Obamacare...(new title): GOP DEATH PLAN: Don-Ryan's Express

[visionary]

 

 

 

[LD0506]

The trogs have painted themselves into a corner again, either they try (and fail) to vote this monstrosity through and have it hung around their necks, or they flinch and pull back from a vote which won't play well with their base. They end up putting the House on the spot again to bring it up and take the blame heading into the midterms.

 

Their gameplan presupposes these huge cuts to Medicaid funding to finance their taxapalooza, one can't happen without the other.

 

In spite of all their baldfaced lies it is seen for what it is, a titanic shift of wealth upwards, not gutting infrastructure to do it a la Reaganomics, which didn't show up right away, it took years for the rot to appear, this is denying services immediately to vast numbers of Americans that they will see as care is refused and hospitals close.

 

Give a man enough rope....................

[Springfield]

Still, here I sit, with a $3,600 bill (after insurance) for a normal, vaginal childbirth, on time, with an epidural, that required a hospital stay of less than 48 hours...

 

...thinking:  thanks Obama

 

But seriously, as somebobody posted earlier.  Neither side has done anything to address the REAL problem.  Health care in America is too ****ing expensive.

[LadySkinsFan]

We can't address healthcare costs when the Republicans are busy gutting it in favor of the wealthy. 

 

 

[skinny21]

3 hours ago, LD0506 said:

The trogs have painted themselves into a corner again, either they try (and fail) to vote this monstrosity through and have it hung around their necks, or they flinch and pull back from a vote which won't play well with their base. They end up putting the House on the spot again to bring it up and take the blame heading into the midterms.

 

Their gameplan presupposes these huge cuts to Medicaid funding to finance their taxapalooza, one can't happen without the other.

 

In spite of all their baldfaced lies it is seen for what it is, a titanic shift of wealth upwards, not gutting infrastructure to do it a la Reaganomics, which didn't show up right away, it took years for the rot to appear, this is denying services immediately to vast numbers of Americans that they will see as care is refused and hospitals close.

 

Give a man enough rope....................

Correct me if I'm wrong, but I believe I read the Medicare "cuts" don't kick in until 2020 - allowing the GOP a chance to keep their promise of repeal and replace, while putting off (one of?) the most damaging aspect to allow them to retain control of congress (and keep the heavily gerrymandered districts in place).  

[LD0506]

1 minute ago, skinny21 said:

Correct me if I'm wrong, but I believe I read the Medicare "cuts" don't kick in until 2020 - allowing the GOP a chance to keep their promise of repeal and replace, while putting off (one of?) the most damaging aspect to allow them to retain control of congress (and keep the heavily gerrymandered districts in place).  

 

The moment that bill passes you will see a ton of for-profit hospital-y corporations consolidating and positioning themselves in reaction to it. They are NOT going to just sit there and be stuck holding bag full of tens of millions in unrecoverable health costs, they have stockholders afterall. No, they are going to yump, they are going to make "just good business" decisions that will entail thousands of hospitals and medical care facilities being shuttered.

 

No matter what lies politicians (of either side and whatever ilk) peddle, the reaction will be instant and widespread. The blame game will crank up and all kinds of genuinely nice and completely unworkable solutions will be floated, but there won't be one iota of upside. Millions will lose the only jobs available in small towns only exacerbating the problem.

[LD0506]

Quote

The area went for Trump in a landslide. And now they won't contact their reps to vote against repeal. Either they don't believe Republicans will really take their insurance away, or they're dumb enough to think it will be replaced with something better. Which at this point you'd have to be weapons grade stupid to believe. Or, they'd rather be destitute than admit the black guy helped them. There is nothing you can do when people are so willing to vote and act against their interests. I've said it before, I just can't help wanting to see the repeal actually take away their insurance. 

 

https://www.dailykos.com/story/2017/7/5/1678174/--I-Don-t-Like-Obamacare-Because-of-Obama-Says-Woman-on-Obamacare?detail=emaildkre

 

Ok, somebody explain to me exactly why I ought to give one small **** about these people? I tell my son "Stupidity should always be painful", how am I not supposed to root for some good ole suffering for idiots?

[AsburySkinsFan]

56 minutes ago, Springfield said:

Still, here I sit, with a $3,600 bill (after insurance) for a normal, vaginal childbirth, on time, with an epidural, that required a hospital stay of less than 48 hours...

 

...thinking:  thanks Obama

 

But seriously, as somebobody posted earlier.  Neither side has done anything to address the REAL problem.  Health care in America is too ****ing expensive.

Been screaming that for a LOOONG time. Both sides only keep focusing on how to pay for ever more expensive care.

[@DCGoldPants]

Tell people they are wrong and stupid isn't going to get a "gee, you're right. Thanks friend" reaction. 

 

 

 

[AsburySkinsFan]

I keep waiting for an insurance plan that takes seriously the reality of medical tourism. 

Just now, @SkinsGoldPants said:

Tell people they are wrong and stupid isn't going to get a "gee, you're right. Thanks friend" reaction. 

Why not? This is Trump's America now where PC is a thing of the past. 

 

[Larry]

1 minute ago, AsburySkinsFan said:

Been screaming that for a LOOONG time. Both sides only keep focusing on how to pay for ever more expensive care.

 

Because the only way to make it cost less, is to give the customer less?  

 

Just a theory.  But I'm pretty sure that every one of the numerous corporations involved in health care are pinching every single penny they can, to try to cut costs as much as possible.  Just like Obamacare mandated that insurance companies have to pay out 80% of what they take in means that insurance costs as much as it does, because they actually spend that much on health care.  

 

And yes, I know that the CEO of MegaHealthCorp makes a lot of money.  I also am willing to bet that if you could magically eliminate his salary, and that of his immediate subordinates, it wouldn't lower the cost of health care by 1%.  

 

In short, I'm pretty sure that health care costs this much, because it actually does cost this much.  That there really isn;t a way to cut the cost, other than delivering less health care.  

 

(Which is why nobody is willing to propose it.)  

 

[LD0506]

8 minutes ago, @SkinsGoldPants said:

Tell people they are wrong and stupid isn't going to get a "gee, you're right. Thanks friend" reaction. 

 

 

 

 And of course you're right, so as far as I'm concerned I have nothing to say at all to any of them. Reality will bite, hard and deep, without a single word being spoken.

 

And as we've seen, when the howling and gnashing of teeth begins, the go-to meme will be "Obama did it!"

 

And I'll laugh, again.

[AsburySkinsFan]

1 minute ago, Larry said:

 

Because the only way to make it cost less, is to give the customer less?  

 

Just a theory.  But I'm pretty sure that every one of the numerous corporations involved in health care are pinching every single penny they can, to try to cut costs as much as possible.  Just like Obamacare mandated that insurance companies have to pay out 80% of what they take in means that insurance costs as much as it does, because they actually spend that much on health care.  

 

And yes, I know that the CEO of MegaHealthCorp makes a lot of money.  I also am willing to bet that if you could magically eliminate his salary, and that of his immediate subordinates, it wouldn't lower the cost of health care by 1%.  

 

In short, I'm pretty sure that health care costs this much, because it actually does cost this much.  That there really isn;t a way to cut the cost, other than delivering less health care.  

 

(Which is why nobody is willing to propose it.)  

 

Except for everywhere else in the world. And don't go on about the quality of care, there are world class hospitals all around the world that are cheaper than ours.

[LadySkinsFan]

11 minutes ago, AsburySkinsFan said:

Been screaming that for a LOOONG time. Both sides only keep focusing on how to pay for ever more expensive care.

 

Because they won't take the profit out of healthcare. Essentially, Springfield is paying the profit. In cash.

[Larry]

31 minutes ago, AsburySkinsFan said:

Except for everywhere else in the world. And don't go on about the quality of care, there are world class hospitals all around the world that are cheaper than ours.

 

So maybe Americans consume more health care than other countries?  

 

Just to pull out a hypothetical, do we have more cardiac bypass operations, per capita, than other countries?  Spend more time in nursing homes?  

 

I have trouble believing that the evil boogyman of profit explains all of that disparity.  (I have no doubt that it's a component.  I just suspect it's not that big.)  I'm pretty sure that if some layer of the complex ecosystem that is health care was running a 50% profit margin, I would have heard of it by now.  

[TradeTheBeal!]

No doubt that over-diagnosis drives a lot of our costs.  Over-diagnosis which is mostly driven by profit motive.

[@DCGoldPants]

44 minutes ago, LD0506 said:

 And of course you're right, so as far as I'm concerned I have nothing to say at all to any of them. Reality will bite, hard and deep, without a single word being spoken.

 

And as we've seen, when the howling and gnashing of teeth begins, the go-to meme will be "Obama did it!"

 

And I'll laugh, again.

 

I don't say anything anymore. Handle my own business. Make sure I'm covered and understand that people are going to get hurt their own repetitive choices. 

 

 

"What we've got here is failure to communicate.
Some men you just can't reach.
So, you get what we had here last week, which is the way he wants it!
Well, he gets it. 
Now,  I don't like it any more than you men." 
 

[bcl05]

10 minutes ago, Larry said:

 

So maybe Americans consume more health care than other countries?  

 

Just to pull out a hypothetical, do we have more cardiac bypass operations, per capita, than other countries?  Spend more time in nursing homes?  

 

I have trouble believing that the evil boogyman of profit explains all of that disparity.  (I have no doubt that it's a component.  I just suspect it's not that big.)  I'm pretty sure that if some layer of the complex ecosystem that is health care was running a 50% profit margin, I would have heard of it by now.  

 

It's not an either/or.  We consume more health care because it is profitable.  We incentivize every layer of the health care industry to do more.  More testing, more intensive care, more surgery, more medications, more imaging, etc.  Much of those decisions are driven by profit/insurance reimbursement.  I am a doc, and my administrative overseers are constantly trying to nudge us to into spending more time and effort on patients and problems for which reimbursement/profit is highest. We try to resist, to make sure our decisions are based on science and need, not profit, but the pressure is constant.  

 

For all that consumption and spending, we have some of the poorest health metrics amongst all modern westernized societies.  This system is clearly grossly inefficient and ineffective at making our population healthier.  

[AsburySkinsFan]

13 minutes ago, Larry said:

 

So maybe Americans consume more health care than other countries?  

 

Just to pull out a hypothetical, do we have more cardiac bypass operations, per capita, than other countries?  Spend more time in nursing homes?  

 

I have trouble believing that the evil boogyman of profit explains all of that disparity.  (I have no doubt that it's a component.  I just suspect it's not that big.)  I'm pretty sure that if some layer of the complex ecosystem that is health care was running a 50% profit margin, I would have heard of it by now.  

You know what a mammogram costs in a top quality hospital in Guatemala? $25 cash

 

US? 

http://health.costhelper.com/mammogram.html

[LadySkinsFan]

Thank you, doc, for the real world look at healthcare in this country. 

 

Profit is driving healthcare.

[AsburySkinsFan]

2 minutes ago, bcl05 said:

 

It's not an either/or.  We consume more health care because it is profitable.  We incentivize every layer of the health care industry to do more.  More testing, more intensive care, more surgery, more medications, more imaging, etc.  Much of those decisions are driven by profit/insurance reimbursement.  I am a doc, and my administrative overseers are constantly trying to nudge us to into spending more time and effort on patients and problems for which reimbursement/profit is highest. We try to resist, to make sure our decisions are based on science and need, not profit, but the pressure is constant.  

 

For all that consumption and spending, we have some of the poorest health metrics amongst all modern westernized societies.  This system is clearly grossly inefficient and ineffective at making our population healthier.  

[Larry]

23 minutes ago, bcl05 said:

 

It's not an either/or.  We consume more health care because it is profitable.  We incentivize every layer of the health care industry to do more.  More testing, more intensive care, more surgery, more medications, more imaging, etc.  Much of those decisions are driven by profit/insurance reimbursement.  I am a doc, and my administrative overseers are constantly trying to nudge us to into spending more time and effort on patients and problems for which reimbursement/profit is highest. We try to resist, to make sure our decisions are based on science and need, not profit, but the pressure is constant.  

 

For all that consumption and spending, we have some of the poorest health metrics amongst all modern westernized societies.  This system is clearly grossly inefficient and ineffective at making our population healthier.  

 

Thanks for the firsthand information.  

 

I was coming back to this thread, to express my skepticism for the notion that my personal physician was diagnosing me with medical conditions I don;t have, because he was behind on his quota on colonoscopies for the year.  But I will defer to your superior knowledge of the situation on the ground.  

 

So, how do we reduce that problem?  "Eliminate profit" may sound like a great idea.  (To some.  To me it sounds like a political slogan for communism, or some other extremist ideology.)  How do you actually accomplish it?  

 

 

---

 

Just trying to pull answers to my own question out of the air, . . . 

 

Maybe the problem is that we've created an ecosystem that's based on "cost plus accounting".  Like the government contractors who get paid for doing something, based on how much they spend on the project, we've created a system where the way to justify more profit is to perform more procedures.  

 

Possible theory:  This pressure you're saying comes, not from the actual patient-care physicians, but from management.  Maybe a rule where management isn;t a function of the size of the company?  Maybe something in the tax code where management salaries are tax deductible (as a business expense), but after management gets to some X$, then only a portion of it is deductible?  Some rule where, when the gross revenue of a company doubles, the money spent on management doesn't double?  

 

At least in my imagination, something like that might discourage the trend towards companies constantly swallowing everything and growing, blob-like, to cover the world.  And instead, encourage the proliferation of a lot of smaller companies.  (A trend which I suspect would be good for us, in all segments of our economy.)  

 

 

---

 

 

20 minutes ago, AsburySkinsFan said:

Gratuitous celebratory pic, contributing nothing other that "Look, my slogan has been vindicated"

 

You do realize that the post you're celebrating just announced that the key to reducing health care costs, is to reduce the amount of health care people get?  

 

Edited July 8, 2017 by Larry

[Springfield]

1 hour ago, Larry said:

 

Because the only way to make it cost less, is to give the customer less?  

 

Just a theory.  But I'm pretty sure that every one of the numerous corporations involved in health care are pinching every single penny they can, to try to cut costs as much as possible.  Just like Obamacare mandated that insurance companies have to pay out 80% of what they take in means that insurance costs as much as it does, because they actually spend that much on health care.  

 

And yes, I know that the CEO of MegaHealthCorp makes a lot of money.  I also am willing to bet that if you could magically eliminate his salary, and that of his immediate subordinates, it wouldn't lower the cost of health care by 1%.  

 

In short, I'm pretty sure that health care costs this much, because it actually does cost this much.  That there really isn;t a way to cut the cost, other than delivering less health care.  

 

(Which is why nobody is willing to propose it.)  

 

 

I disagree.

 

i think that the huge amount you see spent one advertising speaks to the contrary.  Everyone profits, outrageously.  From the hospitals, to the Heath care companies, to the middlemen selling companies health coverage.

 

I think the biggest problem to solve when lowering the overall cost of health care is the fact that many, many people will lose their jobs.

[bcl05]

I want to be clear about what I'm saying.  I am not saying that docs are doing clearly unnecessary tests or are intentionally misdiagnosing patients for purely financial reasons.  Our administrators don't come out and say "do more of X."  They do, however, have monthly meetings where they show us highly detailed metrics regarding patient volumes, charges, reimbursements, etc.  They don't come and show us metrics of how healthy our patients are, how scientifically sound our decisions were, etc.  

 

Decision making in medicine is rarely black-and-white.  How sick does someone have to be to get a chest x-ray?  How many blood tests do you need to reassure yourself that this fever is just the flu and not leukemia?  Are you sure you don't need an MRI for this patient with a headache?  It could be a tumor... etc.etc.etc.

 

There are many things that weigh into these decisions.  The financial piece is a constant background pressure.  I don't think any docs that I know actively and consciously choose things for purely financial reasons (I'm sure there are some out there).  However, I think it definitely seeps into our background/unconscious decision making and keeps pushing us to do more and more.

 

One of the problems is that this is all so opaque.  There isn't anyone in the health care industry who is incentivized to reign in spending.  Right now, we incentivize health care activity, not health care outcomes.  If we can somehow incentivize the industry to keep people healthier, rather than keep people more engaged in the health care industry, we can actually make progress.

 

I don't really know how that would work.  I think Obamacare was a tiny step in the right direction, though was really inadequate to make the big changes that need to happen.  I know the republican plan currently out there would be a huge step in the wrong direction.  

Edited July 8, 2017 by bcl05

[AsburySkinsFan]

8 minutes ago, Larry said:

You do realize that the post you're celebrating just announced that the key to reducing health care costs, is to reduce the amount of health care people get?  

 

You realize that I went to the doctor once or twice per year growing up and never when I had a cold. I think as Americans we are over consumers of health care on a number of fronts. So would reducing that really hurt? I don't think so, especially given the first hand information that we have from a physician who has already stated that the medical staff are already being pressured to push more profitable treatments. Start balancing that with the over consumption and I think we start truly addressing half of the equation.