Maybe he was going to retire anyway and Bucc was the one who's making the correlation between that decision and Obamacare. I don't know. But IF the doctor is making an unethical money grab, and IF he's only in the position to do so because he has Obamacare as a scapegoat, AND if that type of moneygrab is widespread, then I don't see why that's not something we should be at least concerned about. Maybe the rest of Obamacare makes up for those setbacks, or maybe that type of behavior should be regulated or somehow mitigated. I just think we shouldn't disregard those indirect impacts as someone else's problem. Sometimes good policy causes indirect problems. Maybe the policy is so great it overcomes the problems, or maybe the policy can foresee and mitigate those problems.

Maybe this is all just because I've worked in criminal justice for so many years. I'm always concerned with the impact of the criminals and the assholes. Medicaid fraud is a huge issue. That doesn't mean we should disband medicaid. it does mean we should hire a few hundred more people to investigate and prosecute it. Even if the problem is someone else's doing. If medicaid fraud had no enforcement or prosecution mechanism, it would be a worse policy. Even if it's criminals that made it worse. Unethical doctors shouldn't be in a position to ruin Obamacare. If there's not that many of them, and it's not a problem, great. If there's a lot, then we have to regulate that behavior so Obamcare works as intended. We can't just say, "well, that's not Obamacare's fault, so we're not going to do anything about it."

That is a post-mortem detemination, after a project had been implemented. Only small portions of the ACA have been implemented to this point. We'd be a the point in an IT project where the equipment was being scoped, and there would be those opposed shouting "The StuxNet virus will bring down this system", when there aren't any Iranian centrifuges as part of the project. Later on another heretofore unknown virus may indeed bring the project down, but it wouldn't have been for reasons due to StuxNet.

Why not just blame the doctor who's taking the action instead of the policy? Because it's easier to blame something that's big and faceless?

Blame the doctor too but what does that accomplish? If enough doctors did this so that the American healthcare system is damaged (I haven no idea if that will happen), then it's an issue that should be addressed. It is a weakness of the policy. Not a moral weakness, but its a weakness that should be addressed and mitigated to the extent possible. The end-game of any policy should be actually benefiting people, not just coming up with a good theoretical idea.

How is this a weakness of policy?

This guy has a right to switch his business model and the only solution to that is forcing him to work, which I think we'd both be against. I question his excuse for doing this, but I don't think the excuse is the reason for his action. He wants some combination of fewer hours worked/more money and he has a right to make that choice.

I think your mistake is seeing the excuse for an action taken as the reason for the action.

I don't think he's taking it as the reason for the action. I think he's saying that if the excuse is what gives him the gumption to do it, then the action happens because the excuse is there.

Right, and we don't know for sure either way. Maybe he would have done it anyway but he's just using Obamacare as an excuse because he doesn't have the balls to tell his patients the truth and have them be mad at him. Net impact the effectiveness of policy as a whole would be almost zero in that instance, except maybe that a bunch of other doctors would be encouraged to do the same thing, but even in that case, maybe it's not a big deal. But, if the policy encouraged many doctors to do something they wouldn't otherwise do, to the detriment of their patients, then that would be an issue with the policy worth addressing or mitigating. it wouldn't really matter to the spurned patients, or the healthcare system as a whole, whether Obamacare directly influenced a sincere response, or whether the doctor was full of shit.

But I don't think the policy provided anything more than a post-hoc excuse. It's hard for me to imagine this guy looking for less hours/more money but deciding not to because he didn't have a national healthcare law to blame it on. He'd blame it on his previous carrier or Medicare or frivolous lawsuits.

Exactly.

The other, more potentially problematic place this has come up in the past is how Obamacare might impact the behavior of small business owners. There's been expressed concern that smaller business might lay people off or move them to part-time to get under the 50 full-time employee threshold. No doubt, there will be business owners who really don't HAVE to take those actions, but they'll just take the opportunity to lay people off in a manner where they can deflect the blame somewhere else. Should policymakers be concerned with that potential response, and should they account for it (even if they just ultimately conclude, "that will probably happen, but its a necessary evil to get where we want to go"), try to mitigate it, or should they disregard it because it's indirect, and possibly insincere or unethical?

Then it wouldn't be a problem. But just for fun, what if he hypothetically did see this as a great opportunity to scale down much more dramatically than he otherwise would have? You wouldn't see that as an issue with Obamacare anyway, right? So really it's an irrelevant distinction. You only want to consider direct, intended impacts of the policy in evaluating it. Which pretty much guarantees that it will be a success in your mind.

The later - disregard it due to its insincerity and make that known.

I don't think he'd say, "Ah, I'd like to cut back and get more money, but there's no health care reform, so forget it." But, I could see him thinking it's not worth pissing off 2400 patients for, or that he won't get enough people to pay this VIP rate to make it worthwhile, then deciding that he can do it because Obamacare is a politically charged item that makes a good scapegoat, and could convince more of his patients to accept his VIP rate instead of telling him to screw off.

That part about making that known is actually not disregarding it, I think you're advocating a information-based approach. That maybe if you can convince enough people that businesses who react in a certain way are full of shit, you can undercut the motivation of that action some. It won't eliminate it all, but it would be one rational response. So I think you're agreeing with me. it might be a tough sell because people have their heels dug in so much on this stuff, but I guarantee part of Obama's strategy is getting accurate information to the public in a way they can access it. That is, guess what, a response to the danger and reality of indirect negative consequences to the policy. Without such communication, the policy as a whole would be a worse policy, even if the harm the communication seeks to mitigate is someone else's fault in a direct sense. Such communication and information only matters at all if there's some concern about mis-information.

This is much different because it clearly connects to policy. Making a hard cutoff and then having people slide under the cutoff is clearly connected. Having a guy switch private insurance carriers and then blame it on a law that makes no requirements on who he works with clearly isn't connected.

There's no point in wasting time imagining what BS complaints people will make while writing laws. It's hard enough trying to foresee the substantive problems.

In other words, there are enough problems with health care and this law that we don't need to make up imagined bullshit scenarios and attribute fake problems to the law.

I just can't figure out how the hell the Democrats didn't see what a mess they were going to make on the employment front when this law was implemented (if it ever does get implemented). The unemployment and part-time employment figures are especially telling.

WOLF: Obamacare's panicked Democrats - Washington Times

At least we're getting reasoned analysis here:


I wonder if the fugitive slave law is #2?

Did someone really just link to the Washington Times?

I'm really surprised at the damage VA Gov. McDonnell has done to himself with the gifts given to him and family members. I really thought he was a strong candidate for Pres in 2016, but with even Cuccinelli backing away from him, he looks done.

Being out of Richmond, I've missed this story. What's up?

SI

This is a pretty good summary,

http://www.foxnews.com/politics/2013...tting-145k-in/

Basically, he and his family were given a lot of gifts by a wealthy businessman and the gifts weren't disclosed. The state and feds are investigating.

Washington Times = Moonie paper. Not worth the paper it's printed on.

MBBF

Alright, the point still remains. Ignore the obvious bias of the Times. How in the hell did the Democrats (or any lawmakers who were involved with crafting the bill for that matter) not see this underemployment debacle coming when they wrote it?

Actually, the point doesn't remain. You think underemployment is new? Kelly Services is the 2nd largest employer in the US. That didn't happen overnight. The trend of part time employment began decades ago. As such, there's no "debacle". Not to mention that the statistics quoted are outright fabrications. They can't even bother to make their numbers add up to the correct number of new jobs added in June! As I said, it's not worth the paper it's printed on.

The only way to prevent stuff like this is to entirely disassociate health care from employment (something I advocate). Medicare for all is just fine by me.

THOSE ARE JUST FANCY LOANS!

What is the "correct answer" to the political strawman equivalent of "does your mother know you pick your nose?"

SI

Too bad that even if this passes the Senate, it has no chance in the House.

Warren Bill To Bring Back Glass-Steagall - Business Insider

I'd be curious to see the actual details. But, yeah, DOA

SI

I'll admit to having to read the article to remember what G-S actually covered.

One bit I particularly enjoyed was this naivety

Umm ... no, that's not the focus of our financial system, nor has it ever been. That would be more aptly described as "people with money making a profit off people who want money".

Congrats to fiscal conservatives in the GOP. Yesterday they passed @200 billion in farm subsidies and 0 for food stamps.

Because we can't afford food stamps.

No big deal Obama has a veto and all democrats would have to oppose this so you have nothing to worry about.

It won't pass, but it deserves to pass. Simply put, if G-S were still in play, we wouldn't have had the housing/financial crisis that we did. It simply wouldn't have been possible given the way the financial markets would have been structured.

Too bad the dumbass Republicans can't learn from two major recessions/depressions something that the Democrats learned back in 1933.

Agreed.

Clinton's signature and a host of other Democrat ones were on GLB. Obama's fiscal policy is owned by Wall Street. Democrats are not blameless in this one.

SI

Also true.

So, for the State Senate abortion bill debate going on tonight in Austin, concealed handguns are allowed to be brought in, but tampons aren't.

I'm sure if you get a concealed carry permit for your tampons, they would let you bring them inside. Otherwise you should just use pads. :D

They weren't letting pads in either, believe it or not.

Um... wha?

SI

Only a good guy with a tampon can stop a bad guy with a tampon - The Maddow Blog

It sounds reasonable. I mean, what are the chances someone is going to throw a gun at a state representative?

A supporter but a couple things go through my mind - can these insurers really make money from these low rates and what do their plans cover or not cover. Still, a good trend.

Health Plan Cost for New Yorkers Set to Fall 50% - NYTimes.com

good direction regardless. It might not look like this in a straight line and itll be fits, starts and changes but the direction is good. Im sure that this is occurring in spite of Obama, not because of him.

Their chart is comparing the most expensive current plan with the most expensive health exchange plans. If you look at the cheapest plans, those rates are going to be significantly higher. Of course, the benefits might be better for the bronze plans. People are still going to have to pay more for them.

From article

Individual mandate at work.


That's a system that's clearly broken.

They're obviously waiting for the 2013 Steam Holiday Sale to buy.

I'll trade you my "new liver" card for your "coverage for my prescription drugs" card!

SI

Only in Kansas can a person this lacking be elected governor and later given a federal government post.......

Sebelius: Obamacare Opponents Like Those Who Opposed Civil Rights | CNS News

cnsnews.com...

wasnt there a thread where people got hammered for something like the Washington Post or something I dunno.

Washington Times. Regardless, the quote is there for all to read. It's a ridiculous statement born of political bias.

The Washington Post is an actual paper ;)

SI

I'd click on that link, but I fear my browser might get dumber just by visiting that site.

Are you using Chrome?

Let me help you then by posting her comments directly without any editorial content. Your browser is a genius compared to this woman.

New York State is a bit of a strange case, because its insurance plans have already been higher, and already had a lot of policies in place that ACA requires.

I like those comments by Sebelius! Fantastic linkage of the two - conservatives have been doing shit like that for years, it's nice when the liberals can fight back with it.

It's a silly thing to hang your hat on, if you're in favor of O-Care. Only 17,000 people had individual insurance in New York, and this "silver-equivalent" cost well over $10,000 per year because New York already couldn't deny coverage for pre-existing conditions. So no healthy person would have considered this plan. Individuals simply don't buy health insurance in New York.

So O-Care forces them to buy it, and the insurance companies in the state figure about 500,000 individuals will, and so it drops the cost considerably because that group will be healthier on average.

It won't work this way in most states. The cost-driver is forcing companies to cover pre-existing conditions. Which is a nice feature, of course, but you have to pay a lot for it. It easily doubles the cost for healthy people.

Meanwhile, businesses are reducing their workers to below 30 hours per week in order to keep them from the insurance requirement. So this drops a lot of workers into the exchange pool. Is this a good thing? Not really, because while that will help the exchange offer better rates, these are poorer workers on average and Medicaid will have to pick up that cost under the plan. This Medicaid expansion was never budgeted as part of O-Care.

Where are you seeing evidence of this happening?

Yeah - heaven forbid insurance companies cover pre-existing conditions. We have some nerve asking them to do that!!

WTF?!??!!?!?

Jim's post doesn't appear edited so I am not sure where your moral outrage is coming from. He said that pre-existing conditions is a nice feature of the plan but also quite costly. It's easier to pretend he said something different I guess.

Are you saying being healthy is a static state? Thus, healthy people will never reap their benefits?

If you're healthy, you can just wait to buy insurance until you need it, and pay the cheaper penalty instead. I guess there's still some risk, because of enrollment periods, but it's a much smaller risk than going without insurance previously. I'm sure they expect a lot of younger and healthier people to go that route, and they'll at least be getting something from them now, where before they weren't contributing at all. I just hope we don't feel the need to bail those people out who had the opportunity for insurance, choose instead to gamble with taxpayer money, and then ended up having to pay for a broken leg out of pocket (i.e., getting billed but not actually paying) until their insurance comes online the next enrollment period, however long that is.

I think we do, if we're also telling them how much we'll pay for it, and that's not enough. Do we expect auto insurers to pay for cars already totaled before we bought the policy? Do we expect home insurers to pay for issues that happened in houses before we bought the policy? Can I buy life insurance on relatives who are already dead?

It doesn't matter. You can walk into an ER with no insurance, no ability to pay, nothing and get treated. That money comes from the people who are able to pay in terms of higher costs. This notion that we have had a free market healthcare system over the last few decades is silly. It's socialized medicine, just implemented in the most retarded possible way ever.

That's making the assumption that there aren't going to be cheaper plans made available, which is already happening. Like I've mentioned before, there is competition now for the insurance companies in the form of the penalty. If they want to get the business of the people and not let that money go to the government in the form of the penalty, then I can see barebones plans being offered at or just below the penalty cost.

Not at all. People will pay the penalties at first, though I think it's quite likely that part of the plan will be delayed as well because the Democrats don't want to lose the Senate next year.

We talk about "gambling" with respect to health insurance. And that's definitely a valid way to look at it. But O-Care forces healthy people to accept a sucker's bet by expanding the pool. So the gambling analogy, while, valid, invokes a response that a smart gambler would decide to avoid the insurance entirely.

This is a complicated issue in that denying health care to the people who most need it is not a great solution.

We desperately need health care reform. But creating more winners and losers (winners being those with jobs with big corporations or the government) only creates more inequities. True health care reform would lower costs and eliminate the link between jobs and insurance.

Sure, and there's no reason to buy anything more than the bare bones plan, because if you need more coverage, you can always just join a better plan if you develop some chronic illness or something. And that's not necessarily a bad thing, as long as it involves more healthy people putting SOMETHING into the system.

Edit: I think it would be cheaper and more effective if the government just provided healthcare directly to more people, and maybe, changing insurance into something that I don't think is even technically "insurance" anymore is a step in that direction. There are just so many middle men. It's pretty tough for a government to spend the most per-capita on healthcare in the world AND deliver once of the worst products value-wise, but somehow, we've pulled that off.

This is only in a handful of states where regulations eliminated high-deductible plans. Being self-employed and living in a state where high-deductible plans are still legal (below "Bronze" - more like "Tin"), my plan has risen about 50% in the last year or so as the O-Care regulations are phased in.

My "Tin" plan made sense, as I am relatively healthy and a high deductible is a good financial decision (I don't go bankrupt if I get into a car crash or develop cancer, both of which have an extremely low chance of happening in the next 20 years).

That's called "single-payer", and is how most of the rest of the industrialized world handles it.

Well, that's the far end of that road, but there could also be a role for private health care companies in the U.S., for those who can afford them and want enhanced care and fancier doctors and hospitals. Our top-level health care is pretty amazing, if you can afford it. But for those who can't afford it, or only want the minimum coverage, and where the government is going to be footing the bill, we don't need the middle man of insurance companies. We don't even need private healthcare providers. All of that just adds to the bottom line. That's why I always thought the goal should be, "get everybody access to health care", instead of "get everybody access to insurance!". Who gives a shit if they have insurance, the important thing is that people don't lose their homes and life savings if they get sick.

So single-payer then?

Sounds good to me - sign me up.

I'm torn on this. It leads inevitably to rationing. But if we consider health care to be a right, and we don't even penalize people for poor decisions (I should lose some weight myself), where else does this lead us?

I can see a solution, though, where the quality of health care declines considerably if we go single-payer. Long waits, massive retirements, and really good doctors setting up shop in nearby countries. Odds are you wouldn't even see a doctor anymore unless you were in a hospital. Most everything would be handled by NPs.

Well, the status quo is unacceptable, and O-Care only exacerbates the problems.

That's also how most everyone in the industrialized world handles it. There are private options everywhere if you want the bells and whistles.

What kind of rationing are we talking about?

I know there is a lot of talk of the fat person who has heart problems, but I really think it evens out. The highest costs come at end-of-life, particularly for the very elderly. And the guy who has a heart attack at 60 isn't collecting 30 years of social security.

Yes, if you want to pay above and beyond the government care, this is still available in those countries. There are still those market forces. However, it creates a baseline so they aren't doing huge chunks of care in really inefficient emergency rooms and paying for it by bankrupting people.

SI

It's a really small % of the healthcare services provided though, isn't it? I'd imagine America would have to have a much larger private sector.

If we're going to try to compare health care systems, though, I wonder - who else has an Obamacare-like system?

The glib answers are "Massachusetts" or "no one because it's stupid without a public option". Honest answer: not sure.

SI

To the first part, we were talking to our tour guide in Moscow about hers. You can pay extra to do certain treatments that are not covered, to get out of the "rationing", I guess if you want to call it that. There are also doctors who will essentially see you after hours to make some extra cash- kindof like the VIP groups here that started the discussion with Bucc earlier only it's not their "day job" (in that you still have to take standard jobs but can make some extra bucks on the side).

SI

I don't think anyone has a system like ours because it is really stupid.

Come on. Lots of industrialized countries have single payer and there are still doctors.

Maybe it will be more like the private/public education split.

Wow, you actually fell for the same extremist black/white rhetoric that you accuse the other side of doing? Perhaps you think it is ok not to reverse the growing Washington habit of lumping into a giant bill lots of otherwise unrelated programs, thus making it more difficult to shine sunlight on each individual program for needed reform.

Splitting the farm bill will make food stamps more transparent and encourage Congress to have an open and honest discussion with the American people about the program - something that also needs to happen with other entitlement programs. Regrettably, the House rushed through the farm-only portion, meaning that Americans did not get an honest debate over the shallow-loss crop insurance program and other forms of corporate welfare hidden in the measure. (snipped from an op/ed).

What countries are these doctors running off to? Mexico?

Canada, obviously.

Or maybe Hawaii.

The reason they are combined is because without it, urban reps won't vote for farm subsidies and rural reps won't vote for food stamps. Neither would get through on their own so they work together to actually get something done for a change.

There is no more wasteful set of programs in D.C. than farm subsidies. Passing those while refusing to discuss foodstamps because they are too expensive is appalling hypocrisy.

edit: And the House still hasn't begun work on a foodstamp bill.

I made it this far before dying of laughter.

I agree, some of the biggest lobbies for the food stamp program are Kraft, walmart and coke. Historicaly, food stamp recipients don't vote or donate much, why would politicans make legislation for them? The same people who got Reagan to call ketchup a vegetable and Obama pizza a veg, will certainly get their precious bad-food stamp bill passed.

Good point, nowhere to run.

I have this perception that Kraft makes every processed food there is and Walmart sells all the processed food sold in this country.

Not to mention that doctors do get paid well in other countries. Specialists in some of these "socialist" countries make more than they do here in the U.S.

If we're worried about a doctor shortage, I'd start with the policies the AMA has helped push through to limit the number of new doctors in this country, along with limit what others are allowed to do. We don't have a free market as it is when a group has limited the supply to alter the true market.

Kraft is run by a bunch of dirty bastards.

I got the letter from my doctor today. Basically, with 3000 patients as the lone doctor of his practice, he could not spend the time needed for each patient (there's a shortage of family physicians here) and would only see that get worse (with more being eligible), not to mention getting harder to make a timely appointment. He needed to drastically reduce the number of patients and he couldn't tell which of his patients to stop coming or do it alphabetical (only accept last names A-C), so he is going to let the market decide. It's the old adage of cost, quality and time - pick two.

I can relate as when I saw an orthopedic doctor for my foot/surgery a few years ago, he was the type of doctor that saw 225-250 patients per day. Awful service and poor quality post-op care.

He should contact the AMA which I'm sure he is a member of and advise them to stop limiting the number of doctors in this country. That way he won't run into these kind of problems. They are the ones that have not let the market decide.

I guess it's possible if those "socialist" states pay for the schooling too.

My wife just emailed our congressman regarding this problem and how it is impacting her program. Last year, 1,100 US medical graduates were not able to find residency programs within the US because Medicare cuts have limited the number of slots available. The congressman responded with a canned "Help me defeat Obamacare!" reply.