Affordable Care Act (AKA Obamacare)

[Diddy]

I really have not heard anything proposed outside the ACA to single payer spectrum that would do anything to correct these problems.

Because such proposals don't exist. Skepticism of government is fine for what it's worth, but gets nowhere.

We're going to have to pay for people's bad health decisions one way or another whether through insurance premiums, taxes, or higher prices. Better to try and handle this rationally than to use personal indignity as an excuse to bury our heads in the sand.

But what gets lost is that a single payer system actually keeps people healthier because people go for preventative care and checkups because they have access to affordable preventative care and checkups. They don't wait until something becomes an issue. Fixing a problem is almost always more expensive than keeping that problem from happening.

This preventative component needs to be factored in as a cost savings against the current system.

Probably covered previously but with the ACA is there any incentive for preventive treatment?

[33anda3rd]

All industries at that scale will work with you. An ER bill runs more than most peoples' cars nowadays, and can run higher than homes in some instances. Just as the auto industry doesn't require you to buy a car with cash and will finance your payment, and just as the home industry will let you take 30 years to pay for a house, the healthcare industry will gladly charge you interest and $10/month so you pay $5000 instead of the $4000 bill.

[Diddy]

All industries at that scale will work with you. An ER bill runs more than most peoples' cars nowadays, and can run higher than homes in some instances. Just as the auto industry doesn't require you to buy a car with cash and will finance your payment, and just as the home industry will let you take 30 years to pay for a house, the healthcare industry will gladly charge you interest and $10/month so you pay $5000 instead of the $4000 bill.

I don't think its legal for them to charge interest.

[Joe Shlabotnik]

I really have not heard anything proposed outside the ACA to single payer spectrum that would do anything to correct these problems.

Because such proposals don't exist. Skepticism of government is fine for what it's worth, but gets nowhere.

We're going to have to pay for people's bad health decisions one way or another whether through insurance premiums, taxes, or higher prices. Better to try and handle this rationally than to use personal indignity as an excuse to bury our heads in the sand.

But what gets lost is that a single payer system actually keeps people healthier because people go for preventative care and checkups because they have access to affordable preventative care and checkups. They don't wait until something becomes an issue. Fixing a problem is almost always more expensive than keeping that problem from happening.

This preventative component needs to be factored in as a cost savings against the current system.

Probably covered previously but with the ACA is there any incentive for preventive treatment?

No, there isn't. As I've said, I am strongly single payer and see ACA as a step in that direction but not the answer.

But, there IS an experiment being run in Maryland that is showing the difference between the prevalent fee-for-service model and a model where good health is made the incentive.

NPR story where I heard about it.

Wikipedia entry on Maryland Hospital Payment System - skip to the '2014 revisions'.

Think for a moment about what would happen if you upended the whole system of financial incentives for hospitals.

What if you said goodbye to what's known as fee-for-service, where hospitals are paid for each procedure, each visit to the emergency room, each overnight stay? What if, instead, hospitals got a fixed pot of money for the whole year, no matter how many people came through the door?

The plan hinged on ending fee-for-service payments to hospitals and moving to something called global budgeting. Instead of being paid per admission, hospitals would get a set amount of money for the entire year for patient care, regardless of how many MRI tests, ER visits or hip replacements there were.

At the end of the year, if there was money left over, the hospitals could keep it.

"Whereas before, hospitals could really only make money by keeping their beds filled, now they can actually do better if their community is healthier and they're preventing admissions," Sharfstein says.

Medicare saw savings the first year and Maryland hospitals reported better outcomes on lower expenditures. Win-win. The experiment has another 3 years to run.

[Arthur Dent]

Martin O'Malley!

[pioneer98]

The thing I keep coming back to is the Postal Service. It is a great example of a business-like government entity that has very little corruption and is highly efficient. It just shows that it's not impossible for government to do something pretty efficiently. I have a small side business where I have to ship small things often. I can ship pretty much anywhere in the continental US for between $2.50 and $3.00. To ship the same thing via UPS would cost like ~$12. Granted, UPS guarantees delivery within 2 days. It's a nice option to have UPS if I need something urgent, but it's not a "need" since the $3 USPS option still gets it there within 3 to 5 days usually.

Health insurance truly is a "need". If rich people want some other more premium option for health care, I'm sure that would still be available one way or another.

You are probably more knowledgeable than I am, but I don't think the postal service is very efficient.

https://www.washingtonpost.com/news/fed ... y-efforts/

Savings from efficiency efforts and increased revenues from some categories of business were not enough to prevent the U.S. Postal Service from posting a loss of $1.9 billion in its second fiscal quarter, postal officials announced Friday.

The report, which follows a previous loss of $1.3 billion in the first quarter, spurred officials to once again call on Congress to enact changes the Postal Service has proposed, including switching to five-day delivery of mail while continuing six-day delivery of packages, and savings on employee health insurance, retirement and other costs.

The fact they are losing money is a reflection on Congress and not on the USPS.

I could list a million examples but I'll just give you one. I have a small side business and I ship hundreds of packages per year. They are small so they cost like $2.50 to $3.00 to ship with USPS. The same package would cost $12 to $13 to ship with UPS. Granted, UPS would guarantee delivery in 2 days. But for $9 or $10, I can wait an extra day or two. The things I sell only cost $20 to $50. If I had to charge my customers $12 to ship things, that's a big hit. I would not sell as many things, for sure. And that's just domestic. International, I once shipped something to Australia via USPS for $12. UPS would have cost like $40.

USPS is an example where the government option is much cheaper for customers like me than the private sector options are. This is because UPS must make a profit, and USPS is not supposed to make a profit. I honestly think something like this could be done with respect to health care. Actually, it is being done like this in other countries, which is why they spend so much less on health care than we do.

[Diddy]

Think for a moment about what would happen if you upended the whole system of financial incentives for hospitals.

What if you said goodbye to what's known as fee-for-service, where hospitals are paid for each procedure, each visit to the emergency room, each overnight stay? What if, instead, hospitals got a fixed pot of money for the whole year, no matter how many people came through the door?

The plan hinged on ending fee-for-service payments to hospitals and moving to something called global budgeting. Instead of being paid per admission, hospitals would get a set amount of money for the entire year for patient care, regardless of how many MRI tests, ER visits or hip replacements there were.

That's somewhat ironic to me. This is coming from my dad and grandpa who use to serve on a hospital board. Patients use to be charged a fixed amount per night. This amount covered everthing for that days stay in the hospital. Insurance companies started demanding itemized billing so they knew where everything was going. When they started assigning itemized costs to services their hospital bills literally trippled, or worse, overnight.

[Tim]

The thing I keep coming back to is the Postal Service. It is a great example of a business-like government entity that has very little corruption and is highly efficient. It just shows that it's not impossible for government to do something pretty efficiently. I have a small side business where I have to ship small things often. I can ship pretty much anywhere in the continental US for between $2.50 and $3.00. To ship the same thing via UPS would cost like ~$12. Granted, UPS guarantees delivery within 2 days. It's a nice option to have UPS if I need something urgent, but it's not a "need" since the $3 USPS option still gets it there within 3 to 5 days usually.

Health insurance truly is a "need". If rich people want some other more premium option for health care, I'm sure that would still be available one way or another.

You are probably more knowledgeable than I am, but I don't think the postal service is very efficient.

https://www.washingtonpost.com/news/fed ... y-efforts/

Savings from efficiency efforts and increased revenues from some categories of business were not enough to prevent the U.S. Postal Service from posting a loss of $1.9 billion in its second fiscal quarter, postal officials announced Friday.

The report, which follows a previous loss of $1.3 billion in the first quarter, spurred officials to once again call on Congress to enact changes the Postal Service has proposed, including switching to five-day delivery of mail while continuing six-day delivery of packages, and savings on employee health insurance, retirement and other costs.

The fact they are losing money is a reflection on Congress and not on the USPS.

I could list a million examples but I'll just give you one. I have a small side business and I ship hundreds of packages per year. They are small so they cost like $2.50 to $3.00 to ship with USPS. The same package would cost $12 to $13 to ship with UPS. Granted, UPS would guarantee delivery in 2 days. But for $9 or $10, I can wait an extra day or two. The things I sell only cost $20 to $50. If I had to charge my customers $12 to ship things, that's a big hit. I would not sell as many things, for sure. And that's just domestic. International, I once shipped something to Australia via USPS for $12. UPS would have cost like $40.

USPS is an example where the government option is much cheaper for customers like me than the private sector options are. This is because UPS must make a profit, and USPS is not supposed to make a profit. I honestly think something like this could be done with respect to health care. Actually, it is being done like this in other countries, which is why they spend so much less on health care than we do.

I have no doubt that shipping something to Australia for $12 is a good deal for you. But who else ends up footing that bill? You think $12 covers that cost?

[pioneer98]

The thing I keep coming back to is the Postal Service. It is a great example of a business-like government entity that has very little corruption and is highly efficient. It just shows that it's not impossible for government to do something pretty efficiently. I have a small side business where I have to ship small things often. I can ship pretty much anywhere in the continental US for between $2.50 and $3.00. To ship the same thing via UPS would cost like ~$12. Granted, UPS guarantees delivery within 2 days. It's a nice option to have UPS if I need something urgent, but it's not a "need" since the $3 USPS option still gets it there within 3 to 5 days usually.

Health insurance truly is a "need". If rich people want some other more premium option for health care, I'm sure that would still be available one way or another.

Isn't the USPS hemorrhaging money?

Congress won't let them raise their prices.

Also, Congress passed a law forcing them to pre-pay all of their pension and health care (there's that thing again) liabilities. They are the only entity, public or private, that has this requirement. Yep, not even other government entities have to do this.

[Diddy]

The thing I keep coming back to is the Postal Service. It is a great example of a business-like government entity that has very little corruption and is highly efficient. It just shows that it's not impossible for government to do something pretty efficiently. I have a small side business where I have to ship small things often. I can ship pretty much anywhere in the continental US for between $2.50 and $3.00. To ship the same thing via UPS would cost like ~$12. Granted, UPS guarantees delivery within 2 days. It's a nice option to have UPS if I need something urgent, but it's not a "need" since the $3 USPS option still gets it there within 3 to 5 days usually.

Health insurance truly is a "need". If rich people want some other more premium option for health care, I'm sure that would still be available one way or another.

You are probably more knowledgeable than I am, but I don't think the postal service is very efficient.

https://www.washingtonpost.com/news/fed ... y-efforts/

Savings from efficiency efforts and increased revenues from some categories of business were not enough to prevent the U.S. Postal Service from posting a loss of $1.9 billion in its second fiscal quarter, postal officials announced Friday.

The report, which follows a previous loss of $1.3 billion in the first quarter, spurred officials to once again call on Congress to enact changes the Postal Service has proposed, including switching to five-day delivery of mail while continuing six-day delivery of packages, and savings on employee health insurance, retirement and other costs.

The fact they are losing money is a reflection on Congress and not on the USPS.

I could list a million examples but I'll just give you one. I have a small side business and I ship hundreds of packages per year. They are small so they cost like $2.50 to $3.00 to ship with USPS. The same package would cost $12 to $13 to ship with UPS. Granted, UPS would guarantee delivery in 2 days. But for $9 or $10, I can wait an extra day or two. The things I sell only cost $20 to $50. If I had to charge my customers $12 to ship things, that's a big hit. I would not sell as many things, for sure. And that's just domestic. International, I once shipped something to Australia via USPS for $12. UPS would have cost like $40.

USPS is an example where the government option is much cheaper for customers like me than the private sector options are. This is because UPS must make a profit, and USPS is not supposed to make a profit. I honestly think something like this could be done with respect to health care. Actually, it is being done like this in other countries, which is why they spend so much less on health care than we do.

I can't make a positive out if a system that loses billions delivering, if my mailbox is average, 90% junk mail.