The Great ObamaCare Debate, Part 237: Back to Court - Page 701 - Politics and Economics

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The Great ObamaCare Debate, Part 237: Back to Court

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07-20-2015 , 04:21 PM

#17501

ikestoys

banned

Join Date: Nov 2006 Posts: 94,424

Quote:

Originally Posted by goofyballer

Pretty sure being an old is less LOL than taking reddit as seriously as you do

Lol soooooper serious! Says the guy who mods Internet forums, lol.

07-20-2015 , 04:52 PM

#17502

goofyballer

Carpal \'Tunnel

Join Date: Jun 2005 Posts: 70,719

lol pretty great timing that I was reading the Republican Nominee thread just now:

Quote:

Originally Posted by ikestoys

lol i'm so upset... let me make more amazing +EV from liberals in this circle jerk!

Quote:

Originally Posted by ikestoys

I got 50 to 500 trump doesn't win, and a lifetime control of an avatar bet vs my perma already.

Quote:

Originally Posted by ikestoys

Also start grabbing your ankles for your incoming avatar.

Quote:

Originally Posted by ikestoys

Keep going bro, just remember I get your avatar soon.

ikes has 86,000 posts here and considers control of some random 2014 reg date troll's avatar as massive +EV in his life, gets mad anytime someone stains reddit's honor on 2+2.

But I mod Video Games, so I guess that's a wash.

07-20-2015 , 05:04 PM

#17503

DudeImBetter

Carpal \'Tunnel

Join Date: Feb 2012 Posts: 10,664

Everyone, including the dude with the avatar on the line, should see the avatar vs perma bet as nothing more than a free roll half court shot on Ikes being gone for life.

Would mods enforce the perma if Trump somehow gets the nod and Ikes either outright refuses to leave or attempts a semantike argument re: why he technically isn't permad for X Y Z reasons or w/e?

07-20-2015 , 05:51 PM

#17504

DrChesspain

Guest

Posts: n/a

Quote:

Originally Posted by renodoc

MacDuff was from his mother's womb untimely ripped.

That was an awesome twist. I always imagine Macbeth ****ting a brick when he hears that.

07-20-2015 , 05:58 PM

#17505

Trolly McTrollson

Carpal \'Tunnel

Join Date: Oct 2010 Posts: 36,801

Quote:

Originally Posted by DrChesspain

That was an awesome twist. I always imagine Macbeth ****ting a brick when he hears that.

It's a rather ikestoysean ending, really. Those witches had some serious semantic nittery in their prophecy.

07-22-2015 , 03:37 AM

#17506

Lilu7

Made 2+2 Great Again

Join Date: Mar 2014 Posts: 2,123

Quote:

Originally Posted by goofyballer

lol pretty great timing that I was reading the Republican Nominee thread just now:

ikes has 86,000 posts here and considers control of some random 2014 reg date troll's avatar as massive +EV in his life, gets mad anytime someone stains reddit's honor on 2+2.

But I mod Video Games, so I guess that's a wash.

Lol goofy I'm a troll now? Don't think I don't see you talking smack behind my back I keep my ears to the street son

Last edited by Lilu7; 07-22-2015 at 03:45 AM.

07-22-2015 , 11:51 AM

#17507

Namath12

Carpal \'Tunnel

Join Date: Jan 2011 Posts: 55,849

I had a bad experience with Aetna so I went out of my way not to pick one of their plans and went Humana instead. Now Aetna is buying Humana http://www.businesswire.com/news/hom...y#.Va-7wPlViko

07-22-2015 , 01:49 PM

#17508

[Phill]

Carpal \'Tunnel

Join Date: Jun 2004 Posts: 52,717

Quote:

Originally Posted by ikestoys

1) It's supposed to be an ali g reference
2) Do you think reddit and gamergate are interchangeable? LOL are you an old?

Ikesisright.

The kiddy porn guys, the rapists and the white supremacists on reddit weren't all necessarily part of gg. Well maybe the rapists.

07-23-2015 , 07:25 PM

#17509

suzzer99

Save the Cheerleader, Save the World

Join Date: Nov 2005 Posts: 99,984

Decision to work on my laptop at the coffee shop for a change of pace: FAIL

Old man conversations abound.

"You know those countries that have socialized medicine like Europe and Canada? When they need something done right they come to the US." Stupid libs.

07-25-2015 , 06:53 PM

#17510

hobbes9324

veteran

Join Date: Mar 2005 Posts: 2,872

Quote:

Originally Posted by ikestoys

Central lines are surgeries... picc lines are completely different.

Nit response from an ER doc.

A significant % of central lines are not surgeries. Unless this is some sort of weird regional sort of phrase which I've never heard. They're procedures. Generally speaking, AFAIK, the incidence of infections of lines placed in the OR is pretty small as it's a much more controlled enviornment that in the ICU.

PICC line ARE different - the P stands for Peripherally - meaning it's more or less a glorified standard IV that is a bit trickier to place with some added issues/problems.

CLASBI, which is what the infection type we're talking about here, is a huge problem that is usually caused by bad technique by a practitioner in using sterile practice. If you gown, glove and prep properly, it shouldn't happen. My hospital has decreased the rate to a nice 0.0% (for the last quarter, anyway) by insisting that proper procedure be applied. A significant # of central lines are done in hospital rooms, primarily because it would be a stupid waste of resources to use up an OR for the procedure, and in a fair number of patients it wouldn't be possible anyway because they're too sick to be moved to an OR. A lot of central lines placed in the OR are in pediatric patients, I think primarily for sedation purposes, and in oncology patients who are going to have the line in for a long time for chemo. For obvious reasons, you very much don't want an onc patient getting an infection.

Central lines placed in the ER are a different sort of animal, for a bunch of reasons that you can probably imagine.

MM MD

Last edited by hobbes9324; 07-25-2015 at 07:01 PM.

07-27-2015 , 02:42 PM

#17511

Double Eagle

Health Care Thread Czar

Join Date: Dec 2003 Posts: 8,323

Latest MEDPAC testimony before Congress indicates that 1) cost shifting from money losing Medicare to private payers is a myth and 2) private payers are not doing a very good job getting providers to constrain their costs which is interesting in the context of Insurance Company merger mania and anti-trust approval.

Quote:

However, hospitals’ overall Medicare margin—a measure of the relationship between Medicare payments for, and hospitals’ costs of, providing care to Medicare patients—is negative. In 2013, the median hospital margin was –5.4 percent. Relatively efficient hospitals (i.e., hospitals with lower costs and better quality over three years) had a median margin of 2 percent in 2013.

Part of the reason Medicare margins are low is that hospitals have high costs per case driven in part by lack of fiscal pressure from private payers. The Healthcare Cost Insitute reports that payment rates from private insurers have grown at an average of over 5 percent annually from 2011 through 2013. Commercial rates, on average, are about 50 percent higher than hospital costs and over 50 percent higher than Medicare rates. For example, Aetna and Blue Shield of California pay hospitals rates that are often 200 percent of Medicare’s rate for inpatient care and 300 percent of Medicare’s rate for outpatient services in California (California Department of Insurance 2014a, California Department of Insurance 2014b). In 2013, hospital all-payer margins were a record-high 7.2 percent.

The Commission has shown that higher payments from private insurers allow hospitals to have higher costs which, in turn, makes Medicare margins more likely to appear inadequate. There is evidence that higher private insurer payments result from hospital consolidation—that is, hospitals have gained greater market power relative to private insurers. When financial resources are abundant hospitals spend more—increasing their number of inputs and cost per input. All else equal, higher costs per case result in lower Medicare margins.

Of course, hospitals vary in their circumstances. Some hospitals have market power, a higher percentage of private payer patients, and stronger revenue from investments and donations. These hospitals tend to have higher costs. Hospitals without these characteristics have lower costs. Put differently: hospitals with the most revenue have the highest costs per admission. For example, we found that hospitals with low private payer profits from 2008 to 2012 had a median standardized Medicare cost per case in 2013 that was about 9 percent less than the national median, and generated a median overall Medicare profit margin of 4 percent. In contrast, hospitals with high private payer profits over the same period had higher costs per case (3 percent above the national median) and lower Medicare margins (–9 percent). This analysis suggests that hospitals can constrain their costs, but the lack of pressure from private payers is discouraging them from doing so.

07-27-2015 , 05:35 PM

#17512

renodoc

Casino Olympics Champion

Join Date: Feb 2004 Posts: 8,357

So do we have a pool for the last Insurance company standing?

I think its United>BCBS>Aetna, but I'm not sure. The Cadillac tax will be the death knell.

07-27-2015 , 08:00 PM

#17513

FlyWf

It's the other way

Join Date: Apr 2004 Posts: 58,097

renodoc what do you think the Cadillac tax is and who do you think it will be a "death knell" for?

(LOL the Cadillac tax is now pretty much the only part of Obamacare that hasn't happened yet. All the previous things were supposed to be death knells but obviously weren't, so we gotta pick SOMETHING in the future that is the bad thing)

07-27-2015 , 08:11 PM

#17514

suzzer99

Save the Cheerleader, Save the World

Join Date: Nov 2005 Posts: 99,984

Come on, let the guy dream that something will put millions back on the uninsured rolls.

07-28-2015 , 10:30 PM

#17515

Double Eagle

Health Care Thread Czar

Join Date: Dec 2003 Posts: 8,323

2016 Premiums soaring in California!

Spoiler:

07-28-2015 , 10:32 PM

#17516

suzzer99

Save the Cheerleader, Save the World

Join Date: Nov 2005 Posts: 99,984

I am shocked rara or eyescrew didn't come in here to breathlessly report that.

07-29-2015 , 03:24 AM

#17517

renodoc

Casino Olympics Champion

Join Date: Feb 2004 Posts: 8,357

Quote:

Originally Posted by FlyWf

Uh, the death knell for the rest of the private insurance market?

Isn't that the point of the law?

07-29-2015 , 10:49 AM

#17518

MrWookie

Don't Call Me Meredith

Join Date: Feb 2005 Posts: 94,159

Uh, no, that's not the point of the law.

07-29-2015 , 11:00 AM

#17519

spidercrab

veteran

Join Date: Jun 2013 Posts: 3,206

Changing topics slightly, I was on vacation last week and read "Misbehaving: The Making of Behavioral Economics", by UChicago economist Richard Thaler. Great book, and I'd highly recommend it. Related to this thread, one footnote really interested me, in the chapter when he talks about applying behavioral economics to public policy:

Quote:

He [Jesse White, Illinois Secretary of State] might have shared this bit of wisdom with President Obama, whose health care law has a very unpopular feature that is called a "mandate". Because the law forbids insurance companies from discriminating against people with preexisting conditions, it needed to have some provision to prevent people from waiting until they get sick or have an accident to buy insurance, and mandating coverage was chosen as the solution to this problem. But there were other ways to achieve this goal. For example, I would favor a combination of automatic enrollment (with opt-out) plus a provision that anyone who opts out of insurance cannot buy a policy for a specified period of time, such as three years.

Counterfactuals are tough, but I'd love to know what how Thaler's favored policy would have been received relative to the mandate. I think it clearly would have had less constitutional difficulty, as it wouldn't have faced the broccoli mandate question. And my gut instinct is that it would have had the same effect on uninsured levels as the mandate. The downside here, I think, would be the same as the downside to a privatized social security system, where people manage their own individual accounts: Once you allow someone to make a choice that turns out poorly ex post (e.g., opting out of insurance and then discovering a brain tumor; investing your private account in penny stocks and losing everything), are we able to say "You took your chances and now you have to suffer the consequences" or would we still provide a backstop?

Anyway, interesting to think about and I very much recommend reading the book.

07-29-2015 , 11:22 AM

#17520

Trolly McTrollson

Carpal \'Tunnel

Join Date: Oct 2010 Posts: 36,801

Quote:

Originally Posted by renodoc

Uh, the death knell for the rest of the private insurance market?

Isn't that the point of the law?

The government mandating people buy insurance is going to bankrupt the insurance industry? Bro, do you even healthcare?

07-29-2015 , 11:40 AM

#17521

FlyWf

It's the other way

Join Date: Apr 2004 Posts: 58,097

Quote:

Originally Posted by renodoc

Uh, the death knell for the rest of the private insurance market?

Isn't that the point of the law?

OK and here's where it's kind of telling you only answered the second of my two questions.

But to answer your question, no, it is not. It's not the point of the ACA, it's not the point of the Cadillac tax. That is an incredibly easy question!

We're now in year 8 of the "universal coverage domestic policy" debate and renodoc still has no idea what's going on lol I can't believe they let him handle knives at work.

07-29-2015 , 11:42 AM

#17522

FlyWf

It's the other way

Join Date: Apr 2004 Posts: 58,097

I honestly think renodoc thinks "Obamacare" has some sort of government option/single payer thing and the Cadillac tax is somehow part of that Kenyan fella's plan to destroy private capitalism and replace it with that moocher socialism the colored folks are so fond of.