Obamacare - My experience so far

Canon EF-S 18-55mm f/3.5-5.6 USM

07/17/2014 04:53:23 PM · #101

Originally posted by bohemka:

I was under the impression that this was common practice all over. I've been responsible for co-payments for late cancellations in Washington state as well as Arizona, and it was the same in Germany.

I didn't say it wasn't common, but it doesn't really accomplish much. It mainly acts as a slap on the wrist for patients, but it costs more than it's worth in headache and whining.

RayEthier

Canon EOS-5D Mark II

07/18/2014 08:48:57 AM · #102

Originally posted by cowboy221977:

Yeah people keep reelecting people like Pelosi....I don't see how that woman functions from day to day

... this might come as a shock to you, but there are others whose words and actions far surpass those you might be alluding to.

Ray

RayEthier

Canon EOS-5D Mark II

Canon EF-S 18-55mm f/3.5-5.6 USM

07/18/2014 09:00:54 AM · #103

Originally posted by DrAchoo:

Originally posted by RayEthier:

Originally posted by DrAchoo:

In Africa, when you see the doctor, you pay SOMETHING. Even if it is a few dollars, because you then associate a value with what you are receiving. Our system has it wrong on both sides. High deductibles and expensive meds have people with traditional insurance UNDERutilizing preventative care while zero costs have people with state insurance OVERutilizing care.

Viewed in this perspective one would think that those making use of the "Zero Cost" module would be the healthiest of the financial groups... I wonder if that could be readily demonstrated.

Ray

Actually, it has been demonstrated in a fascinating study in Oregon, but demonstrated to the negative. Free healthcare overutilized expensive services like ER visits more than uninsured controls of equal demographics. No long term health benefits were demonstrated either. I'll have to dig up the link.

Here you go. Abstracts to a number of studies which have come from the "Oregon Health Study".

Perhaps I missed it but these studies seemingly related almost exclusively to the increase in visits to things like the ER and there was no information as to whether or not the users health improved... which was the gist of my argument.

As pointed out by

Scalvert we must also take into consideration the fact that when one is offered access to services for free, and that they are not familiar with the process, they are bound to want to take full advantage of the gift provided them.

I would argue that a well educated population who was made familiar with the proper process to follow, would (n a perfect world) lead to a significant reduction in long lasting health problems since a lot of these could be dealt with and corrected at the onset.

Just my uninformed view.

Ray

07/18/2014 11:01:42 AM · #104

The health outcomes are in the NEJM abstract at the bottom of that link (there was more than one abstract):

"This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain."

EDIT: I'm going to add a sentence about the diabetes before someone makes a natural objection: "Medicaid coverage significantly increased the diagnosis of diabetes and use of diabetes medication, but we observed no significant effect on average glycosylated hemoglobin levels nor on the percent with levels >6.5%."

Message edited by author 2014-07-18 11:13:54.

scalvert

Canon EOS-5D Mark III

07/18/2014 11:31:14 AM · #105

Originally posted by RayEthier:

...there was no information as to whether or not the users health improved... which was the gist of my argument.

The study looked at four particular health measures: high blood pressure, high glycated hemoglobin, high cholesterol and long term risk of heart disease. The result was a small improvement in all four categories, but nothing major. These were able-bodied adults in the relatively healthy 19-64 range, so you wouldn't expect a huge gain. "If you look at the table in their study and look at baseline blood pressure it was like 119 over 76" and that "was normal. You wouldnâ��t expect it to go down by nine. It would be a bad thing for normal blood pressure to drop that much. All we should care about is blood pressure in the small subset that had high blood pressure. But they donâ��t present that."

Canon 12x IS USM (S3 IS built-in Lens) -- 36-432mm (35mm EQ)

07/18/2014 11:38:54 AM · #106

Shannon is both right and wrong. There are small improvements, but none are statistically significant. In a cohort with nearly 6,000 people on a side it is unlikely we are missing a real effect and one should most properly attribute the difference found to chance.

EDIT: I was able to find the p values for these measurements. Statistically speaking, we consider it meaningful if the p value is less than 0.05. The closest value was 0.23 and the worst was 0.8. Unimpressive. By contrast, when they reported a lower screening for depressing the p value was 0.02. and the liklihood of receiving a diagnosis of diabetes was a value of <0.001.

Message edited by author 2014-07-18 11:42:31.

GeneralE

Canon PowerShot S3 IS

07/18/2014 01:07:16 PM · #107

Diabetics who are poor enough to qualify for Medicaid are also likely to face challenges in affording a "proper" diabetes-friendly diet, stable housing, and other factors which could impact their health as much as any medication regimen.

raish

Olympus C-2500L

Nikon AF Nikkor 50mm f/1.4D

07/18/2014 01:30:33 PM · #108

'measured physical health outcomes'

nimbly sidesteps:
*increased use of health care services
*raised rates of diabetes detection and management
*lower rates of depression
*reduced financial strain

cheap at half the price

07/18/2014 03:04:13 PM · #109

Originally posted by raish:

A) Ray asked about "physical health outcomes" so 1 and 4 are not pertinent to his question.
B) 2 was addressed and not sidestepped. Read my post. Diabetes was detected and "managed" and it didn't show an effect in the most common ways we measure diabetic control.
C) 3 could be real. It was a 10% decrease in a screen for depression.

You take the data and make your own conclusions. If you feel that represent a robust effect of putting people on Medicaid, then you should advocate strongly for such policies. If you feel that doesn't represent a robust effect, then you, at the least, should alter your possible narrative to "why should we put people on Medicaid" or seek solutions to making Medicaid more effective.

I got no beef against Medicaid. I got no beef against poor people (I think my credentials in this regard speak strongly for the opposite). I am, however, open to data and this, unfortunately, puts the conventional wisdom in some doubt.

Nikon AF Nikkor 50mm f/1.4D

07/18/2014 03:06:29 PM · #110

Originally posted by GeneralE:

I think that makes sense. It doesn't look like Medicaid addresses this. So if you want to avoid "expensive" things like strokes, heart attacks, and neuropathies, it seems like we are probably going to have to do more/something else if we hope to make a difference.

raish

Olympus C-2500L

07/18/2014 03:36:26 PM · #111

I've a nasty feeling you beg the question of conventional wisdom, but don't take it personally. I don't really have any business in a rant about US health, whereas you very much do. I'm a fan of the NHS who oversaw my health free of charge for the first thirty-something years of my life. And of whatever they do here in Norway, which is perhaps more like that which is advocated elsewhere in this three, i.e. paying something but not being taken to the cleaners.

07/18/2014 04:06:34 PM · #112

Originally posted by raish:

Well, hey, I agree with some of your notion. Any system the US is going to come up with is going to be some bastardization of free market capitalism and fully socialized medicine. I doubt another system will ever see the light of day and that is just what it is for better or for worse.

Let me take a moment to applaud your correct usage of the term "beg the question". :) It is rarely used in proper context. It is possible I am being self-referential with my idea of "conventional wisdom", but I don't think so. Given my profession, I naturally follow these conversations in society and I do know the argument that "putting people on insurance is economically useful because it lowers the use of expensive care like ER visits" is commonly put forward. This study does not offer support, although it also does not single-handedly defeat it.

EDIT: As support for the idea that this argument is conventional wisdom I typed "why should we put people on medicaid" into google and clicked the very top result. The actual point of the essay is not important (It turns out to be anti-ACA and from The Federalist), but to quote: "For years, Americans were told ad nauseum that converting uninsured patients who overuse the ER into insured patients whose doctors could catch problems earlier would help contain exploding healthcare costs." At the very least this would support that this is a widespread idea.

Message edited by author 2014-07-18 16:17:17.

07/22/2014 12:13:03 PM · #113

Well it appears that obamacare has suffered another blow... This time dealing with the subsidies

scalvert

Canon EOS-5D Mark III

07/22/2014 12:37:09 PM · #114

Don't get too excited. The ACA's provisions, including a clause that says ANY â��exchangeâ�� shall be considered an â��entity that is established by a State,â�� comepletely negate the premise of these two judges' opnion and the decision will be overturned on appeal. Another court has already reached the opposite conclusion on the same challenge. Not that it wouldn't be poetic justice if insurance in Republican states that refused to setup exchanges suddenly skyrocketed because they finally managed to deny Obamacare for their constituents...

Message edited by author 2014-07-22 12:37:24.

Canon 12x IS USM (S3 IS built-in Lens) -- 36-432mm (35mm EQ)

07/22/2014 01:20:14 PM · #115

I am just watching as this entire law is slowly crumbling around Obama. It is just a matter of time.

GeneralE

Canon PowerShot S3 IS

07/22/2014 01:27:35 PM · #116

Originally posted by cowboy221977:

It is just a matter of time.

... until we are back to double-digit health care premium inflation, denial of claims (for those who can get insurance), record CEO incomes and insurance company profits ... if you listen to the debate before the bill was passed there was near-unanimity (except from big pharma/big insurance and their Congressional lackeys) that the "current" system was "broken" ... we may have the "best health care" in the world, but the lack of a logical and efficient (as opposed to profitable) system of delivery makes it largely unavailable to large segments of the population.

Message edited by author 2014-07-22 13:32:04.

Cory

Canon EOS-1D Mark IV

Canon EF 85mm f/1.2L II USM

07/22/2014 02:22:36 PM · #117

Originally posted by GeneralE:

Originally posted by cowboy221977:
It is just a matter of time.

... until we are back to double-digit health care premium inflation, denial of claims (for those who can get insurance), record CEO incomes and insurance company profits ... if you listen to the debate before the bill was passed there was near-unanimity (except from big pharma/big insurance and their Congressional lackeys) that the "current" system was "broken" ... we may have the "best health care" in the world, but the lack of a logical and efficient (as opposed to profitable) system of delivery makes it largely unavailable to large segments of the population.

You're totally right... except the part where you fail to realize that it's still broken...

GeneralE

Canon PowerShot S3 IS

Canon 12x IS USM (S3 IS built-in Lens) -- 36-432mm (35mm EQ)

07/22/2014 02:29:25 PM · #118

Originally posted by Cory:

You're totally right... except the part where you fail to realize that it's still broken...

Oh I know that, it's just slightly less broken than the former way. However, those who want to dismantle the ACA and go back to health care for the rich and totally indigent only would have liked what I want even less ... :-(

scalvert

Canon EOS-5D Mark III

07/22/2014 02:30:05 PM · #119

One appeals court voted 2-1 against the federal subsidies while a similar one voted 3-0 that they were legal. Ted Cruz called the first ruling "a repudiation of Obamacare and all the lawlessness that has come with it." Presumably, the second ruling would therefore be an even stronger affirmation of Obamacare and the legitimacy that has come with it.

07/24/2014 01:29:42 PM · #120

One thing that might help advance the conversation is to realize that the ACA experience might be very different depending on where you live. Frankly we are nearing crisis mode in Oregon. Today the AP had an article summarizing our struggles.

Oregon feels the strain after health care overhaul floods the system with Medicaid enrollees

The Eugene paper picked it up and added to it (so the article is similar but adds flavor for Lane county which is where I am located)

State strains under huge medicaid enrollment

Add to this the fiasco with the Oregon online marketplace Cover Oregon which cost $250 million dollars and didn't enroll a single person (amusingly called a "bump in the road" in the paper). We have not had a good time out here.

Tamron SP AF 28-75mm f/2.8 XR Di for Canon

07/24/2014 01:37:35 PM · #121

It seems that 5 US territories have been exempted

BrennanOB

Canon EOS-1D Mark II

07/24/2014 02:37:51 PM · #122

Originally posted by DrAchoo:

Frankly we are nearing crisis mode in Oregon.

I thought one of the comments from the first article was on point.
"the underlying issue, with both Medicaid expansion and the VA, is a lack of primary physicians and other first-level providers. the problem is especially acute in poorer areas far from major population centers, like eastern Kentucky or downstate Oregon.

that shortage existed long before Obama was elected. fewer med -school grads are pursuing careers in primary-care, and the compensation for a primary in rural areas is untenable for anyone carrying a student-loan burden.

incentives are needed, both from the government and from health-care providers, to encourage more primaries, and have them practice in poorer areas. student-loan forgiveness, bonuses, etc. we can pay for someone's college via ROTC in exchange for four years of military service; why not this?

a group of consumers with purchasing power has been greatly expanded; it's up to private enterprise, in partnership with government, to increase supply to meet their demand."

Canon EF-S 18-55mm f/3.5-5.6

07/24/2014 03:59:57 PM · #123

Good points Brennan, but the powers that be should have foreseen the problem (believe me the doctors knew it was coming). Your solutions also cost money which is something we are supposed to be saving. There are no easy solutions now.

Oregon is potentially in big trouble because this was the year we are supposed to show a 2% reduction in health care expenditure to maintain our Medicaid waiver that allows us to run the program under what is called the "Oregon Health Plan". I can see no way this is going to be achieved which means the end of the system as we've experienced it for over a decade or a special pardon (and I don't even know that is possible).

escapetooz

Canon EOS-500D Rebel T1i

09/05/2014 11:02:32 AM · #124

Originally posted by Lydia:

Originally posted by escapetooz:
For me, as a person that literally hasn't been insured since the age of 11 (with the exception of when I lived in South Korea) I couldn't be more pleased. I was so excited to go to the doctor, get a bunch of tests done, and pay only $25. I could hardly believe it.

When I was uninsured it was a nightmare. I let myself get really really sick on occasion and just wouldn't go because I knew it would cost hundreds of dollars. One time my family forced me to go and paid for it for me. The doctor took my blood and talked to me a bit then concluded it was stress- $300 to get a needle in my arm and told what I already knew. I was so pissed.

I'm not seeing the connection between doctor wait times and the ACA? In my experience it's always been like that depending on where you live and how many doctors are available, especially with specialists. Maybe now more people ABLE to go to the doctor and thus things filling up more, hard to say.

So... now... you can go to the doctor and... get a needle in your arm for "free" and... you're happy because... why?

Because it's not people you know.. .your family ... who are paying for your inadequate care?

It's strangers who are working to pay for your inadequate care now, and... suddenly ... you're okay with it all?

I know.. .I do konw... that I'm making a point that doesn't need to be made. But... in fact... SOMEONE is still working to pay for medical care for all ... AND they're paying TWICE the cost that they used to pay for it themselves.

WHY is this okay? Why is it okay that since ObamaCare kicked in (for whatever reason), that the people who WERE paying "x" dollars for their healthcare, are now paying X times 2 for their healthcare, whilst the government takes the money from Social Security to fund...

Nothing.

And... the taxpayers who are STILL earning wages... instead of quitting and... going "on the dole"... are paying twice the cost to insure their family than they used to pay.

What's right about that?

What's right about going to work each day... (my husband travels an hour and a half each way... each day) to pay twice what we used to pay for health care... because of ObamaCare... to pay for all of the extras... the maternity care for me... (I've paid for my own hysterectomy and have NO female parts, yet I'm REQUIRED to have maternity care in my plan...)

What is SENSIBLE about this?

Please tell me.

There is NO POSSIBLE WAY THAT I CAN BECOME PREGNANT. Yet... OBAMACare requires me to have maternity care...

FOR MY OWN GOOD.

Thank you. But.. I feel safe enough without maternity care.

After all... I DID pay for all of my female parts to be removed.

This is all over the place. You seem to be taking offense to my story for very personal reasons.

The maternity care bit is a shame but it's a small flaw in a larger system as opposed to the huge, gaping systematic flaws that used to exist like denying people coverage for preexisting conditions (which could be anything really the insurance companies wanted to deny you for).

We all pay for stuff we don't agree with or need. I don't have children but my taxes go towards school. I'm a pacifist and my taxes go towards war and militarized police squads. I'm anti-corporatist but I pay for tax breaks and big farm subsidies. Apparently you feel entitled to some special pity party because you don't want to help poor people? No. It doesn't work that way. That's called living in a society.

Yea, it sucks that your rates went up. I don't really understand how that all works or why. All I know is I see more good than harm happening so far. And you can begrudge me all you want, but I'm happy as a clam that I can go to a freakin doctor if I need to.

Also, need I mention the cost of an uninsured population and no preventative care? Because uninsured people DO get medical attention but it usually comes in the form of ER visits that never get paid for. Who pays for all that do you think?

Message edited by author 2014-09-05 11:03:09.