Projections of ACA impact on 2014 elections

[abandonconflict]

[h=1]Ron Paul's Campaign Manager Died of Pneumonia, Penniless and Uninsured[/h]
At CNN's Tea Party-indulging debate on Monday, Ron Paul, a medical doctor, faced a pointed line of questioning from Wolf Blitzer regarding the case of an uninsured young man who suddenly found himself in dire need of intensive health care.
Should the state pay his bills? Paul responded, "That's what freedom is all about: taking your own risks. This whole idea that you have to take care of everybody—"

The Raw Paw revolution!

 

[tokeprep]

When I have to PROVE that what I want to open is necessary, who decides? Do you trust the deciders to not be corrupt? Should my competition have a right to petition against me saying "nah, we got this".

Imagine if Burger King were told they couldn't open because there was already a McDonald's so we don't NEED Burger King. Hell, there is a subway on every corner practically, maybe we should close half? This is the logic used toward the health care industry.

I certainly don't trust the regulators or agree with certificate of need regimes, but since I've never seen any evidence that there's a significant difference in the states with versus the states without, the decision seems more objective than subjective. If you can't objectively show another hospital is needed, you probably aren't interested in building one.

 

[tokeprep]

Tokeprep,

Do you have a definition of Public Goods and if so, why doesn't healthcare qualify (by your definition) as such?

Healthcare isn't a public good. Emergency rooms only have the legal obligation to stabilize without payment.

 

[ginwilly]

I certainly don't trust the regulators or agree with certificate of need regimes, but since I've never seen any evidence that there's a significant difference in the states with versus the states without, the decision seems more objective than subjective. If you can't objectively show another hospital is needed, you probably aren't interested in building one.

We are not talking just hospitals, we are talking about medical equipment sales, home health, physical therapy, surgery centers etc. Compare that to not being able to put in another 7-11 because there is not an objective need. This stifles competition. If I can deliver better care, cheaper, why can't I open another hospital right across the street from another one?

 

[tokeprep]

We are not talking just hospitals, we are talking about medical equipment sales, home health, physical therapy, surgery centers etc. Compare that to not being able to put in another 7-11 because there is not an objective need. This stifles competition. If I can deliver better care, cheaper, why can't I open another hospital right across the street from another one?

In almost 1/3 of the states you can. Is there a meaningful difference between certificate states and non-certificate states? Like I said, I've never seen any evidence that says there is, which suggests that the regulatory requirement doesn't actually stand in the way of competition--it's an annoying hoop but not an insurmountable barrier.

 

[ginwilly]

In almost 1/3 of the states you can. Is there a meaningful difference between certificate states and non-certificate states? Like I said, I've never seen any evidence that says there is, which suggests that the regulatory requirement doesn't actually stand in the way of competition--it's an annoying hoop but not an insurmountable barrier.

Another layer of bureaucracy that only does a little damage is not a good enough reason to accept it. I'm not sure if we can quantify how many people never attempted to open an oxygen supply store because of the costs of CONs and risks involved in not ever seeing that money. It's non-refundable if you are turned down. It's nonsensical.

Another reason to do away with CONs is corruption. The politically connected will have theirs approved and those same politically connected can prevent others from competing with them.

The purpose and thought behind them was that if a hospital had a bunch of empty beds, they would charge more to make up the difference, this is impossible with DRGs. It was an idea to reduce hospital costs that never really happened and a position of power was created. Men with power have been shown to be less than righteous most of the time.

The thought that if I built an open MRI suite across the street from a hospital it will make costs go up is wrong, surely you see this. The paranoia that decided we needed CONs thought the hospital would just charge more to make up for the loss x-rays, illegal. When you see what the medicare fee schedule is like for non-hospitals compared to hospitals after EMTALA you would see why we want the most non-hospital affiliated billing IDs as possible. Hospitals can legally charge more than my open MRI across the street because of EMTALA, but can also work to deny me entry into the market.

This mechanism is at best useless like you claim and at worst, causing higher costs and blocking people from entering the market. If either of us are right, I see no good in CONs.

 

[heckler73]

Healthcare isn't a public good. Emergency rooms only have the legal obligation to stabilize without payment.

[HR][/HR]1) A public good is nonrival in consumption: even though one person consumes the good, others may also consume it.
2) A public good is nonexclusive: it is impossible (or at least very costly) to exclude anyone from consuming the good.
[HR][/HR]--James A. Brander, "Government Policy toward Business" (4th ed.)

I'd say healthcare is a public good by definition (which you failed to provide as justification), just like water and electricity supply, sewage treatment, light-houses (possibly obsolete example), roads, national defense...

I'm also somewhat confused by your desire for "single-payer", socialized medicine, yet emphasize free-markets--with a delusional hat-tip to the demonstrably false model of perfect competition--as a solution.
Furthermore, you implied a responsibility for gov't as a preventative (i.e. tax sources of negative externalities) but leave the crux of the matter (treatment) open-ended.

If you want the former, why extol the latter?
Can you expound upon this seeming contradiction in your logic? It's possible I am missing something in the links of your reasoning.
Where is this threshold of personal responsibility such that "free-market" solutions are better in your opinion? At the door, or in the bed? Somewhere in between?

In Canada, we've been having debates (at least among economist circles) of modifying our system just a little to reduce waste (i.e. someone going to the emergency room for "sniffles", etc.) by imposing a token $5 or $10 charge, which really only covers some basic capital costs like stationery. But putting that minor threshold in the way will cause people to reassess their need. This is still considered nonexclusive because if there is a need, the person will still receive treatment (since someone will put-up the $5 quite readily if the patient is obviously without means). There is also an experiment underway that rewards efficiency of treatment, so as to also reduce wait times...
These kinds of ideas are how one "tweaks" a public healthcare system. Now doesn't that seem simpler and less costly than trying to expand a "free-market"?
Because your version of market solutions sounds like it requires even more complexity with respect to gov't involvement than a public system.

However, as mentioned, I may just misunderstand some link in your logic...

 

[tokeprep]

[HR][/HR]1) A public good is nonrival in consumption: even though one person consumes the good, others may also consume it.
2) A public good is nonexclusive: it is impossible (or at least very costly) to exclude anyone from consuming the good.
[HR][/HR]--James A. Brander, "Government Policy toward Business" (4th ed.) [/quotea

Healthcare fails point one. An hour of doctor time consumed by one patient cannot be consumed by another patient; a dose of medicine consumed by one patient cannot be consumed by another patient. It's not at all comparable to air, national defense, or roads.

I'd say healthcare is a public good by definition (which you failed to provide as justification), just like water and electricity supply, sewage treatment, light-houses (possibly obsolete example), roads, national defense...

I thought you were trying to suggest that all people consume healthcare anyway, whether they pay for it or not, and thus it is a public good because it will inevitably be provided. That's why I noted that emergency rooms only have the legal obligation to stabilize--the amount of healthcare you can actually consume without paying for it is quite limited. It will not inevitably be provided.

I'm also somewhat confused by your desire for "single-payer", socialized medicine, yet emphasize free-markets--with a delusional hat-tip to the demonstrably false model of perfect competition--as a solution.
Furthermore, you implied a responsibility for gov't as a preventative (i.e. tax sources of negative externalities) but leave the crux of the matter (treatment) open-ended.

If you want the former, why extol the latter?
Can you expound upon this seeming contradiction in your logic? It's possible I am missing something in the links of your reasoning.
Where is this threshold of personal responsibility such that "free-market" solutions are better in your opinion? At the door, or in the bed? Somewhere in between?

I don't desire single payer. I said I would rather have single payer over what we presently have, meaning it was my pick of two bad options. Ideally Americans would shop for healthcare like they shop for everything else and the healthcare industry would be subject to the same antitrust rules that every other industry has to follow. Price competition in healthcare is considered a dirty thing because "People will die!" It's a bullshit excuse to protect fat profits and fat salaries built on monopoly power and insurance price masking.

If you go buy a car, are you going to do it without any discussion whatsoever of price? If you ask the price and the dealer says "I can't tell you," are you going to drive it off the lot anyway and use it for a month before the bill shows up? For any good but healthcare this would be unthinkable in the United States: we spend hours and even days finding the best price on a TV (a fucking TV!) but not a second finding the best price on healthcare services. TVs are more advanced yet cheaper than they ever have been in history; healthcare is more expensive.

On taxation specifically: Programs like Medicare and Medicaid aren't going anywhere. As long as the government is going to pay for healthcare, it should discourage bad behavior that ends up costing American taxpayers vast sums of money. Preventing heart disease, diabetes, cancer, etc. saves money that the government will otherwise be obligated to spend. And where people choose to pay the tax, it should be earmarked for medical programs to reflect some of the ultimate cost to the government.

In Canada, we've been having debates (at least among economist circles) of modifying our system just a little to reduce waste (i.e. someone going to the emergency room for "sniffles", etc.) by imposing a token $5 or $10 charge, which really only covers some basic capital costs like stationery. But putting that minor threshold in the way will cause people to reassess their need. This is still considered nonexclusive because if there is a need, the person will still receive treatment (since someone will put-up the $5 quite readily if the patient is obviously without means). There is also an experiment underway that rewards efficiency of treatment, so as to also reduce wait times...
These kinds of ideas are how one "tweaks" a public healthcare system. Now doesn't that seem simpler and less costly than trying to expand a "free-market"?
Because your version of market solutions sounds like it requires even more complexity with respect to gov't involvement than a public system.

However, as mentioned, I may just misunderstand some link in your logic...

I think you just misunderstand. I want a private market with transparent pricing where consumers have incentives to care about price and healthcare providers are forced to compete with each other.

 

[tokeprep]

Another layer of bureaucracy that only does a little damage is not a good enough reason to accept it. I'm not sure if we can quantify how many people never attempted to open an oxygen supply store because of the costs of CONs and risks involved in not ever seeing that money. It's non-refundable if you are turned down. It's nonsensical.

Another reason to do away with CONs is corruption. The politically connected will have theirs approved and those same politically connected can prevent others from competing with them.

The purpose and thought behind them was that if a hospital had a bunch of empty beds, they would charge more to make up the difference, this is impossible with DRGs. It was an idea to reduce hospital costs that never really happened and a position of power was created. Men with power have been shown to be less than righteous most of the time.

The thought that if I built an open MRI suite across the street from a hospital it will make costs go up is wrong, surely you see this. The paranoia that decided we needed CONs thought the hospital would just charge more to make up for the loss x-rays, illegal. When you see what the medicare fee schedule is like for non-hospitals compared to hospitals after EMTALA you would see why we want the most non-hospital affiliated billing IDs as possible. Hospitals can legally charge more than my open MRI across the street because of EMTALA, but can also work to deny me entry into the market.

This mechanism is at best useless like you claim and at worst, causing higher costs and blocking people from entering the market. If either of us are right, I see no good in CONs.

I'm not disagreeing with your point that the certificates are unnecessary and provide no benefits. I'm only taking issue with your thesis that they meaningfully affect the supply of healthcare. You're suggesting that regulators turn these things down all the time to prevent competition (for whatever reason). If that were true, I think there would be meaningful pricing differences between certificate states and non-certificate states. I have not seen any evidence that such differences exist (I said it hoping you had some), which is why I called the certificates hoops instead of insurmountable barriers--people just jump through them.

You brought up convenience stores and restaurants and suggested that there would be fewer of them if proprietors had to obtain certificates of need from regulators, and I absolutely agree. But those businesses are not especially capital intensive or sophisticated compared to most healthcare enterprises. Most stores and restaurants fail because the owners should have known better than to open them in the first place. In healthcare, the more significant amounts of money and more substantial organizational requirements attract savvy, competent investors and managers who are unlikely to take risks without compelling evidence of an objective need. A store can succeed simply by undercutting the prices of the store next door; a hospital's task isn't nearly so simple given the existing structure of the healthcare industry. The presence of health insurance and the government make opening a hospital far, far more complicated than opening a restaurant. Healthcare is a rigged and gamed market unlike any other in this country, a fact that sophisticated businessmen certainly comprehend and consider in making their investment decisions.

 

[heckler73]

[HR][/HR]1) A public good is nonrival in consumption: even though one person consumes the good, others may also consume it.
2) A public good is nonexclusive: it is impossible (or at least very costly) to exclude anyone from consuming the good.
[HR][/HR]--James A. Brander, "Government Policy toward Business" (4th ed.)

Healthcare fails point one. An hour of doctor time consumed by one patient cannot be consumed by another patient; a dose of medicine consumed by one patient cannot be consumed by another patient. It's not at all comparable to air, national defense, or roads.

How about parks then? Conceivably, one could fill up the park with people such that it becomes impossible for anyone else to enjoy it. Does that mean it is not a public good?
Just because the demand on the service has a limit, does not preclude it from fulfilling the definition, in principle.
That's why there is usually more than one specialist available; to help alleviate that strain.
A doctor alone does not equate to healthcare as a whole. (cf. fallacy of composition)

If you go buy a car, are you going to do it without any discussion whatsoever of price? If you ask the price and the dealer says "I can't tell you," are you going to drive it off the lot anyway and use it for a month before the bill shows up? For any good but healthcare this would be unthinkable in the United States: we spend hours and even days finding the best price on a TV (a fucking TV!) but not a second finding the best price on healthcare services. TVs are more advanced yet cheaper than they ever have been in history; healthcare is more expensive.

If I don't care about the type of car, then why do I care about price? I'm only interested in getting the car as quickly as possible so I can get from A to B...
You're also mixing subjects such as product differentiation into this picture...
Try comparing broken arms to broken arms, instead of TVs... Although the cost of materials used for the cast can differ, the actual act of setting the bone in place is fairly standard... unless someone can use mental powers and voodoo to do it painlessly.
It's not the same as a consumer good or service, in the aggregate, outside of narrow conditions (i.e. cosmetic surgery or other non-essential procedures, equipment/medicine variations, etc).

I think you just misunderstand. I want a private market with transparent pricing where consumers have incentives to care about price and healthcare providers are forced to compete with each other.

You are correct. I did misunderstand you. Now I see your idea is worse than I originally thought.
Instead of promoting a two-tier system of public and private options, you'd prefer zero public option...
I can see how this is a difficult topic to resolve differences over, since I've known practically nothing other than Universal healthcare coupled with secondary insurance for "minor" costs/procedures (and have been more than content with that), whereas you've only known what it's like under private enterprise. Or am I making a rash presumption there?

 

[UncleBuck]

Healthcare isn't a public good.

OMFG there are no words.

devryU is even more of a ripoff than i thought.

 

[tokeprep]

How about parks then? Conceivably, one could fill up the park with people such that it becomes impossible for anyone else to enjoy it. Does that mean it is not a public good?
Just because the demand on the service has a limit, does not preclude it from fulfilling the definition, in principle.
That's why there is usually more than one specialist available; to help alleviate that strain.
A doctor alone does not equate to healthcare as a whole. (cf. fallacy of composition)

If it no longer satisfies the definition, how can you call it a public good? If use of the road destroys the road so that no one can use it, it ceases to be a public good; if you stuff a park so full of people that no one can use the park, it ceases to be a public good; if you drink all of the water in the river, it ceases to be a public good; if you overwhelm the sanitation system such that it ceases to work, it is no longer a public good.

Healthcare resources are scarce and they will not be provided regardless of ability to pay, thus healthcare is not a public good. You can argue about the first part of the definition, sure, but the second part is fatal.

If I don't care about the type of car, then why do I care about price? I'm only interested in getting the car as quickly as possible so I can get from A to B...
You're also mixing subjects such as product differentiation into this picture...
Try comparing broken arms to broken arms, instead of TVs... Although the cost of materials used for the cast can differ, the actual act of setting the bone in place is fairly standard... unless someone can use mental powers and voodoo to do it painlessly.
It's not the same as a consumer good or service, in the aggregate, outside of narrow conditions (i.e. cosmetic surgery or other non-essential procedures, equipment/medicine variations, etc).

My car diatribe is about insurance masking costs and inflating prices. It's about the present healthcare system and Obamacare's extension of that system. If you don't care about the price and you only care about getting from A to B, you're unnecessarily driving prices up. That was the point. If we shopped for healthcare services like we shopped for TVs, the prices would be lower because the hospital charging $10,000 would have very little business with another hospital charging $2,500 for exactly the same thing. The second hospital would have to lower its price to get the business back. In the present American system, the consumer typically has no idea one hospital is charging $2,500 while the other is charging $10,000; consequently, a lot of people unnecessarily pay $10,000 for something that should only cost $2,500.

You are correct. I did misunderstand you. Now I see your idea is worse than I originally thought.
Instead of promoting a two-tier system of public and private options, you'd prefer zero public option...
I can see how this is a difficult topic to resolve differences over, since I've known practically nothing other than Universal healthcare coupled with secondary insurance for "minor" costs/procedures (and have been more than content with that), whereas you've only known what it's like under private enterprise. Or am I making a rash presumption there?

I want the best system at the best price. American healthcare is absurdly expensive because it's not competitive, not because the system is private. I think real competition would reduce prices substantially more than simply permitting the government to control costs.

 

[see4]

[video=youtube;9dSB_7TPeeY]http://www.youtube.com/watch?v=9dSB_7TPeeY[/video]

 

[heckler73]

If it no longer satisfies the definition, how can you call it a public good? If use of the road destroys the road so that no one can use it, it ceases to be a public good; if you stuff a park so full of people that no one can use the park, it ceases to be a public good; if you drink all of the water in the river, it ceases to be a public good; if you overwhelm the sanitation system such that it ceases to work, it is no longer a public good.

I suspect you are now perverting the definition because sanitation systems can become overloaded, too. So now you claim there are no public goods.
Well, let me know when you need to call private industry to repair the storm drains on your street.
Maybe some Italians will come work there for cheaper...
I heard they'll provide "protection services", too, in case you get fed up with that other public good called Police. La Camorra would make a great SWAT team if you're down with a little ultra-violence

Healthcare resources are scarce and they will not be provided regardless of ability to pay, thus healthcare is not a public good. You can argue about the first part of the definition, sure, but the second part is fatal.

Technically, everything is scarce, in the long run. Even bullshit and stupidity has its limits.

This does not preclude healthcare being a public good. The specialist nature of it makes it difficult to provide adequate supply. Yet, if there were enough people of merit available, the demand could be met. But now we get down to actuarial issues such as Cost-benefit analysis and probabilities; Demand and Supply flows are never constant in healthcare. And that's one of the reasons Triage is used in the medical system... assess needs and treat appropriately...

And now the "second" part is fatal? no... I think your omission of "public goods" from the lexicon is the fatal part.
Hell, we haven't even gotten to subjects such as moral hazard yet, and your position is already tenuous.

 

[tokeprep]

I suspect you are now perverting the definition because sanitation systems can become overloaded, too. So now you claim there are no public goods.
Well, let me know when you need to call private industry to repair the storm drains on your street.
Maybe some Italians will come work there for cheaper...
I heard they'll provide "protection services", too, in case you get fed up with that other public good called Police. La Camorra would make a great SWAT team if you're down with a little ultra-violence

You demanded to work within a definition and now you want to ignore the definition. By your own definition healthcare is not a public good. That's the end. I don't understand why you're so intent on labeling it as a public good.

True public goods are provided to additional people at little or no additional cost. When the population grows, national defense doesn't cost more; when twice as many people are in a park, the park doesn't cost additional money; when more people use a road that doesn't alter how much was paid for the road in the first place. Healthcare is fundamentally different because providing care to additional people requires substantial additional costs to be incurred.

Technically, everything is scarce, in the long run. Even bullshit and stupidity has its limits.

This does not preclude healthcare being a public good. The specialist nature of it makes it difficult to provide adequate supply. Yet, if there were enough people of merit available, the demand could be met. But now we get down to actuarial issues such as Cost-benefit analysis and probabilities; Demand and Supply flows are never constant in healthcare. And that's one of the reasons Triage is used in the medical system... assess needs and treat appropriately...

And now the "second" part is fatal? no... I think your omission of "public goods" from the lexicon is the fatal part.
Hell, we haven't even gotten to subjects such as moral hazard yet, and your position is already tenuous.

I'm quite puzzled at your ignoring the definition provided. Healthcare can satisfy a non-economic definition of "public good" but it does not satisfy the economic definition.

 

[greenlikemoney]

Conversly
If they fix the website and people sign up

The Republicans could be put out to pasture for the foreseeable future

Now what are the Republicans scared of other than a Black man who is President?

But what if.....if, if, if, if......Didn't you libturds use the word WHEN in the recent past? Now it's IF.....

 

[H R Puff N Stuff]

its sad all that repubs have is hoping someone else fails, thats just weak good luck gop your going to need all the help you can get ,they are supposed to run a country and there focussing on a website real smart keep up the good work.

 

[Doer]

But what if.....if, if, if, if......Didn't you libturds use the word WHEN in the recent past? Now it's IF.....

Wow. They didn't think this would screw into they 2014 election? Should have done an actual job instead of just a poltical hack that CNN is saying is 1/2 government intrusion and pick and choose punishments for States.

Fully 1/2 the code is for Politics and info gathering according to the report.

Oh it will be the show case of failure, along with Benghazi. Did anyone see the 60 mins Segment? Not good for DEMS in '14.

I think this is Mafia style break out the Insurance Business. And the aim of a Breakout is to heap so much abuse that the business must be liquidated and the structure burned for insurance.

It is just a giant tax and payola scam. Obama was elected for one thing only to me.

That was to rescue the Mob/Union pension bosses. They, at least 100, were headed for Ponzi Jail and the Union no-work, job extortion would be over.

So, we get a one purpose Underworld Machine President, to fix the Unions and breakout the Insurance companies to keep the Elite Medical coverage for the privileged...the Cadillac plans.

It is already giving the horsepower of public opinion back to Darrell Issa. Those from afar should know our public opinion self rule. It is how we elect leaders.

 

[desert dude]

But what if.....if, if, if, if......Didn't you libturds use the word WHEN in the recent past? Now it's IF.....

The looming storm for the Dems is not the failure of the web site, that is just a bit of relatively short-term comedy for the country to enjoy. The coming problem, completely owned by the Dems, is that ACA itself is going to fail. Young, healthy people are not going to participate and that will cause insurance premiums to explode. Never forget, the very first word in the title of the act is "affordable" and that is something that ACA is not.

The big, ugly budget battle over the summer that has all the lib tards clapping their hands with glee can be summarized as this: The Republicans tried defund ACA, and the Dems "refused to negotiate" and now COMPLETELY own ACA. When it fails, it will be on the Dems heads. From a personal perspective, the only joy I will take from this is seeing the likes of UncelDufus, CheeseDick, and that women, Schylaar being completely humiliated.

Maybe we can elect Gary Johnson in '16...

 

[ChesusRice]

But what if.....if, if, if, if......Didn't you libturds use the word WHEN in the recent past? Now it's IF.....

Well the probability must be very high for Obamacare to succeed or you wouldn't have braindead politicians and followers of Ted Cruz who said

“If there is ever a time to defeat Obamacare, it is now,” Cruz said at a briefing at the Heritage Foundation. “Moreover, we have, I believe, the best opportunity we will have, and possibly the last good opportunity we will have to defund Obamacare with the continuing resolution.”
“If we do not pursue this strategy,” he said later, “we are saying we surrender. Obamacare will be a permanent feature of the American economy.”…
“If the subsidies kick in, the prospect or full repeal of Obamacare diminish dramatically,” Cruz said.