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View Diary: This is the real 'rate shock': My parents' amazing Obamacare story  (164 comments)

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  •  It doesn't do that. What it does is provide a (7+ / 0-)

    mechanism to let the costs be covered for people who were previously locked out from "insurance".

    A larger pool does not make health care cheaper.  With regard to "insurance" -- quoted because we are really treating insurance like a pre-paid health care plan, not insurance -- a larger pool lowers costs only if a sufficient number of young and healthy people are willing to join the pool and pay premiums that are high relative to their actual cost of health care.  If they do that, the extra pay-in will make it possible to provide "insurance" to those whose health care costs are higher.

    But that doesn't reduce the cost of health care. It merely allows one group of people to pay part of the costs for another. They subsidies do the same thing, but on a broader scale.

    The real costs come from the providers of health care -- doctors, hospitals, pharmaceuticals, etc.  Worse, those costs don't make health care better, probably does actual injury to many patients in the name of pursuing a buck.

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Sun Nov 10, 2013 at 10:40:16 AM PST

    [ Parent ]

    •  YES. (3+ / 0-)
      Recommended by:
      HappyinNM, dinotrac, rl en france

      something needs to be done about providers.  Insurance companies, pain in the neck though they are, have had to raise premiums to cover outrageous costs at the source.

      "If there are no dogs in heaven, then when I die I want to go where they went." - Will Rogers

      by Kentucky DeanDemocrat on Sun Nov 10, 2013 at 10:42:58 AM PST

      [ Parent ]

    •  One of the changes is that providers won't be (1+ / 0-)
      Recommended by:
      Aquarius40

      paid by fee-for-service. Also, they're putting together electronic medical records. Both will discourage multiple tests and procedures.

      •  No. Still paid on fee-for-service basis. (0+ / 0-)

        There are some special programs built into ACA that will work differently, but, for the most part, it's the same-old same-old.

        A big shame, too, because a lot of people earlier in the process had good ideas to lower costs in meaningful ways.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Sun Nov 10, 2013 at 11:13:47 AM PST

        [ Parent ]

    •  bear in mind (7+ / 0-)

      the uninsured show up at the ER  unstable,
      sick, dying,  and the ER bandages them up,
      and pushes them out to the curb to call a taxi.

      It's a heck of a lot cheaper to treat someone with
      Diabetes or an ear infection at a walk in clinic,
      at a Internist or at a Nurse-practitioner,

      and make sure their problems are treated early.

      An ounce of prevention beats a pound of cure.

      •  Oh, I'm sure that will have an impact. (0+ / 0-)

        But -- how big is that problem when compared to the sytem as a whole?

        I'm sure the savings come under the "nice to have" category.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Sun Nov 10, 2013 at 11:15:33 AM PST

        [ Parent ]

        •  it's a big one. (0+ / 0-)

          the  uninsured show up at the ER,

          they get treated at the most expensive rate,

          they pay nothing due to EMTALA,  and then
          that cost gets layered on every other schmuck coming
          into the hospital.

          •  don't pay anything????? (0+ / 0-)

            I think not.  currently a non-insured/non-Medicaid patient is presented with a health care credit card loaded with the balance due.  granted the patient cannot be charged interest. BUT the patient must make arrangements for payment.  if the patient cannot make that payment, or misses one the interest starts to accrue.  if the patient cannot make the payment at all, they are turned over for collection, that leads to bankruptcy.  if the patient has no income or assets to sieze the debt may or may not be written off after a time.

            most people are honest and honorable.  they feel the responsibility to pay their debt.   they struggle to make at least a minimum payment and see the balance grow. and god forbid they need follow up or more care. or medicine.

            this will change only moderately under the ACA, since even with a small premium there are still co-pays, and deductibles to pay.

            please let me know if this will no longer be true under the ACA.

    •  Hospitals are getting penalized if a discharged (1+ / 0-)
      Recommended by:
      TerryDarc

      patient has to be re-admitted within (I think) thirty days.  It's already having a impact.  I think there are other small bore provisions also making a difference.  It's a start.  

      Sorry, I'm not good enough with my iPad to find corroboration.

      We must, indeed, all hang together, or assuredly we shall all hang separately. B. Franklin

      by Observerinvancouver on Sun Nov 10, 2013 at 11:55:48 AM PST

      [ Parent ]

      •  that sounds like a bad idea (0+ / 0-)

        More to the point, it sounds like something that will encourage needlessly long hospital stays.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Sun Nov 10, 2013 at 04:56:16 PM PST

        [ Parent ]

        •  no it's not (0+ / 0-)

          until now, most stays were 23 hours! and out the door.  with the patient having to be taken to the doctors office for followups by taxi, friends or family members. to be jostled and exposed to the germs of others, when staying in the hospital room, supervised by nurses, to be seen at rounds would have been less stressful on the patient. often the dr. finds something and re-admits the patient, for another 23 hour period.  the statistics prove the point.

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