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Photo of man who supports obamacare at the supreme court in washington dc on 6/28/12.
With the dust settling around Obamacare after its successful first enrollment period, looking ahead to what this health insurance reform will and won't do seems in order. It's going to be informative for the inevitable debate about more systemic healthcare reform. Almost-universal health insurance will save lives, it will help effect some cost savings in the system, and it will help protect public health, but it doesn't solve problems of the U.S.'s out-of-whack healthcare costs, or automatically improve access to health care. With that in mind, Adrianna McIntyre at Vox sums up some basic but not widely known facts about health insurance, and what this all can mean for the next, inevitable round of reform.

First, people will increase their use of health care because they'll be able to afford it, and that means illnesses can be caught earlier and treated more effectively in many cases. That can save money throughout the whole system, ultimately, but it will drive up healthcare spending. And the flip side of the coin is that people will also increase their spending on care that isn't necessarily effective. The Affordable Care Act has some measures on the provider side to try to hold down unnecessary and wasteful treatment, but it really only has the teeth for doing that in Medicare.

Emergency room use will probably actually increase, because people will have insurance to cover their visits, and will probably continue to use the ER for things that aren't necessarily emergencies. That's because universal health insurance doesn't mean that there aren't barriers to getting care—lack of local primary care providers, inability to get time off work to see the doctor, all of the things that makes life a struggle for many people will continue to exist, insurance or no. That ties inextricably into the next point McIntyre makes: "Social determinants of health, defined by the CDC as 'the circumstances in which people are born, grow up, live, work, and age,' also play a huge—albeit less clearly understood—role in health." Nutrition, a safe and healthy environment, education—all these things factor into health. The U.S. spends just $0.56 on social programs for every dollar spent on healthcare, and inverted ratio from every other developed nation's spending.

Of course there's good news. Getting more and earlier health care helps avert catastrophic illnesses, and will save many from catastrophic healthcare costs. Perhaps as a result of not having to worry about having their lives ruined by a lack of health insurance, people who have it report better mental and physical health. That was found both in a survey by Rice University and in a study in Oregon of newly enrolled Medicaid patients.

Ultimately, health insurance saves lives—for the people who have it and who have access to good care. The ACA gives the country a good start but it's not the silver bullet for a very broken system.

Insurance can't solve a problem that's incredibly fundamental to our health spending problems: spending is distributed across different patients in a radically unequal fashion. About 5 percent of patients are responsible for half of all health spending. Meanwhile, the cheapest 50 percent of patients account for less than 3 percent of spending. […] Expanding coverage isn't likely to change this distribution. Other health reforms—changing how we pay for care, not just who we cover—hold much more promise.
Obamacare is how you start reform, and it might even have the elements of an ultimate healthcare system reform. For example, the Swiss system maintains private insurance—it just effectively regulates both insurers and healthcare providers and device makers and pharmaceuticals to keep costs down. Getting single payer actually might end up being easier than forcing the industry to cut its profits or a government how to effectively regulate, but the possibility still remains. The ACA puts the country on that path.

But first we have to get beyond the "incoherent mishmash" that is the current Republican party.

Originally posted to Joan McCarter on Mon Jun 02, 2014 at 04:01 PM PDT.

Also republished by Obamacare Saves Lives and Daily Kos.

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Comment Preferences

  •  Tip Jar (26+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Mon Jun 02, 2014 at 04:01:07 PM PDT

  •  I like the sign. (3+ / 0-)
    Recommended by:
    badger, thanatokephaloides, ypochris

    Why not just abolish health insurance as it currently exists?

    If we expand Medicare to cover everyone, we could abolish the VA health system too.

    •  Actually, the VA is a specialized system (4+ / 0-)

      that has expertise in war wounds that civilian healthcare systems don't, it knows military patients and serves them better than civilian providers can, so taking the VA out is not a good idea.
      An abrupt "abolishment" of the current system is also not a good idea. ACA is a start on reforming the system and I believe will eventually lead us to a Single Payer system.
      The Exchanges are already gaining traction and some states that have their own are considering abandoning them for the Federal Exchange. Once that boils down to California and maybe Vermont having their own but everyone else on the Federal System, it will become obvious that treating every state differently is inefficient, economies of scale can be invoked by the larger Exchange. I'd like to see MedicAid included in the Exchanges as the "subsidized" low-cost option. Instead of a subsidy being paid to a 4Profit system, MedicAid availability is widened to include everyone that would be eligible for subsidy, putting the 4Ps out of the bottom 1/3 of the market. That would make the MedicAid/subsidy pool larger and would increase demand for providers to serve the MedicAid market (better than they do now).

      If I ran this circus, things would be DIFFERENT!

      by CwV on Mon Jun 02, 2014 at 05:00:37 PM PDT

      [ Parent ]

      •  Interesting points (2+ / 0-)
        Recommended by:
        ypochris, CwV

        1. Obviously a Medicare expansion would not cover battlefield  health care.  To the extent that war wounds require specialized care then it might not cover that either.  So, I see that as a valid criticism of my assertion.

        On the other hand, how much of the VA health care system is devoted to exactly the same types of health problems that the general population faces?  I don't know the answer to that question, but I'll hazard a completely unsubstantiated opinion that it is a large percentage.

        2.  I totally agree that an abrupt abolishment would be inappropriate.  A universal expansion of Medicare would need to be phased in, and supplanting the VA might take some time.  Another issue would be what to do with the facilities.  One idea would be to turn them into Medicare clinics that serve the general population.

      •  Agreed. (2+ / 0-)
        Recommended by:
        jessbell911, Whatithink

        But this diary is old enough that I can no longer recommend your comment.

        How can we expect family and general practitioners to deal with  the mental and physical problems war generates?

  •  Thanks for posting this. (3+ / 0-)

    Yes, it's time to look ahead and figure out where we go from here, aside from any fixes that are needed to the ACA.

    To some extent, health care providers will begin to adapt to the new environment in ways we can't foresee just yet.  Where opportunities exist, innovative providers will begin to offer responses to these opportunities.

    One thing to think about in the somewhat short run is the notion of transparency in the various cost components of health care.  As we know, you can get vastly different price quotes for exactly the same procedure at the same hospital or clinic, simply based on whether you have insurance or not, or which the insurance company you're with.  It has nothing to do with the actual cost of the procedure.  It's unlike anything I've seen in any other marketplace.  I wonder how much of the cost of health care is artificially high just based on the complete lack of transparency.

    "The truest measure of compassion lies not in our service of those on the margins, but in our willingness to see ourselves in kinship with them." Father Gregory Boyle, Homeboy Industries

    by Mr MadAsHell on Mon Jun 02, 2014 at 04:20:33 PM PDT

    •  Transparency - YES! (5+ / 0-)

      I had never had health insurance before, and overall I am quite pleased with my policy under ACA.  However, the claims - what my providers bill and how the company processes them - are incomprehensible.

      There must be a better way!

      My 88-year-old father's Medicare bills are complex, but compared to mine under a private plan, they are easy and simple.

      So, how about adding some standardization to the transparency?  How about a rule that says a provider must set one price for a particular procedure and cannot charge a different price regardless of who is going to pay?

    •  What opportunities will exist? (0+ / 0-)

      Instituting policies that will keep their patients healthier?  Installing electronic systems that allow providers to communicate information about patients with other providers more efficiently?

      Those "opportunities" that will help the system but will cost money to implement and reduce the profits of providers all sound like a very bad business plan.

      "All that is necessary for evil to triumph is for good men to do nothing" - Edmund Burke

      by SueDe on Fri Jun 06, 2014 at 07:00:32 PM PDT

      [ Parent ]

      •  Electronic communication is a part (1+ / 0-)
        Recommended by:

        the ACA.  It is a vital tool so tests, including x-rays, etc., are not duplicated when a patient comes into a different hospital setting.  It will coordinate communications between doctors, as well as nursing homes, etc.  This was part of the package of the ACA, and began in 2011.

        As a member of Kaiser Permanente, electronic info for all patients here in So. California is well used.  You can go into any medical satellite, an ER in any city and your medical information is at the fingertips of those treating you.  Your prescriptions, past history, all there for pursal.

        Kaiser began implementing this back in 2004; over 10 years.  As a patient I can email my doctor, a pharmacist, and other allied health personnel if I have a question about my visit, or my prescriptions.

        This will be a nationwide practice, but the obstruction and balking by the Republicans has made the launch frustrating.  There is no question it cuts down on test repeats, on a patient's misinterpreting instructions, etc.

        The ACA is taking this country on the road to the 21st century.  We have been behind the Western Industrialized countries for decades.  It is about time we came to our senses.

        •  Unfortunately, the various EMR (electronic medi... (0+ / 0-)

          Unfortunately, the various EMR (electronic medical records) systems used by various clinic systems are still not communicating with each other, meaning that in most cases, when your primary care doc refers you to the next larger system for specialist care, the records that are sent are paper or faxes. PLUS, just because a clinic has your records, doesn't mean that the docs read your history. Or even care about your history. Been there....unfortunately. (Also, as a doctor's spouse, I've heard plenty of complaints about the EMR. He's had to learn 5 systems in the last 8 years. The clinic, hospital, xray department, and nursing home are attached. They each have a different in efficient EMR system.)

  •  Squeezing doctors' time (6+ / 0-)

    Another limitation of our current health system that health insurance reform leaves in place is the current practice of squeezing doctors' time.

    Nowadays most primary care physicians are limited to about five minutes per patient. If they spend more time, then their pay goes down. And yet much valuable work, especially on the diagnostic and preventive side takes more time-- time that our current system has no mechanism for compensating, even though it can improve health and save money overall.

    "The smartest man in the room is not always right." -Richard Holbrooke

    by Demi Moaned on Mon Jun 02, 2014 at 04:21:31 PM PDT

    •  It doesn't just leave it in place, (4+ / 0-)

      it makes it much worse. The Affordable Care Act mandates that doctors perform tasks formerly left to secretaries, such as Physician Order Entry, and complicates it by mandating thousands of new diagnosis codes that must be looked up constantly to get it right. My wife spends about a third of her time that was formerly spent with patients doing paperwork.

      Basically, the entire burden of cost reduction, improved patient care, and "accountability" has been dumped on physicians, with no additional, or even reduced, compensation. Doctors, many of whom favored the act before they felt the consequences, and still do favor single payer, appear to universally despise Obamacare. My wife even went so far as to say, a few days ago, "I hope Republicans win next time, just to pay the Democrats back for Obamacare".

      What do they expect, when they adopt a pro-insurance, pro- big pharm, anti-doctor Republican health care plan as their own?

      •  Would Have Happened Anyway (1+ / 0-)
        Recommended by:
        Demi Moaned

        The changes in the ICD (International Classification of Diseases) would have happened whether the ACA was passed or not.  The two are exclusive.  The fact that doctors might dislike Obamacare only shows that they are as susceptible to propaganda as anyone else and perhaps even more because their interests outside medicine tend to be severely restricted.  Further, who else besides doctors can drive any increase in productivity?  The doctors have set up the system so that they alone can determine who can practice in virtually every state, so they will be the entities who must drive productivity.  Obamacare isn't the cause of any grief your spouse might be experiencing.

        "Love the Truth, defend the Truth, speak the Truth, and hear the Truth" - Jan Hus, d.1415 CE

        by PrahaPartizan on Mon Jun 02, 2014 at 08:39:47 PM PDT

        [ Parent ]

        •  It isn't propaganda causing them to hate it, (0+ / 0-)

          it is the vastly increased work load. Pre-Obamacare, my wife typically got home in the early afternoon. Now, she's rarely done with work before seven. A direct result of the new law.

          If that isn't a serious impact, I don't know what is. And she doesn't get paid any more for it.

          However beneficial it may be for the general public, the Affordable Care Act is a disaster for physicians. Who, as a rule, know a lot more about it than your average internet poster. I agree their interests outside of medicine are limited, but this is not outside of medicine, it is their new reality. A reality that is causing many to quit practice.

          What we need to do is ditch the Affordable Care Act and replace it with Medicare for all - a solution doctors would be quite happy with. Why are we ruled by what insurance and pharmaceutical companies want?

          •  It's Not the ACA (0+ / 0-)

            The changes in the requirements of the ICD would have happened without the ACA, still requiring additional work by physicians.  Pleast note that - the ACA didn't drive the changes in the ICD and reporting requirements.

            If, as you claim, she used to return home by, say, 3:00PM, and she now returns home only at around 7:00PM, then she was doing something seriously wrong before the ACA got passed and you didn't know it.  Physicians have been required to document their diagnoses for their patients long before the passage of the ACA.  Unless she's seeing many more patients due to the passage of the ACA and being required to document them because they are new patients, her documentation requirements will not have changed much.

            Thanks for telling me that I don't know much about the ACA or the ICD, in a back-handed way too I might add.  I've lived this for the last forty years with my spouse who has been a hospital administrator executive dealing with managed care for that time and we've talked a lot about these issues for that entire time ever since she was going to graduate school in the discipline.  Dealing with insurance isn't something inside medicine, except as it affects physicians income, which is about the only thing that captures their attention.

            I'd agree that the ACA ought to be ditched and replaced with a single-payer system, whether Medicare for all or whatever.  That push ought to be done because the resulting system would be more efficient than the Rube Goldberg structure which has had to be implemented for the ACA.  But doctors aren't going to be happy with Medicare for all either, because it will dampen their incomes as well over the long run but will hopefully re-balance the manner in which medicine is practiced.

            "Love the Truth, defend the Truth, speak the Truth, and hear the Truth" - Jan Hus, d.1415 CE

            by PrahaPartizan on Tue Jun 03, 2014 at 06:20:09 AM PDT

            [ Parent ]

            •  Physician order entry (0+ / 0-)

              is a new thing. She spends a lot of time doing data entry, looking up codes, etc. - something that used to be done by other staff. She can't just dictate any more. It is a huge waste of physician time.

              As you should know, the vast majority of physicians are not in private practice. As physician salaries are a very small part of the overall expense of a health care system, they are unlikely to be affected by reduced reimbursement rates negotiated by Medicare. Insurance companies, after all, are even less willing to pay out their money than the government is willing to spend tax dollars.

              •  It's Still Not the ACA (1+ / 0-)
                Recommended by:

                It sounds as if the problems your spouse is encountering stem from changes made at her practice and not from the ACA's implementation.  Since it sounds as if she's a salaried physician working for a health system of some sort, it would appear that they are feeding her a line that the changes are due to the ACA.  It certainly makes it easier for them to justify reducing the support staff while reducing the grousing they'd get from their physicians.

                About the only real function of the private health insurers these days is to whack off the top of the payments their 15% skim to go to dividends and bonuses for the execs.  They slipstream on the payment schedules that Medicare and Medicaid pay and provide very little "added value."  I usually think of them as the organized crime element of healthcare.  I'm sure the mob keeps smacking itself in the head for not having come up with the scheme - and it's legal.

                "Love the Truth, defend the Truth, speak the Truth, and hear the Truth" - Jan Hus, d.1415 CE

                by PrahaPartizan on Tue Jun 03, 2014 at 07:46:16 AM PDT

                [ Parent ]

              •  My husband is a physician. He doesn't look up c... (0+ / 0-)

                My husband is a physician. He doesn't look up codes. Staff does that. Ditto at the big clinic I sometimes go to. Staff has done that for years. The biggest difference for my husband, but starting 9 years ago was the No Dictating. He types well, and types in the check mark type things in the EMR while he is seeing the patient, but does the longer notes later. The EMR is really hard on docs who don't type well. But how did they get through college without typing?. My husband is 65.

            •  It seems that some people are assuming that the... (0+ / 0-)

              It seems that some people are assuming that the coding thing is new. Hardly. Yes, there have been updates, but when I worked at BCBS in 1975-1976, we had the ICDA codes and procedure codes, which were on claims, processed by (fairly primative) computers. But putting complex medical procedures & complex insurance policies into computer binary coding was like stuffing dinosaurs into straws. Yikes.

      •  Your post is anonymous and we are to (0+ / 0-)

        believe your wife is a doctor.  That may well be.  However, as a retired allied health professional I can tell you the many doctors I keep in contact with would never
        "wish" for a Republican in order to disarm Obamacare.

        Do you or your "wife," have any idea how much hospitals lose on ER acute treatment they bill but never receive?  Do you understand that the hospitals have to make up that difference somehow.  That is why insurance rates skyrocket because it is you and me, the insured who our insurance companies take it out on.  There is no one else.

        How many times have I talked to specialized doctors who fix an accident victim with expertise and pride only to lament that the followup will never take place, the physical therapy and ongoing treatment because this patient doesn't have health insurance.

        This unfortunate patient also may never work again in his/her field because of a disability that would never have occurred if a year-long regimen of physical therapy was utilized.

        This is not anti-doctor, but it is opening fields in the medical profession, nursing, and allied health fields.  It is a good thing.

        •  Well, my reaction was to put her absentee ballot (0+ / 0-)

          request form in the "round file". (OMG, Democratic voter suppression!) I was shocked, but that's what she said.

          I'm surprised that the "many doctors" you know are Democrats - most around here are strongly Republican. The AMA is strongly Republican - my wife refuses to join for that reason. Which is why it was so surprising that she said that.

          •  The doctors do not discuss their party (0+ / 0-)

            affiliation.  What we discuss is the fact that the ACA, Obamacare, or whatever you call it was very necessary, as one of the monumental achievements of this decade and as a tool to better our society; it had to come.

            Without this reform and regulation of our insurance industry, this country could never sustain the old way of dealing with ever rising premiums, and the millions of people without coverage.  

            •  No, the ACA didn't have to come. (0+ / 0-)

              There were much better alternatives proposed, alternatives used by every other industrialized nation and many poor ones. Various versions of single payer healthcare. Personally I prefer Medicare for all.

              The ACA is a regulatory nightmare, with the primary goal being to protect the interests of insurance and pharmaceutical companies. Hospital systems may, or may not, see a benefit, and doctors get screwed. What does a doctor on a salary (almost all) care if the hospital they work for gets paid or not? Their only interest is the well-being of the patient, not their insurance status.

              •  You must realize that there was absolutely (0+ / 0-)

                no way a reform of our better access to health insurance could have gone to single payer or Medicare for all. Congress would have had no part of it.  As it is, the liars out there  call the ACA "socialized" medicine; single payer and Medicare for would not fly.  

                Romneycare was first proposed by the Heritage Foundation, a conservative think tank, which the Koch Brothers support (funding). Many of the ideas of Romneycare came from the Heritage Foundation.

                Romneycare was to be the model for the country.  It has been a success in Massachusettes.  Many of those who helped get it off the ground were brought in to consult on the ACA.

                This idea would be a monumental achievement and a very complex idea to take it nationally.  However, being that it started out as a Republican idea, who'd of thought there would be so much resistance?  Oh, yeah, because it would be a positive for the Obama Administration.  

                You are mistaken in your assessment of whether or not hospitals would benefit; the answer is yes they will.  The rural hospitals in the red states where republicans have barred Medicaid expansion are the ones who are suffering financially and will be until their governors and legislatures wise up.

                I don't know where you are coming from with doctor's pay and them getting screwed.  There are 63 new preventative measures mandated in the ACA; doctors will be reimbursed for them.  Doctors will be compensated for their work, as always.  What the ACA will do is promote more young people to go into the health care profession.  There are wide-open opportunities in various health fields and allied health fields.  In ten years, when the dust settles, when necessary fixes and tweaks are made, then let's have this discussion again.

                You will read and hear all kinds of arguments against and for the ACA.  Those that are from reliable sources have a much more optimistic viewpoint.

    •  System Allows for Different Time Demands (1+ / 0-)
      Recommended by:
      Demi Moaned

      The patient coding system definitely allows for variations in the relative health of the patient and their relationship with the physician providing the care.  Some patients who have more complicated histories are billed at a different rate than those whose histories are less difficult.  Physicians seeing new patients are compensated for the difference in time required to counsel a new patient versus an established patient.  

      One can dispute whether the physicians are compensated adequately or sufficiently for the time they do provide patients of any stripe but it is not true that the system possesses no mechanism for reflecting differences in patients health or status with the physician.  Unfortunately, our health care system 20 years ago made the decision that compensation to physicians who could FIX problems would be higher than compensation to physicians who could help PREVENT or MITIGATE problems.  It likely stems from a patient base which doesn't believe that bad things can happen to them unless those bad things do happen to them, in which case it is the worst thing ever to happen in the world because it happened to THEM.

      "Love the Truth, defend the Truth, speak the Truth, and hear the Truth" - Jan Hus, d.1415 CE

      by PrahaPartizan on Mon Jun 02, 2014 at 08:31:50 PM PDT

      [ Parent ]

  •  Paperwork, administration, and costs ad nausem (6+ / 0-)

    Like dark matter in the universe, our system has a tremendous amount of paperwork, documentation, and administrative overhead that is unseen but exerts a large force on healthcare costs.

    We already have a mishmash system. Different insurance companies have different rules, require a hefty amount of documentation to support claims, and have different billing systems and requirements. All of that information needs someone to record it, collect it, attest to it, code it, store it, process it, etc., etc., etc.

    Then their is the billing and collections systems. Hospitals and health systems need expertise on all those different insurers to submit and collect on charges.

    Inefficient computer systems don't help. Though the lack of standardization and insurer micromanagement drives some/much/most of the inefficiency in healthcare IT. That and a lack of standardization on anything and the silos of healthcare organization.

    I can go to almost any country in the world and use an ATM to access my bank account. The healthcare system? Your primary physician is probably on a different computer system than the hospital s/he uses, or the specialist s/he refers you to, or the local pharmacy. And god forbid you go to a dentist or vision care; that's a whole 'nother ballgame completely.

    But, the big bugaboo in our "system" is fee for service billing: providers charging for every single line item: every pill, every treatment, every test, every everything. It's like buying a car part by part, then getting billed separately for assembly. And some third party arguing without you about whether you really really really need four wheels.

    This creates much of the complexity in our system, and the over utilization of expensive services. That's a whole series of diaries by somebody smarter than me.

    We can and must get a more standardized and streamlined healthcare system, without fee for service billing. The ACA provides a way to start down that road. Whether that road leads to single payor or not, we get a less expensive system in the process.

    A man does as he is when he can do what he wants

    by BobBlueMass on Mon Jun 02, 2014 at 04:52:38 PM PDT

    •  What are the alternatives (0+ / 0-)

      to fee for service billing?

      I'm clueless about this stuff, and would appreciate any insight you care to share.

    •  Bundled Services (0+ / 0-)
      "...But, the big bugaboo in our "system" is fee for service billing: providers charging for every single line item: every pill, every treatment, every test, every everything. It's like buying a car part by part, then getting billed separately for assembly. And some third party arguing without you about whether you really really really need four wheels..."
      Well, the alternative would be charging for a fee for a particular diagnosis and the likely charges which would be necessary to treat the diagnosis.  That means some people will be paying for some treatments which they specifically don't use.  It would be like the cable TV bill most of us get every month wherein we get charged for X channels when most of us use only X-495 channels per month.  Some folks will scream bloody blue murder, but it's the only way that an institution like a hospital can recover its real costs for being able to provide all of the services necessary for its patients.  It either gets billed as "fee for service" or it gets averaged out in a grand billing systems.

      "Love the Truth, defend the Truth, speak the Truth, and hear the Truth" - Jan Hus, d.1415 CE

      by PrahaPartizan on Mon Jun 02, 2014 at 08:47:53 PM PDT

      [ Parent ]

      •  Exactly, it would be like your car repair shop (0+ / 0-)

        charging you a flat $1500-2000 fee for repairing your transmission even if it only required replacing a single bolt because that is the average cost of transmission work (as some cars will need the entire gearbox replaced).

        You have watched Faux News, now lose 2d10 SAN.

        by Throw The Bums Out on Mon Jun 02, 2014 at 10:07:14 PM PDT

        [ Parent ]

    •  However keep in mind that health care is (0+ / 0-)

      more like repairing or even rebuilding a car than making one in the first place.  If your car repair shop charged you a flat $1500 fee for transmission repair even if they had to just replace a single bolt because that was the average cost of repairs as some people would need a full rebuild or even replacement I think you would be pretty pissed off.

      You have watched Faux News, now lose 2d10 SAN.

      by Throw The Bums Out on Mon Jun 02, 2014 at 10:05:58 PM PDT

      [ Parent ]

  •  You're still dealing with private insurers (7+ / 0-)

    so you have delays for pre-approvals, arbitrary categorization of some procedures as "investigational" (meaning they won't pay), and limitations on where you can be treated and covered (for HMO and PPO plans, which is what most people have under ACA).

    My insurer, for example, has PPO contracts with all of the major Seattle hospitals and UW, and those places list them on their web sites. But my specific plan doesn't consider them preferred providers at all. Even my doctor has the problem that her insurance plan won't cover some places she might want to go for treatment for herself and her family.

    All of that pushed the start of my treatment back more than a month, and entailed a lot of anxiety and frustration. It's bad enough being sick.

    No matter how cynical you become, it's never enough to keep up - Lily Tomlin

    by badger on Mon Jun 02, 2014 at 05:37:04 PM PDT

  •  Emergency Room use (1+ / 0-)
    Recommended by:
    Emergency room use will probably actually increase, because people will have insurance to cover their visits, and will probably continue to use the ER for things that aren't necessarily emergencies.
    I can't remember where I read this, but according to some early statistics this is not the case, especially where Medicaid has been expanded to cover more of the working poor.

    Given the opportunity, people will go to a doctor rather than go to an emergency room.  Given how busy many of the working poor are, holding multiple jobs, and given how much time it takes to wait for care in an ER, this should not surprise us.

    I wish I could remember the source, but given the time costs of using an ER, it shouldn't surprise us if the better statistics bear this out.  Given a better option, poor people are as rational as anyone else.

    "Politicians don't see the light until they feel the heat." (Rep. Keith Ellison)

    by mbayrob on Mon Jun 02, 2014 at 06:25:38 PM PDT

    •  However if the doctor's office is only open (0+ / 0-)

      monday through thursday from 10am to 4pm and you can't take time off then you will probably be willing to spend the extra time in the ER as at least you can do that on the weekend.  That is one of the big problems that the ACA can't and won't solve.

      You have watched Faux News, now lose 2d10 SAN.

      by Throw The Bums Out on Mon Jun 02, 2014 at 10:09:45 PM PDT

      [ Parent ]

      •  Since the ACA there has been an (0+ / 0-)

        increase in Urgent Care clinics designed to treat non-life-threatening problems.  In the Kaiser Permanente  system they have had Urgent Care Centers available for decades.  It is where you go to be stitched up, to treat the flu, earaches, etc.

        This is a problem that the ACA is solving.

    •  If the clinic/ER gets federal grant money, the ... (0+ / 0-)

      If the clinic/ER gets federal grant money, the patients have to be seen within 15 minutes. My husband now sleeps, if he sleeps at all, at the hospital, when he is on call. His shift is Thursdays, 7:30 am - Fri 7:30 pm. When he's not in the ER on Thursdays, he has to see patients in the clinic. Friday, he's just in the clinic.

  •  "Obamacare is how you start reform?" (1+ / 0-)
    Recommended by:

    No, it isn't.   One of main beefs I had back in 2009 was that the public-optionless ACA entrenches and enshrines the for-profit insurance model of healthcare delivery to such a degree that it will be difficult to ever get rid of it.  And it's exacerbated by the fact that millions of liberal Democrats have become emotionally invested in cheerleading for insurance industry, which is where the ACA has led us.

    Fundamental reform is more difficult now, not less difficult.

    •  This almost certainly can't be true... (0+ / 0-)

      If the implementations as they are now and with the upcoming ones through year 2016 are to go as  written, the federal government has intervened in so far as they've finally told the provate health insurers that has the monopoly over our country you CANNOT any longer allow any patients to die and go bankrupt because of our extravagantly priced Big Pharma lobbying base. The downside as it is being a conservative reform born from the Heritage Foundation (where uncoincidentally the lead man there now was almost single handedly reaponsible for holding the smoking gun to Republicans' heads on our most recent Government Shutdown) is that all those that refuse to puchase some sort of cheaper alternative that is government mandated or from a private market insurer have to pay an annual federal tax penalty. Not the most effective means, as many critics Left & Right and everyone in between have pointed out endlessly the past four years on,but its a vast enough improvement over the status quo ante.

      Adding to the new illegality of insured patients going bankrupt, you do have the universally beloved additions of young adults staying on their parents' insurance plans an extra 3 years (since the majority are unemployed and living there at home now anyways post College),  an expansive risk pool that wasn't available to working and poor class people ever before including those out of regular full-time jobs, and most importantly capitalizing on a Reagan era reform, less crowded and understaffed ER's overall as that was the reductive last or only resort of so many ungortunate souls on the past. The latest reports already have the ACA saving more than $200 million on the national deficit than originally forecasted.

      We can always, should and inevitably will reform it to something like an Eastern European universal care model and/or Medicaid for all in the coming years; the most important part now is keeping Democrats a majority in Congress and in the presidency to make that even a remote reality, preferrably of the populist economic Left variety. The next is of course, overturning the egregious Supreme Court campaign finance laws that are beyond congesting our democratic system. It's more or less a Social Security and Medicare level entitlement where repeal is out of the question now...

      "Life is indeed a mystery; everyone must stand alone....Dearly beloved, we are gathered today to get through this thing called life!"

      by Politikator09 on Fri Jun 06, 2014 at 10:51:54 PM PDT

      [ Parent ]

  •  good start (0+ / 0-)

    Obamacare is a good start but still lacking.  Too bad it is only half Swiss.  The Heritage plan was part Swiss as well.  Too bad politicians are more worried about who gets credit than doing something right.  Even though the Swiss are probably going to make their base plan single payer for our country the Swiss would work out well.  Still allows for market forces but has everyone covered.
    The reality is that single payer is decades away if ever.  The Swiss can happen much sooner.  That will require dems to admit that fixes need to be done and reps to admit that repeal isn't going to happen!  Pols are so frustrating!

  •  Switzerland is the most expensive (0+ / 0-)

    place to buy health insurance in Europe.  The country is second only to the U.S. in terms of insurance costs, and everyone agrees it's because of the privatization of the market.  But the delivery of care in Switzerland is much less expensive than in the U.S. because of very tight, very effective regulations on costs.  The Swiss enforce their regulations.

    Getting over that hurdle will be the toughest in reforming the U.S. health care system.

    "All that is necessary for evil to triumph is for good men to do nothing" - Edmund Burke

    by SueDe on Fri Jun 06, 2014 at 06:46:55 PM PDT

  •  A medicare buy in should be an option (0+ / 0-)

    Those who don't qualify are paying into it to begin with. Most economists from what I've heard think that at least the current private employer provided insurance should be taxable to the employer and employee because having to pay extra reduces unnecessary tests and such.

    Yet this could go too far and reduce total care to reduce costs. So how to tax it? Since one is already paying into FICA taxes, if a competitive rate could be offered as an alternative to private health care one will be paying their way partly through the system out of pocket. As well as out of payroll just as they are now. Wouldn't modest buy-ins provide added revenue, especially if many healthy people pay in?

    So perhaps without raising taxes  more revenues come into the system without raising anyone's taxes. Aside from closing corporate loopholes for the sake of the working class funneling some of it directly to Medicare. And capital gains taxes as well to buffer against costs.

    But mostly if people are paying less out of pocket than they would  on private insurance for the same coverage, it goes into the general coffers. Especially if more healthy folks use it. We spend less on them when younger like any private insurance company. And can better invest to make more money for Medicare. And help keep overhead stable and viable. Especially with the financial leverage of huge volumes of services and supplies to bid on, unmatched in the private sector.

    It's a hard ideological sell to some but if it saves everyone money one way or another it's an argument to be made over and over again.

  •  How the stars are aligned for success with the ACA (0+ / 0-)

    is beginning to manifest in jobs growth. Look at what's happening in the Medicaid expansion states, the blue line, compared to the non-participants. After the SCOTUS decision in June 2012, the rate of jobs growth in Health Services trended differently in the expansion states. They surged ahead of the rest and opened up a gap which keeps getting wider.

    Growth in Health Services jobs in Medicaid expansion states versus non-Medicaid expansion states.
    What about the quality of the jobs added? It's a large number and the jobs are diverse. For about 20% of the new jobs, the average annual wage is about $86,000, well above average.
    •  Source, please. (0+ / 0-)

      I can't cite it elsewhere without one.

      Back off, man. I'm a logician.—GOPBusters™

      by Mokurai on Sat Jun 07, 2014 at 10:15:03 AM PDT

      [ Parent ]

      •  This is mine. (0+ / 0-)

        The information herein is the proprietary research and analysis of Mark Lippman, based on data published by the Bureau of Labor Statistics (BLS) in the public domain. The BLS is a US federal government agency. Research and analysis are exclusively statistical in nature including data from the BLS Current Employment Statistics, Local Area Unemployment Statistics, and Quarterly Census of Employment and Wages in accordance with the North American Industry Classification System.  

        •  Well, if it's proprietary (0+ / 0-)

          I can't quote it regardless.

          Are you willing to give a link to the source data?

          Back off, man. I'm a logician.—GOPBusters™

          by Mokurai on Sat Jun 07, 2014 at 12:40:35 PM PDT

          [ Parent ]

          •  Of course, I'd be willing. The BLS retrieval isn't (0+ / 0-)


            It starts at this data-portal:


            In the data series input box, you enter a code like this one:


            Then click 'Next' to go to a screen with options for filtering and output. This code returns the # of individuals employed in Alabama in Health Services in '000s for each month for the last 10 years. Filtering out pre-2010 could be a good choice for Obamacare.

            If you retrieved the data, you'd see it isn't on a page that can be linked.

            •  Thank you (0+ / 0-)

              Why aren't you willing to allow us to repost your graph with attribution, say under a Creative Commons license?

              Back off, man. I'm a logician.—GOPBusters™

              by Mokurai on Sat Jun 07, 2014 at 03:41:24 PM PDT

              [ Parent ]

              •  Did someone say I was unwilling? I would (0+ / 0-)

                consider it. I haven't had a compelling reason to do so.  

                Posting research findings that I consider very positive for Democrats doesn't always get a friendly reception which leaves me a little skittish.

                Even if I write a piece that's recognized in the Community Spotlight and is well received, I have to accept comments that are destructive to the Democratic Party, too.

                •  That's how I understood your statement (0+ / 0-)

                  You said that it was proprietary, which means that you are holding onto your copyright, and not allowing reuse under Creative Commons.

                  Do you know what sort of Creative Commons licenses there are? You might want

                  CC BY-NC-ND

                  This license is the most restrictive of our six main licenses, only allowing others to download your works and share them with others as long as they credit you, but they can’t change them in any way or use them commercially.

                  You can mark it in the dKos image library as
                  Use anywhere, w/ attribution
                  and add the specific license abbreviation in the description.

                  Back off, man. I'm a logician.—GOPBusters™

                  by Mokurai on Sun Jun 08, 2014 at 04:26:16 PM PDT

                  [ Parent ]

  •  Being poor is bad for your health - single payer (0+ / 0-)
    In 2012, higher income respondents were 29% more likely to describe their health as “excellent” or “very good” than lower income respondents. In 2009, that difference was only 17%.  At that time, lower and higher-income Canadians were also equally accessing health care services. However, in 2012, Canadians who earned less than $30,000 a year accessed health care services 16% more than those earning $60,000 or more.

    A recent [left-wing] Broadbent Institute study found that 58% of Conservative supporters, 71% of New Democrats and 72% of Liberals are all willing to pay more to protect social programs and make reducing income inequality a higher priority.

    With universal free access to health care, the poorer health may be due to
    - poorer nutrition due to smaller food budget
    - unfilled prescriptions as most provinces don't pay for pharma (although the poor are often subsidized)
    - no time to access care - three jobs syndrome
    - incidental costs to access care - babysitter, transportation

    Conclusion: Fix income inequality, improve population's health.

  •  Biggest question: how/when is the government go... (0+ / 0-)

    Biggest question: how/when is the government going to increase the number of places/slots for new medical school students and residents? There is a huge shortage, and would have been, regardless of the ACA, but Obama will be blamed. As I see it, young docs coming out are given several offers from various clinics. This drives up the compensation. But the docs and PAs and NPs are just about the only people in the clinics who can bill for their services, so charges are high to cover ALL THOSE SUPPORTIVE STAFF plus the high salary of the young docs. So then management, often non medical business people, push the docs to push more people through in less time, resulting in either frustrated docs working long hours, or docs being less thorough than then should be. [Said as the spouse of a doc who has practiced since 1977 but who has refused to work for a private clinic. ... And as a patient who, unfortunately has a couple of surgeries done by surgeons who, it turns out, weren't as thorough as they should have been looking at my history. I'm recovering, after finally finding better doctors.]

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