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04/02/2014 07:18:34 AM · #226
Originally posted by jagar:

"You and I aren't likely to agree on what is good, given that you're about as conservative as our president" what's that mean Cory ?

Some people are not as courageous as others, some people are more skillful, some people are more fortunate, some people are less disciplined than others, some people are fragile emotionally while others are as solid as rocks and some are just downright selfish. A vast web different beings and it's our job to love them all. Happiness is not an individual matter.


Indeed, in most of the world, Obama would not be anything close to liberal, if anything he'd be a centrist or even slightly right of center on most things.

Try to get past the whole Republican vs. Democrat and conservative vs liberal fuss. The real reason the US has a shitty health care system is greed. Corporate greed, greedy politicians, greedy doctors, greedy patients…all of those who would exploit the suffering of another human to gain excess profit. And yes, I know that all doctors aren't greedy, all patients aren't either. I'm sure that there might be a few honest corporations that really wants to help people. I'm not so sure about politicians, at least the ones able to influence health care nationwide.
04/02/2014 12:32:07 PM · #227
Originally posted by Spork99:

So, you'd rather pay for her healthcare via higher costs and bills when people like her wait until they're sick enough to go to the ER instead of taking preventative measures for less by going earlier to a physician or health clinic?


I think this is a good example where there is a split between the idea and the reality. Getting patients to receive preventative care is an obvious goal. However, here in Oregon we had the typical bolus of people sign up for insurance but there are not enough PCPs to see them. The reality now is that when you sign up you get your insurance plan along with a statement that you are not assigned a PCP and if you have medical needs to go to urgent care or the ER until they can assign you one.

Doctors saw this coming from a long way off, but the politicians either didn't think of it or swept that problem under the rug. A study of medicaid patients in Oregon that was published this year (but looked at patients over the last five years so isn't a direct judgement on the ACA) showed that Medicaid patients counterintuitively utilized "expensive" services like the ER MORE than patients without insurance. The "party line" is that we get them insurance so they stop going to the ER, but reality appears to have a mind of its own.

NPR link to article on Medicaid study.

Message edited by author 2014-04-02 12:35:11.
04/02/2014 12:45:40 PM · #228
Originally posted by jagar:

"You and I aren't likely to agree on what is good, given that you're about as conservative as our president" what's that mean Cory ?

Some people are not as courageous as others, some people are more skillful, some people are more fortunate, some people are less disciplined than others, some people are fragile emotionally while others are as solid as rocks and some are just downright selfish. A vast web different beings and it's our job to love them all. Happiness is not an individual matter.


Wow, super weak response. I love how you always focus on one useless point while walking past everything of value which was said. It is genuinely insulting and infuriating to try to talk with you.

I asked you serious questions, and quite cleverly (I think) countered your Gandhi with Gandhi.. And yet, you give me this? I really am insulted. Unless you take the time to go back and actually show a bit of respect, you can count on me being much less pleasant to you in the future, and you can absolutely bet that I'm even better at giving shitty responses than you.

Message edited by author 2014-04-02 12:51:04.
04/02/2014 12:49:42 PM · #229
Originally posted by DrAchoo:

A study of medicaid patients in Oregon that was published this year (but looked at patients over the last five years so isn't a direct judgement on the ACA) showed that Medicaid patients counterintuitively utilized "expensive" services like the ER MORE than patients without insurance. The "party line" is that we get them insurance so they stop going to the ER, but reality appears to have a mind of its own.

If medicaid reimbursements weren't so low (or fees so high?) then more primary care providers would see those patients for preventive care. If you "have insurance" but you can't find a provider to take it then you go to the ER. Now, if it was a requirement of the the ACA that all providers MUST see Medicaid patients I think you'd see this particular problem diminish a lot.
04/02/2014 12:54:23 PM · #230
Originally posted by DrAchoo:

Originally posted by Spork99:

So, you'd rather pay for her healthcare via higher costs and bills when people like her wait until they're sick enough to go to the ER instead of taking preventative measures for less by going earlier to a physician or health clinic?


I think this is a good example where there is a split between the idea and the reality. Getting patients to receive preventative care is an obvious goal. However, here in Oregon we had the typical bolus of people sign up for insurance but there are not enough PCPs to see them. The reality now is that when you sign up you get your insurance plan along with a statement that you are not assigned a PCP and if you have medical needs to go to urgent care or the ER until they can assign you one.

Doctors saw this coming from a long way off, but the politicians either didn't think of it or swept that problem under the rug. A study of medicaid patients in Oregon that was published this year (but looked at patients over the last five years so isn't a direct judgement on the ACA) showed that Medicaid patients counterintuitively utilized "expensive" services like the ER MORE than patients without insurance. The "party line" is that we get them insurance so they stop going to the ER, but reality appears to have a mind of its own.

NPR link to article on Medicaid study.


Surely you don't think it was only Doctors who saw this coming? It didn't take a genius to realize that adding more new patients into an already stressed system was going to go poorly.

Additionally, why do you find it counterintuitive that medicare patients would selectively utilize 'expensive' services more than uninsured patients? I find that it's pretty normal that people don't give a damn what something costs if they're not the ones footing the bill.
04/02/2014 01:04:51 PM · #231
Originally posted by GeneralE:

Originally posted by DrAchoo:

A study of medicaid patients in Oregon that was published this year (but looked at patients over the last five years so isn't a direct judgement on the ACA) showed that Medicaid patients counterintuitively utilized "expensive" services like the ER MORE than patients without insurance. The "party line" is that we get them insurance so they stop going to the ER, but reality appears to have a mind of its own.

If medicaid reimbursements weren't so low (or fees so high?) then more primary care providers would see those patients for preventive care. If you "have insurance" but you can't find a provider to take it then you go to the ER. Now, if it was a requirement of the the ACA that all providers MUST see Medicaid patients I think you'd see this particular problem diminish a lot.


Not the particular problem here, Paul. There are simply not enough providers to see new patients. Even with private insurance you will struggle to find a PCP here.
04/02/2014 01:06:11 PM · #232
Originally posted by Cory:

Additionally, why do you find it counterintuitive that medicare patients would selectively utilize 'expensive' services more than uninsured patients? I find that it's pretty normal that people don't give a damn what something costs if they're not the ones footing the bill.


It was countertintuitive to conventional wisdome that insurance = preventative care = less ER visits.
04/02/2014 01:08:01 PM · #233
Originally posted by DrAchoo:

There are simply not enough providers to see new patients. Even with private insurance you will struggle to find a PCP here.

Hmmm ... I could use more hours -- maybe I should apply for an Oregon license ...
04/02/2014 01:16:43 PM · #234
Originally posted by DrAchoo:

Originally posted by Cory:

Additionally, why do you find it counterintuitive that medicare patients would selectively utilize 'expensive' services more than uninsured patients? I find that it's pretty normal that people don't give a damn what something costs if they're not the ones footing the bill.


It was countertintuitive to conventional wisdome that insurance = preventative care = less ER visits.


And that is the problem with academics. :) They think that because they're smart, everyone else should be too.

The simple fact is that preventive care isn't free even with insurance (not sure about medicare), but even if it was free, it would still take up time, and no-one (except hypochondriacs) really likes going to the doctor.

Looking at it from that point of view, I think it's pretty normal that they'll seek treatment for illness or injury, while ignoring routine care. Hell, even I do that all the time, every day I choose what I will simply not get done, because there is ALWAYS more for me to go than I can get done. Do you think I'm going to write a $100,000 SOW or go get a physical? Which one do you think my boss is more likely to appreciate? "Gee, sorry man, I know we just lost a hundred grand, but I've got a clean bill of health!"

Compound that with the fact that they're paying a co-pay for that service and the chances of them seeking medical care which isn't clearly needed is pretty damned low, add in the cultural norms, where it isn't considered normal to go to the doctor unless you're ill or injured, and you've got a pretty good model of reality.
04/02/2014 01:17:50 PM · #235
Originally posted by DrAchoo:

Originally posted by Spork99:

So, you'd rather pay for her healthcare via higher costs and bills when people like her wait until they're sick enough to go to the ER instead of taking preventative measures for less by going earlier to a physician or health clinic?


I think this is a good example where there is a split between the idea and the reality. Getting patients to receive preventative care is an obvious goal. However, here in Oregon we had the typical bolus of people sign up for insurance but there are not enough PCPs to see them. The reality now is that when you sign up you get your insurance plan along with a statement that you are not assigned a PCP and if you have medical needs to go to urgent care or the ER until they can assign you one.

Doctors saw this coming from a long way off, but the politicians either didn't think of it or swept that problem under the rug. A study of medicaid patients in Oregon that was published this year (but looked at patients over the last five years so isn't a direct judgement on the ACA) showed that Medicaid patients counterintuitively utilized "expensive" services like the ER MORE than patients without insurance. The "party line" is that we get them insurance so they stop going to the ER, but reality appears to have a mind of its own.

NPR link to article on Medicaid study.


From the linked article:

"Because Medicaid recipients are by definition low income, Medicaid doesn't use higher patient payments to deter emergency room use like many private insurers do, Nolan says.

But the key to getting inappropriate costs down for all patients, she says, is educating people about where they should go when it's not an emergency."


So, essentially what they've done is make ER another free clinic. The key isn't to remove access to PCP services, it's educating the people.

Also, most, if not all, of the insurance plans offered under the ACA will, like my insurance, have a financial disincentive for non-emergency use of the ER unlike the example of Medicare cited in the article.

04/02/2014 01:29:45 PM · #236
Originally posted by Cory:


The simple fact is that preventive care isn't free even with insurance (not sure about medicare), but even if it was free, it would still take up time, and no-one (except hypochondriacs) really likes going to the doctor.



Certain types of preventative care is free with medicare, (basic & cancer screenings). I have a $50 copay to see a doctor. I have a 20% copay for hospital and outpatient surgeries. That's with a medicare advantage plan (HMO) that I pay extra for. With straight medicare you pay 20% of everything with an initial deductible.
04/02/2014 01:34:45 PM · #237
Originally posted by Spork99:

Also, most, if not all, of the insurance plans offered under the ACA will, like my insurance, have a financial disincentive for non-emergency use of the ER unlike the example of Medicare cited in the article.


You are probably only partly right. Here in Oregon the breakdown is that a large portion of ACA patients in the exchange have been assigned/chosen Trillium which is Oregon Medicaid.

Here's a local NPR article about the problem in Lane County. Note the assigning of Trillium and note the problem is identified as "not enough doctors" (that's mainly to Paul who is welcome to come up here if he wants).

9,000 Patients can't find a doctor

All these real world problems are valid reasons to say the ACA not working as advertised at the current time.

Gotta go see a patient. Hmmm. I see she is "unassigned Trillium" which means she can use the "expensive" services of a specialist without the referral at least for the first visit...

EDIT: I just have to chuckle in the article about the "solutions". If we recall...the problem is "not enough doctors", right? So one of the proposed solutions? "Second, Trillium is granting Lane County $900,000 to open a new clinic but in an existing building. A custom build would take too long." Ummm...who is going to man this new clinic? The literal answer by the head of Trillium at a physician meeting six weeks ago? Retired doctors. Good luck with that. It's lunacy to think that plan will work.

Message edited by author 2014-04-02 13:47:38.
04/02/2014 02:15:09 PM · #238
Originally posted by DrAchoo:

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All these real world problems are valid reasons to say the ACA not working as advertised at the current time.



Not working perfectly, I would say.

But, on the whole, better than what was before it. And far better than what the Republicans had on the table, which was either nothing or the "Let them Die" plan.
04/02/2014 02:18:47 PM · #239
Originally posted by Spork99:

Originally posted by DrAchoo:

[/url]

All these real world problems are valid reasons to say the ACA not working as advertised at the current time.



Not working perfectly, I would say.

But, on the whole, better than what was before it. And far better than what the Republicans had on the table, which was either nothing or the "Let them Die" plan.


I reservedly agree, because the crux comes down to money. However the system winds up, does it spend more money or less and who pays and is it sustainable? Those questions can't be answered as of now because there hasn't been enough time. I think the law has been altered, delayed and changed so much that the CBO estimates are out the window. It's easy to say things are "better" when you spend more money. That's why we spend so much money in the government. How could it not be "better"? But the question is whether it is sustainable.
04/02/2014 02:21:43 PM · #240
Originally posted by Cory:

The simple fact is that preventive care isn't free even with insurance...

I don't think that's correct. Preventive care/annual checkups are covered in full with no deductible or co-pay under new ACA plans, and I believe that even includes tests for diabetes, blood pressure concerns, cancer screenings, and even depression.
04/02/2014 03:05:16 PM · #241
Originally posted by DrAchoo:

Originally posted by Spork99:

Originally posted by DrAchoo:

[/url]

All these real world problems are valid reasons to say the ACA not working as advertised at the current time.



Not working perfectly, I would say.

But, on the whole, better than what was before it. And far better than what the Republicans had on the table, which was either nothing or the "Let them Die" plan.


I reservedly agree, because the crux comes down to money. However the system winds up, does it spend more money or less and who pays and is it sustainable? Those questions can't be answered as of now because there hasn't been enough time. I think the law has been altered, delayed and changed so much that the CBO estimates are out the window. It's easy to say things are "better" when you spend more money. That's why we spend so much money in the government. How could it not be "better"? But the question is whether it is sustainable.


No doubt that further changes to the system need to be made, but the majority of the civilized world has figured out how to do it far better than we have, so there's hope. Maybe we could quit playing "World Cop", militarizing our police forces and help a few folks at home have better lives. Not as much chest thumping machismo, but better for all.
04/02/2014 03:07:31 PM · #242
Originally posted by Spork99:

Originally posted by Cory:



Nah, I don't believe in the death penalty for being a prick. I'd just like to see someone stomp on his face a little.


Rampart division, LAPD then, get yer Rodney King on.


Ha! Nice one.

Nah, as you know, I'm not the group-work type, I don't need a badge, a gun, and 500 other gang members to cover for me - I'm just fine working alone thanks.
04/02/2014 03:09:10 PM · #243
Originally posted by Spork99:



No doubt that further changes to the system need to be made, but the majority of the civilized world has figured out how to do it far better than we have, so there's hope. Maybe we could quit playing "World Cop", militarizing our police forces and help a few folks at home have better lives. Not as much chest thumping machismo, but better for all.


Another 'act of kindness' that is sure to only bite us in the ass. We spend billions each year to ensure that other nations are safely able to detest us.
04/02/2014 05:43:06 PM · #244
Participants in this thread: Keep your emotions in check and keep on topic or this thread will be locked.
04/02/2014 06:28:57 PM · #245
Originally posted by Cory:

Originally posted by Spork99:



No doubt that further changes to the system need to be made, but the majority of the civilized world has figured out how to do it far better than we have, so there's hope. Maybe we could quit playing "World Cop", militarizing our police forces and help a few folks at home have better lives. Not as much chest thumping machismo, but better for all.


Another 'act of kindness' that is sure to only bite us in the ass. We spend billions each year to ensure that other nations are safely able to detest us.


Aaaaaaaaand we're back to defense… Just think what we could do towards taking care of our people with all the money spent on blowing up other people and countries under the guise of the "War on Terror"
04/02/2014 07:04:00 PM · #246
Originally posted by Cory:

Originally posted by Kelli:


Why? Her husband had a stroke. He's now disabled and on medicare. She worked when she was young, before she had kids then was a stay at home mother after that. They've lost everything. Their savings, their home. Why would you begrudge her coverage?


Look, I feel for her, but in the end life's kinda like that - you can't always win... But when you try to make sure everyone wins the only realistic outcome is that everyone loses.


So Kelli's aunt has a good plan and you don't. You're right, life isn't fair. Not sure where you come to the conclusion everyone is losing because thats not the case. I make good money and pay accordingly. I'd rather suffer in the pocketbook than my health and I suspect you do too if you didnt let yourself get so windup by others who strongly disagree with you.

Message edited by author 2014-04-02 19:06:38.
04/03/2014 12:14:53 AM · #247
Originally posted by yanko:

Originally posted by Cory:

Originally posted by Kelli:


Why? Her husband had a stroke. He's now disabled and on medicare. She worked when she was young, before she had kids then was a stay at home mother after that. They've lost everything. Their savings, their home. Why would you begrudge her coverage?


Look, I feel for her, but in the end life's kinda like that - you can't always win... But when you try to make sure everyone wins the only realistic outcome is that everyone loses.


So Kelli's aunt has a good plan and you don't. You're right, life isn't fair. Not sure where you come to the conclusion everyone is losing because thats not the case. I make good money and pay accordingly. I'd rather suffer in the pocketbook than my health and I suspect you do too if you didnt let yourself get so windup by others who strongly disagree with you.


I really had to laugh at this.

Yes, the person who's putting in less is getting much more, and the person who's putting in more is getting far less.

Hey, as long as that sits well with you and seems right, then there's nothing I can possibly say that would change your opinion here.
04/03/2014 01:15:41 AM · #248
Originally posted by Cory:

Originally posted by yanko:

Originally posted by Cory:

Originally posted by Kelli:


Why? Her husband had a stroke. He's now disabled and on medicare. She worked when she was young, before she had kids then was a stay at home mother after that. They've lost everything. Their savings, their home. Why would you begrudge her coverage?


Look, I feel for her, but in the end life's kinda like that - you can't always win... But when you try to make sure everyone wins the only realistic outcome is that everyone loses.


So Kelli's aunt has a good plan and you don't. You're right, life isn't fair. Not sure where you come to the conclusion everyone is losing because thats not the case. I make good money and pay accordingly. I'd rather suffer in the pocketbook than my health and I suspect you do too if you didnt let yourself get so windup by others who strongly disagree with you.


I really had to laugh at this.

Yes, the person who's putting in less is getting much more, and the person who's putting in more is getting far less.

Hey, as long as that sits well with you and seems right, then there's nothing I can possibly say that would change your opinion here.


That's how insurance has worked since the beginning of time. Why is it funny now? Do I think this is a fair system? No. Do I think it can be better? Yes. Is it better now for those who suffer the most? Hell fucking yeah. If you want to convince people then stories like yours need to be a bit more compelling. Right now yours is like complaining about a chipped nail.
04/03/2014 01:51:34 AM · #249
Originally posted by DrAchoo:

Originally posted by Spork99:

So, you'd rather pay for her healthcare via higher costs and bills when people like her wait until they're sick enough to go to the ER instead of taking preventative measures for less by going earlier to a physician or health clinic?


I think this is a good example where there is a split between the idea and the reality. Getting patients to receive preventative care is an obvious goal. However, here in Oregon we had the typical bolus of people sign up for insurance but there are not enough PCPs to see them. The reality now is that when you sign up you get your insurance plan along with a statement that you are not assigned a PCP and if you have medical needs to go to urgent care or the ER until they can assign you one.

Doctors saw this coming from a long way off, but the politicians either didn't think of it or swept that problem under the rug. A study of medicaid patients in Oregon that was published this year (but looked at patients over the last five years so isn't a direct judgement on the ACA) showed that Medicaid patients counterintuitively utilized "expensive" services like the ER MORE than patients without insurance. The "party line" is that we get them insurance so they stop going to the ER, but reality appears to have a mind of its own.

NPR link to article on Medicaid study.


According to Kaiser there are 397,130 active PCPs in the US and according to the DMDC we have 1,369,532 active military personnel. For what? Those two large bodies of water that flank this country does more to protect the US than the military and it's free.
04/03/2014 01:53:52 AM · #250
Originally posted by yanko:

Originally posted by Cory:



Yes, the person who's putting in less is getting much more, and the person who's putting in more is getting far less.


That's how insurance has worked since the beginning of time. Why is it funny now? Do I think this is a fair system? No. Do I think it can be better? Yes. Is it better now for those who suffer the most? Hell fucking yeah. If you want to convince people then stories like yours need to be a bit more compelling. Right now yours is like complaining about a chipped nail.


But yanko, that's not at all how this has worked previously.

Previously you paid more and you got more, you payed less and you got less. That makes sense. To pay more and get less, or pay less and get more, that doesn't make sense to me, not in the least.

It LOOKS better now for those who suffer the most, however, given that what we currently have is so broken as to unsustainable, I don't think that this is going to help anyone long term.

My story doesn't need to be compelling, you're a communist, I am not, there's nothing I could say to compel you to see things my way. I'm very much a zero-sum believer - I don't believe that everyone should win, I believe in losers and have a very strong distaste for the entire soccer trophy mentality that pervades our society today. I always have been this way - I don't take help from others and don't take it well when others DEMAND that I help them. Screw em, I'll help if I want to, but forcing me to do so is VERY distasteful to me, and I can't foresee my position on this changing.
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