Affordable Health Care act - have you read it?
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The Affordable Health Care act does nothing to lower the cost of healthcare per capita in the U.S. It remains to be seen if it doesn't increase healthcare costs hidden in added taxes over time.
"Nothing" is too strong a word. I'd agree it probably doesn't do enough, but it doesn't do nothing to lower future costs.
For example (carriage returns added):The ACA also includes a number of provisions to address the problem of rapidly rising
health costs in the United States.
The first is the Cadillac tax, which should reduce the incidence of very generous health insurance plans and thereby excessive demand for health care.
The second is new health insurance “exchanges,” state-organized marketplaces where non-group and small group insurers must compete in a transparent marketplace that is designed to maximize competition and lower premiums.
The third is the Independent Payment Advisory Board, which is charged with re-designing reimbursement of providers under Medicare to lower costs and ensure quality; this board’s recommendations are subject to an up or down vote by Congress.
The fourth is a new research institute — with sizeable funding — to study the comparative effectiveness of medical treatments, in an effort to understand which treatments are most cost effective.
Finally, there are many pilot programs examining alternative organizations and reimbursement structures for medical providers in an attempt to finds ways to undo the pernicious incentives of our retrospective “fee-for-service” medical reimbursement system.
There are dozens of other provisions in the ACA that are not reviewed here as well, on topics ranging from incentives for improving the quality of health care, to a new social insurance program for long-term care, to incentives to increase primary care provision, and so on.
http://economics.mit.edu/files/6829
THE IMPACTS OF THE AFFORDABLE CARE ACT: HOW REASONABLE ARE THE PROJECTIONS?
Jonathan Gruber
Working Paper 17168
Who is paying for all of these boards, programs, research, and pilot programs? Nevermind, I think I know the answer. So, healthcare might end up a little cheaper but my taxes will have to go up to get there?0 -
If someone that has the means to get healthcare but chooses not to get it gets sick what is my responsibility in that? You seem to think society is to blame if that person goes bankrupt or worse due to their choose.
Since you just answered me with another question, I'll take that as "they can die, for all I care." And I don't think society is to blame, I just think that since we're in a position to make sure that nobody has to make that decision, we should, especially with the drag healthcare is on the economy.
Also, it'd be nice if you posted references to back up your agruments.
Your arguments are based on some fantasy that doesn't exist. The Affordable Health Care Act which this discussion is about and which is the law of the land in the US will not make sure everyone has health insurance.
http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act
"CBO originally estimated the legislation will reduce the number of uninsured residents by 30 million, leaving 25 million uninsured residents in 2019 after the bill's provisions have all taken effect."
In addition, healthcare costs (Health Insurance cost + Treatment cost) will increase despite the Affordable Health Care Act. In fact, the following reference say healthcare costs will increase BECAUSE of the Affordable Health Care Act. The US will continue to have the highest per capita cost for health care in the world and the gap will be even wider.
http://www.forbes.com/sites/sallypipes/2013/01/07/obamacare-guarantees-higher-health-insurance-premiums-3000-higher/
http://www.forbes.com/sites/chrisconover/2012/11/27/young-people-under-obamacare-cash-cow-for-older-workers/
http://online.wsj.com/article/SB10001424127887323936804578227890968100984.html
http://www.cnbc.com/id/100340096
So not only will 25 million people still be at risk of going bankrupt due to an emergency medical issue, they will go bankrupt quicker because it will cost more!
Feel free to rebut with references ;p.0 -
This is the historical debt outstanding as per the US Treasury (which I linked to earlier):
09/30/2002 6,228,235,965,597.16
09/30/2001 5,807,463,412,200.06
09/30/2000 5,674,178,209,886.86
09/30/1999 5,656,270,901,615.43
09/30/1998 5,526,193,008,897.62
09/30/1997 5,413,146,011,397.34
09/30/1996 5,224,810,939,135.73
09/29/1995 4,973,982,900,709.39
09/30/1994 4,692,749,910,013.32
09/30/1993 4,411,488,883,139.38
09/30/1992 4,064,620,655,521.66
09/30/1991 3,665,303,351,697.03
09/28/1990 3,233,313,451,777.25
09/29/1989 2,857,430,960,187.32
So unless my head is totally full of snot, as it is anyway, then it could stand to reason that our debt has gone up and is continuing to go up thus continually in a deficit.
Man, we have gone off in a tangent.
I'm anal enough with numbers that this was driving me crazy. You are accurately quoting numbers showing that the gross debt when up, even in years when we were running a total surplus, an on-budget surplus, and an off-budget surplus. It's taken me a while but I think I finally understand . . . and it convinces me that the gross debt is the wrong thing to be looking at.
For example, take 2000, the year with the highest surplus.
Here are the numbers (all numbers in billions and all taken from the "Table 1.1" spreadsheet here: http://www.whitehouse.gov/omb/budget/Historicals/ ).
Total Receipts 2,025,191
Total Outlays 1,788,950
Total Surplus or Deficit (–) 236,241
On-budget Receipts 1,544,605
On-budget Outlays 1,458,185
On-budget Surplus or Deficit (–) 86,422
Off-budget Receipts 480,584
Off-budget Outlays 330,765
Off-budge Surplus or Deficit (–) 149,819
All those numbers are consistent. Whether we're talking about Total, On-Budget, or Off-Budget, the surplus/deficit is equal to receipts minus outlays. And whether we're talking about receipts, outlays, or surplus/deficit, total is equal to on-budget plus off-budget.
So if the total, on-budget, and off-budget were all in surplus (receipts greater than outlays), why did the gross debt go from $5,656 million at the end of FY1999 to $5,674 billion at the end of FY2000?
Crazy as it sounds, it's because running a surplus on Social Security and Medicare increases the gross debt. This is because the extra payroll taxes above what is needed for benefits this year are invested in a treasury bonds, increasing the gross debt.
This is what they are trying to get at here:The annual change in debt is not equal to the "total deficit" typically reported in the media. Social Security payroll taxes and benefit payments, along with the net balance of the U.S. Postal Service, are considered "off-budget", while most other expenditure and receipt categories are considered "on-budget." The total federal deficit is the sum of the on-budget deficit (or surplus) and the off-budget deficit (or surplus). Since FY1960, the federal government has run on-budget deficits except for FY1999 and FY2000, and total federal deficits except in FY1969 and FY1998–FY2001.[40]
In large part because of Social Security surpluses, the total deficit is smaller than the on-budget deficit. The surplus of Social Security payroll taxes over benefit payments is spent by the government for other purposes. However, the government credits the Social Security Trust fund for the surplus amount, adding to the "intragovernmental debt." The total federal debt is divided into "intragovernmental debt" and "debt held by the public." In other words, spending the "off budget" Social Security surplus adds to the total national debt (by increasing the intragovernmental debt) while the surplus reduces the "total" deficit reported in the media.
http://en.wikipedia.org/wiki/United_States_public_debt#Calculating_the_annual_change_in_debt
This is of course exactly what you started off complaining about. And I agree with you on that.
What I disagree with is any statement that there were not "real" surpluses under the last few years of the Clinton presidency. With or without Social Security and Medicare taxes, the government took in more than it payed out in FY1999 and FY2000. The "gross debt" only increased because of the bizarre way that the trust funds are accounted for in the "gross debt."0 -
Your arguments are based on some fantasy that doesn't exist. The Affordable Health Care Act which this discussion is about and which is the law of the land in the US will not make sure everyone has health insurance.
http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act
"CBO originally estimated the legislation will reduce the number of uninsured residents by 30 million, leaving 25 million uninsured residents in 2019 after the bill's provisions have all taken effect."
In addition, healthcare costs (Health Insurance cost + Treatment cost) will increase despite the Affordable Health Care Act. In fact, the following reference say healthcare costs will increase BECAUSE of the Affordable Health Care Act. The US will continue to have the highest per capita cost for health care in the world and the gap will be even wider.
http://www.forbes.com/sites/sallypipes/2013/01/07/obamacare-guarantees-higher-health-insurance-premiums-3000-higher/
http://www.forbes.com/sites/chrisconover/2012/11/27/young-people-under-obamacare-cash-cow-for-older-workers/
http://online.wsj.com/article/SB10001424127887323936804578227890968100984.html
http://www.cnbc.com/id/100340096
So not only will 25 million people still be at risk of going bankrupt due to an emergency medical issue, they will go bankrupt quicker because it will cost more!
Feel free to rebut with references ;p.
I guess I should have stayed more on topic then, because my point was advocating single-payer. We'll see what really happens.
ETA: I concede that I haven't read enough to know the costs of the bill in it's current form.0 -
Your arguments are based on some fantasy that doesn't exist. The Affordable Health Care Act which this discussion is about and which is the law of the land in the US will not make sure everyone has health insurance.
http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act
"CBO originally estimated the legislation will reduce the number of uninsured residents by 30 million, leaving 25 million uninsured residents in 2019 after the bill's provisions have all taken effect."
In addition, healthcare costs (Health Insurance cost + Treatment cost) will increase despite the Affordable Health Care Act. In fact, the following reference say healthcare costs will increase BECAUSE of the Affordable Health Care Act. The US will continue to have the highest per capita cost for health care in the world and the gap will be even wider.
http://www.forbes.com/sites/sallypipes/2013/01/07/obamacare-guarantees-higher-health-insurance-premiums-3000-higher/
http://www.forbes.com/sites/chrisconover/2012/11/27/young-people-under-obamacare-cash-cow-for-older-workers/
http://online.wsj.com/article/SB10001424127887323936804578227890968100984.html
http://www.cnbc.com/id/100340096
So not only will 25 million people still be at risk of going bankrupt due to an emergency medical issue, they will go bankrupt quicker because it will cost more!
Feel free to rebut with references ;p.
I guess I should have stayed more on topic then, because my point was advocating single-payer. We'll see what really happens.
ETA: I concede that I haven't read enough to know the costs of the bill in it's current form.
If we were just discussing a single payer system similar to what Canada has I could probably live with that. I may not like it but I could live with it.
Another example of the insanity happening in the US.
http://www.cbsnews.com/8301-204_162-57507297/cure-for-womans-scorpion-sting-costs-$83k/0 -
Marcie Edmonds provided a copy of her bill to The Arizona Republic last week that showed Chandler Regional Medical Center charged her $39,652 per dose of Anascorp, a scorpion antivenom approved by the Food and Drug Administration last summer. She received two doses to treat her symptoms during a three-hour hospital stay in June following a bark scorpion sting.
. . . .
The Arizona Republic reported last year about the pricey markup Arizona hospitals were charging for the antivenom made in Mexico. Pharmacies in Mexico charge about $100 per dose.
After the Food and Drug Administration approved the drug last year, Tennessee-based Rare Disease Therapeutics sold the drug to a distributor for $3,500 per dose. The distributor charged hospitals about $3,780 per dose.
Read more: http://www.azcentral.com/business/articles/20120905bill-scorpion-bite-reduced.html#ixzz2NdWqcgW1
I expect that this wouldn't be an issue if she had gone to a hospital in her insurance network. The insurance company would have a negotiated price that they were willing to pay the hospital and it would be a lot closer to $3,780 than $39,652. Or the insurance company would refuse to pay for the antivenom and the angry articles would be about the heartless insurance company instead of the greedy hospital.
Price transparency would help quite a bit, especially for non-time-critical or elective care. I don't think it's reasonable for a woman with a scorpion bite to shop around for the hospital with the lowest anti-venom price or do a detailed cost/benefit analysis while she's laying in the ER.0 -
Here is a pretty decent article on costs.
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/15/why-an-mri-costs-1080-in-america-and-280-in-france/The 2010 health-reform law does little to directly address prices. It includes provisions forcing hospitals to publish their prices, which would bring more transparency to this issue, and it gives lawmakers more tools and more information they could use to address prices at some future date. The hope is that by gathering more data to find out which treatments truly work, the federal government will eventually be able to set prices based on the value of treatments, which would be easier than simply setting lower prices across-the-board. But this is, for the most part, a fight the bill ducked, which is part of the reason that even its most committed defenders don’t think we’ll be paying anything like what they’re paying in other countries anytime soon.0 -
Here is a pretty decent article on costs.
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/15/why-an-mri-costs-1080-in-america-and-280-in-france/The 2010 health-reform law does little to directly address prices. It includes provisions forcing hospitals to publish their prices, which would bring more transparency to this issue, and it gives lawmakers more tools and more information they could use to address prices at some future date. The hope is that by gathering more data to find out which treatments truly work, the federal government will eventually be able to set prices based on the value of treatments, which would be easier than simply setting lower prices across-the-board. But this is, for the most part, a fight the bill ducked, which is part of the reason that even its most committed defenders don’t think we’ll be paying anything like what they’re paying in other countries anytime soon.
There is no question that the ACA is somewhat of a Rube Goldberg device--given all of the major constituencies involved, and the political realities, it's not surprising.
I do not claim for one second to be an expert on the details of the bill. However, whenever I read a new article about it, I am always impressed at how detailed it is, and how thoroughly it attempts to address many of the issues involved in this complicated issue.
A recent story by Sarah Kliff--who is kind of the point person for health care for the Washington Post, as I understand it--suggests that the costs for Medicare have dramatically slowed--and that could substantially change the outlook for the future.
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/15/want-to-debate-medicare-costs-you-need-to-see-this-chart-first/
Right now, no one knows exactly why the costs have slowed, or if this is a long-term change. But positive news is positive news.0 -
An article on health related bankruptcies....
http://articles.cnn.com/2009-06-05/health/bankruptcy.medical.bills_1_medical-bills-bankruptcies-health-insurance/2?_s=PM:HEALTHThey concluded that 62.1 percent of the bankruptcies were medically related because the individuals either had more than $5,000 (or 10 percent of their pretax income) in medical bills, mortgaged their home to pay for medical bills, or lost significant income due to an illness. On average, medically bankrupt families had $17,943 in out-of-pocket expenses, including $26,971 for those who lacked insurance and $17,749 who had insurance at some point.
Overall, three-quarters of the people with a medically-related bankruptcy had health insurance, they say.
The Affordable Health Care act is the law of the land in the US. I think a lot of supporters are going to be very disappointed with how little it does to help solve the the health care issues this country faces.0 -
And I think many of its detractors will be disappointed at how little it changes their personal healthcare.0
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From Azdak's link:The White House is out Friday with its annual Economic Report of the President. It contains this chart that shows Medicare as a percent of the economy if it grows on pace with prior projections — or if it grows at the same rate as it has since 2009. The difference is very stark.
The reason for that yawning difference: Health-care costs growth has seen a steep decline over the past few years. Instead of outpacing the rest of the economy, it has grown at the exact same rate.
If that cost growth persists, it could make all the difference for Medicare: The entitlement program would, by 2085, make up 4 percent of the economy instead of the previously projected 7 percent.
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/15/want-to-debate-medicare-costs-you-need-to-see-this-chart-first/0 -
And I think many of its detractors will be disappointed at how little it changes their personal healthcare.
If my health insurance costs go up then my healthcare costs go up. If my health insurance costs double like some are saying it will, I would say that is a significant change and not a little change.0 -
The some who say such nonsense are the very people I'm talking about.0
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The some who say such nonsense are the very people I'm talking about.
http://www.forbes.com/sites/sallypipes/2013/01/07/obamacare-guarantees-higher-health-insurance-premiums-3000-higher/At the end of 2012, Mark Bertolini, the CEO of Aetna, the third-largest health insurer in the country, warned that many consumers would face “premium rate shock” with the advent of Obamacare’s major insurance regulations in 2014. He predicted that unsubsidized premiums would rise 20 to 50 percent, on average.
For some people, premiums would double. “We’re going to see some markets go up as much as 100 percent,” Bertolini told Bloomberg News.In California, Blue Shield has asked regulators to approve premium increases of up to 20 percent. Obamacare’s new regulations were a factor in the request.When Obamacare was making its way through Congress, the Congressional Budget Office warned that premiums in the individual market would increase by 10-13 percent.
These are not detractors. These are the actual entities that set the prices and the CBO. I appreciate that you like the direction this country is going with the addition of the Affordable Health Care act but it might be time to take off the blinders to the negative impact it will have on many people.0 -
I don't think people realize how much this is going to cost. And worse, how much healthcare will decline for the chronically ill. Think end stage renal disease...0
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Failure actually...
Besides, people were treated in ERs already...i just hope we'll have the same setup like they have in CR. Public hospitals for the poor. Private hospitals for those of us who want real healthcare.0 -
Yes, Sally Pipes is the very type of person I'm talking about. She's been advocating less government involvement in healthcare for years. I think she will be shocked when her dire predictions don't come true. Or would be shocked if she were honest.0
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From the Forbes Sally Pipes column:In other words, health insurance costs are going up. And for that, you can thank Obamacare.
Healthcare insurance costs have been increasing faster than inflation for decades. Even Pipes can't blame that on Obamacare. She is probably right that they will continue to increase, but wrong to blame it all on Obamacare. The question is whether Obamacare will bend the curve. The data so far shows that it might well.
http://en.wikipedia.org/wiki/Health_care_in_the_United_States#Impact_on_U.S._economic_productivity0
