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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 22 to 46 of 52. Go back in thread:
Posted by jane d on November 8, 2016, at 6:36:56
In reply to Re: Obamacare and medicare Vs private + more, posted by Phillipa on November 7, 2016, at 17:52:42
> Not sure if this link will work or not but this just arrived in my subscriptions to newsletters. Hoping it works. ACA is what is spoken or with others in title. Interesting Phillipa
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> http://www.berkeleywellness.com/healthy-community/health-care-policy/article/americas-not-so-great-health-care-system?&ic=610Hi Phillipa,
Interesting article. I read it a little differently than you did. It seems to me to be only indirectly about the ACA. The problems it talks about mostly predate the ACA or are outside of it. The comparison of costs in 2013 in the US vs the rest of the world are from before the act was fully in effect. And the outrage of medicare not being allowed to negotiate drug prices has nothing to do with the act at all.
One thing I hadn't realized is that we still had policies out there that were not required to comply with the ACA. I need to look up just which parts they are allowed to ignore.
In another post you mentioned knowing people who had lost jobs due to illness. Unfortunately that does happen. Someday I'd like to see medical coverage totally separated from employment. As long as employers are footing the bill they are motivated to get rid of anyone they think may cost them more either because they got sick or just because they are older and some kid in human resources thinks they will get sick soon.
I'm glad you can get doctors if you want them under medicare. I think medicare is one thing we've done right as a country.
Posted by jane d on November 8, 2016, at 6:46:40
In reply to Re: Obamacare and medicare Vs private + more, posted by Christ_empowered on November 7, 2016, at 18:59:48
> docs in other countries don't make as much as docs here in the US. Many of our docs now come from overseas and/or get training overseas.
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> I think a public option would fix a lot of this hot mess. Plus, we're more than a little bit behind the rest of the 21st century, affluent, developed world in having universal health care. I have a friend...he's from the Netherlands. They have universal health care. They have private insurance options, too. His mother's insurance covers her botox. I guess the private coverage is for higher end stuff? I dunno...
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> ObamaCare is a mess, but the system before was worse for a lot of people (most people?). A public option is the best idea, but with health care largely a for profit enterprise in the US (especially mental health), how's that going to happen? Money talk$Hi CE,
I was a fan of the public option too. I wonder if there is any way to get there from now. Or if we should.
It may be time to start talking about what kind of fixes we need and which of those we can really get instead of just fighting to keep the ACA from being totally destroyed.
Jane
Posted by jane d on November 8, 2016, at 6:58:50
In reply to Re: ACA » jane d, posted by Tabitha on November 7, 2016, at 13:59:53
I'm not trying to ignore you Tabitha or Baseball. I just had nothing to add to or dispute in either of your posts.
And to Scott and everyone else who would rather it stayed totally non political. I understand but I think that polite discussion of why the issues at stake are important to us is part of what the entire process is about. And in some ways you all are as much my community as the people who live next door. I certainly share a hugely important part of my life with you (even if I wish we'd all been spared that).
Posted by Phillipa on November 8, 2016, at 8:48:49
In reply to Re: ACA, posted by jane d on November 8, 2016, at 6:58:50
Jane there you have it. It is really our ability to negotiate the medication prices with the drug companies. Yes a lot to fix out there and agree that employment and medical care should remain separate. And so far medicaire is what keeps me from ending up with bills that I couldn't even imagine paying. Nice to have a civil conversation too. Phillipa
Posted by baseball55 on November 8, 2016, at 19:26:13
In reply to Re: Obamacare and medicare Vs private + more » Christ_empowered, posted by Phillipa on November 7, 2016, at 19:54:09
> It's a mess all over the world from what overseas friends write me. Evidently Sweden is #1 but their tax rate is extremely high. Disability insurance I would guess for a lot with mental illness and don't like this term as it's an illness like any other one like appendicitis, Mental health is no longer a separate entity. Phillipa
The World Health Organization ranks France #1, but Sweden is close behind. The US ranks #37 in access and outcomes.
Yes, taxes are higher in Europe, but consider this. You pay more taxes but you don't have to pay for:
health insurance or health care
college education
child care in the first 6-12 months after birth
In addition, you get fully paid parental leave for 6-12 months after a birth
Unemployment benefits that replace 80% of wages for 1-2 years (in the US , unemployment replaces 40% on average, lasts for 6 months and, because of onerous eligibility criteria, only 1/2 of the unemployed receive benefits)
Public pensions that replace 75% of wages (SS only about 40% on average).
I could go on. But higher taxes mean lower out-of-pocket spending for a variety of things.
Posted by Lamdage22 on November 9, 2016, at 13:12:19
In reply to Re: Obamacare and medicare Vs private + more, posted by baseball55 on November 8, 2016, at 19:26:13
you do pay for healthcare according to your income
Posted by linkadge on November 9, 2016, at 19:45:38
In reply to Re: Obamacare and medicare Vs private + more, posted by Lamdage22 on November 9, 2016, at 13:12:19
The "Canadian System" is a joke. I have several cavities which I don't fill as I would be paying 100% out of pocket. Also, I pay 100% for my medication (much of which I don't fill as I have to pay for it).
Obamacare simply takes health care dollars from one group, extracts its "overhead costs" and redistributes a small portion to the less fortunate. Sure, some are healthier, but the system is much sicker overall.
Nothing is free.
Linkadge
Posted by Lamdage22 on November 10, 2016, at 3:06:20
In reply to Re: Obamacare and medicare Vs private + more, posted by linkadge on November 9, 2016, at 19:45:38
there is so much more support for the mentally ill in germany which is one of the reasons why i am staying.
Posted by baseball55 on November 10, 2016, at 18:37:25
In reply to Re: Obamacare and medicare Vs private + more, posted by linkadge on November 9, 2016, at 19:45:38
> The "Canadian System" is a joke. I have several cavities which I don't fill as I would be paying 100% out of pocket. Also, I pay 100% for my medication (much of which I don't fill as I have to pay for it).
Canada is a disappointment. They have great emergency care but long waits for elective and non-urgent procedures. No dental. No free drugs, though the prices are negotiated and are much lower than in the US. Canada doesn't fund their system as well as the UK, France, Germany, Japan, others.
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> Obamacare simply takes health care dollars from one group, extracts its "overhead costs" and redistributes a small portion to the less fortunate. Sure, some are healthier, but the system is much sicker overall.
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I don't know what this means. That everyone pays in but sick people generate most of the costs? Isn't that true in any system? That's the nature of health insurance, whether public or private. Or do you mean something else?
Also, as far as redistributing a "small portion", the ACA did limit how much insurance companies could use on overhead and profits. I think it's 15%, which is still too much. A public option could outperform private insurance due to low overhead, which is why the insurance companies opposed it when the act was being negotiated.
> Nothing is free.
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Posted by linkadge on November 11, 2016, at 19:44:05
In reply to Re: Obamacare and medicare Vs private + more, posted by baseball55 on November 10, 2016, at 18:37:25
Canadian drugs aren't always cheaper than US drugs. Last time I was on generic Prozac (2010) it was over $50 for one month at Walmart Canada, yet under $10 at Walmart US.
>I don't know what this means. That everyone pays >in but sick people generate most of the costs? >Isn't that true in any system?
What I mean is that (in many ways) you need to make the middle class sicker, in order to make the lower class less sick. The rising deductibles under Obamacare means that many in the middle class forgoe medicines and treatments which were once possible for them. I don't believe this is ethical (although, on the surface it pretends to be), especially since only a portion of that which is taken, is redistributed.
>That's the nature of health insurance, whether >public or private. Or do you mean something else?
>Also, as far as redistributing a "small >portion", the ACA did limit how much insurance >companies could use on overhead and profits.Let me use an analogy:
Democrats would think it is fair to take one year of life from 50 individuals, in order to add 42.5 years of life to an individual who would die younger (I.e. 50 years - 15% = 42.5 years 'redistributed'). In reality, however, the *total* cost of the 'redistribution' is likely much higher than 15%.
Obamacare does not add to the 'net health' of the system. When something is 'free' and delivered without individual accountability, it becomes abused and it hence inherently wasteful.
Linakdge
Posted by baseball55 on November 12, 2016, at 19:23:47
In reply to Re: Obamacare and medicare Vs private + more, posted by linkadge on November 11, 2016, at 19:44:05
> What I mean is that (in many ways) you need to make the middle class sicker, in order to make the lower class less sick. The rising deductibles under Obamacare means that many in the middle class forgoe medicines and treatments which were once possible for them. I don't believe this is ethical (although, on the surface it pretends to be), especially since only a portion of that which is taken, is redistributed.
What you don't understand about the US health care system is that all of the people buying insurance on the exchanges didn't have ANY insurance before. So they are not forgoing treatments "once possible for them." Also, the ACA subsidizes, pretty heavily, premiums for people with incomes up to 4x the US poverty line - about $90,000 for a family of 4. You seem to think the ACA is only for those with low incomes, but that is not true at all. And what do you mean -being taken and redistributed - taken by whom, redistributed to whom
The 15% I mentioned is the maximum allowed insurance companies for profits, administration and overhead. It is too much, but less than it used to be. And it was the Republicans and insurance companies who nixed a public insurance choice, which would have had low overhead (Medicare, the public program for the elderly, has an overhead rate of 4%)
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> Let me use an analogy:
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> Democrats would think it is fair to take one year of life from 50 individuals, in order to add 42.5 years of life to an individual who would die younger (I.e. 50 years - 15% = 42.5 years 'redistributed'). In reality, however, the *total* cost of the 'redistribution' is likely much higher than 15%.
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> Obamacare does not add to the 'net health' of the system. When something is 'free' and delivered without individual accountability, it becomes abused and it hence inherently wasteful.
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> I don't know what you mean about democrats believing in comparing years of life. In the US, it's typically conservatives, not liberals, who want cost-benefit analyses done for environmental rules. No such analysis is done for health care.I don't agree that things that are free are abused. Do people break their legs in France because it's free to get it set? Or suffer depression in Canada because it's free to visit a psychiatrist? Are you mentally ill because it's free to be so in Canada?
And, in any case, you seem not to understand the US system. People have high co-pays and deductibles, including the vast majority who have their insurance through work. Americans are very big on cost-shifting, so that people become more "responsible consumers" and shop around for lower cost providers. But let me ask you - if you had blinding headaches and your doctor prescribed an MRI, would you spend a week calling around trying to find the lowest cost MRI provider? (Assuming you could get a straight answer about the cost, which you probably could not.)
I really don't know what you're talking about.
And, just for some non-medical examples. Do people swim more when the public pool is free and thus "abuse" the free pool? Do people in Europe and Canada and Japan go to college because it's free or very cheap and "abuse" the cheap higher education? Do parents in the US and most other developed countries "abuse" the free K-12 education system by sending their kids to school? Or abuse free fire protection by setting their homes on fire?
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Posted by Phillipa on November 12, 2016, at 19:54:04
In reply to Re: Obamacare and medicare Vs private + more, posted by baseball55 on November 12, 2016, at 19:23:47
Sorry this is so untrue. Of the people I know and talk to around town those that were very sick had their private healthcare cancelled by their insurance companies. Were forced into Obama care . And since they can no longer pay the premiums which rise every year they are forgoing insurance and would rather pay the penalty. And not talking of mental health issures. Talking of people with heart disease and cancer. And as far as employers paying for insurance many now hire people, with the incentive of working 90 days first and when the 90 days is up they get laid off. And the others the lower income. So many that I know that live in doublewides since living in country now are without insurance. I am lucky to own a new real house on a .65 acre of land. This area is just being built up as land is disappearing. But even more lucky to have Medicare & supplemental USAA as husband's Dad was in the Military. All illness is not psychiatric? Don't you know anyone who mentally is fine but has cancer? So many die of cancer and have the funds to pay cash for treatment. And in NC alone 3 out of the 5 companies that provided the ACA have pulled out. United Healthcare is just one of them. Phillipa
Posted by linkadge on November 12, 2016, at 20:04:56
In reply to Re: Obamacare and medicare Vs private + more, posted by baseball55 on November 12, 2016, at 19:23:47
>What you don't understand about the US health >care system is that all of the people buying >insurance on the exchanges didn't have ANY >insurance before. So they are not forgoing >
>treatments "once possible for them."I totally understand this.
What you don't understand is that many middle class people already had health insurance, and now they're paying more (for less coverage) in order to cover people who previously couldn't afford it, didn't qualify, or both.
Nothing is magical about it. Money is taken, and a portion is redistributed. Some people have better coverage, others have it much worse.
The 'net health' of Americans is not improving.
Fox news explains this well. Apparently CNN has not.
Linkadge
Posted by baseball55 on November 12, 2016, at 20:17:48
In reply to Re: Obamacare and medicare Vs private + more, posted by linkadge on November 12, 2016, at 20:04:56
So you get your info from Fox News. 'nough said.
I don't watch CNN or any TV news for that matter. I am an economist and one of my fields is health care. So I get my news from professionals in the field, some who support ACA, some who don't but all of whom reason by actual data and careful analysis.
Your contention that funds are being redistributed from the middle class to the poor shows you understand nothing about the actual US health care system, before and after the ACA, Phillipa's anecdotes notwithstanding.
> Fox news explains this well. Apparently CNN has not. >
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Posted by Phillipa on November 12, 2016, at 20:28:51
In reply to Re: Obamacare and medicare Vs private + more, posted by baseball55 on November 12, 2016, at 20:17:48
Being a retired RN I subscribe to a lot of RN & doctor sites and medical professionals know the ACA isn't working. So many doctors were going to retire if Trump hadn't won. The RN's, Pharmacists, Other health care professionals also can't wait for the ACA to be fixed so to speak. So far Trump is keeping the insurance through parents till age 26, and keep that you may have pre-existing conditions still covered. Two excellent things to remain. Phillipa
Posted by linkadge on November 13, 2016, at 7:17:22
In reply to Re: Obamacare and medicare Vs private + more, posted by baseball55 on November 12, 2016, at 20:17:48
>So I get my news from professionals in the field, >some who support ACA, some who don't but all of >whom reason by actual data and careful analysis.
>Your contention that funds are being
>redistributed from the middle class to the poor
>shows you understand nothing about the actual US
>health care system, before and after the ACA, Phillipa's anecdotes notwithstanding.My background is in mathematical analysis and optimization. For an economist, one would *expect* a solid background in mathematics. However, your statements clearly show an ignorance of basic mathematical principles.
The "redistribution" is an analogy for what is actually occurring.
You seem to think that money comes from nowhere in order to provide the less fortunate with "free health care".
What Phillipa has described is not the exception, it is appearing to be the rule. Those who had insurance *are* receiving a lower quality of coverage and / or higher premiums and deductibles in order to pay for those who were previously uninsured. This is actuarial science.
Call it what you will. This is the redistribution.
Linkadge
Posted by linkadge on November 13, 2016, at 7:19:30
In reply to Re: Obamacare and medicare Vs private + more » baseball55, posted by Phillipa on November 12, 2016, at 20:28:51
Yeah, thank goodness Trump got in.
We don't need 4 more years of Keynesian socialist Econ 101.
Linkadge
Posted by Phillipa on November 13, 2016, at 9:00:21
In reply to Re: Obamacare and medicare Vs private + more » Phillipa, posted by linkadge on November 13, 2016, at 7:19:30
Link I know hoping to see some changes in favor of the middle class again so they can obtain insurance. So many have lost theirs and just can't afford the current system. So glad you have the knowledge of math I don't have to present. How are you? Phillipa
Posted by linkadge on November 13, 2016, at 12:56:20
In reply to Re: Obamacare and medicare Vs private + more » linkadge, posted by Phillipa on November 13, 2016, at 9:00:21
I'm doing fairly well. How about yourself?
Linkadge
Posted by Phillipa on November 13, 2016, at 17:44:24
In reply to Re: Obamacare and medicare Vs private + more, posted by linkadge on November 13, 2016, at 12:56:20
Link good to hear. You have always been such a great resource. Other than getting old doing as well as expected. Thanks for asking. Phillipa
Posted by pontormo on November 15, 2016, at 17:11:08
In reply to Re: Obamacare and medicare Vs private + more » baseball55, posted by Phillipa on November 12, 2016, at 20:28:51
He's not keeping anything so far-- he's talking. Talking is a lot different from keeping.
Anyway, what's being promoted is Paul Ryan's jettisoning of the ACA and the current medicare system, and substiuting a voucher system and private insurers for medicare. Based on Ryan's general aproach to social programs, I can assure you the vouchers will not cover much in the way of care. This will include medicare, as I said-- so you may be less happy that Trump was elected as things unfold than you are now.
As may many of the people who voted for him.
Posted by Phillipa on November 15, 2016, at 19:56:33
In reply to Re: Obamacare and medicare Vs private + more, posted by pontormo on November 15, 2016, at 17:11:08
As of now I am pleased. Just had the 3D mammogram free for medicaire. So planning on this system for now. Phillipa
Posted by Phillipa on November 15, 2016, at 22:44:51
In reply to Re: Obamacare and medicare Vs private + more, posted by pontormo on November 15, 2016, at 17:11:08
Nothing happening to Medicaire. The Wealthy could be effected though. So no worries here. Phlllipa
http://time.com/money/4517168/2017-medicare-premiums-could-jump-20/
Posted by Zyprexa on November 16, 2016, at 6:02:13
In reply to Re: Obamacare and medicare Vs private + more, posted by baseball55 on November 12, 2016, at 19:23:47
I agree. I used to live in Canada and did not abuse the health care. Infact the health care abused me! They kept trowing me in the mental hospital and giving me ECTs for a month, against my will. Just cause I wouldn't take my meds.
Posted by Christ_empowered on November 16, 2016, at 7:17:18
In reply to Re: Obamacare and medicare Vs private + more » baseball55, posted by Zyprexa on November 16, 2016, at 6:02:13
hey zyprexa. I'm sorry about the involuntary hospitalization and forced ECT. I was given ECT against my will, too, and that's traumatizing. Not to mention that it knocked points off my IQ that I've only recently (miraculously) recovered.
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