http://theweek.com/articles/671238/d...medium=twitter

" In a word, Medicaid. some 16 million people have gotten on Medicaid since 2013, and importantly, the coverage is pretty good."

It's good if you're a patient. Or an ER doc, for that matter - my group has done OK with Obamacare/Medicaid, because we went from having 40% of the patients we see pay nothing to paying Medicaid rates. Something is better than nothing.

If you're a hospital, the numbers don't look so good. Medicaid pays significantly less than Medicare, and Medicare is where, if you run a sharp operation, you can just squeeze out a small profit. No office/hospital/clinic can stay open taking nothing but Medicaid/Obamacare patients, which is why even with their "insurance" they can't get any sort of primary care on a regular basis.

Since as a society we're incapable of having an honest discussion about this stuff, it's gonna get a lot worse. Shockingly, Congress isn't going to do anything to help.

MM MD

i will watch a republican die of terminal illness with a certain amount of schaudenfreude before contributing one penny to some ****ing kickstarter/gofundme for their medical care

oh u voted for trump? want to repeal ACA? ya, "that's on them"

Ultra-hyper-liberal. Apparently she's collecting unemployment, which is somehow just enough to disqualify her for a hospital discount program. So she should have been eligible for lots of subsidies. Not sure when she lost her job. She's also extremely overweight (250 maybe) and in her 40s - not the kind of person who should be going w/o health insurance.

I donated some anyway. I've gone w/o insurance off and on - until landing this sweet soul-sucking corporate job. She's up to $850 out of $45k after 12 hours. Guessing she'll settle with the hospital for < $10k somewhere down the line.

Wasn't Hillary going to repeal Obamacare as well?

No.

I'm pretty sure that's exactly what she said during the debate and Bill called it a disaster.

Pretty sure that's exactly not what happened except in your mind. But this is 2016 and you are entitled to your own facts. So yeeeehahh!

I'm not trying to argue with you. During the debate Hillary said there were some great things about Obamacare, and some things that needed changing. Bill said it was the craziest thing he's ever seen. Bottom line, just like anything, Obamacare is good for some people, and bad for others.

Health coverage isn't the problem, it's the absurd cost of healthcare that is the problem. Unfortunately there will never be a candidate who will attack the legal system to help lower costs.

The legal system is such a paltry effect on costs.

Isn't one of the arguments that the cost of malpractice suits and insurance is one of the reasons for the rising costs of healthcare?

It is an argument that has been made, yes. It is not an especially good one. But monied interests do know that people don't like lawyers that they can rile up the masses over some person "undeservingly" getting a large payout, and so they like to talk about it to obfuscate other things.

Not to mention, Eddy, you're doubly wrong. Like 30 states have enacted tort reform. It's politically easy because of the above. It also hasn't solved surging medical costs in those states, but the GOP is still arguing that they just haven't tort-reformed enough.

Those states just didn't go far enough. We should it open it up so the doctors can sue the patients!

Jesus Christ

Tort Reform is for insurance companies, not doctors

Yeah. It never ceases to amaze me how effective the right is at spreading their bull****.

To an extent.

The direct cost of med mal probably isn't that significant, at least when you're talking about a trillion dollar system. Depending on the specialty, most docs get sued anywhere from never to every few years, and the docs win most of the cases.

The real problem is the costs of defensive medicine that is practiced in an attempt to not get sued in the first place. It's a cost that's tough to quantify, but there's no reason to think it's not huge. As I noted some pages back, a workup for, say chest pain in an ED can run from a few hundred to tens of thousand of $$ depending on what tests are ordered. Note that my bill doesn't really change much regardless of what I order - I'm going to bill out a level 4 (about $385 last I checked) - I don't get paid more for ordering more tests, no matter how expensive they are. But a lot of testing is undertaken because of fears of being sued. Ironically, a fair number of studies suggest that the additional testing has minimal, if any effect in terms of avoiding lawsuits.....

MM MD

I never understood either of the Clinton's statements on Obamacare - it was a badly flawed program, but I suspect Obama put it in place just to get the ball rolling, with the assumption that Hillary would win and make the adjustments needed. If you assume 16 years for the program before another president, it would be so entrenched that it would be impossible to repeal. Bill needed to keep his ****ing mouth shut, and the fact that he didn't makes me wonder if he's getting a little soft in the head.

But yeah, there's a huge difference between repeal and adjust.

MM MD

This is just not borne out by the studies that have taken place in Texas and other states where MedMal Tort reform has been enacted every one of which reports no decrease in utilization post reform.

You're assuming that the fear of being sued is related to the dollars. It's mostly the process that drives the fear of being sued. Even if you win, you don't win.

It's a complicated topic - from a RAND study a few years ago "We agree that the tort system does a poor job of distinguishing between good physicians and those who are incompetent or careless and a poor job of motivating diligent behavior.3 Indeed, one possible interpretation of our findings is that even when the threat of being sued for malpractice is substantially reduced, physicians are just as careful. Perhaps it is time to abandon the term “defensive medicine,” in recognition that the complex set of motivations that inform clinical decision making is really just the practice of medicine, imperfect as it is."

From a JAMA study of 2014 "In conclusion, although a large portion of hospital orders had some defensive component, our study found that few orders were completely defensive, and that physicians’ attitudes about defensive medicine did not correlate with cost. Our findings suggest that only a small portion of medical costs might be reduced by tort reform."

So it's a swamp - a large portion of orders have some defensive medicine baked in, but the influence on cost is unceratin, and tort reform might not make much of a difference, in terms of $$ saved.

I've always felt that the medmal topic is peripheral to health care costs, anyway - there are a lot of other drivers of costs that are probably a lot more important. Docs are VERY slow to change their practice patterns even when there is really good evidence that doing so would be wise. And this is all kind of a derail, anyway.

MM MD

This never happened

Gently tell mom, "This is what you voted for. Doesn't America feel greater?"

The Paul Ryan Gofundme Healthcare system

Yeah, I agree with all this, and it's why I was so quick to poo poo tort reform, even knowing that "defensive medicine" is a much more real thing. That said, given how little this practice changes when defense is not as necessary, I think "defensive medicine" is a poor name for what appears to be "overconsumption of tests as the established standard of care in American medicine."