How is healthcare reform coming along? State, National, International, posted by Concerned, a resident of the Another Pleasanton neighborhood neighborhood, on Jun 8, 2011 at 8:36 am
"A report by McKinsey & Co. has found that 30% of employers are likely to stop offering workers health insurance after the bulk of the Obama administration's health overhaul takes effect in 2014.
The findings come as a growing number of employers are seeking waivers from an early provision in the overhaul that requires them to enrich their benefits this year. At the end of April, the administration had granted 1,372 employers, unions and insurance companies one-year exemptions from the law's requirement that they not cap annual benefit payouts below $750,000 per person a year."
I would love to hear the defense of Obamacare now. This is what we get when we pass a law that doesn't go to the heart of the matter and deal with the industry issues that are driving up healthcare costs and therefore making it unaffordable by many.
But if the ultimate goal was to use this law as a path towards government sponsored universal care, then it can be deemed as a success so far. The only problem with this is we are out of money and won't be able to follow-through on the commitment.
Posted by Concerned, a resident of the Another Pleasanton neighborhood neighborhood, on Jun 8, 2011 at 9:06 am
Oh, and do you believe it is feasible that we as a society can afford to spend millions of dollars per patient?
If not, we either have the choice of rationing healthcare or we can put in place a structure that forces greater competition in healthcare to drive down costs.
I prefer the latter. But I suspect Obamacare as it is written right now is doing the opposite. Because of it more companies are going to drop healthcare coverage leaving it up to the governent. This concerns me because we all know how Medicare turned out. It is 10-20x more expensive than envisioned.
We need greater competition in healthcare to drive down costs.
Posted by Janna, a resident of Dublin, on Jun 8, 2011 at 9:45 am Janna is a member (registered user) of PleasantonWeekly.com
Free or extremely low-cost access to doctors for preventative and routine health exams would go a long way in reducing the overall amount we spend on individual healthcare. Seems like a no-brainer to me.
Proactive, not just reactive. Our society tends to go towards the latter in most matters.
Posted by Stacey, a resident of the Amberwood/Wood Meadows neighborhood, on Jun 8, 2011 at 10:16 am Stacey is a member (registered user) of PleasantonWeekly.com
"What is your take on whether/not Obamacare has been successful with extending coverage (in a way affordable by society) and driving down the cost of healthcare?"
Given that the provisions that are supposed to drive down costs haven't been implemented yet, your question is premature.
"Remember, our healthcare system already costs 2x that of most developed nations and we aren't any healthier."
And that's with the system we have now. It's a sure sign that the employer-based health insurance we have now is real broken. It would be great to move away from employer-based health insurance. That's a big, big cost for many employers, both public and private. We sit here and complain on this forum about labor costs for public employees and PUSD teachers complain about how their rising health care costs end up being a pay cut to their take-home pay, and how OPEB health care benefits for retirees are so high yet ignore the very real fact that such costs would be greatly reduced if health insurance were not employer-based.
"Oh, and do you believe it is feasible that we as a society can afford to spend millions of dollars per patient?"
It's a bad question. We spend way more than we should be spending NOW because of our outlier status and we, as a country, are in poorer health than many other First World countries. A system designed to drive down costs makes it much more affordable. One way to achieve that has to do with larger risk pools.
Holding up Medicare as an example of how expensive a government-run system is is also bad. The reason Federal health care costs are so high and getting higher is the same reason why private health care costs are so high. The difference is that private companies have a much easier time of putting in place lifetime and per annum caps and then selling you insurance for the same price and you think you're getting some great deal when in fact you're becoming increasingly underinsured. Don't try to get an organ transplant!
"We need greater competition in healthcare to drive down costs."
Greater competition doesn't work in this model because insurance is a form of "Spending Other People's Money". Consumers have little awareness of costs and little incentive to shop around when they're spending OPM. If you want real competition, we should do away with health insurance and force everyone to buy services directly from providers. We'd see how far that goes...
Posted by Concerned, a resident of the Another Pleasanton neighborhood neighborhood, on Jun 8, 2011 at 10:51 am
I agree with you that the current employer-based system is broken. We need more price visibility to 1) drive better decisions by consumers 2) expose the price/cost of vendors so that consumers can make better decisions and for market forces to drive business towards most efficient vendors.
Regarding Medicare, I don't follow your logic. It is a fact that Medicare has ended up being at least 10x more than planned. It is a fact that prior to Medicare that 70% of the population had insurance yet the medical costs as a percent of GDP were much less than today. It is a fact that employer-based insurance coverage started back in the 50's. How can you not conclude that the advent of Medicare (one large customer footing the bill regardless of the price) has not distorted the market? Just look at all the marginal medical suppliers who advertise on TV today and say "don't worry, it is covered by Medicare".
I'm not sure why the healthcare rationalization question is a bad one. Healthcare costs continue to go in one direction - up. And as the government starts to pick up even more of the tab (as the McKinsey study highlights), the government will be stuck with an even bigger bill. Given the state of the overall deficit, it is only a matter of time that rationalization will hit all health programs - Obamacare, Medicare and Medicaid. Like is already starting to happen with Medicaid. Do you see a different future than this?
From your perspective, what are the big cost reduction drivers of Obamacare and when do you expect them to kick in? As you are likely personally aware, cost have only continued to go up since the passage of this bill.
Posted by Concerned, a resident of the Another Pleasanton neighborhood neighborhood, on Jun 8, 2011 at 10:54 am
Stacey - Have you ever studied the case study of lasik surgery? Why did such a complex procedure drop so precipitously in price? Because it is a properly functioning market that is not being distorted by government subsidies and insurance.
Posted by Bill, a resident of the Amberwood/Wood Meadows neighborhood, on Jun 8, 2011 at 1:22 pm
You need the healthcare system, like the tax system, to be ineffient so that more people are employed. And it will get worst as time goes on because more people will be driven to these service sector jobs as the number of high quality manufacturing jobs keep disappearing.
My wife caught an intestinal bug while on vacation to France. At 2am in the morning the hotel summoned a doctor from his residence to come to treat her. The physician gave my wife some medicine that helped her with the discomfort and told her that the sickness would past in a couple of days. Charge for this was $60.
Can you imagine that a doctor actually got out of bed at 2am, got in his car and drove to treat a patient and dispensed medicine for $60! In the USA you couldn't even get a doctor to drive to a patient, and if they did it certainly would cost you more then an ER vist which is $1000 per hour typically. And the pills would be exta.
Posted by Packard, a resident of the Bordeaux Estates neighborhood, on Jun 8, 2011 at 3:39 pm
As the American public becomes increasingly familiar with the new health care provisions, support for the law will continue to go upward. What no death camps? So-called patriot Republicans and other idiots will continue to oppose it, only because the Dems were responsible for passing it.
Posted by Concerned, a resident of the Another Pleasanton neighborhood neighborhood, on Jun 8, 2011 at 4:22 pm
Not sure where you are drawing your conclusions from. Here is the latest from Rasmussen:
Health Care Law
54% Favor Repeal of Health Care Law, 56% Say Law Will Increase Deficit
The latest Rasmussen Reports national telephone survey of Likely Voters shows that 54% of Likely U.S. Voters at least somewhat favor repeal of the law, while 39% are at least somewhat opposed. This includes 40% who Strongly Favor repeal and 26% who Strongly Oppose it. (To see survey question wording, click here.)
The majority of voters have favored repeal every week but one since Congress passed the health care law in late March 2010. Weekly tracking has found support for repeal ranging from a low of 47% to a high of 63%.
Most Political Class voters (64%) continue to oppose repeal of the law, while a majority of Mainstream voters (67%) favor the law’s repeal.
Overall, half of voters (51%) believe the law will be bad for the United States, while 34% say it will be good for the country. Just four percent (4%) say the law will have no real impact.
But this discussion here isn't whether/not there is public support for the law, but whether/not it will improve the situation. Per the McKinsey study, it is heading in the wrong direction.
Stacey - where did you go? I'd be curious to get your take on my response to your comments.
Posted by b, a resident of the Another Pleasanton neighborhood neighborhood, on Jun 8, 2011 at 9:08 pm
When employers stop offering insurance, this nation will begin to realize just how badly we're being ripped off by insurance companies. It is a massive, unjustifiable tax that is disguised as private enterprise.
Do you even have any idea how much your health insurance costs your employer? How much of your employer's money is going to insurance companies, instead of into your paycheck or retirement plan?
The solution is to follow the lead of the Aussies and Canadians--they provide better care for their citizens, at far lower cost than these insurance industry crooks.
Posted by Concerned, a resident of the Another Pleasanton neighborhood neighborhood, on Jun 9, 2011 at 10:02 am
b - I tend to agree with you that insurance companies have had a negative influence on the cost of health care. However, I believe they are part of a broader problem where the end consumer is not aware of prices and therefore vendors charge what they want and there really isn't much competition. Insurance companies help to make pricing opaque.
I do believe that an equally detrimental participant has been the government in the form of Medicare/Medicaid. One would expect prices to increase if you have a very large purchaser in the market that is not price sensitive (as Medicare has been).
While I agree that health care desperately needs to be reformed, I'm not sure Obamacare was the answer. In fact, I believe we are begining to see the ill-effects of it. It is too bad that some of the Republican-sponsored market-oriented suggestions weren't adopted - e.g. inter-state competition for health insurance.
Posted by b, a resident of the Another Pleasanton neighborhood neighborhood, on Jun 9, 2011 at 4:21 pm
Concerned, I agree with you on your first point. It is true that consumers are largely oblivious to the provider costs, as well.
Unfortunately, passing the costs directly to consumers doesn't solve the problem, either. Insurance companies have far more bargaining power than consumers. Consumers who pay for medical care on their own are generally charged far higher rates than what insurance companies pay.
I disagree with your statement about Medicare/Medicaid, though. Medicare/Medicaid reimbursement rates are far lower than private insurance reimbursement rates. The government has massive bargaining power. And from what I hear from several doctors, the US Government pays claims with much less hassle and delay than private insurers.
The private insurers do not have the same leverage as the government. Large medical groups (Sutter is a well-know example) strong arm insurers into accepting their reimbursement terms, since they have so many facilities, doctors and patients. But they don't have the same strength to negotiate rates with the US Government, or to turn away the large number of customers who come with Medicare.
This is also why Australia and Canada offer great models--they keep costs low by being the only player in the market. They reimburse just enough to make medicine an attractive career path, and no more. Healthcare is outstanding in those nations, without all the waste and excessive costs we have here.
Many Americans are allergic to anything that's called a tax, and we all pay dearly for that allergy.
Posted by Concerned, a resident of the Another Pleasanton neighborhood neighborhood, on Jun 9, 2011 at 5:31 pm
b - but it does work to pass costs directly onto consumers. Look at the Lasik example where insurance is not involved and yet prices have declined dramatically over the years due to basic market forces.
And remember way back when pre-insurance and pre-Medicare when important health care services (non siscretionary like Lasik) were cheaper?
I am not an expert and I for sure don't know the solution to the problem but I get this sinking feeling that Obamacare has only made things worse. I really wish the Democrats/Republicans would have compromised on this one.
Posted by b, a resident of the Another Pleasanton neighborhood neighborhood, on Jun 10, 2011 at 6:47 am
I was not advocating for passing costs on to consumers. I was merely responding to your point about consumers not being aware of the costs.
The solution is nationalized health insurance. Only the US Government has the bargaining power to drive the fat out of both the insurance model and the provider model. Capitalism is alive and well in both Canada and Australia, and healthcare and insurance are both desirable career paths in those nations. The difference is that they're not bankrupting sick people to protect corporate profits.
Obamacare will succeed to the extent that it will protect many more people. But if the frame is an industry overhaul, it will be measured a failure. The attempts at real reforms were washed out of the plan, unfortunately.
Posted by Concerned, a resident of the Another Pleasanton neighborhood neighborhood, on Jun 10, 2011 at 10:11 am
I'm referring to the general Lasik procedure that is as low at $500/eye these days. 10-15 years ago it was thousands of dollars higher.
If you trust in the pooling effect of single government purchasing of healthcare, can you help me understand why you trust that will happen in the US? Case in point, the Federal government has been trying to put a cap on medical fees for at least a decade and every year congress passes an exemption to not pose a cap. There is no political will to control costs. How will the future be any different?
Heck, Congress is putting in barriers to increasing competition - e.g. reimportation of cheaper drugs, barriers to lower cost services ...
Posted by get real, a resident of the Canyon Creek neighborhood, on Jun 10, 2011 at 11:32 am
Rasmussen is not a reputable pollster. It gets paid big bucks by Republican hacks and big wealth to post seriously skewed numbers that are used for propaganda purposes. Its numbers are consistently 10-12 points off the mark.
Posted by Really?, a resident of the Another Pleasanton neighborhood neighborhood, on Jun 10, 2011 at 12:18 pm
Wow - do they teach you this at Progressive School? Rule 1 - always undermine the other side and especially their sources? Rule 2 - Never debate the issue on its merits ...
Let's see what NYT has to say about Rasmussen. Not quite what you communicated above. They are as accurate as most other polls. See below:
In 2010, Nate Silver of the New York Times blog FiveThirtyEight wrote the article “Is Rasmussen Reports biased?”, in which he mostly defended Rasmussen from allegations of bias. . However, by later in the year, Rasmussen's polling results diverged notably from other mainstream pollsters, which Silver labeled a 'house effect.' He went on to explore other factors which may have explained the effect such as the use of a likely voter model, and claimed that Rasmussen conducted its polls in a way that excluded the majority of the population from answering.  Silver also criticized Rasmussen for often only polling races months before the election, which prevented them from having polls just before the election which could be assessed for accuracy. In response, he wrote that he was “looking appropriate ways to punish pollsters” like Rasmussen in his pollster rating models who don’t poll in the final days before an election. 
After Election night that year, Silver concluded that Rasmussen's polls were the least accurate of the major pollsters in 2010, having an average error of 5.8 points and a pro-Republican bias of 3.9 points according to Silver's model.  He singled out as an example the Hawaii Senate Race, which Rasmussen showed the incumbent 13 points ahead, where he in actuality won by 53 - a difference of 40 points, or "the largest error ever recorded in a general election in FiveThirtyEight’s database, which includes all polls conducted since 1998."
Posted by Stacey, a resident of the Amberwood/Wood Meadows neighborhood, on Jun 10, 2011 at 1:42 pm Stacey is a member (registered user) of PleasantonWeekly.com
I thought you had found a study that explains why Lasik is cheaper these days. It would indicate what had greater effect in the price drop: improved efficiencies in the technology, delivery, or price competition.
Posted by CancerMama, a resident of the Another Pleasanton neighborhood neighborhood, on Jun 11, 2011 at 9:24 am
@Stacey, I often agree with you, but I take it you've never dealt with a cancer diagnosis. Treatment can cost millions. I know: I'm dealing with it right now. So yes, some of us DO need more than $750K.