Affordable and Quality Health Care

[mike777]

Well, it's not just for the very poor. But largely I think there is room for discussion here. I believe that as things stand now, Medicaid is binary. There is a line. Beneath it you have Medicaid and it is very good. Above it, just a little above it, and it is gone. And someone at 141 % of the poverty line is going to have a seriously tough time affording unassisted coverage at anywhere near that level. I think, but I am not at all sure, that there is some middle spade where the kisd are still eligible for Medicaid even if the parents are above the line and not eligible.

 

But my general thrust is that we need to think through as a country just what seems reasonable and what we can afford.

 

I have often posted that I believe this country has been very good to me. I could cite many examples, but I'll skip that. I think it is good for everyone to help people do better. I suspect that many of my fellow citizens agree with this. Obama once addressed some of this, but very clumsily, with his "You didn't build that" . This was an insulting and divisive way to get at a point that I think has merit. We all gain if we help people do better. I favor taking this view seriously, and I think that it would have broad support if presented correctly. Health care is certainly a part of this.

 

Ken I don't thing the discussion is focused on what seems reasonable and what we can afford. Perhaps or not the discussion should be what you suggest but it is not.

 

the discussion starts health care is right; if you disagree you are evil and we can dismiss you.

the discussion starts with everyone and that means everyone is entitled to good quality health care...

[cherdano]

Ken. There are people out there who read the CBO report for you, and them write up summaries and explanations. They are called "journalists". You used to be able to buy their writeups in a bundle of

paper delivered to your door step every morning, combined with news reports, some entertainment stories or sports coverage. These days you can read their writeup essentially for free on your computer screen if you use a Web browser, the only cost being that they also automatically display some advertising content.

 

Let us know if you need help finding such writeups.

[billw55]

Ken. There are people out there who read the CBO report for you, and them write up summaries and explanations. They are called "journalists". You used to be able to buy their writeups in a bundle of

paper delivered to your door step every morning, combined with news reports, some entertainment stories or sports coverage. These days you can read their writeup essentially for free on your computer screen if you use a Web browser, the only cost being that they also automatically display some advertising content.

 

Let us know if you need help finding such writeups.

 

The problem, obviously, is that it is difficult to know which writeups to trust.

[Winstonm]

Ken I don't thing the discussion is focused on what seems reasonable and what we can afford. Perhaps or not the discussion should be what you suggest but it is not.

 

the discussion starts health care is right; if you disagree you are evil and we can dismiss you.

the discussion starts with everyone and that means everyone is entitled to good quality health care...

 

Mike, you seem to have a penchant for overstatement. The discussion is whether or not a basic minimum level of healthcare should be considered a right in a developed country such as the U.S.A.?

 

There is no judgement of evil for the opposition - judgement like that is reserved for the religious right. :P

 

So, with that out of the way, let me ask you, Mike: who in the U.S.A. do you believe is not entitled to a basic minimum level of healthcare?

[mike777]

Mike, you seem to have a penchant for overstatement. The discussion is whether or not a basic minimum level of healthcare should be considered a right in a developed country such as the U.S.A.?

 

There is no judgement of evil for the opposition - judgement like that is reserved for the religious right. :P

 

So, with that out of the way, let me ask you, Mike: who in the U.S.A. do you believe is not entitled to a basic minimum level of healthcare?

 

Winston a basic minimum level of health care is called good healthcare or do you consider it bad health care and just how do progressives view people who don't believe health care is a right and an entitlement ....your post supports my viewpoint more than you seem to realize

 

the discussion starts with your post...not with Ken's viewpoint...my point

 

I am happy to hear that you and other liberals don't view the denial of health care as evil or bad

 

 

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as for the CBO predictions...I have posted numerous pieces of evidence over the years on how their predictions are worthless, often worthless

[Winstonm]

Winston a basic minimum level of health care is called good healthcare or do you consider it bad health care and just how do progressives view people who don't believe health care is a right and an entitlement ....your post supports my viewpoint more than you seem to realize

 

the discussion starts with your post...not with Ken's viewpoint...my point

 

 

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as for the CBO predictions...I have posted numerous pieces of evidence over the years on how their predictions are worthless, often worthless

 

You didn't answer the question. Who is not entitled to basic healthcare?

 

I don't view "people" who disagree as either good or bad. I consider their arguments. I have not seen an argument that persuades me why everyone should not have some accepted minimum standard of healthcare.

 

I don't know about CBO being worthless - they are often inaccurate but usually get the basic direction right. That 14 million gained health coverage under the ACA instead of the 22 million the CBO projected doesn't mean their estimates are "worthless".

 

You tend to a binary viewpoint. Good/bad. Worth/Worthless. That's not a realistic viewpoint.

[PassedOut]

Winston a basic minimum level of health care is called good healthcare or do you consider it bad health care and just how do progressives view people who don't believe health care is a right and an entitlement ....your post supports my viewpoint more than you seem to realize

No, Winston's expressed viewpoint is quite different from your characterization of it.

 

the discussion starts with your post...not with Ken's viewpoint...my point

No, the discussion starts with your post in 2008.

 

as for the CBO predictions...I have posted numerous pieces of evidence over the years on how their predictions are worthless, often worthless

No, the CBO predictions are not worthless, even though sometimes not borne out -- as can happen with all serious economic predictions.

[rmnka447]

I worked in healthcare so I've seen some of this up close and personally. Prior to the ACA, hospital emergency rooms were the only places the working poor could go to seek care - this led to emergency rooms having to prioritize which patients to see first and led to long waits for the less emergent patients.

 

For the well-to-do, there is no reason they cannot continue as they have. There are doctors who have very private practices and they do not accept medicare or medicaid and limit the size of their practices.

 

You are right that supply and demand will take time to balance - and it will be a difficult adjustment. But something needs to be done to help hold down costs and get more people treated. Eliminating care in order to cut taxes for the wealthy has not been shown to be effective in generating jobs or economic growth, so why not admit that supply-side is not the sole answer but only a part of a greater economic system that is driven by demand, followed by supply-side savings that add to growth.

One of the big claims for ACA was that it would reduce emergency room visits thus savings lots of money expended for extremely expensive healthcare by getting people into more regular forms of healthcare delivery that are cheaper.

 

The following is an article I found that seems fairly balanced as it refers to several studies of emergency room data. It certainly shows that emergency room usage has not gone down with ACA.

 

http://www.politifact.com/truth-o-meter/statements/2017/mar/10/tom-price/hhs-chief-tom-price-correct-er-use-obamacare/

 

Uninsured visits to emergency rooms were down but they were offset by increased Medicaid and private insurance visits. So basically since Medicaid is essentially free to those enrolled in it, the public is still paying for those visits by the formerly uninsured except it's just coming out of a different bucket.

 

All I was saying in my original comments was that as you significantly increase the amount of people with real health care insurance, the total demand for healthcare being sought will significantly increase. You can't ever expect to reduce health care costs in that scenario unless you provide increased capacity to deliver health care. It's simple supply and demand. If you don't increase healthcare delivery capacity, then you'll drive up health care costs and create scarcity which results in rationing of those services and possibly even less quality of delivery. Ultimately, that will mean some people will have access denied or delayed a la the VA. And we know that has resulted in some veteran's deaths.

 

Simply providing insurance isn't a panacea. It has to be accompanied by a concomitant serious look at how to expand healthcare capacity. But that's not how the discussion is being framed.

[mike777]

One of the big claims for ACA was that it would reduce emergency room visits thus savings lots of money expended for extremely expensive healthcare by getting people into more regular forms of healthcare delivery that are cheaper.

 

The following is an article I found that seems fairly balanced as it refers to several studies of emergency room data. It certainly shows that emergency room usage has not gone down with ACA.

 

http://www.politifact.com/truth-o-meter/statements/2017/mar/10/tom-price/hhs-chief-tom-price-correct-er-use-obamacare/

 

Uninsured visits to emergency rooms were down but they were offset by increased Medicaid and private insurance visits. So basically since Medicaid is essentially free to those enrolled in it, the public is still paying for those visits by the formerly uninsured except it's just coming out of a different bucket.

 

All I was saying in my original comments was that as you significantly increase the amount of people with real health care insurance, the total demand for healthcare being sought will significantly increase. You can't ever expect to reduce health care costs in that scenario unless you provide increased capacity to deliver health care. It's simple supply and demand. If you don't increase healthcare delivery capacity, then you'll drive up health care costs and create scarcity which results in rationing of those services and possibly even less quality of delivery. Ultimately, that will mean some people will have access denied or delayed a la the VA. And we know that has resulted in some veteran's deaths.

 

Simply providing insurance isn't a panacea. It has to be accompanied by a concomitant serious look at how to expand healthcare capacity. But that's not how the discussion is being framed.

 

It should be noted that emergency room care is not the worst possible health care...it is the best, the best of the best health care in the history of health care. The docs and nurses are the best of the best

[cherdano]

The problem, obviously, is that it is difficult to know which writeups to trust.

No this is not difficult.

[mike777]

Speaking of Medicaid.

 

nbc news reports over 400 doctors in 30 states busted for 1.3 billion Medicaid fraud.

[Winstonm]

It should be noted that emergency room care is not the worst possible health care...it is the best, the best of the best health care in the history of health care. The docs and nurses are the best of the best

 

Are you a health care professional, Mike? Have you ever worked in an E.R.? I have. E.R. doctors are like any other doctors. They range from great to poor. Many are inexperienced. E.R. nurses tend to be adrenaline junkies who simply love the pace of E.R.

 

To say it is the best of the best is BS. Sorry.

[Winstonm]

One of the big claims for ACA was that it would reduce emergency room visits thus savings lots of money expended for extremely expensive healthcare by getting people into more regular forms of healthcare delivery that are cheaper.

 

The following is an article I found that seems fairly balanced as it refers to several studies of emergency room data. It certainly shows that emergency room usage has not gone down with ACA.

 

http://www.politifact.com/truth-o-meter/statements/2017/mar/10/tom-price/hhs-chief-tom-price-correct-er-use-obamacare/

 

Uninsured visits to emergency rooms were down but they were offset by increased Medicaid and private insurance visits. So basically since Medicaid is essentially free to those enrolled in it, the public is still paying for those visits by the formerly uninsured except it's just coming out of a different bucket.

 

All I was saying in my original comments was that as you significantly increase the amount of people with real health care insurance, the total demand for healthcare being sought will significantly increase. You can't ever expect to reduce health care costs in that scenario unless you provide increased capacity to deliver health care. It's simple supply and demand. If you don't increase healthcare delivery capacity, then you'll drive up health care costs and create scarcity which results in rationing of those services and possibly even less quality of delivery. Ultimately, that will mean some people will have access denied or delayed a la the VA. And we know that has resulted in some veteran's deaths.

 

Simply providing insurance isn't a panacea. It has to be accompanied by a concomitant serious look at how to expand healthcare capacity. But that's not how the discussion is being framed.

 

First, thank you for posting from a reasonable source. If you noticed, the general viewpoint was that ER use had gone up slightly since the ACA - but not from uninsured patients. There are many reasons from my experience why that could be so - a lot of it from either lack of knowledge or simply laziness about finding and using a primary care doctor.

 

Secondly, I am not a fan of the ACA - only in that it was the only thing that politically could be passed at the time. I think we will have to go to a single payer system in order to control costs.

[mike777]

Are you a health care professional, Mike? Have you ever worked in an E.R.? I have. E.R. doctors are like any other doctors. They range from great to poor. Many are inexperienced. E.R. nurses tend to be adrenaline junkies who simply love the pace of E.R.

 

To say it is the best of the best is BS. Sorry.

 

 

I will stand by post...ER doctors and nurses are the best of the best in the history of health care....it is not repeat not in any way minimum health care.

 

Sorry to hear in your experience ER docs and nurses are like any other doctors and nurses. Sorry to hear in your experience you found Many to be inexperienced or junkies. To answer your question, yes I have many close relatives and very close friends in the field. I would add that for most of my youth I and my family and our neighbors doc was the ER room....I grew up in the generation where the ER room was the family doc.

 

to say the least at my current age I seem to visit docs....dentists....eye docs...etc more in one year then I did in my first 21 years. thankfully....not the ER...yet

 

zzzzIt all makes me believe the stats that most of health care goes for paying for the last 6 months we are alive.

 

Perhaps if we all can die 7 months earlier we can cut health care costs 50%. :)

 

 

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Speaking of costs...the last few months yet again drive in point how we bring our family members to the doctor, etc and costs have never repeat never come up one time...AMAZING In an era where you hear that a simple bed pan can costs thousands or a bandaid or asprin....I can envision costs of a million bucks for who knows what..these docs are doing....

[kenberg]

Ken. There are people out there who read the CBO report for you, and them write up summaries and explanations. They are called "journalists". You used to be able to buy their writeups in a bundle of

paper delivered to your door step every morning, combined with news reports, some entertainment stories or sports coverage. These days you can read their writeup essentially for free on your computer screen if you use a Web browser, the only cost being that they also automatically display some advertising content.

 

Let us know if you need help finding such writeups.

 

True enough, but it puts one more intermediary into the mix. I found table 5 of the actual report to be of interest, for example, and this might or might not show up in a newspaper article.

 

Returning my general thoughts:

 

Going back to when the aca was first put through I have thought it important to distinguish between the parts where the exchanges and the complications that go with them were involved and the parts where the exchanges were not necessary. An increase, or a decrease, in Medicaid coverage does not have anything to do with exchanges, as near as I can see. When the aca first got going, the increase in the number of people receiving Medicaid was touted as one of its major successes. OK, but for that we did not need all the extra baggage of exchanges. And now, as 22m are going to lose coverage if the Senate plan goes through, I would like to know how this relates to exchanges, in particular I would like to know how much is simply a dramatic cut back in Medicaid.

 

Here is why I think this is important: There are issues involving how much the government should be assisting people, and there are issues involving the general administrative structure of doing it. Expanding or contracting Medicaid is largely linked to the first, the exchanges are linked to the second. Views on the first may not correlate closely with views on the second.

 

Quite possibly none of this matters since, as near as I can tell at present, there is very little interest in doing anything good anyway. The Senate/Presidential interest is in passing something, anything, it doesn't matter what it is, that can be sold as repeal and replace. So discussion of merit is beside the point. That's very too bad, but I am still interested in how much is a scaling back of Medicaid and how much is a redoing of the exchanges.

[kenberg]

On a different set of recent posts, in my experience emergency room care is a very very mixed bag. Very.

[mike777]

I found comments from renown British cardiac surgeon Stephen Westaby informative in this whole discussion regarding socialized medicine, minimum health care coverage and Medicaid budgets.

 

Britain's National Health Care service values saving money over saving lives.

NHS is reluctant to cover the costs of advanced interventions.

He discusses treatment delays and poor attention to best practices by the NHS

Medical Directors are intent on ensuring that "no one does anything new or interesting" (lets call that innovation or lack thereof)

[Winstonm]

On a different set of recent posts, in my experience emergency room care is a very very mixed bag. Very.

 

It is interesting that your experience and my experience is at odds with the poster who is selling ER as the best answer for healthcare.

[barmar]

Simply providing insurance isn't a panacea. It has to be accompanied by a concomitant serious look at how to expand healthcare capacity. But that's not how the discussion is being framed.

The ACA is clearly not a panacea, it's full of compromises that were necessary to get it passed. But it was a step in the right direction, with plans to implement other improvements like cost containment. The GOP is trying to go backwards, without replacing it with a better solution.

[RedSpawn]

The ACA is clearly not a panacea, it's full of compromises that were necessary to get it passed. But it was a step in the right direction, with plans to implement other improvements like cost containment. The GOP is trying to go backwards, without replacing it with a better solution.

The GOP is trying to rollback ACA so it can give tax breaks to the wealthy constituents before the 2018 midterm elections. There is a method to the madness.

[mike777]

The GOP is trying to rollback ACA so it can give tax breaks to the wealthy constituents before the 2018 midterm elections. There is a method to the madness.

 

Negative income tax or Universal Income anyone? :)

 

 

as for health care some version or form of medicare or Medicaid for everyone seems the pathway, We can deal with paying for it, fixing it, stopping fraud and waste and some form of tort reform for later.

 

As long as there are tests to perform to stop a lawsuit, patients refuse to ask the cost, we only ask if it hurts, docs will order it.

[ldrews]

Recent study/report on how US Health Care compares to other developed countries: http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/

[Winstonm]

Recent study/report on how US Health Care compares to other developed countries: http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/

 

This is good. Thanks for the post.

[ldrews]

So it appears that the Republican Senate couldn't get its act together, even to just repeal Obamacare. Just another indication of the lack of social consensus.

 

Obamacare will continue to be the law of the land for the foreseeable future. And it appears to be imploding. All of those people who now have individual/family coverage and can't afford the premiums, copays or deductibles. And all of those people who are eligible but cannot even get coverage because there are no insurers left in their area. Let us hope that not too many people get hurt.

[cherdano]

So it appears that the Republican Senate couldn't get its act together, even to just repeal Obamacare. Just another indication of the lack of social consensus.

To the contrary, it is a sign of a majority social consensus that the government should help its citizens to get healthcare.

 

Obamacare will continue to be the law of the land for the foreseeable future. And it appears to be imploding. All of those people who now have individual/family coverage and can't afford the premiums, copays or deductibles. And all of those people who are eligible but cannot even get coverage because there are no insurers left in their area. Let us hope that not too many people get hurt.

 

How, exactly, would they have been better off if one of the GOP repeal/replace/rexxxx bills had passed?