I wish they would do something about the cost. The only long-term hope I have is if all those uninsured stop going to emergency rooms and start going to actual doctors (because they all have real coverage now, right?) maybe it will drop hospital costs some.

But until they address cost, things will just keep getting worse.

Man...I need about 6-12 months off, but then it's time for some new republican straw poll debate hilarity. Rick Santorum teaching us about the female anatomy. Michele Bachmann double fisting those fictitious job creators. Chris Christie lathering on Nuru gel and giving Israel a sliding massage. It's going to be fucking awesome.

I think it's much more complex than just going to actual doctors. For example, Medicare-the white elephant in the room-spent 25% of all its cost on people in the last year of their lives.

Not a glowing reaction from the stock market either on the EU front.

Maybe we can start with a "death incentive" (tax breaks to your grandkids or something if you decline expensive treatment), and then gradually move into the "death panels".

I was laughing hard until I got to the bolded part, not laughing now. That's just taking it way to far, you can't drop a mental image into my brain like that. Not cool at all.

Death panels. Otherwise known as The Insurance Companies.

Wouldn't it be "Otherwise known as Medicare"? :D

On a more serious note, it's a problem that has to get fixed, somehow, someway. It's a ticking time bomb that is going to grow and grow worse.

Anyone know how the other countries with universal health care handles this? Although Obama doesn't want to admit it and obviously there aren't death panels per the GOP, there has to be some sort of "rationing"?

About the costs - it has to be a coordinated effort on Providers, Insurers, Pharma and Government to lower costs somehow. I do not believe free market will make this happen without some sort of significant push from Government (e.g. gas mileage would not have progressed as well as it has without government mandate).

Well, here we already have rationing. It's just done at the offices of Anthem and United Health Care saying "no, you don't need that treatment to live", saying dialysis is covered but a $X00K kidney transplant is not.

SI

In England if you are on the National Healthcare plan providers will not go to extrodinary life saving measures for certain illness/age groups. Don't know how well that would go over here.

Of course Canada taxes the hell out of booze and cigarettes, we could do that and add legalization of marijuana to the equation and tax that a ton as well to help subsidize costs.

Okay guys, lets get it done. Obviously a deal won't get signed before the deadline and it will need to get pushed again (with some reassuring words from both parties). Can't we just say this is the last extension and just do it?

I don't think Obama has a clear mandate on this and the GOP obviously doesn't. Everything has to be on the table and lets make this big enough to really make a difference long term. The wars are winding down and the economy is recovering ...

Boehner wants 'bridge' to avoid 'fiscal cliff,' with eyes on 'major' deal in 2013 | Fox News

...meanwhile, Mitch McConnell said that his new number one priority was to get reelected. Oh, and that Obama was still a failure and that if he wanted anything done Obama would still have to go through him first.

I'd love to see ta reform where the effective rates are closer to the marginal rates, but that's a terrifically complex problem given the no tax pledge and the influence peddlers pushing to keep their tax break. That isn't going to be solved in the next 6 weeks.

The only realistic way to increase revenue is by increasing the marginal rates somewhere. I doubt that will happen before Xmas, but if we get to Jan 1 it happens automatically and then the Dems can propose a bill lowering rates for whomever they wish.

Aren't more and more doctors and hospitals not taking Medicare anymore due to low reimbursement rates?

It'd be nice if the Republicans revolted and forced him to step down from his leadership position, because he's been a joke ever since he said his number one priority was to make Obama a one-term president. But I don't suppose that will happen.

I think the President has to push his advantage right now, and not let the Republicans try to delay and let some of the election sting fade.

So long as insurance companies can keep charging higher and higher rates and there's no transparency into the system, this will continue. Frankly, it's criminal how much things cost in the medical industry.

Can someone explain to me why an insurance company is charged $50K for a two day stay in the hospital?* For the room and board costs, I mean: doctor fees are on top of that. You aren't actually sleeping in the MRI machine. The giant sailboat hotel in Dubai "only" charges about $2000 per night and I imagine they have a lot better food and service.

And those costs are all passed along to us in terms of higher premiums. I'm hoping some of the transparency from the ACA and the exchanges improves this but we have a long way to go to bring medical costs under control.

SI

*Actual bill from someone in the last year at a standard hotel

It's really the most ridiculous and corrupt thing about this country. I know a guy that paid $18k out of pocket for an infection and appendix removal WITH insurance.

I'm afraid the ACA just codifies and legitimizes this system, and makes it available to more people.

You didn't see me all excited about it as soon as single payer was off the table and especially the instant a public option went by the wayside. Now there are some sneaky ways to get a public option back in there but it's not going to happen overnight.

It's not the 15% administrative overhead that is killing us. It's the price gouging that just gets passed along as both the providers and insurance companies are complicit with this, especially at the hospital level.

SI

Because 5 other people went to the emergency room for sniffles and paid nothing. And the real crime is the insurance company was only charged $50K, a person with no insurance who can pay would probably have been billed $75K - $100K (based on my experience with what my insurance pays for meds and what the pharmacy tried to charge me due to an insurance snafu).

So 5 E.R. treatments for sniffles requires a hospital to pass along $50,000 in costs? I don't think we've hit upon the explanation for high costs yet.

Hospitals hand out plenty of free care to those that can't pay. The primary method is through the emergency room, where they can't turn folks away. Emergency room care costs more to provide than other types of care, especially for things like people coming down with colds that think they might have the flu and so go to the ER, when a primary care doc would have been better.

So the hospital makes it up somewhere else. Sure, there are other explanations as well, but it's definitely a key one.

I said it elsewhere, I'll repeat - perhaps the one way Obamacare will actually fight costs is if by covering everyone, these types of patients end up able to see primary care physicians instead of choking up ERs, we might end up seeing a reduction in total costs.

I believe MRI machines cost around from $1 million to $3 million to buy, never mind the operating costs (and the length of each scan)?

With Medicare, doctors and hospitals just barely-if they do-cover the treatment costs for each procedure provided with Medicare payments.

I guess it's possible that the providers might have some modest cost reduction, but should we be optimistic that those savings will be passed on in full to the insurance companies, AND the insurance company customers? There's not really a competitive marketplace to encourage that sort of thing.

But that's my point: that was the itemized cost just for the hospital room and board. Nothing else.

The actual surgery and medical procedures were more than another $50K and the total cost well over $100K.

SI

Are we talking U.S. costs or non U.S. costs? If its U.S. costs we have to multiply everything by 10 for some reason.

Because you're being charged to cover the costs of patients who don't allow the hospitals to cover the expenses. It's quite said that if you have insurance, you are basically paying for those who don't,, get free treatment, or are on Medicare.

Magnetic resonance imaging - Wikipedia, the free encyclopedia
MRI costs appear to be either be $2-$3M or $50K, depending on type. Funny how the portable MRI became popular as soon as tax credits and Medicare reimbursement went down for MRI machines.

Gotta support the medical-industrial complex somehow. Your 10:1 ratio still gets passed on to the consumers, tho

SI

I'm guessing a MRI machine costs the same $1-$3 million for hospitals and facilities, around the world. The real cost/markup comes when funding the purchase, along with the construction (of the facility for the machine and it's staff), operational, and maintenance costs, (financing for the hospital) is passed on to you, which the rates I'm assuming are set on a number of variables such as what percentage of patients have insurance that pays.

Boehner to Obama: Compromise means agreeing to new revenue from the tax fairy if you agree to implement Romney's economic proposals.

Since there are required expense ratios for insurance companies (i.e. insurance companies are required to pay a certain percent of the premium they collect on medical claims), you can be sure that in that part of the link, savings will be passed on.

It's a bargaining position (hopefully), Obama has the advantage that he can just wait for the Bush cuts to expire (restoring CLinton-era (ie balanced budget) taxes), and then propose new tax cuts on those below 200/250 thousand a year. Put Republicans in the explicit position of rejecting lower taxes for 95% of America.

So what kind of cost reductions do you expect? Either as an across the board %, or, there are particular kinds of savings that will be more immediately noticeable?

It's just so hard not to be skeptical, but I'm trying to have an open mind. It's hard to expect anything other than the ACA not quite working out and not reducing costs, with the blame of course going to Republicans for not agreeing to the public option. (Edit: And if we had the public option, and that didn't significantly decrease healthcare costs, the blame would go to the Republicans for not agreeing to a single payer plan....We have what we have, I just want to know what the proponents say it's going to do and then praise them if it happens or hold them accountable if it doesn't.)

What kind of cost reductions do I expect from the ACA in total, or from the shift in utilization from ER to PCP? I don't expect cost reductions from the ACA overall -- that's not going to happen if insurers aren't denying coverage for pre-existing conditions, and the shift from ER to PCP will cause some savings, but not enough to make up for that.

If the IPAB is allowed to do their job that will have a real effect on slowing the growth of Medicare spending. I'm not convinced, though, that they'll be allowed to lower costs through lower reimbursements.

This is why I hate so many Dems. Peter Orszag:


We should reduce the long-term deficit by cutting something that isn't a driver of the long-term deficit so that Republicans will be happy.

:rant:

A couple years ago I showed my preferences as such:

Single Payer > Public Option > Obamacare > Doing Nothing > Free Market

Now I should note that my main goal is less about reducing cost and more about increasing overall health and access. Having said that, I do believe it will reduce costs or at the very least increase cost effectiveness. Not only will the shift from ER to PCP help save money, but the shift from reactive care to preventative care will help as well.

It's possible that I could end up being completely wrong and you can "hold me accountable" (whatever that means) for it. It wouldn't be the first time I was wrong and certainly won't be the last. However, even if I'm wrong and costs go up, I'm still in favor of the plan because more people will have access to health care. And I'll blame the GOP no matter what because I think the public option and single payer are both better plans, even if they would've cost more. Some things are worth paying for.

What I mean by accountability, and maybe this is a fantasy, is that I'd just like the Dems, with the power that they have, to effectuate policy, with stated goals, from which we can evaluate the policies to some degree. Sure it's true that they can't ever have their perfectly preferred policy, but that's true of any party in a democracy. Surely the Republicans would do their own thing if they didn't have any legislative opposition at all. But still, the Republicans clearly own the Patriot Act, and the Bush tax cuts, and maybe even the wars. It doesn't seem like the Dems own as much, at least in recent years - they seem more content to own ideas and concepts. There's always that out, "well, maybe this didn't work great, or maybe we didn't reduce unemployment as much as we said we would, but there's this other party around that keeps us from doing the really great stuff" (I'm sure the republicans feel the same way). I do hope ACA is eventually owned and delivers big-time, that would only give further momentum to go in that direction (whatever direction THAT is, I'm not actually sure, but if it improves the healthcare system at all, then it's a decent direction).

Interesting, part of me wants to say "About freaking time.." but then there's the other part of me that wonders if this statement is so going to enrage the right of right wingers that there's going to be a leadership fight over it..

Boehner: 'Obamacare is the law of the land' - NBC Politics

I think it gives the GOP a tool to use if Obamacare doesn't work in four years or so.


Isn't this a paradox? Don't you need to reduce the current costs to make it more accessible?

Well this could be one possibly solution for it.

Judd doesn't rule out challenging McConnell in '14

Spoken like a politician wannabe. :) That campaign would be worth the price of admission I think, but hard to say right now how much of a chance she'd have against him in that state.

Yeah, that is about as political a comment as you can get. If anything, she already has a poltical minded publicist, which says a lot about her mind-set. There is also buzz that Tennessee dems want to keep her to either run for governor, or against Lamar Alexander.

Gen. Petraeus just resigned as CIA director, citing extra-marital affair. WTF?

I dunno, if he can't do good enough counter-intelligence on his affair, how can he do so for the country? ;)

No crap. There were already rumors he was leaving because of the investigation about Benghazi, but no one had any idea about this.

Huh. I remember once upon a time, Petraeus getting labeled with the epithet 'Betray Us' by some liberals when Bush was President. I dunno if it was to do with anything he did, or just his association with the Hated One.

For some reason, that nickname was the first thing to pop up when I read that the resignation was prompted by his affair.

The Betray Us nickname was because he was advocating for the Surge, IIRC.