Heh, the Conservatives have been correct all along...

[TheHumanAlphabet]

You can't keep your health care, or your doctor...

and the WH knew some 10 million would lose coverage.

People are so stupid and lazy, they want free **** for nothing and are losing their liberties in the process and don't know it.

Fear this administration and fear Pelosi and Reid. They do not have your best interest at heart nor that of the U.S. They only want to expand government and their control over you.

[yermom]

so do you have anything to base this on, or are you just listen to talk radio to get inspired again?

are you actually responding to anything, or just decided to rant again today?

[olevetonahill]

so do you have anything to base this on, or are you just listen to talk radio to get inspired again?

are you actually responding to anything, or just decided to rant again today?

I aint got a Dog in this fight But read this.

http://news.yahoo.com/obama-administration-knew-millions-wouldn-t-be-able-to-keep-insurance--report-222249311.html

[TheHumanAlphabet]

so do you have anything to base this on, or are you just listen to talk radio to get inspired again?

are you actually responding to anything, or just decided to rant again today?

Yeah, I am just a nut bag, but everything I have said before is coming true today... Yeah, I am just a nut bag... :rolleyes:

[OULenexaman]

more people losing their plans than people signing up....great concept.

[achiro]

There will be at least as many people without insurance as there are now except that the scale will shift slightly up the income ladder. More in the lower end will have it paid for while a bunch in the middle class will struggle to barely afford it or not have it at all.

[FaninAma]

so do you have anything to base this on, or are you just listen to talk radio to get inspired again?

are you actually responding to anything, or just decided to rant again today?
So, do you consider NBC news or Yahoo a part of the right wing talk radio cabal?

Just wait until the flood of new medicaid patients hit the system. It will collapse. 95% of all the new Obamacare enrollees are new medicaid patients. Somehow I don't think that will pay for all the subsidies and lower rates that Obamacare needs to function.

[FaninAma]

There will be at least as many people without insurance as there are now except that the scale will shift slightly up the income ladder. More in the lower end will have it paid for while a bunch in the middle class will struggle to barely afford it or not have it at all.
There will be a ****load of new medicaid patients. I feel sorry for the truly needy children who depend on this program. It will totally collapse under the weight of the added burden.

[KantoSooner]

Okay, so now these folks do their medical care at ER's across the country. Under ACA, what will change?

One of the fallacies that's annoyed me is the rhetorical use of terms like 'program' or 'plan' or 'system' to imply that whatever it is that's coming is somehow an integrated whole while what we have had is not. Hell, pre-ACA/Obamacare, we have HAD a 'system': those who are uninsured or can't pay simply go to their nearest ER and get what they need done (in the most expensive ward of the hospital). Then they leave. They don't pay, and have no ability or intent to pay. The hospitals then turn around and push up charges across the board to pay for this uncompensated care. It seems like they bump it up about 25X of what they are actually out, but that's another issue.

Is issuing them a card going to change the fact that a) they will still get care and, b) they still won't pay for it and, c) the rest of us will pay for it? I don't see where all the new patients are going to come from.

[FaninAma]

Okay, so now these folks do their medical care at ER's across the country. Under ACA, what will change?

One of the fallacies that's annoyed me is the rhetorical use of terms like 'program' or 'plan' or 'system' to imply that whatever it is that's coming is somehow an integrated whole while what we have had is not. Hell, pre-ACA/Obamacare, we have HAD a 'system': those who are uninsured or can't pay simply go to their nearest ER and get what they need done (in the most expensive ward of the hospital). Then they leave. They don't pay, and have no ability or intent to pay. The hospitals then turn around and push up charges across the board to pay for this uncompensated care. It seems like they bump it up about 25X of what they are actually out, but that's another issue.

Is issuing them a card going to change the fact that a) they will still get care and, b) they still won't pay for it and, c) the rest of us will pay for it? I don't see where all the new patients are going to come from.

What will change? Medicaid patients have a 3x higher rate of healthcare utilization than self-pay and 2x higher than privately insured patients. Less than 30% of private docs take new medicaid patients at current reimbursement rates. Guess what will happen when reimbursement rates fall as they must when a larger pool of patients is covered by a finite pool of funds?

Right now the trend is for corporations to open Urgent Care centers which are ER's in everything but name. They get reimbursed at lower rates than ER's but the big advantage for them is they are NOT required to accept all patients regardless of insurance like designated ERs are so many of them do not and will not accept medicaid. Self-pay patients are required to pay at the time of service.

That leaves true ERs and government facilities as the only places that will accept medicaid. Can you surmise what is going to happen at these facilities? They will be overwhelmed and will lose a lot of money leading many of the smaller facilities that can't offset this loss to close.

Also, the overwhelming flood will collapse Obamacare
http://www.cbsnews.com/8301-505267_162-57609254/medicaid-enrollment-spike-a-threat-to-obamacare-structure/

(Apologies to yermom for linking to an article from a right wing media site.)

[BermudaSooner]

maybe basic economics needs to be taught in high school, as anyone with the ability to think knew what was and will happen with ACA.

[RUSH LIMBAUGH is my clone!]

maybe basic economics needs to be taught in high school, as anyone with the ability to think knew what was and will happen with ACA.Very sad to see us vote as we do. Challenging times ahead.

[lexsooner]

Yeah, I am just a nut bag, but everything I have said before is coming true today... Yeah, I am just a nut bag... :rolleyes:

What, there's now evidence the fainting White House guest was fake?

[TheHumanAlphabet]

What, there's now evidence the fainting White House guest was fake?

It will come out... the drip drip drip eventually sheds light on this administration and their cabal...

[KantoSooner]

Fanin, where are the 'extra' patients coming from? I've had a household full of old people the last few years. What with a collapsed vertebra or two, multiple potassium overloads, a couple of falls, urinary tract bleeding and my own kidney stone, I've spent way more time in the local ER than most non-professionals. And it's full all the damn time with the lower economic strata getting their health maintenance taken care of.
My question is not so much about the system per se, but about where all the 'new' patients will come from. I don't see it. They're already in the ER, getting cared for and not paying. What will change except the method of payment? You, me and every other taxpayer pay now and, I fully expect, will pay in the future.

[sooner_born_1960]

maybe basic economics needs to be taught in high school, as anyone with the ability to think knew what was and will happen with ACA.
Basic arithmetic is taught from elementary school onward.

[FaninAma]

Fanin, where are the 'extra' patients coming from? I've had a household full of old people the last few years. What with a collapsed vertebra or two, multiple potassium overloads, a couple of falls, urinary tract bleeding and my own kidney stone, I've spent way more time in the local ER than most non-professionals. And it's full all the damn time with the lower economic strata getting their health maintenance taken care of.
My question is not so much about the system per se, but about where all the 'new' patients will come from. I don't see it. They're already in the ER, getting cared for and not paying. What will change except the method of payment? You, me and every other taxpayer pay now and, I fully expect, will pay in the future.
They are coming from patients who do not qualify for medicaid before but do under Obamacare. The reason medicaid over utilizes healthcare is because they have no financial stake in seeking medical care. They pay no copays or deductibles even minimum type fees like $5 for an office visit.

There was a way to cover people with chronic problems without overthrowing the entire system. Plus, we are broke. Where is the money coming from. I wish money and resources grew on trees and that everybody could have everything they need in this world but you know that is not realistic. That's why you plan ahead. That's why you live in cockroach infested efficiencies to pay your way through college and medical school and put off having a family until you are able to support your family without asking strangers to do so and that includes our elderly parents. That is my responsibilty and my privilege. I would never allow my kids to go without health care coverage. I would never allow my 76 year old mother to go without health care or any other necessity.

I asked a Vietnamese doctor why he waited so long to start medical school(he was in residency when he was in his late 30's). He replied,"It was my turn." I asked him to explain. He stated that everybody in their extended family worked and put other family members through school when they were able and that he helped to put others through school who then helped put him through school as well as helping other family members with expenses including the very young and the very old. I was immensley impressed but this country does not have that type of discipline. They fail in their family duties and then expect strangers to make up for their shortcomings.

[KantoSooner]

Fair enough. I just am unconvinced that the same folks who were using the ER and not paying before are somehow going to multiply now that they still don't have to pay.

It would seem to me that all we've done is changed the channel through which payment is routed. Those who didn't pay before are still not going to pay. So why would there be more of them? And from whence would these more come?

[FaninAma]

Fair enough. I just am unconvinced that the same folks who were using the ER and not paying before are somehow going to multiply now that they still don't have to pay.

It would seem to me that all we've done is changed the channel through which payment is routed. Those who didn't pay before are still not going to pay. So why would there be more of them? And from whence would these more come?

Let me ask you a question. If the average person has a cold and feels lousy but knows they have to pay to see the doctor are they going to stay at home and see if it gets better or shell out $200 to go to the Urgent Care or even their private doctor? Now give that same person a free voucher for the visit and the prescriptions and what will most do?

i have medicaid patients ask for prescriptions for meds even though over the counter meds would work just as well but I know if I don't write that script their kid is likely to go without treatment.

Once the 20 million new medicaid patients get their free bus pass they are going to ride the bus a lot more.

The medical field has contributed significantly to the problem by raising expectations that are not supported by economic logic. Longevity in a society is influenced far more by improvements in preventative measures like immunizations and better nutrition/public health systems. Even with heroic acute care measures the benefit to society of $100,000 spent to make a premature child well outweighs a $10,000 procedure to help an 80 year old patient with chronic health issues. I am sorry if I sound heartless but in a world of exanding populations and limited resources there will have to be some very tough choices made. And when these choices are made the ruling class should not be allowed to exempt themselves.

[KantoSooner]

First off, we can solve teh rising population thing with birth control. That's pretty easy....and a different topic all together.

I guess I'm not phrasing my question properly. From the limited personal observation I've done, it doesn't look like the pre-Obamacare world held too many restraints on access for the medicaid crowd. essentially, they went to the ER whenever, for whatever, got it done and didn't pay. And they had no assets to go after so the hospital either ate the loss or the taxpayer did.

Now, with Obamacare, the same folks will get pretty much the same deal, I guess: go in and get what they want and not pay. I'm not seeing anything new to drive new volumes.

[FaninAma]

First off, we can solve teh rising population thing with birth control. That's pretty easy....and a different topic all together.

I guess I'm not phrasing my question properly. From the limited personal observation I've done, it doesn't look like the pre-Obamacare world held too many restraints on access for the medicaid crowd. essentially, they went to the ER whenever, for whatever, got it done and didn't pay. And they had no assets to go after so the hospital either ate the loss or the taxpayer did.

Now, with Obamacare, the same folks will get pretty much the same deal, I guess: go in and get what they want and not pay. I'm not seeing anything new to drive new volumes.

Pre-Obama Care: 50 million medicaid patients
Post-Obama Care: 70+ million medicaid patients

Pre-Obama Care: State and federal cost of medicaid program rising 8+% a year.
Post-Obama Care: ????

Yearly Healthcare Contacts:

Self Pay: Less than 2 times a year
Private Insurance: 3 times a year
Medicaid: 6 times a year

Number of patients in an insurance group x the average number of annual visits = volume/cost.

Make no mistake about it, there is cost shifting going on now with uninsured costs being born by local entities(hospitals and doctors who accept medicaid) and insurance purchasers. The cost of these patients will still be born by the same people.....medical providers and the privately insured patients who aren't subsidized but the taxpayers are now going to pick up some of the tab of the providers although public providers will suffer because of the increased volume of low reimbursing medicaid patients.

Winners in ObamaCare: Insurance companies, new medicaid patients and those with heavily subsidized plans, private medical providers who will refuse to see medicaid but will be able to increase patients with minimally defined benefits.

Losers: public hospitals and clinics, privately insured patients, current medicaid patients who are truly needy and who will now have to share resources with the new medicaid patients(especially children of the very poor) and especially the current and future taxpayers.

[yermom]

I aint got a Dog in this fight But read this.

http://news.yahoo.com/obama-administration-knew-millions-wouldn-t-be-able-to-keep-insurance--report-222249311.html

is this what he was responding to specifically? there is no link in the post. just a rant.


So, do you consider NBC news or Yahoo a part of the right wing talk radio cabal?

Just wait until the flood of new medicaid patients hit the system. It will collapse. 95% of all the new Obamacare enrollees are new medicaid patients. Somehow I don't think that will pay for all the subsidies and lower rates that Obamacare needs to function.

there was no source for anything.


Pre-Obama Care: 50 million medicaid patients
Post-Obama Care: 70+ million medicaid patients

Pre-Obama Care: State and federal cost of medicaid program rising 8+% a year.
Post-Obama Care: ????

Yearly Healthcare Contacts:

Self Pay: Less than 2 times a year
Private Insurance: 3 times a year
Medicaid: 6 times a year

Number of patients in an insurance group x the average number of annual visits = volume/cost.

Make no mistake about it, there is cost shifting going on now with uninsured costs being born by local entities(hospitals and doctors who accept medicaid) and insurance purchasers. The cost of these patients will still be born by the same people.....medical providers and the privately insured patients who aren't subsidized but the taxpayers are now going to pick up some of the tab of the providers although public providers will suffer because of the increased volume of low reimbursing medicaid patients.

Winners in ObamaCare: Insurance companies, new medicaid patients and those with heavily subsidized plans, private medical providers who will refuse to see medicaid but will be able to increase patients with minimally defined benefits.

Losers: public hospitals and clinics, privately insured patients, current medicaid patients who are truly needy and who will now have to share resources with the new medicaid patients(especially children of the very poor) and especially the current and future taxpayers.

where are the stats for the group that is already "no pay"? you are just talking over Kanto's point. we already foot the bill for them. they go whenever. expanding medicaid is such a change how? seems to me now they aren't permanently screwed by huge debts they aren't likely ever going to pay anyway for routine medical care.

[FaninAma]

is this what he was responding to specifically? there is no link in the post. just a rant.



there was no source for anything.



where are the stats for the group that is already "no pay"? you are just talking over Kanto's point. we already foot the bill for them. they go whenever. expanding medicaid is such a change how? seems to me now they aren't permanently screwed by huge debts they aren't likely ever going to pay anyway for routine medical care.
"Just a rant." Whatever. You are just in denial........ typical of the type of blind partisanship that refuses to hold the politicians that bought your vote responsible.

Google the term "Obamacare enrollees mainly medicaid" and you"ll get all of the links you want.

Also try Googling "Obama knew insurance policies would be cancelled". That bastion of right wing propaganda, NBC, has been the media outlet out front on this story.

[achiro]

First off, we can solve teh rising population thing with birth control. That's pretty easy....and a different topic all together.

I guess I'm not phrasing my question properly. From the limited personal observation I've done, it doesn't look like the pre-Obamacare world held too many restraints on access for the medicaid crowd. essentially, they went to the ER whenever, for whatever, got it done and didn't pay. And they had no assets to go after so the hospital either ate the loss or the taxpayer did.

Now, with Obamacare, the same folks will get pretty much the same deal, I guess: go in and get what they want and not pay. I'm not seeing anything new to drive new volumes.
There are so many aspects to what you are asking but simply put:
More people+same amount of gubment money=less benefits for each person
A person that now has medicaid that didn't before is more apt to go to the doctor for simple things that really don't need care, many docs don't accept medicaid so they end up in the ER. Medicaid still won't pay for many of the tests/procedures/prescription that are done in the ER. In fact, they will probably cover less because as I stated before more people=less benefits paid.
Huge deductibles for many more than before means more folks not able to pay their bills.
All of that(and more) means that the ER's will be left holding the bills for more than they already do.

[yermom]

"Just a rant." Whatever. You are just in denial........ typical of the type of blind partisanship that refuses to hold the politicians that bought your vote responsible.

Google the term "Obamacare enrollees mainly medicaid" and you"ll get all of the links you want.

Also try Googling "Obama knew insurance policies would be cancelled". That bastion of right wing propaganda, NBC, has been the media outlet out front on this story.

Blah blah blah. Partisan my ***.

It's one thing to comment on a link. It's another to just comment on something like everyone knows what you are talking about. It's not like everyone is reading the same crap you are

[FaninAma]

so do you have anything to base this on, or are you just listen to talk radio to get inspired again?

are you actually responding to anything, or just decided to rant again today?

Have you been living in a cave the past 48 hours? You must have been to not know this **** has been all over the non-talk radio media.

[yermom]

Sorry if I don't fap to Obama news 24x7

But I give this all a big "meh"

[KantoSooner]

I think I've confused the issue by inclusion of the word 'medicaid'. Drop that. I dont know for sure, but many of the folks in my ER did not appear to have bupkis. No card. But they walked in, got help and walked out without paying. Whether Obamacare issues them a card or not and makes them 'official' they existed before and exist now.

I'm just not seeing 20 million destitute, yet stoic folks who were staying home and suffering before Barry decided to issue them cards.

And on the issue of 'issuing them cards' I'm not so sure they get on the system even after the ACA is fully implemented. We're not talking about the most organized folks here. Many are the same ones for whom getting any form of picture ID in order to vote is somehow a massive burden. Signing up for Obamacare? Let's just say there won't be 100% uptake on that.

Anyway, whoever's right, we're about to find out. And, regardless, it's not going to be anything that controls our out of control healthcare costs.

[TheHumanAlphabet]

"Just a rant." Whatever. You are just in denial........ typical of the type of blind partisanship that refuses to hold the politicians that bought your vote responsible.

.

Yermom is a Leftist hack and only spews the mantra of the Left...

[yermom]

which mantra is that?

i think both sides are idiots. just because i don't join in on the circle jerks around here i'm a "leftist"

[okie52]

which mantra is that?

i think both sides are idiots. just because i don't join in on the circle jerks around here i'm a "leftist"

And you use your left hand....

[KantoSooner]

So, liberals use their left hands.

Conservatives must use their right, correct?

I would guess that undecideds would switch off if they were going to be consistent, but they're not known for consistency, so maybe they kind of go in spurts, excuse the pun.

But then we'd get off into truly inventive territory.

What would it mean, for example, to discover that an acquaintance was fond of female blowup dolls? Would that be emblematic of a communist? So that those who leaned to male blow up dolls were thusly most likely to be closet nazi's?

And those eager for flagellation with bamboo staves would be fans of, oh, I don't know, La Familia Kim?

Perhaps anyone who substituted a handful of ghee for foreplay would be deemed a fellow traveler with the suggestively named Congress Party of India?

Probably nothing to be found in Brazil, from what I can suss out, they pretty much confine themselves to large portions of live rumpy with actual women. The cheek of them!

But it does make one ponder the potential horror of an item seen in the 'hobby' room of one of the Texas congressional delegation not long ago. Perhaps my eyes deceived me, but it appeared to be an English saddle...with an electric cord emerging from the back.

Sometimes you simply don't want to know the answer to obvious questions.

[okie52]

Liberals use their left hands and their buttholes....

JK

[RUSH LIMBAUGH is my clone!]

unargueable

[BermudaSooner]

Sorry if I don't fap to Obama news 24x7

But I give this all a big "meh"

If you were one of the hundreds of thousands paying, for example, $1200 a month for a policy that met your needs and were forced to buy a policy that cost $2100 a month I think your reaction would be something other than, "meh."

[Soonerjeepman]

I think I've confused the issue by inclusion of the word 'medicaid'. Drop that. I dont know for sure, but many of the folks in my ER did not appear to have bupkis. No card. But they walked in, got help and walked out without paying. Whether Obamacare issues them a card or not and makes them 'official' they existed before and exist now.

I'm just not seeing 20 million destitute, yet stoic folks who were staying home and suffering before Barry decided to issue them cards.

And on the issue of 'issuing them cards' I'm not so sure they get on the system even after the ACA is fully implemented. We're not talking about the most organized folks here. Many are the same ones for whom getting any form of picture ID in order to vote is somehow a massive burden. Signing up for Obamacare? Let's just say there won't be 100% uptake on that.

Anyway, whoever's right, we're about to find out. And, regardless, it's not going to be anything that controls our out of control healthcare costs.

so basically he KEPT his promise of healthcare for all without really changing anything...

I do agree with FIA, that I think there will be more patients...maybe they didn't want the hassle of arguing about paying so they didn't go, now they don't have that issue..

[yermom]

If you were one of the hundreds of thousands paying, for example, $1200 a month for a policy that met your needs and were forced to buy a policy that cost $2100 a month I think your reaction would be something other than, "meh."

i've yet to have insurance and not watch the cost climb every year. i have no idea what your plan is like, or where it comes from, but IMO the problem is for-profit health care in the first place. on a more realistic point, the fact that it's basically impossible for most people to actually shop around for insurance makes them be able to charge whatever they want, on both ends.

[FaninAma]

Kanto, all I can do is tell you to follow me around a downtown Ft. Worth children's ER and see what I am talking about. We treat 70% medicaid. 20 to 25% private insurance and less than 10% self-pay. The rates in this company's sattelite urgent cares are about the same with only the percentage of insured patients going up in more affluent areas and medicaid going down. Self-pay stays the same.I am tired of trying to convince you that when people have to pay out of pocket or get a bill they do not show up for trivial crap. When it is free they show up for everything. They call 911 fortrivial things. They demand the most expensive forms of treatment. If you really don't understand the economics of human nature I can't do a thing to help you understand.


BTW, in the European and Australian systems hardly anybody goes to the doctor without ponying up prior to being seen by the PCP's in the form of copays. The Massachussets plan heralded by Democrats requires a copay by Medicaid patients.

More and more doctors are going to refuse to accept medicaid so tell me how expanding it helps medicaid patients. Reimbursement rates will be cut in 2014.

I can't do anything more to help you understand or believe what I am saying. 23 years of experience in pediatrics tells me that the only safety net for really poor kids is about to totally collapse.

BTW, in 23 years of being in pediatrics I have never seen a kid with chronic medical issues go without coverage.........either private insurance, medicaid or disability coverage. That issue is just a strawman used by the Democrats.

Yermom, do you think that under Obamacare the insurance companies are going to freeze their rates now? And consider they are now forced to offer significantly expanded benefits. What do you think the insurance companies are going to do? If the Democrats had any spine at all they would have just put in a one payer system and haved the turmoil that will be the result of this crap.

[8timechamps]

I think Fanin and Kanto are talking about two separate issues, both of you are correct, but about different things.

Kanto, I think your point is about the folks that use the ER as their primary care physician, and that it won't change. Which I agree with. People that use the ER for their primary care do it because they 1) aren't going to pay for it, and 2) it's convenient. Even if routine care is covered under the ACA, the people that use the ER for that purpose probably aren't going to change. It's sick.

Fanin, I think you're talking more to the overall burden on the system this new law is causing. My thinking is that this law could turn health care into the DMV. You go to the doctor, and you have a 2 hour wait with 100 other people in front of you. It's also sick.

[FaninAma]

8times, I really don't understand the confusion. Kanto thinks unisnsured patients utilize medical services at the samg rate as Medicaid. That is simply not the case. Medicaid patients have no financial disincentive to use their Medicaid card save the barrier of inconvenience of waiting hours and hours in the shrinking number of clinics and ERs that accept medicaid.

Expanding medicaid strains an already strained system which hurts the ones who need it the most. Expanding medicaid will result in more medical expenditures by the government leading to higher deficits. It is undeniable that without systemic changes in patient expectations and use patterns Obamacare will be a total disaster.

[yermom]

Yermom, do you think that under Obamacare the insurance companies are going to freeze their rates now? And consider they are now forced to offer significantly expanded benefits. What do you think the insurance companies are going to do? If the Democrats had any spine at all they would have just put in a one payer system and haved the turmoil that will be the result of this crap.

that is the gist of what i said from day one. Obamacare doesn't go far enough. they caved all over the place just to pass something.

[8timechamps]

8times, I really don't understand the confusion. Kanto thinks unisnsured patients utilize medical services at the samg rate as Medicaid. That is simply not the case. Medicaid patients have no financial disincentive to use their Medicaid card save the barrier of inconvenience of waiting hours and hours in the shrinking number of clinics and ERs that accept medicaid.

Expanding medicaid strains an already strained system which hurts the ones who need it the most. Expanding medicaid will result in more medical expenditures by the government leading to higher deficits. It is undeniable that without systemic changes in patient expectations and use patterns Obamacare will be a total disaster.

I defer to your knowledge in this area, because I know you see it everyday. I was under the impression that Kanto was talking more about the use of ERs in general as PCPs. I may have misinterpreted his posts.

Let me ask you this, as a Physician, do you think there is a way to salvage this mess? Again, I'm not in the arena, but from where I stand, it appears that there will be no good endgame here. In the end, we'll be left with a broken ACA, that's not utilized, and will cost far more than it benefits the public.

[8timechamps]

that is the gist of what i said from day one. Obamacare doesn't go far enough. they caved all over the place just to pass something.

From what I understand, the dems weren't able to garner enough support in their caucus to pursue a single payer system.

[yermom]

you said caucus

[cleller]

you said caucus

Racist!

[KantoSooner]

8times, I really don't understand the confusion. Kanto thinks unisnsured patients utilize medical services at the samg rate as Medicaid. That is simply not the case. Medicaid patients have no financial disincentive to use their Medicaid card save the barrier of inconvenience of waiting hours and hours in the shrinking number of clinics and ERs that accept medicaid.

Expanding medicaid strains an already strained system which hurts the ones who need it the most. Expanding medicaid will result in more medical expenditures by the government leading to higher deficits. It is undeniable that without systemic changes in patient expectations and use patterns Obamacare will be a total disaster.

Fanin, the point I was trying to make was precisely what 8TC restated: that I fail to see an 'extra' 20 million folks getting into the game because of Obamacare who've been on the sidelines not involved in the healthcare system to date. That was pretty much it. If you reread my posts (though why you'd want to is a stretch. Reading most posts, mine or anyone else's, more than once is kind of painful.) I think you'll find that we are broadly in agreement: the 'new system' does nothing to address out of control cost inflation. And one mechanism that drives this is a lack of disincentive for wasteful medicine (unneeded tests/procedures, overuse of ERs, etc.)

I am still guardedly in favor of a 'national health system'. I don't see that Obamacare is addressing cost and thus don't feel that Obamacare, at least as it is structured today, can succeed.

Let me broaden the point still further by adding that I don't see a market solution succeeding much better when you factor in licensing and regulation which strip the market for healthcare of any meaningful bargaining/shopping mechanism to control costs.

[RUSH LIMBAUGH is my clone!]

From what I understand, the dems weren't able to garner enough support in their caucus to pursue a single payer system.entirely possible the dems don't want to chance taxpayer/citizens outrage, or major loss of support. Instead, the plan of continuing to go through the charade of Obamacare, to crash the health insurance industry, cause chaos regarding health care, and have the masses screaming for a full govt. takeover/Single Payer system, is more likely.

[KantoSooner]

It wouldn't surprise me in the least. And I'm not sure it's all that sinister, really. The health insurance industry has been leading the nation around by the yank for long enough. You can't negotiate what you pay them. You can't negotiate what you pay the hospitals/doctors/drug companies, so you're screwed. Thus, I'm not sure burning it to the ground and starting over is that bad a deal. If we all have to pretend that a big forest fire hit and we have to deal with triage medicine for a year or two, perhaps that would be the lesser of evils.

[RUSH LIMBAUGH is my clone!]

well, govt. meddling and actions causing more expensive healthcare in the first place, has been a problem for a long time. Now that they have gotten what they have always wanted, more control over our freedom and our lives, it's no stretch to think Obamacare was planned chaos, with the subsequent result of government taking complete contol of the healthcare industry. Rest assured, it will be in qualified and equitable hands.:wink:

[KantoSooner]

Or it could be on of those industries that Von Hayek felt were going to be well nigh impossible to apply capitalism to. I know he felt that way about the military.

[FaninAma]

Kanto, the 20 million weren't sitting on the sidelines but they weren't using medical services at nearly the same rate they will be when they get Medicaid.

when you have a safety net program, like Medicaid is, there is a limit of how many patients the system can serve without becoming a useless ineffective system.

There are a lot of. Kids who need Medicaid. They are already finding a shrinking number of providers who will see them. This expansion is going to worsen that trend significantly.

There is another issue. The less medicaid reimburses for services rendered the more pressure is applied to make self-pay and privately insured patients pay more.

Taxes will have to be raised significantly directly or via increased insurance premiums or services will be cut. Which choice do you prefer?

[RUSH LIMBAUGH is my clone!]

Or it could be on of those industries that Von Hayek felt were going to be well nigh impossible to apply capitalism to. I know he felt that way about the military.The founders of the country also thought the military to be the responsibility of government. not so for the health industry.

[bluedogok]

well, govt. meddling and actions causing more expensive healthcare in the first place, has been a problem for a long time. Now that they have gotten what they have always wanted, more control over our freedom and our lives, it's no stretch to think Obamacare was planned chaos, with the subsequent result of government taking complete contol of the healthcare industry. Rest assured, it will be in qualified and equitable hands.:wink:
I feel like that has been their intention all along. Obamacare is just one step closer to that, really a means to an end.

[RUSH LIMBAUGH is my clone!]

"BAAAAAH BAAAAH ETC."- America's Remains

[KantoSooner]

The founders of the country also thought the military to be the responsibility of government. not so for the health industry.

To be fair, the 'health industry' of 1787 consisted of 'Barber Surgeons' and guys who'd come around to bleed you if you felt poorly. The Founders didn't have too much directly on point to say about the internet, a global long distance telephone system or aircraft transit rights, either.

My point, Rush, is that, if we're going to require licensing of medical professionals and certification of drugs, procedures and equipment, we're already a long, long way away from a free market. And can expect to see precisely the distortions we are in fact seeing. The market can't fix what it is not applied to.

[KantoSooner]

Kanto, the 20 million weren't sitting on the sidelines but they weren't using medical services at nearly the same rate they will be when they get Medicaid.

when you have a safety net program, like Medicaid is, there is a limit of how many patients the system can serve without becoming a useless ineffective system.

There are a lot of. Kids who need Medicaid. They are already finding a shrinking number of providers who will see them. This expansion is going to worsen that trend significantly.

There is another issue. The less medicaid reimburses for services rendered the more pressure is applied to make self-pay and privately insured patients pay more.

Taxes will have to be raised significantly directly or via increased insurance premiums or services will be cut. Which choice do you prefer?

And I would guess you would argue that the increase in demand for services comes from the observation that Medicaid patients visit the doctor more frequently than others?

If I was forced to make the choice posed in your last sentence, I'd choose fewer services. Send people with the sniffles home with instructions to have a bowl of soup and go to bed. If need be, 'federalize' doctors serving medicaid patients so that they enjoyed sovereign immunity from suit; that should be enough to empower them to tell demanding jerks to F*** O**.

[RUSH LIMBAUGH is my clone!]

My point, Rush, is that, if we're going to require licensing of medical professionals and certification of drugs, procedures and equipment, we're already a long, long way away from a free market. And can expect to see precisely the distortions we are in fact seeing. The market can't fix what it is not applied to.As articulate as you are, you should do better than that. To make a leap from testing of medical people and products to advocating, or at least approving of the complete control of the healthcare industry is sheer nonsense. Really, it's as much or even more destructive than other areas of socialism/fascism. You SHOULD realize that. I would never expect Ton Loc nor Yermom to get it, but I would at least think you should at least acknowledge the highhandedness as a potential problem.

[Ton Loc]

As articulate as you are, you should do better than that. To make a leap from testing of medical people and products to advocating, or at least approving of the complete control of the healthcare industry is sheer nonsense. Really, it's as much or even more destructive than other areas of socialism/fascism. You SHOULD realize that. I would never expect Ton Loc nor Yermom to get it, but I would at least think you should at least acknowledge the highhandedness as a potential problem.

Ouch! I'm not even involved here. :surprise:

[KantoSooner]

As articulate as you are, you should do better than that. To make a leap from testing of medical people and products to advocating, or at least approving of the complete control of the healthcare industry is sheer nonsense. Really, it's as much or even more destructive than other areas of socialism/fascism. You SHOULD realize that. I would never expect Ton Loc nor Yermom to get it, but I would at least think you should at least acknowledge the highhandedness as a potential problem.

Two quickies:

First, The regulation of the medical industry is not limited to the two items listed in my post above. When you add up all the licensing, the certification, the immense involvement of medicaid, medicare, the CDC, government administered health services (Indian health, DoD, etc), our health care system has very much been formed by government involvement. (excuse the the tense prose, what I'm trying to capture is the fact of this government influence at the same time acknowledging that there has been very little, if any, steering going on. Government has waded in and screwed everything up without any plan and now it's a giant mess.)

Second, I am not making the leap that you accuse me of. What I am saying is that it's nonsense to hold forth the pre-ACA US medical system as a bastion of free enterprise. It wasn't. And I'm not sure that we can effectively apply market principles to an industry that is not now operating in any sort of open market and MAY not be amenable to operating in any real sense in a free market.

I would think that this observation would square rather nicely with much of what you've opined on the topic.

[RUSH LIMBAUGH is my clone!]

Two quickies:

First, The regulation of the medical industry is not limited to the two items listed in my post above. When you add up all the licensing, the certification, the immense involvement of medicaid, medicare, the CDC, government administered health services (Indian health, DoD, etc), our health care system has very much been formed by government involvement. (excuse the the tense prose, what I'm trying to capture is the fact of this government influence at the same time acknowledging that there has been very little, if any, steering going on. Government has waded in and screwed everything up without any plan and now it's a giant mess.)

Second, I am not making the leap that you accuse me of. What I am saying is that it's nonsense to hold forth the pre-ACA US medical system as a bastion of free enterprise. It wasn't. And I'm not sure that we can effectively apply market principles to an industry that is not now operating in any sort of open market and MAY not be amenable to operating in any real sense in a free market.

I would think that this observation would square rather nicely with much of what you've opined on the topic. Thanks for amplifying.
I don't think we have had anything close to proper involvement by the govt. in most areas of the economy, certainly including the Medical Industry. Of course it has been excessive. To not back down from the excessive, illegal intervention, and to actually make it substantially more pervasive, is certainly the wrong direction to go.

The government should limit itself to the activities that are proscribed for it by our laws. We are WAY outa control.

[yermom]

you mean the laws that congress passes?

[RUSH LIMBAUGH is my clone!]

you mean the laws that congress passes?Why didn't you guess the Constitution?

[diverdog]

As articulate as you are, you should do better than that. To make a leap from testing of medical people and products to advocating, or at least approving of the complete control of the healthcare industry is sheer nonsense. Really, it's as much or even more destructive than other areas of socialism/fascism. You SHOULD realize that. I would never expect Ton Loc nor Yermom to get it, but I would at least think you should at least acknowledge the highhandedness as a potential problem.

So lets hear your solution on fixing runaway medical cost.

[yermom]

Why didn't you guess the Constitution?

seems to me that some things have changed since it was originally written.