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

[Wrong Direction]

If you walk in and pay cash you will pay twice the expense of what some insurance companies will allow.

This is true of pharmacies and doctor's offices too.

There is no market because you are not aware of a price when you walk in.. Ask and they won't tell you a price, if they tell you a price you can't hold them to a price. They'll charge you whatever, because they can. It's not a market where you can shop and compare. Not generally when you need imminant attention, and not even when you have time to plan in my personal experience.

In today's system, this is largely true. That's why we need reforms. I wouldn't lean on today's system as a model for where we need to be.

I'll also note that the market doesn't begin and end with prior planning for prices. See how consumers react when they are told that a 1/4 mile non-emergency ambulance transport will cost them $750. You'll see that they won't pay it, and the market would react by supplying non-emergent transportation for much less. Today's "marketplace" disincents that cheaper option from coming to market.

---------- Post added July-23rd-2012 at 02:03 PM ----------

I can do better than describe such a model. I can point to more than 30 such models working in the world today which the World Health Organization ranks above ours...

Will there be cuts, absolutely as the most expensive system in the world is 40-50% more effiecent ( less expensive) than our system. Are these cuts "arbitrary", no; because these systems outperform our system for delivering services.

Yes they do, and they aren't examples of a free market system, and they are also options in the ACA.

The challenges in comparing foreign and domestic healthcare systems are legend. Once again, the ACA puts its name to a lot of things, but it severly limits options like this through it's various mandates and tax shelter limitations. This is a good example of a way I think the ACA could be amended, as opposed to repealed and replaced, and achieve a similar result. So, I'm not saying it's all bad.

"capitate payment" ?

Generally speaking, it's setting an amount that the government/insurance company will pay to a provider (e.g., monthly) for services in advance. Government does this through bundling payments. What this does in incent less care because it moves actual treatment from a profit center to a cost center. This is a way to reduce overutilization that is rampant in a fee for service system and to reduce price inflation. The problem is that too much incentive for reduced care, at some point, could result in worse outcomes. It could also lower productivity from the provider community, depending on the way it's implemented. I'm not convinced the former is a real-world fear, but the economic case can be made very easily.

Edited July 23, 2012 by Wrong Direction

[PeterMP]

This is just false. There have been studies showing HSAs save money.

http://www.banyan-llc.com/bc/bc.nsf/archivedarticles/Aetna-Study-Shows-CDHPs-Can-Save-Money

There's much more on the subject. Frankly, I think the savings would be even larger if our whole system was introduced to cost sharing. Yes, we'd lower waste through overutilization of the system, but the real benefit would be in the outlandish prices for very simple services. A market is definitely the solution to part of the problem, IMO.

I think your study shows that people that are healthy and don't have very high healthcare costs sign up for HSA.

---------- Post added July-23rd-2012 at 02:30 PM ----------

I get the focus on residencies and primary care, but this is all woefully inadequate, which is my point. I know a guy on the faculty at Stanford who is beside himself because of the number of high quality applicants they turn away from their med school. Listening to him, there are many more wanna be doctors than the system will allow for.

I don't want to be misconstrued here. A general increase in the number of med schools (or nursing/pharmacy schools) is a good thing. However, it's not nearly enough to address our medium-term shortages AND it fails to substantively address the high costs of med school/training in any way other than subsidy (e.g., not market-based).

I'm sure the faculty at Stanford would love to take in every highly qualified candidate and leave all the other's to other med schools.

I don't think there is any evidence that there is a large number of people that could pass the boards and get resident positions that aren't able to go to med school.

The other day I even saw a Carribean Med School that was advertising for students w/o an MCAT, which would suggest to me that they are hurting for qualified students.

What do you want the government to do that wouldn't be getting away from a free market. We have state run med schools, non-profits, for profits, and even ones in the Carribean. Costs are still going up.

[JMS]

Go look at the fines and then look at the cost of insurance and now tell me they're comparable. They're not, and Roberts did say that..

No he didn't he said..

Roberts disagreed -- and his distinction swung the case. Roberts argued that the penalty resembled a tax in a few ways. First, it raises money (about $4 billion a year according to the IRS) just like a tax. Second, it's paid to Treasury when households file their tax returns. Third, the fee is calculated based on taxable income and number of dependents, like taxes.

http://www.theatlantic.com/business/archive/2012/06/the-tiny-distinction-that-saved-obamacare-why-the-penalty-is-a-tax/259140/

Here is Ginsburg on the subject..

A tax is to raise revenue, tax is a revenue-raising device, and the purpose of this exaction is to get people into the health care risk -- risk pool before they need medical care. And so it will be successful if it doesn't raise any revenue, if it gets people to buy the insurance, that's -- that's what this penalty is -- this penalty is designed to affect conduct.

obama recenty

"It's less a tax or a penalty than it is a principle — which is you can't be a freeloader on other folks when it comes to your health care, if you can afford it," Obama said in an interview with

Toledo's WTOL

http://www.politico.com/politico44/2012/07/obama-health-care-mandate-is-a-principle-129274.html

[Wrong Direction]

No he didn't he said..

This:

Roberts:

http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf

Such an analysis suggests that the shared responsibilitypayment may for constitutional purposes be considered a tax. The payment is not so high that there is really no choice but to buy healthinsurance;

[PeterMP]

This:

Roberts:

http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf

They somewhat diminish it, but the supreme court even said (Roberts) that it's a tax fine and not a penalty because the amount is small relative to the cost of insurance. The fine does not, therefore, ensure that not buying insurance is "not a viable savings plan."

I'm sorry, but those two things are not equal. If the penalty is about the same as the costs of buying insurance, then it gives you choices.

The Roberts statement certainly doesn't suggest that it is small with respect to the insurance costs.

[Wrong Direction]

I think your study shows that people that are healthy and don't have very high healthcare costs sign up for HSA.

There are many studies out there on HSAs. To my knowledge, they are not limited to healthy people. HSAs are being implemented in the employer market more and more, so there's some valid before and after data for similar populations to look at.

I'm sure the faculty at Stanford would love to take in every highly qualified candidate and leave all the other's to other med schools.

I don't think there is any evidence that there is a large number of people that could pass the boards and get resident positions that aren't able to go to med school.

Fair enough. My faculty friend is pretty adamant about the larger problem, but this is anecdotal. I'm not aware of documented evidence so I'll just leave this discussion where it stands.

[PeterMP]

There are many studies out there on HSAs. To my knowledge, they are not limited to healthy people. HSAs are being implemented in the employer market more and more, so there's some valid before and after data for similar populations to look at.

There is and much of it is mixed

http://onlinelibrary.wiley.com/doi/10.1002/hec.1757/abstract;jsessionid=CD3951F89608FD4A4C00ED6DFB42657D.d01t01?deniedAccessCustomisedMessage=&userIsAuthenticated=false

"Overall, introduction of HDHP had no impact on health-care costs, positive impact on the number of outpatient visits and mixed impacts on the inpatient and emergency room visit counts. The QDID estimates suggest HDHP introduction generally impacted subjects in upper percentiles (50th, 75th and 90th)."

"HDHPs may be most effective at reducing health-care spending among individuals with moderate health-care consumption. Specifically, our QDID results indicate that individuals between the 50th and 75th percentiles of spending, or $1400–$4500 at baseline, experience the largest relative decreases in spending post-HDHP enrollment."

And even more provides essentially no infromation on the point that you were trying to make like the study you posted.

Edited July 23, 2012 by PeterMP

[Wrong Direction]

I'm sorry, but those two things are not equal. If the penalty is about the same as the costs of buying insurance, then it gives you choices.

The Roberts statement certainly doesn't suggest that it is small with respect to the insurance costs.

Not exactly. However, Roberts does distinguish between a tax and a penalty by degree.

http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf

Page 35

Our cases confirm this functional approach. For example, in Drexel Furniture, we focused on three practicalcharacteristics of the so-called tax on employing childlaborers that convinced us the "tax" was actually a penalty. First, the tax imposed an exceedingly heavy burden—10 percent of a company’s net income—on those who employed children, no matter how small their infraction.

...

The same analysis here suggests that the shared responsibility payment may for constitutional purposes be considered a tax, not a penalty: First, for most Americans the amount due will be far less than the price of insurance, and, by statute, it can never be more.8

Footnote:

8In 2016, for example, individuals making $35,000 a year are expected to owe the IRS about $60 for any month in which they do not have health insurance. Someone with an annual income of $100,000 a year would likely owe about $200. The price of a qualifying insurance

policy is projected to be around $400 per month. See D. Newman, CRS Report for Congress, Individual Mandate and Related Information Requirements Under PPACA 7, and n. 25 (2011).

---------- Post added July-23rd-2012 at 03:32 PM ----------

And even more provides essentially no infromation on the point that you were trying to make like the study you posted.

Sure it does. I wasn't exactly responding to a challenging point. JMS said this:

because no intellectual argument can be created that would support using a free market to provide healthcare.

Clearly there is an intellectual argument that supports using a free market.

[PeterMP]

Not exactly. However, Roberts does distinguish between a tax and a penalty by degree.

Okay, point taken.

The mandate "tax" is much less than getting insurance and Roberts sees that has an important differentiation.

[JMS]

This:

Roberts:

http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf

you said Roberts was quoted as saying the penalty / tax was not comparable to insurance... now your quoting him as saying the penalty / tax was not so great as to not give consumers a choice; they aren't the same thing at all. The entire idea of the penalty was to take away a fiscal incentive to not buy insurance and that's a reasonable statement which Robbert's quote you provided doesn't refute.

[LadySkinsFan]

Why would you chose not to be insured, when pre-existing conditions are covered?

Because even though pre-existing conditions are now covered, the premiums are sky high. No thanks.

[Wrong Direction]

you said Roberts was quoted as saying the penalty / tax was not comparable to insurance... now your quoting him as saying the penalty / tax was not so great as to not give consumers a choice; they aren't the same thing at all. The entire idea of the penalty was to take away a fiscal incentive to not buy insurance and that's a reasonable statement which Robbert's quote you provided doesn't refute.

We're waaaay into semantics here.

I wouldn't use the words "take away." I'd use reduce. The reason the semantic argument is important is because if the tax actually "took away" the incentive to not buy insurance, it would be considered a penalty, which would mean the federal government wouldn't have the constitutional authority to put it in place because it falls under the state's policing powers.

That's the legal justification produced by Roberts. He assumes that many people will choose the tax of $60-$200/month over the $400/month insurance premium. On the low end of incomes/tax, that's seemingly a fair assumption.

[Son of Gadsden]

If party A is going to make bad decisions and party B is going to make bad decisions, then I need to consider other factors in making my deicion than the quality of the decision made.

If party A can make bad decisions AND cost less money, then that gives party A an advantage over paty B.

If you don't have insurance companies, then you no longer have to keep track of who has what insurance.

All those records and details are extra over head. The associated costs simply go away.

Not to mention duplication of the efforts by individual insurance companies can be eliminated.

As well as things like advertisement and recruiting customers.

The associated costs are eliminated not transferred (or at least transferred to non-medical related costs. You might see them show up in things like the price you pay for cable tv).

Your argument hasn't changed, my argument hasn't changed, and neither of us seem to be budging on our stance. Even hearing your arguments, as someone who works in insurance...I just don't see it. I've heard the agents' sides, I've got my side as a policy holder, I've heard every bit of the law that I care to hear, I know the Constitution like the back of my hand. I also truly believe in capitalism/freemarket/democracy. But most of all, I believe in the people to make their bad decisions rather than choosing between two parties that make worse decisions.

However, seems JMS and Wrong Direction are moving 10 times faster than us in this argument, so I'm just going to take the sidelines now.

I respect your opinion, and more so respect the way you've said it. And I appreciate a mature argument that didn't involve insults. Tis hard to find that on the internet.

[PeterMP]

Your argument hasn't changed, my argument hasn't changed, and neither of us seem to be budging on our stance. Even hearing your arguments, as someone who works in insurance...I just don't see it. I've heard the agents' sides, I've got my side as a policy holder, I've heard every bit of the law that I care to hear, I know the Constitution like the back of my hand. I also truly believe in capitalism/freemarket/democracy. But most of all, I believe in the people to make their bad decisions rather than choosing between two parties that make worse decisions.

However, seems JMS and Wrong Direction are moving 10 times faster than us in this argument, so I'm just going to take the sidelines now.

I respect your opinion, and more so respect the way you've said it. And I appreciate a mature argument that didn't involve insults. Tis hard to find that on the internet.

The people is one of the parties I was talking about.

Party A is the government. They will make bad decisions, but if it is a universal system, then they will do so w/ reduced costs.

Party B is the people. They will make bad decisions and it will cost us more because of fragmentation in the system that causes more costs in terms over head.

**EDIT**

It doesn't make sense to blindly believe in free markets. There is no reason to believe that will ALWAYS work. For free markets to work, it requires that it is possible to actually make good decisions.

If people are essentially making random (or worse) decisions, a free market will fail.

There are reasons w/ respect to healthcare we may have reached that point.

Free markets do have real limits.

Edited July 24, 2012 by PeterMP

[Wrong Direction]

**EDIT**

It doesn't make sense to blindly believe in free markets. There is no reason to believe that will ALWAYS work. For free markets to work, it requires that it is possible to actually make good decisions.

If people are essentially making random (or worse) decisions, a free market will fail.

There are reasons w/ respect to healthcare we may have reached that point.

Free markets do have real limits.

It's worth noting the distinction between general message board posts about the free market and policies actually proposed or supported by our major political parties.

Neither party is supporting anything resembling a pure free market. The Democrats couldn't hold together their caucus in support of a national single-payer option. We're left with variations of proposals that are in-between free-market and pure socialism.

I feel like many people dismiss Republican free market proposals out of hand with the arguments you make above (e.g., intelligent decisions) and costs.

In response, I first point out that R's specifically support dedicating funds for the sick and the poor. This is a deliberate divergence from a pure free market to make sure the system can work for the vulnerable.

I also note that healthcare decisions are not (generally) and should not be made in a vacuum. Patients go to Dr.'s for consults for a reason.

What a small infusion of a free market - like making some cost sharing mandatory - would accomplish is it would give incentive to people to become more informed about their healthcare decisions; to ask more questions of their Doctors, and it would also create an environment where Doctors are looking out even more for their patient's well-being, in a broader way than simply ordering tests.

I genuinely believe there are fundamental reforms (like removing any link to Medicare FFS pricing in Medicare Advantage, simply mandating some cost sharing, designing a subsidy scheme that provides health dollars for the poor so they have some skin in the game, allowing groups to pool together to design their own plan outside of federal mandates) that could radically bend the cost curve.

These reforms would infuse elements of the free market without leaving the poor, stupid, consumer on their own to make "essentially random" healthcare decisions.

[shk75]

This whole skin in the game thing has been hotly debated since the RAND study that showed that the less cost sharing individuals experience the more health services they use. There is also a diminishing return in terms of health gained once you are at your 8th, 9th, or 10th doctor's visit for that year.

The key is striking a balance where citizens are not sacrificing necessary care because they cannot afford it but are also not wantonly abusing the system without regard to the costs they are incurring.

I have seen HSAs mentioned a lot here and the Republicans have a love affair with them; the same with high deductible plans. The problem with these two is that numerous studies have shown that these programs are overburdening beneficiaries who are being forced to sacrifice needed health care because they cannot afford it. I think both of these programs can play a role in a revamped system, but neither one is a panacea.

The bottom line is how do you control costs while simultaneously increasing access to care and ensuring high quality. It is not an easy task especially when the system is so fragmented and there are myriad invested interest groups. The ACA tried to accomplish this with various different programs and time will tell if they are successful. However, my guess is that more incremental reforms will take place within the next 20-30 years.

My final point is that if you do not impose global budgets and price controls how then do you control a good like health care that is so inelastic? Many do not want government footing the bill but that means someone else will have to pay and that someone will not have the purchasing power that the federal government has. This results in a shortsighted conclusion - I do not want to pay higher taxes for health care but I am OK with paying even more to insurance companies/out of pocket. If you are so anti-government that you are OK with paying more just so your taxes are less, then nobody will change your mind about this issue.

[PeterMP]

It's worth noting the distinction between general message board posts about the free market and policies actually proposed or supported by our major political parties.

Neither party is supporting anything resembling a pure free market. The Democrats couldn't hold together their caucus in support of a national single-payer option. We're left with variations of proposals that are in-between free-market and pure socialism.

I feel like many people dismiss Republican free market proposals out of hand with the arguments you make above (e.g., intelligent decisions) and costs.

In response, I first point out that R's specifically support dedicating funds for the sick and the poor. This is a deliberate divergence from a pure free market to make sure the system can work for the vulnerable.

I also note that healthcare decisions are not (generally) and should not be made in a vacuum. Patients go to Dr.'s for consults for a reason.

What a small infusion of a free market - like making some cost sharing mandatory - would accomplish is it would give incentive to people to become more informed about their healthcare decisions; to ask more questions of their Doctors, and it would also create an environment where Doctors are looking out even more for their patient's well-being, in a broader way than simply ordering tests.

I genuinely believe there are fundamental reforms (like removing any link to Medicare FFS pricing in Medicare Advantage, simply mandating some cost sharing, designing a subsidy scheme that provides health dollars for the poor so they have some skin in the game, allowing groups to pool together to design their own plan outside of federal mandates) that could radically bend the cost curve.

These reforms would infuse elements of the free market without leaving the poor, stupid, consumer on their own to make "essentially random" healthcare decisions.

1. It depends on how the healthcare/money is given to the poor. If it is given to them and then they are "pushed" into a free market system, then the end result is no different. If you start putting limits and controls on it (like we sort of talked about with respect to food stamps), then you don't really have those people in a free market and people can complain the reforms didn't work because of the restrictions that weren't free market in nature. You simply give them money or some sort of credit, like we do with food stamps, and they are going to make bad decisions. You will get the healthcare equivalent of obesity from picking bad food choices.

2. If your picking an advisor for anything essentially at random, then you are likely then simply getting random advice. The end result, with respect to a free market, isn't any better. If there was any real way to ensure that doctors in "general" were actually good or if people had any actual way to properly evaluate their doctors, this issue would go away.

I've posted in other threads issues with doctors and their knowledge. There is actually a study out there that shows that doctors are more influenced by Pharma advertising then the general public. And realistically, it isn't easy for them. They are busy people trying to work, but the information underlying what they are doing is constantly changing and not changing in simple manners in most cases. Frequently, we start out w/ X is good or bad, and then it turns into well X is good under these cases for these people, but it can actually be bad in these cases. And in the intermerdiate (i.e. going from X being good or bad to the more nuanced position) time, there is lot of seemingly contradictory information out there.

And most doctors aren't at all prepared to deal with something a little bit out of the norm.

This is my own true story. I have two young kids. We got two cats. After having the cats for about a month they were diagnosed with common cat worms. According to the web and our vet, it is very common for kittens to have worms. Even if you treat them, the treatment only works if the worms are in the right stage of their life cycle.

Okay, it was easy to get the cats cleared up. About a month later, my youngest daughter comes down with a multiday unexplained fever. This is about the right time frame for her to actually show infections from worms from the cats (generally this has been thought to be extremely rare, but in fact a study done in the last decade or so shows that ~10% of the population has antibodies to cat worms, in most cases though they aren't known to be an issue).

We've already talked to the peditricians office about the issue over the phone when we found out the cats got the worms because we worried about the kids and at a regular check up for her before she even got the fever.

Then a few days into the fever we take her in and they do a routine check for strep, ear infection, sinus infection, etc and she has none of these.

After a few more days, the fever doesn't go away and so this is actually a sympton of a human having cat worms so we make an appointment to take her in where we've now told them over the phone to make the appointment that we are worried that she has worms from the cat.

Now, my wife and I are both PhD biochemists and have read up on this, and she even works with parasites and knows several parasitologists and has talked to them.

She takes my daughter in and says we'd like to do a test to she if she has cat worms.

They say sure, and order a test to look at my daughter's feces (which works great if you are a human infected with human worms or a cat infected with cat worms, but not if you are a human infected with cat worms).

My wife knows this and tells them you can't look at the feces you have to do a blood test to see if she has the antibodies to the cat worms. The doctor (a different doctor then we normally see and that we had talked to before, but still you think this would all be in her "chart" somewhere) looks in a red book and says 'No, this is what the red book says we should do.'

My wife isn't like me. She's not a very pushy person and she's there with a sick kid that has a fever so she just leaves and calls me.

Before they get home, she calls me. I call the doctor and end up talking to a nurse, and I tell them I'm looking at the CDC web page that says for cat worms in human you can't look at the feces you have to do this blood based test.

The doctor calls me back, not bothering to look at the CDC page, and tells me the book says to look at the feces. I tell her the CDC says the worms won't come out in the feces and therefore looking at the feces won't matter and you have to do the blood based test, and I'm looking at the CDC page and I can e-mail her the link if she likes.

We sort of go around and she seems to understand.

But then she ends up back at if my daughter has worms the fact that she has vomitted (which she'd done once in what at this point in time was a 1 week fever) suggests their in her intestines, and then they should be in the feces.

At this point time, I'm yelling in the phone, I'm looking at the CDC web page. Do you really think the CDC is wrong?

Finally, she agrees to call the testing company and ask them what test to do, and the next day we get a form to do the right test.

Turns out my daughter didn't have worms.

Now, remember research shows that about 10% of people have these worms and while they aren't known to be an issue for most people (in most cases, the larva get "lost" in our system, can't find their way back to the intestines to end up in the feces and end up just encysting somewhere in your body and not causing you any issues as far as we know, unless they end up somewhere like your eye in which case you can lose your vision).

We'd generally told the practice that we had cats that had worms and showed up with a kid that was showing symptoms of having worms and they didn't put it together, and then even after we told them we wanted a specific test done, they still couldn't get it together right. If we were 80% of the population, even if we went in and told them we wanted the test done for worms, we would have had the wrong test done.

We've talked about switching peditricians, but several parasitologists have told us unless you are dealing with an infectious disease specialists your not going to find a pediatrician that doesn't have that issue. You walk into essentially any peditrician office and tell them I think my toddler got worms from my cat, and they are going to tell, we'll check the stools.

Now, we knew this wasn't right because we understood the difference between Toxocara cati (the cat form) and other forms of Toxocara.

And these are people we have been going to for over 5 years and up and until this point people we were happy with.

But I don't think you realistically expect most people to get to that point.

And we actually have to FEW doctors. It appears that we might have to find away for the people that aren't making the cut off to become doctors to keep up w/ healthcare demands.

That doesn't give me a lot of help the popluation of doctors is going to improve.

And because of how malpractice claims and cases are counducted and frequently settled out of court as part of confidential agreemtns, it is at least very difficult to even know if your doctor is REALLY REALLY bad and made several major mistakes.

---------- Post added July-25th-2012 at 01:27 AM ----------

CBO is predicting LOWER costs based on the Supreme Court ruling because some states won't expand Medicaid.

http://money.cnn.com/2012/07/23/news/economy/health-reform/index.htm?hpt=hp_t2

Edited July 25, 2012 by PeterMP

[Jumbo]

Apologies if this already made it in here:

Health care repeal would widen deficit by $109 billion, says CBO

http://news.yahoo.com/blogs/ticket/health-care-repeal-widen-deficit-109-billion-says-194408630.html

I'm not quoting any of the article at the link because it's brief enough.

[gbear]

Peter MP,

I can see how that experience would frustrate you. I see similar things dealing with my MS, even when dealing with Neurologists. I'm lucky I have a nurse for a wife who has ingrained in me a sense of need to question the why things are done or not done. I've been lucky at Hopkins to get a doctor who stays current. At my last appointment where he said he had to go over the treatment options with me because I am in uncharted territory for the length of time I have been on the drug I take, I asked him about the claim of no cases of PML with the alternative drug he presented. PML is essentially a brain infection which usually kills or severely disables. He said, "Wow, you've heard about that case too. It's thought to be the result of the Tysabri taken before the switch of drugs." Tysabri is the drug I am on. I was impressed, because I only knew about the case because it was written up in a few journal articles the month before, and those articles had been posted on patientlikeme.com.

The flip side is the presentation at an MS dinner I attended last week. The presenter said all kinds of things I was pretty sure were wrong. She claimed everyone who has a first flare progresses. I had always heard roughly a third do not. In fact, this is said on the national MS foundation website as well. Then she went on to say everyone who has an event should be on a disease modifying drug. It's not that I disagree with her, but I asked "Have these drugs been shown to slow the progression of symptoms? I know they reduce flares, but I haven't seen long term studies." She responded flares cause long term symptoms so reducing flares reduces long term symptoms. The logic is fine there, but I note the FDA doesn't use symptom progression for MS treatments as a benchmark, only flares. In fact anecdotal evidence seems to argue little long term benefit to the front line drugs. I noted this to my table, but didn't want to be the unknowing jerk questioning the doctor in her presentation...

Two days later, a study is published showing no significant difference in disability progression between patients who took Avonex or Rebif versus patients who remained untreated. Now the doctor has been treating MS patients for 25 years. So she would be the presumed expert. However, how much time is left to study the just released data? A patient has to be informed, and I know talking with my table about what information pushed them from drug to drug, that most are not. Heck, 2 people at my table stopped tysabri when they found out they were JC+ which gives them a 1 in 250 to 1 in 350 chance of getting PML. Their doctor pulled them from Tysabri because of these odds only saying "there is a risk you could die on it, so I am pulling you off it." When I told them those odds are equal to or better than the odds cancer patients face when choosing to have chemo for the most treatable kind of cancer, they were surprised. I told them to question their doctor on what the chances are and then make an informed decision together. They never thought to ask, and they never thought they had a right to insist in a say in the decision. I reminded them they can go to another doctor.

As a population we are not informed, and the amount we expect our doctors to do while staying up to the minute is perhaps unfair. I know I email my neurologist before my visit with questions before every visit. I always think of it as giving him the best chance to be able to answer my questions instead of springing them on him. Still there are cases like yours where we don't see whom we normally see, and getting the doctor the needed information isn't a given. I'm not sure how current reform efforts or a totally free or socialized market will ever address these issues.

[mikered30]

Nearly one in 10 employers to drop health coverage. One in three respondents said they could stop offering coverage if the law requires them to provide more generous benefits than they do now, if a tax on high-cost plans takes effect in 2018 as scheduled or if they decide it would be cheaper for them to pay the penalty for not providing insurance.

http://m.washingtontimes.com/blog/inside-politics/2012/jul/24/nearly-one-10-employers-drop-health-coverage/

[gbear]

Mike, beware slanted polls.

"If forced to increase coverage or drop all together will you drop?" Means companies who already provide health insurance will drop is a stretch. How about a follow up noting what percentage of current plans will fall below the minimum requirements? How about asking if they will cut back coverage if they don't have to provide as much and have an option to switch to less coverage?

The presentation of facts in this seems like an author who starts with an opinion and looks for facts to prove it. Just asking the questions above would lead to a more complete and possibly more damning or vindicating conclusion.

If one is more interested in other information from study, 9% are considering dropping insurance because the costs of providing them keep going up (regardless of Affordable Care Act). http://articles.latimes.com/2012/jun/30/business/la-fi-employers-opt-out-20120630 and http://www.latimes.com/business/money/la-fi-mo-employers-healthcare-20120724,0,5878835.story

The Affordable Care Act does not seem to be enough of a deterent to dropping them, but where does one get the dropping them because of AFA? If healthcare benefit costs go up 9% a year, I would be surprised if only 10% stop paying for them. At some point, it's not about wanting to provide them for employees anymore, AFA or not.

[Tulane Skins Fan]

Apologies if this already made it in here:

Health care repeal would widen deficit by $109 billion, says CBO

http://news.yahoo.com/blogs/ticket/health-care-repeal-widen-deficit-109-billion-says-194408630.html

I'm not quoting any of the article at the link because it's brief enough.

I think this is very interesting. Don't the republicans have to come up with a way to account for 109 billion in savings now if they try to repeal Obamacare again?

[JMS]

Apologies if this already made it in here:

Health care repeal would widen deficit by $109 billion, says CBO

http://news.yahoo.com/blogs/ticket/health-care-repeal-widen-deficit-109-billion-says-194408630.html

I'm not quoting any of the article at the link because it's brief enough.

Additionally the CBO said the supreme court ruling would reduce the cost of the program by 84 billion over 11 years as fewer states are expected to implement the expansion of medicare, resulting in 10 million fewer Americans with coverage.

Kind of a dubious savings.

http://www.reuters.com/article/2012/07/24/us-usa-budget-healthcare-idUSBRE86N1AJ20120724

Edited July 25, 2012 by JMS

[Tulane Skins Fan]

The CBO's new report also says ACA will cost billions less than previously projected, largely because they are predicting several states will opt out of the medicare expansion thus that expansion which is 90% paid for by the federal government will is now expected to cover 10 million fewer people.

My 10 million number might be off, I just heard the lead in to the story yesterday evening...

I believe the number was 3 million will lose health insurance. But that is not as significant a story as the CBO estimating that the repeal would add 100 billion to the deficit.

So, the GOP plan to repeal is a "job-killing health care act" that would add "hundreds of billions of dollars to our kids' future."

[JMS]

I think this is very interesting. Don't the republicans have to come up with a way to account for 109 billion in savings now if they try to repeal Obamacare again?

No, although the Republicans wrote a principles document when they became the majority of the house in 2010 which said they would match any spending increases with offsetting cuts; they also wrote an exemption into the principle which allowed them to cut Obamacare and apply that expense to the deficit.

Edited July 25, 2012 by JMS