Since Obamacare, very few doctors own their practice anymore. Large hospitals have bought up most of the small practices. Consolidation into megacorporations is a feature of Obamacare. Regardless of what they say, lefties love large corporations and get a thrill up their leg when they get even larger.
The real point is that O'care had to sell out to special interests to get passed, so it did nothing to reduce the overall cost of medical care, which is way too high in the USA.
It seems to be in a death spiral. Some Trumpian decisions amplified that, probably on purpose.
-- John Larkin Highland Technology, Inc lunatic fringe electronics
As always that's easier said than done, especially with white collar shenanigans.
Hells teeth, it is difficult enough to stamp out gross criminal misconduct by individuals, e.g. Harold Shipman or Rodney Ledward. There's little chance of doing the same with large corporations.
That's only necessary if you /do/ have to fight over the bill! Remove that necessity and a lot of money can be saved.
It is also the reason the NHS is the closest thing we have to a national religion.
Indeed. Money is a very bad incentive to mix into this particular pot.
I can't believe anyone who supports Trump would make this statement about * anyone* else. Trump is the ultimate "my way or the highway" guy. Hell, he can't even find anyone who will agree with him long enough to retain a pos t under him. One hint of not toeing the line and they're out of there!
Rick C.
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Before the ACA, I was thinking of what it would take to start a company tha t did nothing but negotiate insurance company like prices without paying an ything. It would be enormously less expensive than insurance and offer muc h of the benefits. But it would have still required a large bureaucracy to manage everything and a large sales force to sign up doctors. There would also be all the same "paperwork" involved since all billing is done using the ICD codes. So while no procedures would be paid for, there would still be plenty of costs. With the advent of the ACA and the minimization of th e economic barrier to obtaining health care this would not be useful.
Rick C.
I had a major surgery a couple years ago and they paid for most of it well before I met my deductible. So there must be something about that which is not a blanket threshold before they pay.
Rick
There are some pegs. For example, IIRC most plans have a limit of several hundred Dollars per hospital day. Though if you need lots of follow-up visits and medication it'll eat up your deductible.
I am perfectly ok with deductibles. I am not ok with our premiums doubling despite going to max allowed deductible. Without that it would have at least tripled after Obamacare became law. I have met people who lost their health care because of Obamacare. Income too high for subsidies, premiums now sky high, lots of kids, thus lots of college costs, home mortgaged to the hilt, no disposable income left. Their only choice was to pay the Obama penalty and go sans insurance, hoping none of their kids would crash on their mountain bike hard.
-- Regards, Joerg http://www.analogconsultants.com/
When you say "limit" do you mean to what is paid or to what you are expecte d to pay? In essence a daily out of pocket maximum?
Hey, a number of folks here talk about wanting competition. Insurance comp anies are free to compete on a level playing field.
Those people who are going without insurance now, what did they do before t he ACA, pay out of pocket for insurance? What is their situation that they don't have any other way of getting insurance? Most people with the sort of incomes you are talking about have insurance through their employer.
Rick C.
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John Larkin sees quite a lot of well-understood subjects as "things that no body understands" so his opinion of what leftists "think they understand" i sn't all that useful.
Unintended consequences are a feature of real life. If Trump ever got his w all it would have unintended consequences too, and his right-wing attitude would be to add more features to deal with them.
Left-wingers are more into evidenced-based solutions, but John Larkin doesn 't understand that particular idea.
What John Larkin is complaining about here is that leftists aren't prepared to wait for evolution to come up with a solution. Because leftists have so me idea of how evolution works - it starts off by killing off the unfit, wh ich makes space for those rare deviants who are better fitted to the new en vironment - they have a marked preference for not changing the environment enough to start killing people and changing the gene-pool.
Leftists do believe in evolution, but they don't like it as a way of drivin g adaption - nobody with any sense would.
-- Bill Sloman, Sydney
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One of the more expensive items on those price lists would what t costs to find out what's wrong with you. Once they know that they may be able to quo te you a price for a procedure that may cure your problem (if the diagnosis was correct, and if you problem is susceptible to intervention, neither of which is guaranteed).
Builders do it all the time, and for much the same reason - no two houses a re identical, even in Levittown.
And there's a problem with measuring performance. You get what you measure for, and what you measure tends to be what's easy to measure, rather than w hat you want.
Incentivising surgeons on their survival rates meant that the team that rep laced my aortic valve spent a couple of months running me through complicat ed and tedious tests just to make sure that I wasn't going to die on their operating table. I would have died anyway if I hadn't got the new aortic va lve, so I couldn't have cared less.
-- Bill Sloman, Sydney
The American health insurance industry lied to Obama about letting people k eep their health plans. Their aim was to make more money, and they bent the legislation to let them do that.
Letting lobbyists write legislation isn't a great idea. They do put in loop
-holes that benefit their clients at everybody else's expense.
Concentrating on the iniquities of US health care is distracting you from t he real problem., which is the special interests dictate the detail of Amer ican legislation.
.
For the medical insurance industry. It did extend medicala insurance cover to people who hadn't been able to afford it before, but the insurance indus try gouged everybody else to cover the cost of insuring people that they pr eviously hadn't thought that they could make money out of.
"Many" is an invented statistic. Get numbers if you want to make that claim .
Has the US national budget suddenly gone backwards since Obamacare was intr oduced?
Find some numbers or give up on the implausible claims.
-- Bill Sloman, Sydney
And you can thing you are doing it without being all that good at it.
Tennis tournaments test tennis-playing ability. Getting patents tests creat ivity, but what it mainly tests is the enthusiasm of your organisation for spending upwards of $10,000 on documenting a particular exercise in creativ ity.
On one occasion I pointed out (n writing) that a particular idea was patent able (without any expectation that Cambridge Instruments would patent it). The nice part came when one of our long term collaborators showed up six m onths later with the patent on the same idea - he'd been the editor of the journal paper that had sparked my idea, so he'd had it earlier.
My boss staged-managed the meeting so that I was able to say that I not onl y thought that the idea was patentable, but that I'd written a memo to say so six months earlier, which was great fun.
-- Bill Sloman, Sydney
o find out what's wrong with you. Once they know that they may be able to q uote you a price for a procedure that may cure your problem (if the diagnos is was correct, and if you problem is susceptible to intervention, neither of which is guaranteed).
No, they can't give you a price on diagnosing a condition... much less a co rrect diagnosis. They can give you a price on the tests... if they were in terested. I was in for my eighth or ninth kidney stone and the doctor want ed to order a CAT scan. My friend pointed out they can run a couple thousa nd dollars. I asked why they wouldn't perform the much cheaper IVP test an d was told they didn't have a radiologist on staff to do the procedure. Se ems they farm out the test interpretation remotely but the IVP had to be pe rformed by a radiologist. So they took a regular X-ray and by then the pai n subsided and I went home with a strainer.
are identical, even in Levittown.
Car repair is the same. Even though cars are not a big unknown, their cond ition is. If they know they need to replace one part, that doesn't mean th ere won't be other things that have to be replaced once they get in there.
One good thing about an HMO provider is that your care can be given to suit what you need, but the payments come from all the customers. Rather the M arxist philosophy of medicine. But then that's what insurance is all about , no?
e for, and what you measure tends to be what's easy to measure, rather than what you want.
eplaced my aortic valve spent a couple of months running me through complic ated and tedious tests just to make sure that I wasn't going to die on thei r operating table. I would have died anyway if I hadn't got the new aortic valve, so I couldn't have cared less.
So what was their criterion for providing the surgery? If you *might* not survive the surgery would they have let you die of your condition?
Rick C.
What you are expected top pay. It's a daily fee for being at the hospital, at Kaiser it is IIRC $500/day. Whether the procedure itself also gets charged against the deductible seems to be somewhat of a gray zone, as is most of the cost in medical. I have heard of people not getting charged more and others where the deductible was maxed out immediately.
Not a problem for us as we have prepared for that using an HSA.
Huh? Obamacare has quashed competition, big time. Many free market plans have been declared "non-compliant" and had to shut down. Now go look on the exchanges like I suggested earlier. You will find that while there is often more than one provider per category the prices inside each category (bronze, silver, etc.) are nearly the same. In some states it's much worse because the number of "competing" providers has dropped to one, for some counties occasionally even zero.
The ones I talked to had health insurance.
As I said, Obamacare priced them out of the market. In some cases the health plans they had were canned by Obamacare and the exchange plans are very expensive if no subsidy. In other cases the plan price shot up hugely like it did for our plan though we kept it grudgingly.
For a good dose of sticker shock try it out by keying in an income above
400% FPL. Bypass all the queastions about how often you are using doctors et cetera by clicking "skip", then it shows all available plans from high co-pay to almost no co-pay.A large percentage of American professionals are self-employed or work for very small companies that do not offer health plans.
-- Regards, Joerg http://www.analogconsultants.com/
osts to find out what's wrong with you. Once they know that they may be abl e to quote you a price for a procedure that may cure your problem (if the d iagnosis was correct, and if you problem is susceptible to intervention, ne ither of which is guaranteed).
correct diagnosis. They can give you a price on the tests... if they were interested. I was in for my eighth or ninth kidney stone and the doctor wa nted to order a CAT scan. My friend pointed out they can run a couple thou sand dollars. I asked why they wouldn't perform the much cheaper IVP test and was told they didn't have a radiologist on staff to do the procedure. Seems they farm out the test interpretation remotely but the IVP had to be performed by a radiologist. So they took a regular X-ray and by then the p ain subsided and I went home with a strainer.
es are identical, even in Levittown.
ndition is. If they know they need to replace one part, that doesn't mean there won't be other things that have to be replaced once they get in there .
it what you need, but the payments come from all the customers. Rather the Marxist philosophy of medicine. But then that's what insurance is all abo ut, no?
ure for, and what you measure tends to be what's easy to measure, rather th an what you want.
replaced my aortic valve spent a couple of months running me through compl icated and tedious tests just to make sure that I wasn't going to die on th eir operating table. I would have died anyway if I hadn't got the new aorti c valve, so I couldn't have cared less.
t survive the surgery would they have let you die of your condition?
Don't know. Most likely they would have referred me to a hospital with more expertise, who get the difficult cases, and don't lose brownie points when some of them die. That's what happened with my father's second coronary by
-pass operation, which reputedly had some interesting moments from which th e surgeon managed to rescue him - but that was in Australia, while I got my new aortic valve in the Netherlands, much more cheaply.
-- Bill Sloman, Sydney
No. The fact that Obamacare was in part to be financed by forcing people out of existing health plans and into Obamacare plans was part of the cost calculation that went along with that legislation. Get the facts before you make such nonsensical statements.
[...]-- Regards, Joerg http://www.analogconsultants.com/
Lol, as if that makes it *soooo* much less painful to get bills for thousan ds of dollars. HSA is just your own money pretax. It's still *your* money .
The law regulates insurance. So they can set a minimum level of coverage. Anyone who wants on provide insurance in line with the law is free to comp ete. You are definitely a glass half empty sort of guy when it comes to th e ACA.
Yep, there are places where insurance companies have found they have more t rouble competing and so drop out of the market. That's true competition. Should we mandate they offer insurance in every market?
So why would they give that up? HOW did they have insurance, job? You lov e your anecdotes, but they never have full information. That's just one pr oblem with anecdotes, the other is they are seldom representative of the po pulation as a whole.
So these people were buying private insurance? That's almost like having n o insurance3 at all. You have expenses and at the end of your policy year your prices triple or you are dropped. This used to happen with small comp any plans too. Cancer under private insurance is an accident waiting to ha ppen as you get dropped and then are uninsurable.
When I looked at insurance on the exchange there was *no* "almost no co-pay ". It was more about the out of pocket maximum.
If you don't like the price of insurance, I guess you prefer the old days o f getting booted because you had expenses.
Yes, and those people can get insurance now while they had a hard time befo re. That's why so many *more* people are insured now.
Rick C.
And you got your "facts" from where?
The sheer amount of lying that went into the Obamacare debate was quite remarkable.
-- Bill Sloman, Sydney
C'mon, you know how it is. Most people tend to spend as if there was no tomorrow. Once money is in the HSA it's locked up for medical purposes. You can't buy a new boat with it unless you are willing to pay a big penalty. Pkus it's pre-tax which makes a big difference.
Yeah, like that sex change operations must be provided for free.
Obamacare is like if the government would prescribe that all cars have to have five seats, have a 2.0 Liter engine and be gray in color.
No, do away with the stupid regulations. It should be up to the people whether they want a catastrophic-only plan or a more plush plan. Not up to the government. That gets back real competition.
I've told you twice niow.
Mostly like we did, a plan bought on the free market.
When it's scores of people it clearly indicates a real problem. It also went through the media, including leftist media.
Yes.
Baloney. Our Kaiser 0/2700 HSA plan suffers none of this. It just shot up in price after Obamacare. Nobody could be dropped for getting sick. Once you were in the plan and paid your premiums they could not cancel. That is and was the same with other private plans like Blue Shield.
Obamacare dumped people out of many private plans by decalring the "non-compliant". That's what got people dumped.
Look again, particularly at Bronze plans. At least here in CA co-pays are about $5k/year per insured.
White is mostly another leftist lie.
No. Many of them can't get any plan because the cost shot up so much. The vast majority in Obamacare plans is in there because they get big subsidies or free health care.
-- Regards, Joerg http://www.analogconsultants.com/
I don't think I have ever been charged more than $25 for a day in the hospital at Kaiser.
When I had my head crash a few years ago, I spent three days in intensive care at SF General, and Kaiser paid for it. Plus a bunch of followups. I signed up for a followup head injury research program and wound up making a small profit on the whole thing.
I think getting employer group health insurance is a major reason that people stay with their employer. I've heard of self-employed people getting together to form sorta nominal companies just so they can get "company" group insurance.
-- John Larkin Highland Technology, Inc lunatic fringe electronics
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