The unofficial Obamacare thread...

[AZ_]

Someone should have told her the 22 million that are that are "losing coverage" aren't losing it. They're going to opt out after Obama tried to force them to spend thousands on a service they don't want.

 

[Huber.]

Don't get me wrong, I appreciate the shit storms she causes. It keeps you people busy.



Have we sent Obama to jail yet for putting his feet on the oval office desk several times?

 

[The Human Q-Tip]

Someone should have told her the 22 million that are that are "losing coverage" aren't losing it. They're going to opt out after Obama tried to force them to spend thousands on a service they don't want.

I'm mystified why anyone would credit the CBO with any accuracy in terms of the number of people who will gain or lose coverage. They're the ones who overestimated the number who would gain private coverage by 121%. Those estimates were wrong right out of the gate, and grew progressively (pun intended) more inaccurate each year, long before the GOP did anything to ObamaCare.

The CBO ability to predict gains and losses in coverage is complete garbage.

 

[DJTJ]

I'm mystified why anyone would credit the CBO with any accuracy in terms of the number of people who will gain or lose coverage. They're the ones who overestimated the number who would gain private coverage by 121%. Those estimates were wrong right out of the gate, and grew progressively (pun intended) more inaccurate each year, long before the GOP did anything to ObamaCare.

The CBO ability to predict gains and losses in coverage is complete garbage.

Do you think there will be a net gain or a net loss under whatever the title of the health care bill will officially be?

 

[AZ_]

I'm mystified why anyone would credit the CBO with any accuracy in terms of the number of people who will gain or lose coverage. They're the ones who overestimated the number who would gain private coverage by 121%. Those estimates were wrong right out of the gate, and grew progressively (pun intended) more inaccurate each year, long before the GOP did anything to ObamaCare.

The CBO ability to predict gains and losses in coverage is complete garbage.

Conservatives replaced that CBO Director with a conservative from the Bush economic team.

http://www.politico.com/story/2015/02/keith-hall-congressional-budget-office-115584

Who they're now apparently slamming for not knowing what to do.


But it sounds great, really impressed with their work thus far. Very populist.

 

[The Human Q-Tip]

Do you think there will be a net gain or a net loss under whatever the title of the health care bill will officially be?

Before I can answer that, I need to know the frame of reference. In other words, will there be a net gain or loss ten years from now compared to what? From the number of people covered right now, or the number of people who will be covered in 10 years if nothing else is passed?

 

[The Human Q-Tip]

Conservatives replaced that CBO Director with a conservative from the Bush economic team.

http://www.politico.com/story/2015/02/keith-hall-congressional-budget-office-115584

Who they're now apparently slamming for not knowing what to do.


But it sounds great, really impressed with their work thus far. Very populist.

So what? They all plug and chug using the same formulas and assumptions. The guy responsible for hitting the buttons on the calculator doesn't matter.

I actually read the entire initial CBO estimate. And what they basically said was "we're making a whole bunch of assumptions, there are a lot of things we can't possibly predict, and there are a lot of things we know will affect the result that we cannot quantify. But, with all those caveats, here's our number."

I mean, the thing was garbage on it's face the first time. But people want "a number", so the CBO produces one. Even though if you actually read their estimates, they basically disavow them.

 

[AZ_]

So what? They all plug and chug using the same formulas and assumptions. The guy responsible for hitting the buttons on the calculator doesn't matter.

I actually read the entire initial CBO estimate. And what they basically said was "we're making a whole bunch of assumptions, there are a lot of things we can't possibly predict, and there are a lot of things we know will affect the result that we cannot quantify. But, with all those caveats, here's our number."

I mean, the thing was garbage on it's face the first time. But people want "a number", so the CBO produces one. Even though if you actually read their estimates, they basically disavow them.

Who can we trust, outside of conservatives, to produce a reasonable expectation for the effects?

We've crossed off the AMA, CBO, AARP, American Cancer Society, AHCA, Americans With Disabilities, basically any physicians group and dozens of others.

 

[The Human Q-Tip]

Who can we trust, outside of conservatives, to produce a reasonable expectation for the effects?

Nobody. Including conservatives. That is the entire point. When the government does anything like this by a large-scale fiat, the number of unintended consequences and unknown/not quantified variables is simply too large to come up with any kind of reasonable estimate. The overall uncertainty is exponentially higher than that because of all the variables in quality of care -- access, choice, development of new drugs/techniques/equipment, etc.. So even if you could come up with a raw number, it's pretty meaningless unless the other things all remain constant.

The best you're going to get is looking at what is being done, asking what incentives it creates, and thinking through the logical consequences of what you're about to do. Quantifying it is pretty pointless.

 

[DJTJ]

Before I can answer that, I need to know the frame of reference. In other words, will there be a net gain or loss ten years from now compared to what? From the number of people covered right now, or the number of people who will be covered in 10 years if nothing else is passed?

From right now. I think that's the easiest to compare.

 

[The Human Q-Tip]

From right now. I think that's the easiest to compare.

Okay, but I think that as a practical matter, that metric is useless. If nothing is done, ObamaCare is going to go into the toilet in terms of the individual exchanges. It didn't bend the cost-curves at all. In fact, a lot of costs are going up even faster. So, I think the correct metric is this bill versus the ACA ten years out, and in that case, I think this bill will probably do better.

There are some underlying economic realities here -- health care has been getting more expensive, we have more poor people, and the population is growing. So, it stands to reason that we will have more uninsured ten years from now anyway. There also is the issue I mentioned in my response to @AZ_ , regarding quality. Sure, you can make sure more people are "covered", but if access/choice/quality are dropping for some people, then that's not necessarily a good thing overall.

And, the issue I mentioned previously regarding the difference between having coverage, and being able to afford actually getting quality care. Lots of stories out there about people who are covered under an ObamaCare policy, but are now saddled with unaffordable out of pocket costs. So again, the "covered" metric is pretty useless.

All that being said, I think a prediction ten years out is pretty much laughable, and so I don't believe it can be accurately predicted whether or not more people will lose coverage than will gain it under the Senate bill.

Anyone who tells you they do know is trying to sell you something.

 

[DJTJ]

Okay, but I think that as a practical matter, that metric is useless. If nothing is done, ObamaCare is going to go into the toilet in terms of the individual exchanges. It didn't bend the cost-curves at all. In fact, a lot of costs are going up even faster. So, I think the correct metric is this bill versus the ACA ten years out, and in that case, I think this bill will probably do better.

There are some underlying economic realities here -- health care has been getting more expensive, we have more poor people, and the population is growing. So, it stands to reason that we will have more uninsured ten years from now anyway. There also is the issue I mentioned in my response to @AZ_ , regarding quality. Sure, you can make sure more people are "covered", but if access/choice/quality are dropping for some people, then that's not necessarily a good thing overall.

And, the issue I mentioned previously regarding the difference between having coverage, and being able to afford actually getting quality care. Lots of stories out there about people who are covered under an ObamaCare policy, but are now saddled with unaffordable out of pocket costs. So again, the "covered" metric is pretty useless.

All that being said, I think a prediction ten years out compared to the numbe ris pretty much laughable, and so I don't believe it can be accurately predicted whether or not more people will lose coverage than will gain it under the Senate bill.

Anyone who tells you they do know is trying to sell you something.

Perfect response.

Affordable insurance defined by low deductibles and premiums is not attainable until regulated cost structures get set. Which you'll then argue it limits incentive for research, to which I'll then say one or the other but not both.

Can we both agree that the ideal healthcare bill gets the most people coverage, while lowering the costs for premiums and deductibles for virtually everyone, regardless of the system?

 

[The Human Q-Tip]

Can we both agree that the ideal healthcare bill gets the most people coverage, while lowering the costs for premiums and deductibles for virtually everyone, regardless of the system?

Well, no, because there are two huge things that overlooks.

1) Taxpayer cost. You're looking at the direct costs to users, but there is the additional variable of government subsidy/spending. If you're building your most people covered/cheapest premiums and deductibles with government payments/subsidies, then the amount of taxpayer money being spent is a major consideration.

2) Quality of care. This includes all the things I mentioned above, like doctor choice, access to tests, medical advancements, etc..

Just to give you an example of what I meant with No. 2, I had an idea awhile back that government-funded health care -- including Medicaid, Medicare, etc., should not include access to any drugs or devices that are under patent. Everything generic. That would have the general effect of lowering those costs, but it would also mean that those people aren't getting the most cutting edge care.

Your definition of the "ideal health care bill" focuses solely on how much we're paying, not the quality of care that's actually being received by those patients.

I suppose I'd add a 3) here that often goes unmentioned but that I believe is a significant issue, and that's what I would call "levelling", or "egalitarianism". In other words, I think the more government gets involved, the greater the pressure to say "well, the people who have really good access and really good care are going to have to give up some of that so that other people can get decent medical coverage."

And I don't think a lot of people want to do that.

 

[DJTJ]

Well, no, because there are two huge things that overlooks.

1) Taxpayer cost. You're looking at the direct costs to users, but there is the additional variable of government subsidy/spending. If you're building your most people covered/cheapest premiums and deductibles with government payments/subsidies, then the amount of taxpayer money being spent is a major consideration.

2) Quality of care. This includes all the things I mentioned above, like doctor choice, access to tests, medical advancements, etc..

Just to give you an example of what I meant with No. 2, I had an idea awhile back that government-funded health care -- including Medicaid, Medicare, etc., should not include access to any drugs or devices that are under patent. Everything generic. That would have the general effect of lowering those costs, but it would also mean that those people aren't getting the most cutting edge care.

Your definition of the "ideal health care bill" focuses solely on how much we're paying, not the quality of care that's actually being received by those patients.

I suppose I'd add a 3) here that often goes unmentioned but that I believe is a significant issue, and that's what I would call "levelling", or "egalitarianism". In other words, I think the more government gets involved, the greater the pressure to say "well, the people who have really good access and really good care are going to have to give up some of that so that other people can get decent medical coverage."

And I don't think a lot of people want to do that.

I'll respond to this when I get home from work and will tag you in it. Good points for good discussion.

 

[BooyaCS]

Well, no, because there are two huge things that overlooks.

1) Taxpayer cost. You're looking at the direct costs to users, but there is the additional variable of government subsidy/spending. If you're building your most people covered/cheapest premiums and deductibles with government payments/subsidies, then the amount of taxpayer money being spent is a major consideration.

2) Quality of care. This includes all the things I mentioned above, like doctor choice, access to tests, medical advancements, etc..

Just to give you an example of what I meant with No. 2, I had an idea awhile back that government-funded health care -- including Medicaid, Medicare, etc., should not include access to any drugs or devices that are under patent. Everything generic. That would have the general effect of lowering those costs, but it would also mean that those people aren't getting the most cutting edge care.

Your definition of the "ideal health care bill" focuses solely on how much we're paying, not the quality of care that's actually being received by those patients.

I suppose I'd add a 3) here that often goes unmentioned but that I believe is a significant issue, and that's what I would call "levelling", or "egalitarianism". In other words, I think the more government gets involved, the greater the pressure to say "well, the people who have really good access and really good care are going to have to give up some of that so that other people can get decent medical coverage."

And I don't think a lot of people want to do that.

I will address these in a little different manner.

1.) Yep the problem is always going to be the "cost" when it comes to insurance. Whether it is tax payers or users someone is going to have to pay. The whole "insurance for healthcare" is flawed.

2.) No one (except doctors and patients) care about Quality of Care. The insurance companies want the cheapest care so they don't have to pay out nearly as much money. It is all about the money.

We need a system that doesn't revolve around insurance. More like a coalition with Doctors that are in charge of the care and can negotiate prices with the consumer. Similar to a subscription basis allow each doctor to set their own prices per visit including discounts and such for their patients.

I suppose I'd add a 3) here that often goes unmentioned but that I believe is a significant issue, and that's what I would call "levelling", or "egalitarianism". In other words, I think the more government gets involved, the greater the pressure to say "well, the people who have really good access and really good care are going to have to give up some of that so that other people can get decent medical coverage."

I think that is a problem with a for profit insurance model in general. If you want the insurance companies to play more fair then they will cut corners at all costs just to make sure they are hitting their profits. In order to control Healthcare costs we need to take out the middle man and put it in control of the doctors and the consumers.