more opportunity and power...


http://1.bp.blogspot.com/-s165Sk8XrbM/TmqnGG87FoI/AAAAAAAACZY/oHc3GNlYiTo/s1600/SatNightFev_061Pyxurz.jpg

No, Phil! You can't **** the IRS. The IRS ****s you! It catches up with you and it ****s you if you ain't planned for it!

[Soonerjeepman]

Woo hoo!
Isn't that Obama such a hero for creating new jobs?

Just gives me the warm fuzzies.

lol..no doubt, just what the libs want..MORE gov jobs to keep voting themselves in..

[sappstuf]

Oklahoma opts out of building healthcare exchanges.

When it is all said and done, the federal government will need to develop, set up and operate health care exchanges for around 20 states... In 316 days.

I wouldn't hold your breath.

[FaninAma]

That would be you're taxed if you aren't one of the poor, correct?

So not EVERYBODY is forced to buy it really.

Also so much for not taxing the middle class as somebody named Obama had said he
wouldn't.

And that will be the thing that causes the system to collapse....... elgibility requirements for the free care will be relaxed and people will find ways to come in under the income requirement to get the free stuff.

That's the way government programs work.

[sappstuf]

The IRS. We don't need additional infrastructure to tax.

And what of the federal government run exchanges? Is that also not a government program?