OBAMA/TRUMPCARE MEGATHREAD

[Y2HH]

This may be fruitless, but I would like to stop and take a moment to say that while I may disagree with some of your opinions or observations, I do value the thought. Believe it or not, many of you are often able to make me think about what you said long after I've responded, and there have been times my view has actually been swayed.

 

So while I do know that I can often come across as a biligerant ass, I do mean well.

Edited November 1, 2013 by Y2HH

[StrangeSox]

Im not sure why you are piling on Jenks. He was honest, he thinks that people should get some support but he doesnt want the govt just throwing money around if people arent going to be responsible with their health.

 

Thats not an outlandish position. In fact maybe things would work better if people tried to flesh out ideas instead of harping on hypocrisy.

His criticism doesn't appear to be limited to government subsidization but to the broader idea of insurance itself--everyone paying into a big, collective pool and only some of us using that money.

[NorthSideSox72]

I can already read your "you shouldn't be eating at McDonalds 5 days a week" complaint when someone has a heart attack with no insurance and sticks the taxpayer with a $100k bill for the emergency room.

 

I want to hone in on this point for a moment.

 

Please explain to me, mechanically, how it is that if someone racks up a $100k hospital, and the taxpayers pay for it if the patient cannot? I feel like I'm a piece of the puzzle here.

 

[StrangeSox]

The category would be "people with insurance," including a big chunk of government-funded health insurance (Medicare/Medicaid) who get stuck with higher costs from health care providers to cover that lost revenue.

[Balta1701]

I want to hone in on this point for a moment.

 

Please explain to me, mechanically, how it is that if someone racks up a $100k hospital, and the taxpayers pay for it if the patient cannot? I feel like I'm a piece of the puzzle here.

Isn't that basically how it happens right now?

 

If a person has no insurance and has a heart attack, they're not going to let the person die if they reach an ambulance. Afterwards, they'll try to get whatever they can from the person, but if the person is uninsured and on minimum wage because they work at the nation's largest employer, the hospital won't be able to recoup anything near the amount spent on the person. That cost gets passed on to whomever it can be passed on to.

 

Under the PPACA, that cost is going to be paid by Medicaid in the states that took the expansion. It's going to continue to be paid by the hospital in the other states, who will of course continue to push their prices higher to everyone else in order to cover those costs.

[NorthSideSox72]

Isn't that basically how it happens right now?

 

If a person has no insurance and has a heart attack, they're not going to let the person die if they reach an ambulance. Afterwards, they'll try to get whatever they can from the person, but if the person is uninsured and on minimum wage because they work at the nation's largest employer, the hospital won't be able to recoup anything near the amount spent on the person. That cost gets passed on to whomever it can be passed on to.

 

Under the PPACA, that cost is going to be paid by Medicaid in the states that took the expansion. It's going to continue to be paid by the hospital in the other states, who will of course continue to push their prices higher to everyone else in order to cover those costs.

Well first of all, I think I meant pre-PPACA.

 

Second, if what you are saying is true... then before PPACA, those costs were NOT going to the taxpayers. The hospitals had to take them as collection items like any other business does, try to recover as much as they can, and write off the rest. But now with PPACA, the hospital can pass that cost onto Medicaid, or just keep doing the same thing?

 

So in other words, for states that TOOK the expansion, we are now charging the taxpayers, when we weren't before? And for the other states, we will continue to NOT pass it on to the taxpayers?

 

[StrangeSox]

Well first of all, I think I meant pre-PPACA.

 

Second, if what you are saying is true... then before PPACA, those costs were NOT going to the taxpayers. The hospitals had to take them as collection items like any other business does, try to recover as much as they can, and write off the rest. But now with PPACA, the hospital can pass that cost onto Medicaid, or just keep doing the same thing?

 

So in other words, for states that TOOK the expansion, we are now charging the taxpayers, when we weren't before? And for the other states, we will continue to NOT pass it on to the taxpayers?

 

But these losses (pre- or post-ACA) can and are estimated and included in the business and pricing models of the health care providers. It's like retail stores taking into account 5% shrinkage (theft & breakage) and having their overall pricing and cost structure reflecting that.

 

So, the "taxpayers" were picking up part of the bill before through increased prices for Medicare/aid patients, and the rest was being picked up by people with private insurance. It's the same now.

[Balta1701]

Well first of all, I think I meant pre-PPACA.

 

Second, if what you are saying is true... then before PPACA, those costs were NOT going to the taxpayers. The hospitals had to take them as collection items like any other business does, try to recover as much as they can, and write off the rest. But now with PPACA, the hospital can pass that cost onto Medicaid, or just keep doing the same thing?

 

So in other words, for states that TOOK the expansion, we are now charging the taxpayers, when we weren't before? And for the other states, we will continue to NOT pass it on to the taxpayers?

I guess I see where you're going here...but man, "hospitals raising their prices for everyone" sure seems like a cost associated with a law (you must treat people at ERs) getting passed on to everyone else who uses health care. I guess I just used taxpayers as a shorthand there although for the reason that it's being charged by the hospital and not the government I guess I can see where you're going.

[Balta1701]

So, the "taxpayers" were picking up part of the bill before through increased prices for Medicare/aid patients, and the rest was being picked up by people with private insurance. It's the same now.

The real difference, just so it's noted, should be that if the people who were on Medicaid who might have had heart attacks do things like "see a doctor" and "get on a regimen of appropriate drugs and exercise as recommended by that Dr." then the bills should fall substantially overall.

[StrangeSox]

Didn't that Oregon Medicaid study show mixed results in that regard?

[Balta1701]

Didn't that Oregon Medicaid study show mixed results in that regard?

No. That study actually showed improved results but the study did not have a large enough sample to be "improved results that are scientifically significant with a 2-sigma margin of error".

 

It was simply incapable of showing positive results in that regard because it was not designed to do so. That's not mixed. That's "why does this box not have apples in it" - "because it's a box of oranges".

[StrangeSox]

I thought it showed that Medicaid did a great job of providing these people with health care access, that they used this access for preventative care and reduced catastrophic illness costs, but that there were no clear results (statistically significant, as you said) about it actually reducing overall health expenditures.

 

Which, don't get me wrong, a program that would be a wash financially but gives millions of more people improved health care would be a fantastic program. I just don't know that we have the data to expect a fairly substantial drop in overall healthcare spending from those who currently (or previously) lacked access to routine health care.

 

okay here's one review of the study I found, and I think this alone is an incredibly important factor:

 

http://www.kevinmd.com/blog/2013/05/oregon...understood.html

 

Insurance gives you peace of mind. I never lie awake worrying that if I get sick, my family will go bankrupt. Medicaid may therefore be giving people reassurance, and making them feel better, which may be why there was less depression in the Medicaid group (they certainly weren’t taking more anti-depressants).

 

Couple that with some other recent studies that show the impact on cognitive ability of chronic stress and anxiety. When you're poor, you're always having to make important decisions on how to allocate your very limited funds to meet your basic needs. Guaranteed healthcare access in itself would lift a substantial burden, reducing stress, increasing financial flexibility and increasing mental wellness (the study did find a substantial drop in depression).

Edited November 1, 2013 by StrangeSox

[Balta1701]

I thought it showed that Medicaid did a great job of providing these people with health care access, that they used this access for preventative care and reduced catastrophic illness costs, but that there were no clear results (statistically significant, as you said) about it actually reducing overall health expenditures.

 

Which, don't get me wrong, a program that would be a wash financially but gives millions of more people improved health care would be a fantastic program. I just don't know that we have the data to expect a fairly substantial drop in overall healthcare spending from those who currently (or previously) lacked access to routine health care.

Exactly - but the key point is that it was literally impossible for the study to show that result.

 

The study actually did show improvements but they were not statistically significant because of sample size. The people on Medicaid showed an average 10% drop in blood pressure, 17% drop in bad cholesterol, compared to the control group - but the sample size was small enough that this result was not "significant". And that's just those 2 terms; presumably not everyone in the Medicaid group went in with high blood pressure.

 

Basically...if the results of the study were that "absolutely no one in the Medicaid group had a heart attack or cancer during the time of this study", it would not have been a significant result (but extra people would be alive).

[StrangeSox]

Timelines may have been too short to show the long-term impacts of healthcare access, but as far as I've read, the study didn't find decreased overall expenditures for people on Medicaid, statistically significant or not.

[Balta1701]

Timelines may have been too short to show the long-term impacts of healthcare access, but as far as I've read, the study didn't find decreased overall expenditures for people on Medicaid, statistically significant or not.

BUT AGAIN IT COULD NOT DO SO.

[cabiness42]

Exactly - but the key point is that it was literally impossible for the study to show that result.

 

The study actually did show improvements but they were not statistically significant because of sample size. The people on Medicaid showed an average 10% drop in blood pressure, 17% drop in bad cholesterol, compared to the control group - but the sample size was small enough that this result was not "significant". And that's just those 2 terms; presumably not everyone in the Medicaid group went in with high blood pressure.

 

Basically...if the results of the study were that "absolutely no one in the Medicaid group had a heart attack or cancer during the time of this study", it would not have been a significant result (but extra people would be alive).

 

Why the f*** are you wasting time and money conducting the study if you aren't going to use a sample size large enough that the results can be statistically significant????

[Balta1701]

Why the f*** are you wasting time and money conducting the study if you aren't going to use a sample size large enough that the results can be statistically significant????

Because lots and lots of people reported their results.

 

(There were also a few parts of the study where there was the possibility of statistically significant results - depression, financial security, self-reported health status...and in those cases there was solid improvement at a statistically significant level).

[StrangeSox]

Why the f*** are you wasting time and money conducting the study if you aren't going to use a sample size large enough that the results can be statistically significant????

 

The opportunity to do a study like that comes around approximately never. They had 90000 people who wanted to sign up for the Oregon Medicaid expansion, but only 10,000 spots. It gave them a randomized control and experimental group. You can't test this stuff in a laboratory, you can only test it in the real world with the best scenarios that are available.

 

And they had plenty of statistically significant results, it's just that some particular measures weren't.

[StrangeSox]

BUT AGAIN IT COULD NOT DO SO.

 

Why? Were they not tracking expenditures by the two groups?

 

edit: from the summary:

 

Medicaid coverage decreased the probability of a positive screening for depression (−9.15 percentage points; 95% confidence interval, −16.70 to −1.60; P = 0.02), increased the use of many preventive services, and nearly eliminated catastrophic out-of-pocket medical expenditures.

 

So what's the bottom-line difference between the increase cost of preventive services and the decreased cost of catastrophic services? I already said "statistically significant or not," so sample sizes don't really enter in here.

 

Basically, what's the supporting data for the idea that we'll see substantial decreases in long-term health care expenditures for people who previously lacked access?

Edited November 1, 2013 by StrangeSox

[southsider2k5]

Here's what I am interested in... I wonder what the drag on the economy is going to be when all of these millions of people get hit with all of these new costs?

[StrangeSox]

Here's what I am interested in... I wonder what the drag on the economy is going to be when all of these millions of people get hit with all of these new costs?

What will the boost to the economy be when millions of people have access to affordable health care services?

[Balta1701]

Here's what I am interested in... I wonder what the drag on the economy is going to be when all of these millions of people get hit with all of these new costs?

 

 

The effect, seemingly, will be a large stimulus.

[southsider2k5]

 

 

The effect, seemingly, will be a large stimulus.

 

I'm sure the people seeing their health plans cancelled agree.

[StrangeSox]

I'm sure the people seeing their health plans cancelled agree.

 

I thought you were asking about a net effect, not whether any one particular individual will be adversely affected?

[southsider2k5]

What will the boost to the economy be when millions of people have access to affordable health care services?

 

To most of lower rungs? Nothing. They weren't "paying" in the first place. They are the loss leaders you just referred to. You yourself said this is going to transfer money from the healthy to the hospitals and insurance companies.