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Kaiser Health News
Friday marks the two-year anniversary of the 2010 health care overhaul law, and despite an upcoming challenge in the Supreme Court, it has already begun to be implemented.
While some of the key features don’t kick in until 2014, the still-controversial law has already altered the health care industry and established a number of consumer benefits.
Here’s an FAQ about some of the law’s provisions that are already in place as well as major features of what’s to come, if the law stays in place.
Q: I don’t have health insurance. Will I have to buy it and what happens if I don’t?
A: Right now, you are not required to have health insurance. But beginning in 2014, most people will have to have it or pay a fine. For individuals, the penalty would start at $95 a year, or up to 1 percent of income, whichever is greater, and rise to $695, or 2.5 percent of income, by 2016.
For families the penalty would be $2,085 or 2.5 percent of household income, whichever is greater by 2016 and beyond. The requirement to have coverage, known as the individual mandate, can be waived for several reasons, including financial hardship or religious beliefs.
Millions of additional people will qualify for Medicaid or federal subsidies to buy insurance under the law.
Q: I get my health coverage at work and I’d like to keep my current plan. Will I be able to do that? How will my plan be affected by the health law?
A: If you get insurance through your job, it is likely to stay that way. But, just as before the law was passed, your employer is not obligated to keep the current plan and may change premiums, deductibles, co-pays and network coverage.
You may have seen some law-related changes already. For example, most plans now ban lifetime coverage limits and include a guarantee that an adult child up to age 26 who can’t get health insurance at a job can stay on her parents’ health plan.
Q: What are some other parts of the law that are now in place?
A: You are likely to be eligible for preventive services with no out-of-pocket costs, such as breast cancer screenings and cholesterol tests.
Health plans can’t cancel your coverage once you get sick -- a practice known as “rescission” -- unless you committed fraud when you applied for coverage.
Children with pre-existing conditions cannot be denied coverage (this will apply to adults in 2014).
Insurers will have to provide rebates to consumers if they spend less than 80 to 85 percent of premium dollars on medical care.
Some existing plans, if they haven’t changed significantly since passage of the law, do not have to abide by certain parts of the law. For example, these “grandfathered” plans can still charge beneficiaries part of the cost for preventive services.
If you’re currently in one of these plans, and your employer makes significant changes, such as raising your out-of-pocket costs, the plan would then have to abide by all aspects of the health law.
Q: I want health insurance but I can’t afford it. What will I do?
A: Depending on your income, you might be eligible for Medicaid, the state-federal program for the poor and disabled. Currently, in most states nonelderly adults without minor children don’t qualify for Medicaid. But beginning in 2014, anyone with an income at or lower than 133 percent of the federal poverty level, (which currently would be $14,856 for an individual or $30,656 for a family of four) will be eligible for Medicaid (based on current poverty guidelines).
Q: What if I make too much money for Medicaid but still can’t afford to buy insurance?
A: You might be eligible for government subsidies to help you pay for private insurance sold in the state-based insurance marketplaces, called exchanges, slated to begin operation in 2014. Exchanges will sell insurance plans to individuals and small businesses.
These premium subsidies will be available for individuals and families with incomes between 133 percent and 400 percent of the poverty level, or $14,856 to $44,680 for individuals and $30,656 to $92,200 for a family of four (based on current poverty guidelines).
Q: Will it be easier for me to get coverage even if I have health problems?
A: Insurers will be barred from rejecting applicants based on health status once the exchanges are operating in 2014.
Q: I own a small business. Will I have to buy health insurance for my workers?
A: No employer is required to provide insurance. But starting in 2014, businesses with 50 or more employees that don’t provide health care coverage and have at least one full-time worker who receives subsidized coverage in the health insurance exchange will have to pay a fee of up to $2,000 per full-time employee. The firm’s first 30 workers would be excluded from the fee.
However, if you have a firm with 50 or fewer people you won’t face any penalties.
In addition, if you own a small business, the health law offers a tax credit to help cover the cost. Employers with 25 or fewer full-time workers who earn an average yearly salary of $50,000 or less today can get tax credits of up 35 percent of the cost of premiums. The credit increases to 50 percent in 2014.
Q: I’m over 65. How does the legislation affect seniors?
A: The law is narrowing a gap in the Medicare Part D prescription drug plan known as the “doughnut hole.” That’s when seniors who have paid a certain initial amount in prescription costs have to pay for all of their drug costs until they spend a total of $4,700 for the year. Then the plan coverage begins again.
That coverage gap will be closed entirely by 2020. Seniors will still be responsible for 25 percent of their prescription drug costs.
The law also has expanded Medicare’s coverage of preventive services, such as screenings for colon, prostate and breast cancer, which are now free to beneficiaries. Medicare will also pay for an annual wellness visit to the doctor.
The federal government’s payments to Medicare Advantage plans, run by private insurers as an alternative to the traditional Medicare, were cut in 2011 and will continue to be reduced in future years. Medicare Advantage costs more per beneficiary than traditional Medicare. Critics of those payment cuts say that could mean the private plans may not offer many extra benefits, such as free eyeglasses, hearing aids and gym memberships that they now provide.
Q: Will I have to pay more for my health care because of the law?
A: No one knows for sure. Even supporters of the law acknowledge its steps to control health costs, such as incentives to coordinate care better, may take a while to show significant savings. Opponents say the law’s additional coverage requirements will make health insurance more expensive for individuals and for the government.
That said, there are some new taxes and fees. For example, starting in 2013, individual with earnings above $200,000 and married couples making more than $250,000 will pay a Medicare payroll tax of 2.35 percent, up from the current 1.45 percent, on income over those thresholds. In addition, higher-income people will face a 3.8 percent tax on unearned income, such as dividends and interest.
Starting in 2018, the law will also impose a 40 percent excise tax on the portion of most employer-sponsored health coverage (excluding dental and vision) that exceeds $10,200 a year and $27,500 for families. The tax has been dubbed a “Cadillac” tax because it hits the most generous plans.
Q. Has the law hit some bumps in the road?
A: Like any major piece of legislation, some aspects have not worked out as well as its authors intended.
For example, the law created high-risk insurance pools to help people purchase health insurance. But enrollment in the pools has been less than expected. In February, the Obama administration announced that almost 50,000 people had signed up for the high-risk pools, but the program, which began in June 2009, was initially expected to enroll between 200,000 to 400,000 people. The cost and the requirements have been difficult for some to meet.
For example, applicants must be uninsured for six months because of a pre-existing medical condition before they can join a pool. And because participants are sicker than the general population, the premiums are higher.
Enrollment has increased since the summer, after the premiums were lowered in some states by as much as 40 percent and some states stepped up advertising.
Another feature of the law that hasn’t worked as envisioned is its long-term care provision. The Community Living Assistance Services and Supports program (CLASS Act) was designed for people to buy federally guaranteed insurance that would have helped consumers eventually cover some long-term-care costs. But last fall, federal officials effectively suspended the program even before it was slated to begin, saying they could not find a way to make it work financially.
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What's coming for the "affordable" (snicker snicker) health care act? I'm all for one of these two:
A. Declared unconstitutional by the Supreme Court
B. Overturned by congressional action next year (necessitating a huge change in the White House and Senate)
Let's hope so
Hell, after reading all of the above you have to be braindead to be against it. It's all good things that help people STAY ALIVE. I hope nothing is overturned on it. People like you just don't seem to want to understand the benefits to everyone. I guess you would rather see your premiums rise as more and more people go to the ER and default on paying the hospital for those ER visits.
There's always a group of pinheads that love to bitch about anything. They hate the government but they are first in line for benefits. Flood insurance, farm subsidies, defense contracts, Wall street bailouts, the list goes on. Healthcare is a BIG problem and it takes a BIG organization to handle it. The for profit companies such as Wellpoint, United Healthcare and BlueCross/Blue Shield have been screwing over us for years.
In case you hadn't noticed, the government runs some pretty dam big items, while not always perfect, they get the job done. The government takes care of or is highly involved in the military, FAA, telecommunications, worker safety, highway system, banking system. Organizations that touch every ones life everyday. So quit bitching.
My husband are senior citizens, age 80 and 77. We pay $178.00 each per month. Plus what medicare take's. I think i will stay with Obama when it happen's, if still living.
BRAVISIMO OldSchoolLatinTeacher!The sanest post on this WHOLE BOARD!
Couldn't Agree with you more
Mike there is NOTHING (well one thing) that the government does that private business has not been able to do cheaper and with better quality, The banking system, it was government regulations that caused the failure of so many banks. The only thing the government really can do decent that private sector cannot is have a military to protect the United States
You mean like illegal aliens?
It's funny how the people who are most interested in ACA are the same people who keep waving in more and more of the people who most often represent the greatest burden to ER's.
Talk about a conflict of interests! :D
WMike-826197
Please Mike, share with us all a SINGLE PROBLEM our government hasn't put into the red?...as a bonus...problem NEVER solved!
mearly
Relevant? Or just another desparate attempt by the failed Obama supporters?
@bluthunder: The postal service is another. Not one penny of our tax money goes into it, yet it has been successful at delivering mail cheaper for many decades. So, naturally, Republicans passed a pension bill in an attempt to destroy it. The weather service is pretty decent, too. NASA got us to the moon. Medicare helps keep our seniors alive and well. Social security gave Paul Ryan a nearly free ride through college. The FDIC insures your money.
And let's make one thing clear: it was the LACK of government regulations that caused banks to create their own failure.
Sandy, Missouri,
when you get a job and pay taxes, and other peoples heathcare, i am willing to bet you will be heard crying from a mile away.
ALL you people with a job, think after you tax increases to pay for all this will still be on the bandwagon to , lol, change? lots of change for sure.... going from your check, to the lazy deadbeats of America.
Then that fine.... what a f'ing joke! this so called president in office... BIGGER JOKE! actually i cant think of a joke bigger than the ...... sitting in the whitehouse, pulling his pud while the rest of America pulls the weight for tha lazy welfare and illegal drools who milk the system.
like any city, in any nation...Ghetto trash ruins the equity.... look at the white house as it is now... nothing but rich ghetto trash.
Sandy, I don't think you get the point. The health care bill is suspicious because of who signed it. It's much like a child walking through his own neighborhood at night, he's suspicious because he looks like he may have signed a healthcare bill.
The two things coincide.
@DAK4Blizzard my point, both fed ex and ups have been doing a better job f delivering packages cheaper faster and with more efficiency then the usps, NASA has been so good that they are not even flying anymore and our astronauts fly on Russian space crafts to the international station now, there are multiple companies that are about ready to offer commercial space flights to the public and to ferry supplies to ths space station, why??? because they can do it cheaper and with more efficiency then the us government!! I never said the government has not accomplished anything I said they do nothing better or more efficient then the private sector.
AND btw DAK4 SOCIAL security is so great that it has been bankrupt for years, is a failed pyramid scheme that anyone else would be jailed for. that the goverment uses as an ISSUE ever 2 years to get elected with. anyone who would save the same amount of money and invest it would of had more money even with the stock hits that have happened. the FDIC is a government joke of an insurance, if your bank fails and you are "insured" do you think you wil get that money back even in a timely manner, no any ther insurance company would be sued and fined for the amount of time it takes to make payouts. so again what besides the military to protect this country can the government do better then the private sector, NOTHING !!
To the Limbaugh wannabees here, back in the 1980's when your people heralded "managed care" that would bring medical coverage to more americans at a lower cost, well, your experiment failed. Go clean your fractured house and depend less on racial slurs toward our President. We pay twice as much for a shorter life span than any industrialized nation. So called managed care has been a blight on our great country.
Universal healthcare would have been so much easier, simplier, and cost effective, but the RepubliCons were too busy practicing their Party Over Country stance. It will happen, but it will take years b/c a Repub cannot say the words: "I was wrong." RepubliCons rather be Right than Free or even healthy.
Many people simply don't make a logical conclusion to the new healthcare law. You are ALREADY paying for EVERYONE who does not have health insurance. There's no way around it. You will continue to pay whether you want to or not every time you pay your premiums.
There are only two choices (well three really).
1. Don't do anything and have your premiums continue its climb until you can no longer pay for them - then risk bankruptcy if you have a medical emergency without ins. (of course with the old way, your insurance company would drop you when you get sick, so bankruptcy is pretty much guaranteed)
2. Require everyone to pay their own way - I don't see what the argument is of not requiring people to be responsible for their own costs. The people that seem to want to complain the loudest are probably the one who want to game the system and not pay for their own insurance.
3. The last choice is early death, you only would need to pay final taxes then :)
Sorry to disappoint you Sandy but here in MA under ObamaCare's parent RomneyCare people still go to the ER at the same rate as in other states. Just because you have health insurance doesn't mean you have access to health care.
The health insurance plan I had a few years ago did not pay for mamograms. Now under the new health care law they are required to include mamograms. This is a bad thing how? These insurance companies have been getting away with murder until this health care law came along. People who become seriously ill will not be able to be dropped by their insurance company.This is a bad thing how? People with pre existing medical conditions will not be able to have coverage denyed to them. This is a bad thing how? A young adult attending college will still be able to have coverage under their parents health insurance plan. This is a bad thing how? People who carry health insurance will no longer have to forgo life saving health screenings because it is not included in their policy. This is a bad thing how? Health insurance premiums have been escalating out of control for the past 12 years now , not because of what you righties call Obamacare. Someone had to address the problems of high costs because the responsible ones who carry health insurance are also paying for those who don't have any. Just like some states that don't require a car owner to carry liability which causes the other insured drivers to pay an additional fee for uninsured motorists. If everyone has insurance it eases the burden on everyone. It's fairly simple. At least president Obama and the Democrats realized something had to be done about the problem that was soaring out of control. All the republicans can do is scream repeal Obamacare and offer no real solutions.
Marci, young people attending college almost ALWAYS can stay on their parents healthcare until they graduate from college. It's called full-time-student-status and it didn't take health care reform to make it happen. It was pretty much there already.
What doesn't make sense is that my kid can now graduate from college, get a high paying job (that requires him to pay something for insurance), but elect to stay on my plan through MY employer for three more years and my employer's insurance would be required to pay for his healthcare. Even if my child were to get married, my own employer's healthcare would still be required to cover him, so long as he is under age 26. If my child were a female and got pregnant, my employer's health insurance would be required to cover that, and keep in mind that my child could have her own job (and make good money), and be married to someone making $100,000 a year. THIS is why employers get so upset about this. It's not the fact that they have to provide care to those who need it, but the fact that they are required to extend their umbrella of coverage to those who may be very capable of having insurance from somewhere else.
Basically, healthcare reform is more about buying votes than about healthcare. And can we lose the "affordable care" name? The CBO just recently announced that it will now cost DOUBLE what was sold to us when it was passed (but then everyone already really knew that... They just lied.)
Kucinich said months ago that the GOP might finally upend ObamaCare and inadvertently open the door to single payer. Sorta back into it, right? I guess that's the law of unintended consequences at work.
I am against the healthcare reform act for two reasons.
First, it was rammed down the throats of America without proper debate or process. Transparency was promised, yet none was delivered. I always think back to Nancy Pelosi's memorable giddy quote: "We've got to pass this so we can see what's in it!" That's the most backward thing I ever heard a politician say. Most would agree that we should find out what's in a bill so we can decide whether or not to pass it!
Secondly, the individual mandate sets a VERY dangerous precedent. Never before has our government been able to require all citizens to buy a private product in the name of "regulating commerce). If this is allowed, then it will be the precedent for many more "individual mandates" to come (and I believe this is the plan). If they can force us to buy health insurance, then they will start requiring those who can afford new cars to buy them (in the name of regulating commerce) and who knows what else. To those of us against the individual mandate, it is purely about freedom. The freedom to choose to have health coverage or the freedom to choose not to.
Bruce does your state make you have auto insurance ? Do they make you have home insurance or liabilty coverage?
30 million people being turned over to a private industry by government mandate to me is way over the top. I wish someone would make 30 million people give a 25 cents I would be fine for the rest of my life I think
The Federal government used to require every adult male to have a musket, ammunition and marching kit to be prepared to join the militia if called. Was that a dangerouse precedent?
@Man of Knowledge -
The 1792 Militia Acts are not remotely the same as Obamacare. First, there was a real chance that a fledgling U.S. would be attacked and soundly defeated by a hugely more powerful and still-smarting British Empire (as we eventually were in 1812), and consequently, national defense was even more important then than it was today. Second, the Militia Acts were eventually replaced by the legislation creating the National Guard. Third, requiring that able-bodied, free white males between 18 and 45 "provide" themselves with a serviceable musket and all of the trimmings is not the same as requiring them to purchase one, as firearms and their accessories were often handed down through generations, so that a man over age 45 could lend his of-age son or grandson his musket and accoutrements. There is no correlating way to hand down or share health insurance plans under Obamacare, and each person is required to spend money on a product which the government deems expedient. THAT is a dangerous precedent that the Militia Acts did not present.
I forgot, who wrote this line? friggn reich wing morons. It was the regulations that made me do it. You guys will believe anything Fox tells you !!!!
MEDICARE FOR ALL would be the cheapest and easiest............
A precedent is a precedent. The fact that the law was changed only supports the argument that is wasn't a precedent at all.
Only some people have to spend money they are not already spending. Roughly 84% of people already have the minimum coverage requirement.
Roughly 15% are exempt because they are under the poverty standard.
That leaves roughly 1% who can afford insurance but don't have it. Why should they freeload off of the rest of us?
anindividual,
"... but the RepubliCons were too busy practicing their Party Over Country stance."
You have GOT to be kidding!! What the hell do you think obama is all about? This clown has split a two (yes, that's right TWO) party political system and is trying to make it a one party system. He has been doing this since he took office. The divide and conquer techinque used in chicago politics is being practiced on a national scale by obama. Give me a break.
Bruce: : Wrong! Your kid can only stay on your policy if insurance is NOT available at his/her job.
Re read the article.
If your child gets married, then either partner who has insurance at their jobs must use that insurance.
Richard: I guess you forgot the Replicons in 2010 saying how they would do everything and anything to make Obama a one term president and we've seen how that played out!
Get real Gil. Silly namecalling and spreading blame around isn't going to work this time....cheers.
Sandy: I guess I am being called braindead by someone who is clearly brainwashed...
Don't bother asking President Obama "what's coming" next with his health care plan...odds are he has no idea.
If the sloppy handling of the 'free contraception for all' mandate and disingenuous dealings with the Catholic leadership he deceived are any indication, the man is not exactly on top of his own plan.
Gilboa...
Congratulations...you just won an award for repeating one single sentence spoken by Mitch McConnell several years ago for the 10,000th time on this site !!!
This is an old, tired, apples to oranges comparison. No, my state does NOT require me to have auto insurance and does not require me to have homeowner's insurance. I only have to have auto insurance if I elect to own a car, but I can elect NOT to have a car and elect NOT to buy auto insurance. The only person who would require me to have homeowner's insurance would be my mortgage holder, and only then to protect their financial interest in the house. However, since my house is paid off, there is absolutely ZERO requirement that I carry any homeowner's insurance at all. Certainly the government doesn't require it.
So to answer your question, there are thousands of people right now in my state who legally have no homeowner's insurance or auto insurance.
Thanks Bruce....thought my world was screwed up because I didn't feel legally obligated by my state to carry homeowner's insurance and my non-auto owning mother feels the same way about not having an auto insurance policy.
It's amazing how weak some of the justifications are for things the president insists we do.
I thought I heard some Fox reporting on required auto insurance. "Almost every state requires you to have Bodily Injury Liability insurance and every states has financial responsibility laws that require you be able to have sufficient assets to pay for any liability you cause in an incident." You might want to read up on your state laws.
So much arguing over WHO is paying for our healthcare, not one single article, comment, or whisper about WHAT it is we are paying for...tragic, the politicians have already won...
Your own post really makes the point quite well, Hanover Phist.... When you say you must "have sufficient assets to pay for any liability". this means that you must EITHER have insurance OR you must be able to show that you have money to pay for any damage you cause. So even when you drive, many states don't require you to buy insurance, but only to show proof of ability to cover an accident. In other words, if you are a multi-millionaire and can show that you are wealthy enough to pay for any damage you cause, then you don't have to have insurance. (Ross Perot challenged the Texas laws requiring insurance back in the 80s because he was a billionaire and said he didn't need to buy insurance to be able to cover an accident.
To translate the same logic to healthcare, if you have enough money to pay for your healthcare, you shouldn't have to buy insurance. To force you to do so would simply be for reasons of forcing you to subsidize the healthcare of others, something that hopefully soon will be unconstitutional.
Oh, and again you only need auto insurance if you choose to own a car. No mandate (yet) that you own a car.
Better check YOUR state laws.
Bruce-308647
I don't like the auto insurance analogy to health care because it does not apply.
To translate the same logic to healthcare, if you have enough money to pay for your healthcare, you shouldn't have to buy insurance. To force you to do so would simply be for reasons of forcing you to subsidize the healthcare of others, something that hopefully soon will be unconstitutional.
First, the government does not force auto dealers to give away the automobiles, yet the government does force hospitals and their doctors to give away their services.
Second, the government subsidizes health care in countless ways that make a quality system possible, they fund medical schools, hospitals, drug research, disease control, medical care for everyone over the age of 65, medical care for all military personnel, and health insurance for all federal employees. The notion that anyone in this country pays for their own care is absurd. No one could even if theyare billionaires.
Since the government pays for nearly half of all health care they have a vested interest in seeing to it that those who can afford it, pay for it. The only way any working person can afford high cost care and have it guaranteed to all is if those with low costs subsidize those with high cost. It cannot work any other way.
Last the mandate is not a mandate it is a choice. The only consequence of choosing not to have insurance is a higher income tax burden. Since those who are uninsured fail to pay roughly 1/3 of their medical bills the government is completely correct in equiring them to pay for it in some way. If they don't they are wasting tax payer money.
Perhaps we should stop giving out free healthcare to those who do not buy insurance. That would likely cause many to re-evaluate their position and buy insurance. In the recent tornados in Indiana, I was surprised at how few people had homeowners insurance on their houses. Why? They said they couldn't afford it. So then what happens? The government comes in with aid to give to the people who elected not to buy insurance so they could "rebuild their lives". Bottom line is, we subsidize and encourage bad behavior by those who decide they'd rather spend their money on things other than insurance. I am betting that nearly 100% of the people who lost their homes with no insurance have cell phones and cable TV, easily enough money to have paid for insurance.
Well, I'm uninsured and I don't pay income tax because i work on a cash only basis as a gardener, carpenter and pulpwood cutter. I don't want to buy my own health care insurance because it is too expensive. I am going to refuse to pay for it, pay the fine and let the rest of you taxpayers foot the bill if i get sick. I make $16,000 a year and i have to feed my family. besides, health care is a right just like the air we breathe the food we eat and the water we drink. Since it is a right it should be free for all. i don't care if nurses and doctors spend long hour in school and later at work. They owe it to me and i deserve it. I they are not paid they should do something else for a living.
:p
jack-1962499
Under ACA, if your family income is below $30,000 per year you are exempt from the minimum coverage requirement plus you automatically qualify for Medicaid.
The first goal of any business is to make a profit; that's how it stays in business. This is a fairly easy concept when it comes to health insurance companies. We know and accept that they are profit-seeking. Corporate health insurance companies are beholden to their stockholders first and foremost. We, their customers, purchase their insurance products to help them be profitable.
Of course, pharmaceutical companies, or medical device manufacturers are businesses seeking profits, too. Like health insurers, these companies thrive in a capitalistic environment by selling their products to the people who need them.
What most patients fail to realize is that doctors' practices, hospitals, pharmacies, testing centers, dental, hearing and vision centers these are all businesses, too. They, too, must focus on income and profits to stay open.
Granted, some are considered to be "non-profit organizations." You will find, however, that many are non-profit in name only. This is true for non-profit health insurers, hospitals and other facilities, even many of the charities that raise money for health-related causes. In some cases, their top employees may earn salaries in the millions, and their advertising budgets rival those of any consumer business. By the end of the year, they have to show they've spent as much as they have earned; that's what makes them non-profit. It does not mean they intend to lose money.
Jack335
Granting your points then I like to pose the question. Who is at the point of sale? Clearly it is a physician in almost every case. Yet people are under the mistaken impression that a physician is not a salesperson. They are. Their first responsibility may be to do no harm, but after that their primary goal is profit. That is not a prescription to lower cost.
Man of Knowledge
Some insurance companies refuse to pay some doctors the amount those doctors believe they are entitled to be paid. When that happens, the doctor will stop accepting that form of insurance as reimbursement.Then, of course, once the doctor no longer accepts that insurance company's reimbursement schedule, then doctors no longer accepts patients who use that payer's insurance.Insurance companies jack-up the Premium till nobody can afford.
Each year, doctors and healthcare facilities like testing labs, hospitals, pharmacies and others, negotiate pricing with health insurers and payers. In its simplest form, it goes like this:
Doctor:
When a patient with diabetes visits my office, I charge $100 for the visit, and $75 for the blood work.
Payer: That's too much money. We'll pay you $55 for the visit and $35 for the blood work.
Doctor: I can't pay my staff or keep my lights turned on for that paltry amount! How about $65 for the visit and $45 for the blood work?
Payer:
That's still too much.
Doctor: Sorry I can't help you.
Payer : I'll join Obama care then
Doctor :
Its all Your call.
President Obama : Doctor, how many patients that you got and treated each month ?
Doctor :
Roughly about 30 patients a month,Mr President.
President Obama : So Mathematically 30p x $105 =$3150
Doctor :
Yes ,I think so.
President Obama: Ok then ,let me offers You.You must leave everything else the same volume of procedures as what you're attending now no less. Obama care give you 300 patients a month,as before they all can't afford your bill, But with conditions, your price must be standardize How about $25 for the visit and $15 for the blood work? That will be 300 x 40 $12,000.
Doctor :
That great Mr President,Its a DEAL,but how about the increase of patients,I'm afraid I'll be sue for negligent,since I'll be attending extra patients and how can I manages ?
President : I believes,with that kind of money you got there,its about time you start to think and expand you business ,and you can start hiring few more unemployed Americans to assists you.Don't worry about the patients suing you,they're now well protected by me,they don't need anymore BS attorney,they got the Director of Consumers protection, that complaints and to watch your back,as what they're watching closely with the greedy banking procedures and practices .
Doctor :
Thanks You,Mr President,You are the smartest President we ever have!
President Obama : You most Welcome,since I'm done with You,I'll deal about the insurance premium,health care facilities like testing labs, hospitals, pharmacies and others, negotiate to cheapest.Since "We are the People".
So much finger pointing and so much debate. However, ask yourself WHY the government wrote a law that the majority of the citizens didn't want, had to bribe congresspersons to pass, AND tell us we must "pass it before we can see what's in it". To make sure those without coverage can get it? No, that's not the reason. If it was there is a simple process. If a person does not make enough we as taxpayers could simply SUBSIDIZE the insurance costs. Just like we do housing costs and food costs for the poor. Because we want people to have a place to live we don't BUY them a place to live with taxpayer dollars do we?
No, we subsidize. That is an easy process and could have been passed with bipartisan support in about 3 months. So WHY did government write a 2000 page law (that very few actually read), that requires 400 new IRS agents, AND will cost TRILLIONS AND TRILLIONS of dollars (that will ultimately bankrupt this country)? Simple - POWER!! Once you have control of the people you have control over what they can do and when. You also can force them to be dependent on the government which means you must rely on them.
This Affordable Care Act (sidebar: isn't that an oxymoron?) is a power grab plain and simple. If liberals REALLY wanted to help those who cannot afford health insurance it could have been solved very very easily. But they didn't want the health insurance issue SOLVED because that would not allow them to have power over you - they have to control the entire industry. If this law is not overturned or repealed this country cannot survive the next 20 years.....
EDITORIAL: ObamaCare could ruin U.S. health care system
http://www.theoaklandpress.com/articles/2012/03/22/opinion/doc4f6b59d51895a786082247.txt
a lot of states already have healthcare for theose who can not afford to provide for themselves.
Louisiana has the LSU medical system.
a few northern states have similar programs.
what states do not provide is medical needs for those who can afford to provide for themselves but instead choose to purchase expensive home, vehicles and other niceties therefore leaving no money for nedical needs.
AMERICAN'S NEED TO MAKE BETTER CHOICES.
What's coming?
This is just a wild guess - More regulations, higher costs, and massive confusion.
While we're on this kick, why not make financial planning for all adults compulsory and put the IRS in charge of doing it? To me that makes almost as much sense as having the Federal government running the health care system.
After that we could put the government in charge of toilet training, to the extent that it's not covered in the health care takeover law. Government officials apparently have a great deal of subject matter experience relating to that.
The people that complain most about healthcare reform either already have health care insurance, have never been rejected because of a pre-existing condition or think everything is fine the way it is. The fact is things have to change--this may not be the best solution, but it's a start. People hated Medicare when it was first written up and now it's a standard way of life for most seniors. For those that complain, I say come up with a better solution. Stop complaining and suggest a better way.
I have a better solution. You pay for your health care, and I'll pay for my health care. No Medicare, no medicaid, and let insurance be only for catastrophic illness - not to pay for a doctor visit when your elbow hurts.
ctviking, is of the typical Christian Mindset of "Let everyone die who can't afford medical care because I am too greedy to give a damn about anyone but myself.". Basically the attitude that Jesus said was totally reprehensable to God.
Sandy, you are not my responsibility and I am not your responsibility. If you or someone else wants to smoke, eat donuts and bacon all day, not exercise, or juggle knives you should have the freedom to do so. But I should not have to pay for your health care.
And you're right, I don't give a damn about you. I don't know you. I do however wish you well. And I would not hurt you. But your life is your own responsibility. So it's up to you how to live it and it's up to you to pay to support yourself.
@ctviking,
Are you saying you're going to pay your healthcare expences out of pocket? Can you afford $100K-200K if God forbid you'll need cancer treatment? Or you'll declare bancruptcy?
Alex, in my first post in this block, I said that insurance should be for catastrophic illness like your $100K - $200K cancer example. Just like car insurance. You call your insurance company when your car gets smashed up - not when you need an oil change or new wiper blades. Health insurance should not be for routine doctor visits.
And with ctviking's post we see what is wrong with America today. His type of attitude is what will destroy this country. They say a country rots from inside and ctviking shows what that rot looks like.
You can judge a society by how they treat their poor, sick and elderly. A society that doesn't care about them and let's them wither and die is a society that will eventually fail and crumble into the dust of time.
Yup, thats one of the main reasons the Roman Empire doomed itself, it stopped caring about its people in a mad rush to get as much wealth as possible even if that meant ruining the value of its currency.
If you think that socialism (because that is what you are describing) is necessary then yes, we are doomed because I will have no part of it.
If your driving on the freeways, flying in airplane or living free in the US, your already part of "socialism".
ctviking, Jesus was a world class socialist more than 2000 years ago. People like you would have been degrading, defaming and trying to run him out on a rail.
First of all, I'm not really sure what you mean by "living free." As for flying in an airplane, I have to purchase my own ticket.
The roads are something that our taxes should pay for. They are shared by all. However our health is not shared. I can't force you to not smoke. I can't force you to exercise. And if you get sick, I don't feel pain. We are all capable of paying for our own health care. If some of us cannot due to their own ineptitude (and because of our government created health care mess) they are not my responsibility.
And the so called freedoms I cited earlier (smoking, exercise), if this abomination of a health care law holds up (fortunately I think either the Supreme Court or a future administration or legislature will save us), those things will eventually go away.
You will probably think I'm crazy but 10 years down the road, when this is costing us trillions of dollars, someone will do a study and determine that if we outlaw smoking, it will save us x billion dollars a year. You may not smoke (neither do I) and say, "so what" but some other people like it. Then will come sugary drinks like coke. Banning those will save of this much a year - and they'll do it. Then comes the cheeseburger, then skiing, etc. Those are all things that some people like to eat or do. And when people complain, the government will say, "but we're paying for your health care." Well guess what, I never asked them to.
Sandy,
I am not religious. However, I disagree about your classification of Jesus as a socialist. He was in favor of helping others - not for demanding that it be done by the state. If you would like to follow his teachings and give to those you feel are needy, you are more than welcome. I'm not telling you not to. I can be very generous too. But I will help whomever I want, whenever I want - or not. Neither you nor the government should make that decision for me.
That seems to be the idea of Buffet sending a check to the IRS as a donation, EVERYONE making a lot of money HAS to pay more...period!
We have become ME since Reagan, greed and selfishness are immoral.
SJC,
NO, we're already paying way too much as it is. Remember, half the people in this country pay no income tax. Spending needs to be reduced, not taxes increased to meet the overblown spending habits of our government.
Haven't seen anyone as self-centered and self-serving as ctviking in quite some time. Must have a very lonely existence. I'm sure he has no friends.
groan ..... Because I don't want my tax money to pay for others mistakes, I'm self-serving, lonely and have no friends? Whatever. Even if that's true, isn't it my right to be self centered? It should be.
Nevertheless I have plenty of friends and a wonderful family. And I am very willing to help them if they need it. Who I am not willing to help is you. Not because you posted a rude message about me but because I don't know you. I know nothing about you. Why should I pay for your health care when you may choose to smoke, or only eat fried foods, or not exercise, or drive your car 120 mph, or a myriad of other things? I shouldn't. Nor should I tell you that you shouldn't do those things if you choose. We are all adults and the very thing this country was founded on is freedom. Freedom includes the freedom to make mistakes, but you alone have to live with the consequences of your mistakes.
You're as wrong as wrong can be Ctviking. Welfare and disability already get free medical. This is not free for the working poor in America. These people are not asking for a handout. They work. The contribute to this country. And you would deny them basic health care? You're just simply WRONG.
yknow, this is a really tough issue, and I can see both sides, and definitely ctvikings point of view
I have a patient now who has completely destroyed her heart through noncompliance with her high blood pressure regimen and continued crack cocaine abuse. Her heart function has deteriorated to the point that she required a defibrillator, which was implanted at a cost of over $100,000
Do you really want to pay that? Is that right?
Keep in mind that healthcare dollars are not a renewable resource...they are limited, and in essence, what you spend on this patient is taking away from another needy patient
I think in England or Canada this person would be told very nicely to get lost, with a huge savings to the system and only a small mortality loss...
Is that right?
Tough questions....
what, imho, needs to be done is cost control. Thats first and foremost. And hopefully by cutting costs we can lower prices enough so that anyone can afford health care, and only a few that will require govt assistance
I do think that extending care to millions of uninsured, while restricting premiums and certian insurance tricks, while morally is difficult to argue with, is financially unfeasable right now. I don't believe for a second that the ACA will cut costs--it will cost money...basic arithmetic
Whats the best way to reduce costs? We'll have to make some tough choices that other countries have done about who gets what. At the same time tort reform is a must. So much money is wasted through defensive medicine and litigation that these savings alone would cut costs much more than the ACA supposedly would
i can't believe i read that whole thread! ctviking, i absolutely 100% agree with you!
i cant believe everyone is bashing you for stating the obvious. at what point does our need for social justice outweigh our need for civil liberties?noone has ever said that the working poor shouldnt get the healthcare they need. all anyone has said is that they should pay for those visits themselves. i was brought up under the impression that i had to save money for "just in case" scenarios. im pretty sure a visit to a physician for a cold qualifies.Sandy- you are seriously equating this guy to the jews that killed jesus? what next? anyone who doesnt want to live in a communist state is the same as hitler?
all of you haters are absolutely right that SOMETHING needs to be done. unfortunately government mandated healthcare is not the solution. i refuse to bust my ass at work, pay an ungodly percentage in taxes, then pay for medicare and medicade, then pay welfare, pay state taxes, property taxes, sales taxes just so i can wake up and work another day just to pay for your medical bills.
you know what? come up with a decent argument that includes some knowledge of facts before you start bad mouthing someone just because they dont agree with you. ctviking, dont let these fools keep you down. your arguments were valid and would sway anyone to atleast think who wasnt a starbucks loving, tree hugging communist hippie. (ooh i can make personal insults to!)
eric, i see your point of view. ive read both good and bad for tort reform. unfortunately everything ive read has been from the extremest point of view on both ends. i have yet to hear an argument that was clear and concise without bringing up the .1 percent who screw it up (those always exist).
as far as cutting costs, it seems to me that the place to start that would be the universities that these future doctors attend. i cant say i blame a doc for charging enormous amounts of money for simple things. medical school isnt cheap and most doctors are broke their first many years. lower the enormous cost of education and (theoretically) we should see the trickle down effect. on the other hand, if im not comfy with the government getting their hands on insurance laws, im not so sure i want them regulating education either...
ctviking you say you are for insurance that will cover the 100-200k catastrophic cancer if it happens, but without the healthcare reform the person that gets this cancer gets dropped as their insurance is “rescission”. The Health care re-form addresses this and other major things that I think everyone agrees should not happen. It as a whole is not perfect, but it is better then going back to what we had before. As time goes on and parts are found to be impractical the reform will mended to fix those issues. As the saying goes "don't through out the baby with the bathwater"
sebastion69 I can see your point on this but I think it is a double edged sword. In order to cut the costs of colleges and the amounts of loans that doctors accrue when going through school you would have to raise taxes in order to subsidize the doctor's education. Or you could try and lower the salaries and equipment costs of the colleges, but then you would end up with less qualified doctors and decrease medical standards. I don't think there is any single right answer, but I would support some subsidization of doctors educations as everyone benefits from it and not just a select few.
@ Sandy, Missouri
"Jesus was a world class socialist more than 2000 years ago."
Jesus asked people to give of their own FREE WILL as a matter of faith in God... he didn't threaten people with imprisonment/punishment if they didn't pay taxes so they could be used to support someone else. That extremely important difference makes him a philanthropic advocate, not a socialist.
Someone give me one example of any society, now or in the past, that has cared for its poor, sick, or elderly. There are none. However, there were times when the church assumed this responsibility, but they gave it up to the government at the government's insistence, and the government failed miserably. The government created millions of people like Sandy who believe that the world owes them a living or something, when they take advantage of every possible way to destroy their health and their lives. I'll bet Sandy is a 400 lb behemoth who spends her day eating Twinkies and watching f**cking Oprah, while she cashes her Social Security check once a month.
IMO people with the best insurance usually have the most catastrophic diagnoses.
The percentage of people who get dropped after they get sick is very tiny, unless you have data to prove otherwise? A single case gets unlimited media attention. Besides that, this issue has been a hot item across the country for a long time now. Insurance companies have been sued and lost. State regulators and legislators have been enacting laws and policies to prevent it. The ACA still allows for your insurer to drop you if they can prove you "commited fraud when you applied for coverage." I would imagine that would include at the very least failing to disclose a pre-existing condition, but who knows what else would qualify as "fraud?"
This health care reform, without government subsidies, would've broken the private system. It would be too expensive, because all of the costs of the requirements get passed along to the people paying premiums. All the the aspects of ACA sound really great on paper. "How can anyone be against it?" they ask. But it all comes down to: who pays for it? There's no free rides. There's no free lunch. Somebody pays. And our country is broke. Within a decade, it's possible that we could be spending a trillion dollars every single year on interest on our debt. Obamacare is going to be far more expensive than anyone ever dreamed. It might very well be the 2-ton brick that smashes the camel. Just the other day I was reading an article saying that because of the high unemployment, Obamacare will be cheaper because more people are eligible for medicare. But if you recall, $500 billion will be cut from the medicare budget to pay for Obamacare. See the problem? I don't care how liberal you are, that should raise your eyebrows just a little, shouldn't it?
tviking pick out what you want to pay for and how much? Now as for your statments the constution you rally around is for all american's not just you. The army that protects us to the roads you drive on are for all not just you and if a majority in goverment passes it that's the way it is not just your way. I hate oil comany tax incentives after a record profit of 117 billion with a B. enough said.
vikings =
every man for himself.............screw society.......survival of the fittest....kill the weak.....no taxes......
@ctviking:
The sad reality is that anybody can be hit with catastrophical condition that costs $100K+. Then what? Let everybody gamble, and if you don't have insurance, too bad, go die, because you can't pay? Or treat them, have them go to bankruptcy, and write it off (at a cost to others, and you, too)? Or maybe require that everybody carry the insurance? While we're at it, why not have the insurance cover the prophylactics. Psycologically, if you don't have to pay for a physical immediately out of pocket, you're more likely to have them. And in the long run, if people visit doctors for exams, they may be less likely to develop more serious conditions, and this saves money.
ctviking: i agree with you completely...and healthcare is not a right...also, I don't understand why people think that by paying the gov't through our hard-earned taxes to administer healthcare is such a wonderful idea. Look at the massive debt this country is already in...and this massively ill-advised law has not been fully inplemented yet.
juanita...
You are correct...and OOOPS !!! The pricetag for health care reform doubled last week from the amount we were told it was going to be.
But we shouldn't complain....the president did it all for us !
Just read the Newsweek article on how Mr. Obama dealt with the Catholic Cardinal in New York...he left the good reverend with a very bitter taste in his mouth ! Father Dolen is a bit too reserved to publicly use the word "liar"...but it is quite obvious that he knows one when he sees one.
In that case the government should stop funding medical research, medical professional education, Medicare, Medicaid, disease control, military care, veteran care or hospitals.
We should have a tacit rule that if you can't pay for care you get none. Because now, the government pays for half of all costs. If they (we) don't have a vested interest in managing that cost then we shouldn't be involved at all.
Too many people have the mistaken idea that they take care of their own cost. They do not. The system before ACA was full of cost sharing and ACA doesn't change that. Health care is a fundamentally communal enterprise. Without government involvement most hospitals would shut their doors for good, most ambulance services would not exist, most doctors would not exist, and only the very wealthy could afford to get care. The rest would be using home remedies and seeing shamans for care.
An personal observation, for what it is worth.
Someone I know recently got a job, created indirectly by the health care law, auditing medicare/medicaid claims by doctors and hospitals. The degree of overpayment (deliberate or accidental) is staggering. Overpayments of 10 times the correct amount are typical (granted the claims they are being asked to audit are types of billing where overstatement is most likely). The point is that this auditing was enabled by the health care law and is going to save the government billions.
This is, of course, just one aspect of the law but an important one ...
I call BS on that...id like to see some evidence of your claims
I agree there is alot of fraud out there, but let me tell you the real story on these new auditing jobs.
My husband and I are both in the medical profession, he manages a medical equipment company that provides medical equipment such as oxygen ect, in the home. Medicare is now demanding paperwork from him that per medicare regulations he is NOT nor ever has been required to have. This is all of the doctors notes ect...let me say that again, these are records that he does not generate nor is he required to have to allow this patient to have equipment and he has provided them with every form that per Medicare law is required.
The companies that are hired to do these audits do not get paid unless they find mistakes. (hmmm, bet I would be finding mistakes) Most of the people doing the audits and denying payment on claims are not qualified to make medical decisions. For example, we had a patient who has only partial lung remaining, his oxygen was denied...an LVN made this decision stating " this patient does not have a need for oxygen" Seriously? (By the way I am proud to have been a practicing LVN for 20 years, but in no way am I qualified to determine that a doctors diagnosis is wrong. I am qualified to ask questions to advocate and protect my patient. )
Yet another patient who had lived with multiple sclerosis for 20 years, bed ridden, completely paralyzed, history of bed sores and high risk for them, an LVN for one of these companies denied payment for a specialized mattress that prevents bed sores. This mattress cost is much less than the treatment of bed sores, which can be thousands of dollars.
These are just 2 examples from one small Mom and Pop company, who is now spending a great amount of time appealing these decisions. Time that could be better used for patient care.
As a home health nurse, medicare has me spending more time doing paperwork, just to justify taking care of this patient, than actual patient care. This is all so they can get rid of all the fraud. Home health nurses save medicare thousands and thousands of dollars, we are the ones keeping these folks out of the hospitals running up tremendous bills, but yet our reimbursements are cut, and it is like pulling teeth to get a patient qualified to receive benefits. Trust me, our services cost pennies compared to the hospital stays we are preventing.
I certainly hope some of you don't get payment denied on your care because of these auditors. Because most companies are not like my husbands...they just go pick up your equipment if you can't write the check, fortunately he cares too much to do that. So yes, there are alot of folks out there he is losing money on, but their quality of life is improved. No thanks to medicare..
eric-2573068, I'm a bit surprised that you're not aware of this. Also, I'm a bit disappointed that that you didn't care to check this yourself since it took me about 10 seconds to get to the Wikipedia page on medicare fraud; it's really not a secret. For example, improper payments were $47.9 billion in 2010 from a $528 billion budget. Apparently the Large Hadron Collider cost a mere $10 billion. Considering the expense of a doctor's visit, it's really not hard to perpetuate white-collar crime in the form of improper billing. Think about it- when a patient bill says a CAT scan or blood-work was ordered at the cost of several hundred dollars, does that somehow scream fraud? Without oversight, it's very easy for an unscrupulous billing company to claim certain tests were done or services were rendered and pocket the difference.
texasnurse,
That was probably the single best post Ive read on any thread for a long, long time...and Ive read a lot of posts in the past year and a half. You summed up the problems and questionable solutions to our health care very well in those stories
Keep fighting the good fight...I, like many others, appreciate what you do even if it doesn't feel like it sometimes
Noah,
Im not suprised at all at how wrong you are. You clearly, like most americans, have no experience with providing medical services, but like those same americans, fancy yourself an expert because you went to wikipedia
Firstly, look at texasnurse's excellent post. Those charges to medicare for oxygen were probably labelled as "fraudelent" by the provider because they were deemed to NOT have a supporting diagnosis. Only one example of how those numbers get inflated
Another big example is just human error. Do you have any idea how complicated medical billing is? Of course you don't....but its the most byzantine operation I have ever seen. And one wrong code will result in a claim being rejected, and possibly classified as fraudulent
However, your biggest problem is that you didn't really address anything in either the first post or my response. The first poster claimed that "overpayments of 10 times the correct amount are typical". Where in your wikipedia page do the numbers support that claim.? Theres no way to know from the numbers you give how much of that was in overpayment, and how much was in payment for services never rendered
I think you should save your disappointment for yourself for poor reading comprehension, and believing everything you read without looking a little deeper
not only that, but your math skills could use some work
Even if we blindly accept your numbers as perfectly accurate, nonwithstanding medical professionals like texasnurse and myself telling you how those numbers are blatantly manipulated for personal gain by the auditors, they amount to 1 out of every 10 medical dollars going to fraud
Certainly way, way too much...but not nearly enough to support "overpayments of 10 times the correct amount"...not even close
Just stop being so naive and realize that auditors get bonuses for any "fraud" they find, and their very job depends on it as it proves their usefulness
In addition, its not easy at all to claim a CT was done and pocket the difference. If the patient reads his bill, he may notice a charge for a test not done. Second of all, you would have to outright lie on the medical record to fabricate an indication to perform said test. With most medical records electronic now, that creates a paper trail written in stone leading directly to your door...drs arent stupid, my friend.
Again, anyone can read a stat and regurgitate it. It takes a modicum of intelligence to understand how that statistic is generated
I call BS on MC in Texas as well. This ole right wing or left wing extremist story of "I know someone who told me................blah, blah, blah" is as commonplace as a cold. Your friend thinks like you so you two sit around and snivel about how it is. Never mind that your friend is a fictional friend, or a friend who is a janitor in actuality, or your friend is someone who incompetent them self. I have a friend who is an extremist left winger and he tells me all the time about wonderful his business is going since Obama took office and how great his sales are and blah blah blah. It's always easy to spot an extremist on either side. They are always having conversations with their own position regardless of what the facts are.
Texasnurse: I feel your pain and the government has been forced to require all this paperwork because of all the fraud in medicare. If people would just work for what they need/want instead of stealing maybe the honest ones like you wouldn't be so burdened.
TexasNurse - what Medicare needs to do is flip what they are doing now. Instead of paying claims and THEN investigating those who file them, they need to certify up front authorized payees (complete with photos, fingerprints etc.) Sort of like the TSA "Pre-Check" program for frequent flyers who have been vetted in advance. Then those practitioners who have a clean history can have their claims paid expeditiously, freeing time and money for the government to go after the rest. It's a huge business and fraud is in the billions, and DME fraud is pervasive, costing taxpayers hundred of millions of dollars.
Texasnurse
I would have to disagree with you. We would rather deal with Medicare (except Medicare "advantage" plans) any day. We can do diagnostic imaging quickly and begin treatment. With the big for profit insurance companies (especially the one with all of those TV commercials about how it takes care of it's members) we have to fight them every inch of the way. In Oncology delays can threaten a patient's life.
Noa R:
With all its super-costly equipment, LHA cost per mile is 30% less than cost per mile of Moscow (Russia) fourth highway ring (built with cheap migrant labor). Guess what. The main construction company in Moscow was owned by the mayor's wife.
Some insurance companies refuse to pay some doctors the amount those doctors believe they are entitled to be paid. When that happens, the doctor will stop accepting that form of insurance as reimbursement.Then, of course, once the doctor no longer accepts that insurance company's reimbursement schedule, then doctors no longer accepts patients who use that payer's insurance.Insurance companies jack-up the Preminum till nobody can afford.
Each year, doctors and healthcare facilities like testing labs, hospitals, pharmacies and others, negotiate pricing with health insurers and payers. In its simplest form, it goes like this:
Doctor: When a patient with diabetes visits my office, I charge $100 for the visit, and $75 for the blood work.
Payer: That's too much money. We'll pay you $55 for the visit and $35 for the blood work.
Doctor: I can't pay my staff or keep my lights turned on for that paltry amount! How about $65 for the visit and $45 for the blood work?
Payer: That's still too m
uch.
Doctor: Sorry I can't help yo
u.
Payer : I'll join Obamacare then
Doctor : Its all Yo
ur call.
President Obama : Doctor, how many patients that yo
u got and treated each month ?
Doctor :
Ro
ughly about 30 patients a month,Mr President.
President Obama : So Mathermatically 30p x $105 =$3150
Doctor
: Yes ,I think so.
President obama: Ok then ,let me offers Yo
u.You must leave everything else the same volume of procedures as what you're attending now no less. Obamacare give you 300 patients a month,as before they all can't afford your bill, But with conditions, your price must be standardise How about $25 for the visit and $15 for the blood work? That will be 300 x 40 $12,000.
Doctor :
Thats great Mr President,Its a DEAL,b
ut how about the increase of patients,I'm afraid I'll be sue for negligent,since i'll be attending extra patients and how can I manages ?
President : I believes,with that kind of money you got there,its about time you start to think and expand you business ,you can start hiring few more,the unemployed Americans to asist you.Don't worry about the patients,they're now well protection,they dont need anymore BS attorney,they got the Director of Commsumers protection, a free complaints and to watch your back ,as what they're watching closely with the greedy banking procedures and practices .
Doctor :Thanks You.Mr President,You are the smartest President we ever have!
President Obama : You most Welcome.
Jack335
That's a nice fantasy, but has no bearing on any legitamate argument about the delivery of health care.
So the law is going to rquire people to buy health insurance they cant afford already which is why they dont have any. And if they dont get health insurance then they get slammed with a fine they cant afford, exactly how can a law force someone to pay something they cant afford? In France they cover everyone via higher taxes, and all the citizens get seen, with little to no waiting time, and the procedures are somehow done with better outcomes and at one seventh what it costs her in America. I wonder why France can solve their healthcare problems with simplicity, yet here in America we fail to solve it with complexity?
As the article points out, if a person truly cannot afford a healthcare insurance plan assistance is available.
Why should I have to pay more because someone decided they would rather spend their money on something else, and so when they are in an accident or get gravely ill the hospital that I go to provides care to that person that now cannot pay and shifts that person's cost to all those that do have insurance?
Morlock,
any proof that in France they have better outcomes with their procedures?
@eric: "In a recent World Health Organization health-care ranking, France came in first, while the U.S. scored 37th, slightly better than Cuba and one notch above Slovenia. France's infant death rate is 3.9 per 1,000 live births, compared with 7 in the U.S., and average life expectancy is 79.4 years, two years more than in the U.S. The country has far more hospital beds and doctors per capita than America, and far lower rates of death from diabetes and heart disease. The difference in deaths from respiratory disease, an often preventable form of mortality, is particularly striking: 31.2 per 100,000 people in France, vs. 61.5 per 100,000 in the U.S."
been to France lately??? obesity rate is drastically lower than the US, thus the lower rates of diabetes, heart disease, and infant mortality - has very little to do with health care system efficiency
#9 versus #128
#1 is Nauru, where nearly 31% of the population is struck with the disease (diabetes)
Why should I buy into health care insurance that I haven't used nor needed in over a decade? When/if I have visited a Dr. I have paid out of pocket. My choice. Cancer? No. I choose not to be treated for it. M.I. ? No. Let me die.
Taxes? Yes, I pay them. Would I pay more? Yes. Why do we have to create a law that dictates I buy something?
@miscreant
jmelan beat me to it...he got it exactly right
You cite mortality data for france and link that to procedural outcomes....how? because that what you want? because it would support your viewpoint?
as jmelan correctly pointed out, there are so many factors that go into mortality to link it to the health care payer, let alone procedural outcomes(of which you have no data) is ridiculous
Its not a leap of logic to go from better mortality directly to procedural outcomes...its a jump of superman proportions...
Now periprocedural mortality rates would be helpful...but overall mortality? You must be joking...
Even with the benefits of the Affordable Care Act clearly laid out, the hard-of-thinking still parrot the FOX talking points.
It's un-American to be so against something that helps so many people just because you are closed-minded.
The reporter in this article makes it very clear that the government doesn't know yet how much this AFC is going to cost. I haven't listened to Fox on this subject but I am concerned about the Federal Government being involved in monitoring my healthcare. Must admit I was also concerned, when I had insurance, that Healthnet was deciding on my healthcare also. They up and cancelled my insurance for pre-existing high cholesterol. Just hope someone figures it out soon so I can get insurance again.
I try to see both points of view. Sometimes I may not consider all of the issues as seen by those with opposing views, but how can anyone read the entire article above and then be against any part of it? I ask those of you that are against the benefits that will come online this year to please explain why a particular benefit is objectionable? Maybe then I can understand why you have such a problem with that/those aspects of healthcare reform.
My problem with this entire discussion is conceptual.
NOTHING in the Constitution permits or authorizes the Federal government to do ANYTHING relating to health care. And NOTHING permits the government to tell me I have to buy a product/service I don't want from a private concern.
I DON'T want any part of this law. I hope it's stricken from the books, either by the Supreme Court or by repeal next year.
This country is on a very dangerous slope. If this law remains in effect, I fear for our Constitution and our liberty.
We have plenty of mandates already imposed by governments. Like insurance for driving a car.
There's a HUGE difference between a State mandate (auto insurance) and a Federal mandate (health insurance, if the ACA survives).
The States are fully sovereign, and can do whatever they want, so long as they aren't barred by their Constitutions and the US Constitution. The national government is NOT fully sovereign and can do only what it has been empowered to do.
I've looked, and I find NOTHING in the US Constitution which allows the US to mandate the purchase of a product from a private entity.
Golly, there are no mentions of airplanes in the Constitution either, no mention of women for that matter until the 20th century when the 19th amendment was added. Just because the words aren't there doesn't mean it doesn't apply. The Founding Fathers could not have imagined our world today.
I still don't see specific objections to the specific benefits outlined above.
better get used to it. It is not unconstitutional nor will you be able to repeal it !!
Thank you Justice Bader-Ginsburg !
Richard;
Apparently you are living in the US pre 1860. "States are fully sovereign" HOHOHOHAHAHA
That has got to be one of the best posts ever on msnbc.
Sure it all boils down to being able to 'work financially'. Always follow the money; it will lead right to where the problem is.
What a shame all of the fighting and bickering about healthcare for all. I don't understand all of it but hell, I haven't been covered for 2 years, been paying out of pocket. Disabled waiting for a damned disability judge for 2 years now because I need a hearing for Disability. Hell I worked my whole life until I could no longer work, On medical leave from work (they cut my insurance and sent me a bill for COBRA...LOL!WTH? WHO COULD AFFORD THAT?)
I'm not 100% sure what the solution is but I'd like to see somebody do SOMETHING so I can get some coverage from SOMEWHERE!
They sure don't have these problems in Canada.
no, but their taxes are much higher and lines are much longer...
My problem "I saw it", has to do with the fact you can afford a computer and internet service, but would not pay for your COBRA payments. If it comes down to it, my health would come first and I would sell what I had to, to cover the cost. Kind of like the article we had in a local paper about the LIHEAP program, yet the lady complaining about the payments had a 60 flat screen and a PS3 in the picture taken for the article. If you can afford a 60" flat screen and a PS3 you can afford to pay your own damn utility bill.
In Canada total tax and non-tax revenue for every level of government equals about 38.4% of GDP, compared to the U.S. rate of 28.2%...Whereas the Canadian healthcare system is 70% government-funded, the US system is just under 50% government-funded (mostly via Medicare and Medicaid); adding the additional healthcare-spending burden to the above figures to obtain comparable numbers (+3% for Canada, +7% for the US) gives adjusted expenditures of 38–39% of GDP for each of the two nations... The U.S. Government spends as much on health care, 7% of GDP, as the Canadian government does, and total healthcare spending is much higher - 14.6% of GDP in the US vs. 10% in Canada. Canadians, however, receive comparable care to those Americans who receive treatment, and result measures, such as life expectancy and infant mortality are better in Canada. Waiting time for ELECTIVE procedures and treatment is longer though the government and physician groups are working to reduce that. Those needing emergency care do not wait. The Ontario Ministry of Health even has a website where you can check wait times by procedure or hospital: '"
again, you make the mistake of using life expectancy and infant mortality as surrogate markers for healthcare quality and/or delivery. How? You don't think there are maybe some other factors that go into life expectancy?
The lower crime rate in canada? The lower rate of hypertension?
I mean really...this idea of mortality being tied directly and only to health care is ridiculous
And you can't brush aside wait times for procedures just because they are elective. Waiting on a hip replacement can cause significant morbidity, and yes, mortality
RickGaffron:
Last time I checked, COBRA payment is much MUCH more than internet access. A month of internet costs a day of food. a month of COBRA is like a month of apartment rent.
eric...
Correct. Mortality rate takes in many factors. Canada doesn't have inner city nineteen year old gangsters killing each other by the thousands, just for starters.
Same thing with the continued article about where the US ranks in educational areas...I don't think places like Finland have cities with 50% dropout rates like we do here, to factor into their overall achievement rates.
There is a simple explanation for why American health care costs so much more than health care in any other country: because we pay so much more for each unit of care. If you leave everything else the same the volume of procedures, the days we spend in the hospital, the number of surgeries we need but plug in the prices Canadians pay, our health-care spending falls by about 50 percent.
Has anyone checked to the cost of a simple visit to the doctor for say the flu or a sinus infection? It's written down on my bill along with my cost since I have insurance. My doctor charges $120 for a 15minute visit, even if I don't take up the full 15 minutes. My nuerologist cost $250 a visit and I must see him since I have a sizure disorder. Forturenately I have very good insurance and those visits cost $25 and $40 respectively. Without insurance I could not afford to go. I have to have a four day outpatient eeg that will cost $4000 with insurance only about $750 or a bit more for me.
If you have insurance consider youself lucky, I certainly do. But not everyone does nor can they afford it. Many self emploed cannot get it. My brother in law is one. He is a hairdresser and he and his family have gone without insurance for many years because a singe self employed person cannot get surance that is affordable. H ejust tore his bicep and it won't get fixed because he has not insurance. Not a good way to go.
It's nice to know that my fellow Americans are selfish louts who care only for themselves. If I recall my if vaguely my New Testament Jesus said something aboutwhen you help the lest of God's people then you serve me. Yes I realize it's a paraphase but Joseph knew it in the old testament and would up serving angels of God without realizing it. So dig with to your Christian charity and be a real Christian and not a whooped up pseudo christian
ill say one thing...if you are a self pay patient the vast majority of docs will give you a big discount...
mine will give me 5%, but most doctors charge people without insurance 25-30% more then they would change the insurance because they have provider contracts with them. So in the end you end up paying much more then the person with insurance even with the 5% discount.
Transplanted Yankee: Is your doctor meeting you on a street corner? S/he has overhead to pay for: the office, heat, lights, receptionist, billing clerk(s), nurses and or PA/NP, supplies, taxes etc., not to mention his or her time and education. Long gone are the days when a doctor worked from home and took chickens or potatoes in lieu of payment. That's why the bills are what they are. Yes doctors - at least specialists - make very good money; I worked with them for over 20 years and like other small business owners cry the blues about how little they have - they should walk in the shoes of the real working poor for a while. But don't forget most of them come out of medical school owing $200-300K in loans, have the start-up costs if they want their own practice or buy-in with another's, plus enormous insurance premiums due to malpractice - even before they see their first patient. Family practitioners make the least of all doctors, yet are the "gatekeepers" to the specialists. Like hospitals, insurance payment levels remain in place for years with no rise, not indexed to inflation, so what profit they may have made early on disappears over time - Medicaid reimbursement rates are so low it's hard to find a doctor who accepts Medicaid in some places. No matter how you slice it, health insurance is a complex problem.
Just so others are aware...as a doctor myself I must tell you that it sounds great to be able to give cash-paying patients a discount on their services. Doctors are people too, and the vast majority of us are in these health professions because we truly want to help people. If I can give a cash patient a discount that allows them to afford the care they need, then that's wonderful.
However, the reality is such that doing so actually creates problems for doctors and hospitals. It's this sneaky little thing called "fee splitting". In essence, a doctor cannot charge two people different rates simply because one has insurance vs. out-of-pocket. The insurance companies will scream bloody murder and threaten to take away our credentialing with them (basically, getting kicked out the "network") if I charge a lesser rate to someone without insurance. It is stated in our contracts that we must charge the same rate to everyone, regardless of the ability to pay.
I can get around this issue somewhat by having my patients sign with a third-party administrator (a pseudo-insurance company, if you will) that "contracts" them at a specific rate, just like other companies, only that this third-party administrator does not actually pay me, the patient pays with their own money. This way, I, as the doctor, am "contracted" at a certain rate and can side-step the "fee splitting" issue. Remember, however, it is still less money that I accept for the same quality care given....I do it for the patients, nothing else.
It's CYA, folks......we, as doctors, live under the constant threat of scrutiny by these insurance companies that have co-opted our health system in America. I cannot just simply walk into my practice and take care of my patients as I see fit. I have to play every little game the government and the insurance industry throw at us. It is a neverending, constantly changing game of simply trying to stay afloat in this hostile industry.
Slightly off-topic, people think doctors are greedy, overpaid shuysters. The reality is that collectively we are not even making the salaries we did (in actual figures) 15-20 years ago! Sure, there are always those unscrupulous types that will fraud and milk the system for personal gain, but they are few and far between. The majority of us mean well for out patients, and are simply trying to make a living after sacrificing so much time, energy and money to get here. I hope this helps....
Floretta- Yes, specialists get paid fairly well, but they have sacrificed an awful lot to get where they are in the first place. When anyone in the surgical field cannot even START practicing until they are in their 30's (with the time spent in school and residencies), they are far behind their peers who did not go to college for 8-10 years. On that same note, it seems as though no one begrudges a specialist mechanic who has a particular ability to fix certain engines...in fact, we gladly pay more for the special ability it takes to do so. So why does everyone knock doctors for being overpaid? We are specialists in general, meaning that not everyone has the gumption (or the ability) to go through the education it takes to become a doctor. (BTW- I'm not chastising you, per se, only the topic at hand!)
Also, as far as Medicaid goes, I accept it and have for years even though the reimbursement rates continue to decrease while the cost of living goes through the roof lately. However, to put things in perspective, if I only saw Medicaid patients, and did not see or treat insurance-based or cash patients, I could not afford to keep my doors open, much less make a living!
Indy...
Thanks for facts...right from the horses mouth ! I don't begrudge a medical expert for anything...someone doesn't like what you charge ? Then go somewhere else.
Doctors and hospitals being able to pay the light bill and keep their doors open never seems to enter the conversation. I think I read that Medicaid reimbursements are even lower than Medicare reimbursements.
A few years ago I read an aricle that claimed that if every single person going thru an emergency room had to but $25 on the table, regardless of income level, our medical system would solve half it's financial problems.
But this being America, of course, why shold anyone have to pay a dime for anything when it comes to medical care ? I'm not very religious, but always thought that "The Lord helps those who help themselves" was a pretty fair concept.
I think that there are portions of it that will benefit a lot of us working people.
Not everybody is going to like it, but give it some time to work.
I would like to think that some of those more controversial provisions can be worked out.
I a being positive.
And I am Australian.
We have national Health car, and dental, and it works and is not Bankrupt.
Canadian here ... I moved back to Canada last year after 23 years in the US (after being diagnosed with diabetes). Most of us up here think Americans against Obamacare are out of their freaking minds, and don't think Obama went far enough. The Republican Party has lost it and are becoming a bunch of flaming sociopaths. When are they going to change the name of the country to The Divided States of America? I pay a little more in taxes, but affordable healthcare (read mostly free, and I'll never lose my life savings or have to file bankruptcy due to catastrophic illness or injury) is well worth it.
but you have very long lines, and the wait to get a hip replacement is something like 6 months at least....in addition, the relatively low salary of specialists makes it extremely unpalatable for anyone to complete the extended training needed to become, say a neurosurgeon that may have saved Liam's wife...
Before you tell me that you haven't experienced long lines, I want you to look up a Canadian supreme court case out of quebec that found that the national health care law banning private practice DID in fact, cause very long wait times that were detrimental to patient health
You don't live here and don't know what you're talking about. The wait times for doctor visits here are no different than I experienced with my HMO (Kelsey-Seybold) in Texas, or my HMO (Kaiser-Permanente) in California. Medical emergencies in Canada are pushed to the front of line, while elective surgeries get a lower priority. The wait times, although inconvenient, can be made less if you put yourself on a cancellation list. And we still have the opportunity to go to a private clinic outside of the government run system and pay a premium, or go the US, IF we chose. Even private institutions here charge less than the costs for the same procedures in the US. Uninsured healthcare costs in the US are indecent and absurd. And don't forget, their are millions of Americans buying their prescriptions from online pharmacies here in Canada because the cost of drugs are less expensive as well. I have a employer-provided prescription plan, and after paying my deductible for the year, my prescriptions now cost $1 each, the pharmacy dispensing fee.
Furthermore, the World Health Organization ranks Canada at No. 30, while the US is at No. 37 in terms of overall healthcare. That seems to be a BIG difference to me. Not to mention that countries that have the best-rated healthcare systems in the world have nationalized healthcare systems.
After 23 years in the US, I can say 2 things about Americans ... they are a fearful and greedy bunch, at least 40% of them, and they are usually Republicans.
Ah yes. The self-righteous posting of another morally superior Canadian.
Canadians and Europeans are free riding parasites. They let the US fund medical innovation (and their defense too, but that's another story). Tell me...how many medical innovations (drugs/devices) will be brought to market if government dictates a crappy, non-economic price? Not many. The US market is what allows the companies developing these innovations to fund them.
If Canada chooses to free ride, fine. But save the faux moralism.
Grandall. I know several Canadians who have moved back to Canada for healthcare. Most of them think we in the US are nuts. I would have to agree with them. As for your morality, I do not question it. However, the empathy you show for others who are sick and the system that works for all your people says a lot regarding your countries morals.
grandall,
you did nothing to address my points.
here's a link from the canadian government showing wait times. If you look the average wait for a hip replacement is 6 months....thats insane. And don't think just because its elective, it can wait that long. You are talking about completely immobilizing a senior for 6 months, putting him at risk for bedsores, infection...especially if this is one who lives alone and can barely take care of himself with 2 functioning hips
Not to mention the significant suffering associated with having a freaking broken leg that can't get operated on
If it were me, and I had worked hard my whole life, payed hundreds of thousands of dollars into the government coffers, this would strike me as unfair.
http://secure.cihi.ca/cihiweb/products/Wait_times_tables_2011_en.pdf
here's a link to the story of the canadian supreme court agreeing that these wait times were detrimental to patient care
http://www.cbc.ca/news/canada/story/2005/06/09/newscoc-health050609.html
You really think 30 and 37 is a big difference? Interesting...
The cost of drugs is cheaper in canada because we americans subsidize drug R and D for the rest of the world. Youre welcome
Eric:
"six months for a hip replacement" might be misleading. This wait time excludes emergency and elective surgeries. It only pertains to priority cases. As I have no idea what a "priority case" is I'll leave that up to someone who can decipher the definition.
Most of the people who vote for Obama will get the taxpayers (which aren't them) to pay their medical insurance.
It's called a government mandated transfer of wealth.
We're on the slippery slope to socialism - and the same quality of health care they have in England and Canada - more taxes, too.
I pay taxes...and I voted for Obama. Kinda shoots down your theory there doesn't it?
And if you don't like socialism don't drive on my roads. Build your own.
The ACA is about as far away from socialism as you can get. Corporatism is a better description.
You seems naive about anything,The Cost of Gasoline in us let say "$4.20 per gallon" while in Europe is $9.00 per gallon more than double.Any reason why us healthcare cost "$7,000" per citizen? while other countries pay 50% less what us paying!
You call that Socialist?Nope Capitalism is the Answer!
In 2014 the Medicare premium will double. But the media won't talk about it.
Medicare's Office of the Actuary estimates (as of mid-February 2012) the 2014 premium to be $117.10. That is for singles with incomes UNDER $85,000 and couples with income UNDER $170,000. Over that, as now, you pay a higher, "income-related" premium. Currently most seniors pay the regular rate.
Medicare premium will double,because the Cost is double.
I would hope that after November, when President Obama is handily re-elected, the House returns to the Democrats and the Senate becomes fillibuster proof we will revisit the Affordable Healthcare Act, and make it a single payer, "Medicare for all system" that we truly need in the US.
we can't afford "medicare for some" as it is right now...what makes you think we can afford "medicare for all"
Yeah, lets get everyone a cadillac and a swimming pool while we're at it...
and if you do that where does the money shift from? You want cheap low cost medicare for all or social security. Some of you have no concept of credits and debits. You all need to take a course in accounting.
If everyone is covered under single-payer you have the widest risk pool possible, including millions of healthy adults who go years between visits to a physician and who would be otherwise cherry-picked by private insurers. Medicare currently has a 5% overhead versus more than double that for private insurers. Between Medicare, Medicaid, state CHIP programs and the VA we are already 60% there. Vermont has had single payer since May of last year, too soon to see the effects but worth watching.
floretta,
how many well people without insurance and money do you think are out there? Enough to cover all the sick uninsured AND future rises in health care spending at todays rates that will be 50% of GDP in 2050?
really? Really?
Medicare has worked for years, If those involved in defrauding the program were aggressively sought after, investigated, prosecuted, then have the book thrown at them we would not have any problems. I am fed up with crybabies that don't have healthcare, don't want healthcare, find any excuse to shove their responsibilities on people who do accept responsibility. Those "crooks" find every excuse including "religious freedom", and especially those who think it is unconstitutional to be accountable for his/her own actions is simply proof of how many in this nation NEED healthcare to cure their mental condition that allows them to think the way they do.
You people make me SICK do not ever come to me for help - you make no effort to help yourselves our your country then TSMF!
I am all for it. I have medical insurance. I sacrificed cell phone and 700 dollar car payment for my insurnace. Meaning that I rather my health than a fancy car and an i-phone. Most people rather the opposit and allow the rest of us to pay for their diseases. Next, I work in health care (I went to school and paid attention, while some others were partying and drinking and having fun) so I have a job that pays well. this new thing will bring more business to my line of work. If you did not pay attention at school and went for a mickieD job because is less responsibility, and you spend your check in big SUV without being able to afford them and iphones, don't complaint and bite the dust.
Why dont you let it be and see how it goes if you dont like it after 3 years of starting scrap it. I mean george bush got 2 wars lasting over a decade each why not let something noble like health care good or bad have a chance for a quarter of that time. If his health care turns out to be the greatest thing and everyone loves it the republicans would never recover so they attack it in its infancy. If it fails it was wasted on at least a good idea not killing hundreds of thousands in wars and legless soldiers not to mention how many thousand suicides and ptsd cases there are,
Not to mention all the free rides and tax breaks soldiers get...oh wait...saying that is taboo yet a blind eye is turned by anti-socialist republicans.
"Free" rides? You like it so much, enlist. Get your own "free ride." You put your own body on the line in exchange for that "free ride."
Floretta: You miss my point. The systems we set up provides armed forces members free/reduced healthcare, dental, education, family care and the list goes on. Not to mention all the state programs that go on to provide subsidies and reduced costs for various things. This is socialism. In a capitalist world we would give them a check and let them fend for themselves. A pure capitalist would say...heck...they new the risks. The military's treatment is of soldiers is socialist. But don't mistake me pointing it out as being against it.
The drug companies and the health care insurance agencies and the stockholders and the CEOs would not allow the affordable health care happens in U.S.A. They will not let that happen.
I appreciate waiting just one month, and not having to wait three months to get on an employer's health insurance plan when I got a full-time job, and when I lost it, I was able to get COBRA, even though I hadn't been employed for six months, as was required before "Obamacare."
Bush didn't care, didn't want to. Cheney cared about Halliburton, and look where that got us.
To the people who complain about the government running a healthcare system. You do realize the government already runs a top notch healthcare system called the Veterans Administration right? It's been running the program since the 1930s.
I can't wait for the fine's to kick in for all those people who dont read the details and think Obamacare means free healthcare.
Me neither. I'm glad they have to pay a fine if they don't purchase healthcare.
I find it highly ironic that a large majority of the comments on this page in opposition to the Affordable Care Act and Healthcare Reform Act or more "cleverly" known as Obamacare, are not steeped in very intelligent conversation. Criticizing anything is extraordinarily easy. The healthcare system is clearly inefficient, considering the United States spends more money (17 percent of GDP) on this system, a far greater amount than any other developed countries. If you don't think the system needs improving, you are delusional. If you do but are critical of this law, might it be possible to offer a solution. I haven't read these and instead see the words "socialism" or "big government." Not all socialistic concepts are bad, including those propagated by Republicans or Democrats, like any program paid for with collective tax dollars. By the way, repealing a law is much harder than just, well, repealing it.
Whats even more ironic. In the states we are trying to move to more socialized healthcare. In Europe they are moving in the opposite direction. It's not that some socialized healthcare is bad, its the timing that's horrid. Our national debt has hit 16 trillion. We honestly cant afford more government subsidized anything right now. If we made a hard attempt to balance the budget it could take years. We haven't even tried. Not good.
All socialism is bad. I will NOT participate. I will not be a productive contributor to a socialistic system. You pay, I will take advantage of the system and not contribute any way I can.
expat: That statement says all anyone needs to know about your character. You already live in a socialist system and have been your entire life.
And I have fought the socialism, and have thought it was bad my entire life!
Step one: outlaw insurance. Nothing will be solved as long as people think they can spend other people's money to solve their problems.
Step two: get government out of the medical business. As long as the wielder of police power has control of medicine, the marketplace cannot work. Lawyers, judges, cops, politicians, all need to be kept out of medicine and medical decisions.
Step three: cash and carry. People need to take responsibility for their own consumption of medical services. That's the only way a free market can work to bring down prices to what people are prepared to pay.
It won't bring down prices, it will just shrink the market to those with the money to pay, eliminating 99% of the population from access to all but basic care. Imagine a credit check while your laying in the street bleeding then no one shows up to help. The street sweepers just pick up the road kill later.
The 1% isn't a large enough market to support all of the medical industry. The industry will have to find work where they can, and that means lower prices as they struggle to attract enough customers to stay in business. Some hospitals may close if their hundreds of millions in shareholder profits drops to only tens of millions a year. Some doctors may choose to become dishwashers at Waffle House rather than lower their fees. But most won't quit. They have too much time invested to just toss it all away. They'll come to realize that a small profit is better than no profit at all.
JohnCarter-428979
This is entirely true. However, the industry has a choice to abandon a market that is not profitable rather than accept prices below cost. Certain costs cannot be mitigated. You're not going to suddenly have lower costs to train physicians or equip hospitals. That is why the market would dramatically shrink.
Health care is 17% of GDP. What do you think would happen if it became 3% of GDP instead? Millions would be out of a job.
Not stated in this article. Obama lied to America and told us the cost would come in around 900 billion for this program. Obamacare does not completely kick in until 2014. Yet, the price tag all ready stands at 1.8 trillion. Since 47% of America pays no taxes, who is going to be soaked for this? The answer is the Middle-Class. You know the Class that BHO claims he is protecting.
I can all ready hear my critics now ... what about the 1%? FYI - this is another Obama lie! Visit our IRS Web Site. The latest figures avaiable are for 2009. Here is what you will find ONLY 9 tenths of 1% of the rich do not pay their fair share.
This is completely false. The $900 billion was an estimated cost over 10 years starting from 2010 when the law passed.
The $1.8 Trillion is also an estimate for 10 years starting in 2012.
It's an apples to oranges comparison. The basic assumptions of the estimates are different.
Estimates over 10 years are always off and will change every year.
still, the point is that it is costing double the amount that was broadcast to the american people. This was done deliberately as most of the measures did not kick in in 2010, but later...so reporting figures from 2010 would make it seem cheaper
Nice try, though
That is very strange contention since the CBO made both estimates.
The law requires time to implement and the cost saving it achieves will take time as well. Instant gratification is nice but was never part of the plan.
Of course it seemed cheaper in 2010. There were less unemployed, less uninsured, and fewer Baby Boomers were reaching retirement. As I said before the cost estimate changes every year. As, by the way the revenue the law generates to pay for itself changes every year.
Its not strange at all if you know how the CBO works...you ask for a projection, and they calculate it for you. So the people pushing the ACA got the numbers they wanted from the CBO and released those...now the true estimates of cost are being released
But naivete apparently was....How exactly will this plan offset all the nice but expensive reforms?
And you really believe any of that wasn't foreseen in 2010? We were already deep in the recession...as for less uninisured--really? enough to now double the cost? Youre grasping at straws here
Wrong. The purpose of the CBO is to be independent and non-partisan. They don't take other peoples numbers, they calculate their own.
I'm not grasping at straws. I'm stating facts. You're the one making false allegations. If you have to make false statements to support your argument, it must be pretty weak.
Again, you miss the point. If I tell them to start counting from 2010, when I KNOW the projected cost will be less, I get one number. If I tell them to start from 2012, I get a different number. Garbage in =garbage out
so weak that you cannot refute them at all? That the only statement you can make is that meaningless last paragraph. Must be a pretty strong argument if you cannot refute it
I've refuted every one. Every time I refute one argument you change the argument and come up with more false arguments. Why not estimate the cost from 2049 to 2059? Why not 3010 to 3020? The debate at the time was not contingent on the time frame of the estimate it was contingent on the cost estimate at the time.
you did not address any points...let me spell it out for you in very simple terms
You claim that the CBO estimate was less in 2010 because of less unemployed, less uninsured, and less baby boomers retiring
I asked you how any of those factors were not foreseen in 2010? We were deep in a recession already at that time, so certainly unemployment could be counted on.
No response from you on that
As far as less uninsured, I'm not sure that is even true, but I asked you how that could result in a doubleling of the cost estimate.
You provided no facts, no evidence, no argument at all to support your stance and refute my implication that that was a ridiculous statment
So, in fact, you have not refuted ANY of my points, aside from some generic comments about the CBO that may or may not be true and impossible to show as fact
I don't change at all. You fail to grasp the point every time. again, I will spell it out for you. Counting starting from 2010, which is what the initial CBO projections were based on, is not accurate because it includes years in which revenue for the act is collected through various medicare cuts, but costs are not taken fully into account as the major provisions which cost money are not implemented until 2014
However, the most recent set of projections, which does include more years of costly reforms with less revenue only years shows a increase in the net cost
make sense now?
Here's a nice liberal take on the situation that may clear it up for you
http://www.washingtonpost.com/blogs/ezra-klein/post/no-the-cbo-hasnt-doubled-its-cost-estimate-for-health-care-reform/2011/08/25/gIQAZj7FPS_blog.html
The funny thing is, we basically agree. The cost estimate using 2010 as a starting year was much less than the cost estimate using a start time of 2014. We disagree on the reasons why. You list some honestly BS reasons with no evidence whatsoever to back them up. I suggest a more sinister reason--the govt knew it would cost more than the 2010 estimate but did not want to admit that at the time because they wanted badly to pass the legislation. Admittedly, I don't have evidence of this either, but certainly would be much, much harder to prove than your contention
What revenue was collected? What Medicare cuts were made between 2010 and 2012?
The primary revenue generating taxes associated with ACA are the increase in the Medicare tax for people earning over $200,000 per year and the investment income Medicare tax for people earning over $200,000 per year. They don't take effect until 2013.
Your original comment claimed Obama lied. I pointed out he did not make the estimate you are calling a lie.
Your next comment was.
Implying the cost estimate started in 2010 because they were intentionally underestimating the cost.
I pointed out the CBO is nonpartisan and used 2010 as the basis for the ten year projection because at the time it was 2010.
You then claimed.
I'm not sure what this implies because it makes no sense. As I pointed out the CBO made both estimates. Why would they skew one estimate then make the next one more accurate
This is from the CBO home page.
http://202.41.85.234:8000/InfoUSA/politics/legbranc/agencies/cbo.html
All of the arguments about costs are irrelevant. For me, this is about my right to decide what medical care I receive or do not receive. This is about my right to control my own body. I do not give a damn about the costs, or about other peoples perceived needs for medical treatments. I do not care about that. I will not become the chattel of the government. My body will not be controlled by the government. I don't want medical care. I don't want the false promises of the medical establishment. I WILL NOT PAY FOR THEM! Period.
expatdownunda
Go for it.
uhhh..i didn't say anything about obama lying...youre mixing up your posters here...
umm..these cuts...first return on google
http://money.usnews.com/money/blogs/the-best-life/2011/08/08/nursing-homes-squeezed-by-medicare-cuts
http://www.nytimes.com/2011/09/20/us/politics/medicare-and-medicaid-face-320-billion-in-cuts-over-10-years.html
as for the rest of your post, im not going to bother quoting it line by line because it can be summed up as a misunderstanding on your part on how the CBO works. I've already stated why you are wrong, however, neither of us works for the CBO so there's no way to show it conclusively. You insist that the CBO does not depend on facts supplied by the government, ie congress. If you go to that same webpage you cited you will find that is untrue
It makes perfect sense, you just fail to grasp the point again. I can see why if you are incapable of understanding a point, it will seem like nonsense.
As simple as possible, the CBO estimate that was initially used for costs was the one that started from 2010, BEFORE costly reforms were implemented. The most recent estimate release, probably conceived at the same time as the initial one, counts from 2012, which includes more years with costly reforms.
Im not saying the CBO was nonpartisan or trying to mislead the american people--im saying the politicians that commissioned the CBO were. Why on earth else would you start counting from 2010, when the major provisions were not slated to start until years later?
Please, please, please addreess the points I specifically laid out in my prior post...also, I can tell you didn't bother to read my link. If you did, you wouldn't be as confused.
edit: should read "partisan", not "nonpartisan"
Sorry about mixing up the posts. You picked up on the comment the other poster made.
As for you links. The first one describes cuts that are not part of ACA but part of improvements in the way Medicare reimburses for certain services.
The second link refers to cuts made for the debt ceiling agreement, not ACA.
Neither of these could have been predicted by CBO and don't relate to ACA anyway.
I answered every one of your questions in detail. You act is if the 10 year window used for the initial estimate did not include the initial implementation of the law. It does.
If you don't understand how the CBO functions I can't help that. But they don't take orders from anyone. That is their reason for existence. They were asked to make a budget analysis of the ACA law and they did. Both parties used that figure.
your mistake here is thinking that medicare cuts not officially part of the ACA are not included in the estimates of its cost. That is untrue. ALL medicare expenditures are taken into account
Neither could have been predicted by the CBO? REally? You think cuts that take place in 2011 are passed into legislation that same year? hahaha...at least a year ahead of time, my friend
the initial ten year window included implementation, but not the major costs.
If you don't get anything else from my posts, understand this. I agreee the CBO is nonpartisan and fair. But its FINDINGS can be manipulated in various ways by politicians.
If you look back to my post 22.2, thats the point i was making. The american people were given the first 10 year estimate, which was not an accurate representation of the cost of the act, as it did not include much of the major costs
If it did, why are the costs now reported to be doubled? Surely not only the reasons you gave (increased unemployment, baby boomer) etc unless you have evidence to support that (which you have not provided up to this point)
If you do not accept my argument about medicare cuts, then why is the cost doubled? Please provide supporting links/citations
Fcuk the law! I am not going to participate in this plan.
FcuK the law! I am not going to participate in paying taxes because we give corporate welfare! I was opposed to the war in Iraq so I don't want to pay for that!
I agree forest. However, there is a bit of a difference, one of these issues involves the direct control of my body, which I will not relinquish. For me, this issue is about privacy, freedom, and autonomy.
If you are an expatdownunda then what are you screaming about?
From what I've heard, if you can't buy the insurance and you don't pay the fine for not doing so, you GO TO JAIL! True or not?
If I go to jail, the taxpayer pays for it.
Frank: Factcheck.org has a good explanation.
In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such failure
I believe the IRS will take the money out of any tax deductions.
However if it were up to me, I would prefer jail time or charges for tax evasion.
Section 501 of the House health care reform bill provides that an individual must be "covered by acceptable coverage at all times." "Acceptable coverage" includes "qualified health benefits plan coverage," "grandfathered health insurance coverage," "Medicare," "Medicaid," coverage provided to members of the armed forces and their dependents, "coverage under the veteran's health care program," people who receive health care "through the Indian Health Service," or other coverage deemed acceptable by the Secretary of Health and Human Services. If a person does not have acceptable health care coverage, Section 501 imposes a tax on that person "not to exceed the applicable national average premium."
Willful failure to pay taxes of any sort can result in civil or criminal penalties.
Starting in 2014, when the requirements for individuals kick in, you will be eligible for subsidies if your income is between 133 percent and 400 percent of the federal poverty level. (In 2009-10, the federal poverty level in the 48 contiguous states and Washington D.C. was $10,830 for one person, $14,570 for a family of two, $18,310 for a family of three, and $22,050 for a family of four). If you wish, you could apply for an exemption based on financial hardship.
If your income is less than 133 percent of the federal poverty level, you will be eligible for Medicaid under that program’s expansion.
This is extortion.
Expat, what is extortion is people requiring healthcare having no insurance gets their cost passed on to us having insurance (and stupidly high premiums) THAT is extortion. Do you have a cure for that?
Mossey?..... so you'd rather have RICH getto trash like Romeny, Bush, Cheney?..... give me a break.....
Romney is just Obama lite, no one with any brains wants either of those commies. Bush and Cheney are puppets of the apartheid Zionist imperialists. We want someone who puts America first. We want someone who believes as our Founders did, someone who honestly supports our Constitution, someone who understands we can't continue living off other people's money indefinitely. We want Ron Paul.