Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

Ted Cruz

7 (6.5%)

Rick Santorum

16 (14.8%)

Michelle Bachmann

13 (12%)

Chris Christie

23 (21.3%)

Rand Paul

49 (45.4%)

Total Members Voted: 107

[mainiac]

Prices are capped and regulated,

For all income brackets?

Yes, the insurance companies have to offer everyone the same price.  Government subsidies come into play after that and have no effect on what the companies get.

And yet healthcare costs are still absurdly high, showing that the negotiations from Medicare and Medicaid aren't nearly enough. They only deal with a fraction of the population, a fraction that hospitals are likely to make deals over considering it'd be good for PR and any losses incurred can be covered by the cost of other services to those not covered by Medicare and Medicaid. In addition to that, Medicare and Medicaid are publically funded, so grouping them together as being the same as private insurance companies is a bit dubious. Are you saying that all insurance companies are going to band together and blanketly demand that costs are cut across the board?

Medicare deals with the elderly and the disabled, i.e. the most expensive people to insure.  The costs are completely reasonable given the people Medicare serves and are roughly sustainable with their current levels of funding, we'd need to increase funding about 5% sometime over the next 20 years to sustain benefits indefinitely with very pessimistic assumptions.  These projections assume that economic growth will be a bit below historical trends and we assume that immigration reform fails and the native birth rate doesn't rebound.

Also two of the big reasons that Medicare costs are so high are 1) private insurance market driving up costs and 2) Medicare Part D inflating drug costs.  Before Obamacare, providers could use the leverage of the higher prices outside Medicare to get Medicare prices a little higher.  Thanks to private insurance looking more like Medicare, that problem will start to shrink.  The other part is Medicare Part D included a provision that explicitly forbade Medicare to use it's bargaining power when it comes to drug prices like it does with most things.  This was, to put it charitably, because Republicans are corrupt fat cats who wanted more money from drug company lobbyists.  A more honest assessment would be unfit for polite conversation.  Sadly the ACA did not succeed in repealing this reprehensible legislation but we can hope.  Despite these handicaps, Medicare has kept costs down far better by using it's bargaining power with providers outside the drug industry.

For a post Obamacare insurance company, neither of these will be a problem.  They don't have Republican senators tying their hands on drug prices.  And insurance companies won't need to bid prices up to stay competitive with Medicare, in fact the comparison to Medicare will help them bargain for lower prices since it shows the providers can operate profitably at those prices.  So given that insurance companies will have these advantages and are starting at inflated prices to begin with, there is a lot of reason for optimism about future prices.

By the way, we haven't even gotten into the stuff in Obamacare not related to universal coverage the keeps costs down.  There are the effectiveness testing requirements, the medical loss ratio requirements, the new electronic medical records system (arguably the single most important thing when you compare the shocking difference in medical errors between US and other advanced nations), community health management organization trials, the single payer program being set up in Vermont, reforms to Medicare part D provider funding practices, a new payment structure in Medicare and Medicaid and so many more things.  Nearly every cost containment idea that serious (i.e. not industry shill) health reformers have proposed in the past 30 years is in there.  I just haven't mentioned any of these because you wanted to know what the individual mandate had to do with keeping costs down.

[MetalSlimeHunt]

So I'm going to listen to a presentation by the head of the North Carolina NAACP on the state's politics and protests tonight. It should be interesting, so I'll give you all a rundown later tonight.

That should be interesting. Can't wait to hear your recap!

From whence I have gone, I, MetalSlimeHunt, do return.

So, it was interesting to say the least. I don't regret going, if nothing else.

It started with an introduction by one of ASU's history professors, in which his basic point was that the actions of the NC General Assembly violate basic logic even if you accept their goals as stated. After him, one of the people who had been arrested at Moral Mondays spoke and sung the freedom song that she had been arrested over (she also told how, hilariously, some of the cops at the detention center got the song stuck in their heads and were humming it).

After that, it went on to the main attraction, Dr. Reverend William Barber, head of the NC NAACP and effective founder of the Moral Mondays protest. He spoke extensively about how this was less a partisan political issue and more a struggle between good and evil, hence the "moral" in Moral Mondays. I find it hard not to agree with him on that, given that the General Assembly has cut Medicaid for thousands of North Carolinians and effectively enacted voter suppression. He went on to talk about the First Reconstruction and Second Reconstruction, with the overarching points that: A. He believes we are on the cusp of a Third Reconstruction, and that this time it can truly succeed. B. Fusion Politics are vitally important for breaking down extreme ideologies, both in the past and here today. C. Framing the issues as moral ones is important, and moral dissent is vital even if it fails (the primary example being the lone dissenter in Plessy v. Furguson.) From there on it was fairly standard "we will never surrender" stuff.

Lots of deafening applause throughout.

What I didn't like: The religious aspect of it all. I know the NAACP was founded on a fairly religious basis and that mobilizing the Christian Left is important until the religion collapses wholesale (and that the guy is a reverend to boot), but it was just too much. For somebody who talked a lot about fusion politics he was dangerously close to alienating secular people, which is far too common. To his credit, he did at least mention nonbelievers once or twice, but it just does not balance out the clear lack of understanding when he would relate everything back to Jesus or say things like "and on that we can agree, no matter what God you worship". The only part that really pissed me off was when he was going through various traditionally opposed people that should work together, and said "or people of faith, or people struggling with their faith, or people who don't share my faith but share my values".

He was a decent speaker, though he tripped over his words a few times when ad libbing and had a (to me) annoying tendency to not pluralize. Still not bad for an hour long speech.

My favorite lines of the whole thing were "When you make Ronald Reagan look like a liberal..." (referencing how Reagan said the Earned Income Tax Credit was one of the most powerful tools to reduce poverty, while the current Republicans hate it and cut it significantly in North Carolina.) And, in reference to NC Senator Apodaca calling the Voting Rights Act a headache and being glad it was struck down: "If you think that was a headache, you haven't seen anything yet, because if you think you can take away people's voting rights without causing yourself a headache, you are out of your cotton-picking mind!"

So, in summery: 8/10, even progressives often disrespect the nonreligious, decent overall though. RIP Republicans (I'm joking of course, they won't be missed) if this continues.

The Moral Monday protestors are currently calling on Governer McCorry to call a special legislative session to resend the Medicaid cuts and voter suppression laws. He's already refused, obviously, but they're continuing to protest, and have an especially large protest planned for December 23rd. 

[GlyphGryph]

You should really read the stuff that came after that if you haven't already. I've stated in my last couple of posts how insurance companies as a single entity can't reasonably refuse service for a hospital

Uh... they can. They do. They seriously do it ALL the time. There are certain hospitals I can't go to (or that I can't go to for specific procedures, even) because the insurance company will NOT pay them. This is before the ACA makes that easier. It is, in fact, standard industry practice. It's weird to insist they can't possible do something that they do all the freakin' time.

[misko27]

Texas Abortion restrictions blocked by judge.

[Chaoswizkid]

Wrong. That percentage is people who buy their insurance individually, not those covered under workplace plans (the vast, vast majority of insured Americans).

Balls. Yes, sorry, I actually knew that but I forgot to include it in the link. The original post has been edited.

So, 2% of the population lost or changed their health insurance when a huge health insurance overhaul came about.

Man I could've predicted that.

I think the greater issue here is that there were a bunch of lies. Well, more like one lie that was stated over and over again. Perhaps 2% of the population isn't eligible for an asterisk clarification, though. I guess that's fair. Edit: This is not meant sarcastically, just in case anyone was wondering.

Most of the stuff said.

Ah, alright then. That does make sense. Thanks for explaining it.

I just haven't mentioned any of these because you wanted to know what the individual mandate had to do with keeping costs down.

...  Damn. Well, all of that other stuff would have been appreciated, but now I realize that it stemmed from me saying that our system was pretty much just mandatory insurance and that's how everything got onto that. If you had broken off and had brought up those other things, I feel like our conversation would have taken a much different turn.

Now I'm a bit more optimistic about the ACA lowering healthcare costs. I just hope that it can actually accomplish that, or if it can't, that it paves the way for something else to do so.

Uh... they can. They do. They seriously do it ALL the time. There are certain hospitals I can't go to (or that I can't go to for specific procedures, even) because the insurance company will NOT pay them. This is before the ACA makes that easier. It is, in fact, standard industry practice. It's weird to insist they can't possible do something that they do all the freakin' time.

You should really read the stuff that came after that if you haven't already. I've stated in my last couple of posts how insurance companies as a single entity can't reasonably refuse service for a hospital

Maybe that wasn't clear, but I meant that to mean all insurance companies banded together as one thing, not an individual insurance company. This discludes hospitals that are fake or clearly have terrible standards (if they exist). This is more like metropolitan hospitals whose location and structure are designed to service thousands of people getting flat-out denied from all insurance companies. I was referencing this:

... hospitals are also located to serve a population. When the population grows beyond their capacity, the hospital is improved, a new hospital is built, clinics are established, etc. While it's possible in cities with large numbers of hospitals that a population can just swap to another nearby hospital, that would completely screw with population metrics and you'd likely see horrible overflows. The hospital that refuses to negotiate down their prices enough would likely shut down, prompting a pretty horrible situation. Now, the hospital wouldn't want that happen so they would be willing to negotiate to a certain degree, but the power is not entirely with the insurance companies because the hospital can say "Well, if you actually went through with your threat, everyone would be pretty screwed and it'd come down to who could better convince people was the bad guy of the situation." This is to say nothing of rural populations which would be in considerable trouble should insurance companies refuse to cover local hospitals.

[Frumple]

I'm... relatively certain they occasional do (/have done) stuff like that last bit? Hearing of someone that has to travel an hour or more to find someone that their insurance is willing to work with (/are willing to work with their insurance) -- when there's plenty of medical care providers closer -- is something I hear about... not exactly regularly, but often enough it triggers commiseration instead of befuddlement, both with me and anyone else who might be involved in the conversation.

E:I'm not sure, but what seems to be that might be a fundamental flaw in your reasoning is the apparent assumption (which I may definitely be misreading, it's late and I'm tired) that the hospitals and insurance companies actually give a shit about the non-fiscal outcomes of their decisions. Some of the ground workers may, but the ones pulling the strings... that stuff only matters strictly to the extent it impacts their profit margins, by and large. If they can pull out an extra 1% on the net by starving a rural county or five out of medical care for a few years, they will. If it means putting hundreds or thousands out of medical care or local medical care... too damn bad. Health care's not what either of the string pullers on either side are there to do, y'know? That just happens to be how they go about doing what they do, in this particular market.

And they've got spin doctors that put the Red Tornado to shame, both groups. These are people that fairly regularly completely wreck families and homes and come out smelling like daisies. Something as minor as starving a city or a few counties of service is basically penny ante crap for the medical and insurance industries.

[Chaoswizkid]

I'm... relatively certain they occasional do (/have done) stuff like that last bit? Hearing of someone that has to travel an hour or more to find someone that their insurance is willing to work with (/are willing to work with their insurance) -- when there's plenty of medical care providers closer -- is something I hear about... not exactly regularly, but often enough it triggers commiseration instead of befuddlement, both with me and anyone else who might be involved in the conversation.

Again, this is not about single insurance companies saying that those who are insured can't go to this certain hospital. This is about if all insurance companies said "fuck that place" at once. I was taking an extreme situation to show that, even in that extreme situation where the bargaining power would be at its maximum, it's still not fully in the insurance companies' hands.

It is a point that has since been rendered moot. I'm only going back to explain to Gryph that I meant something other than what he thought I meant.

E:I'm not sure, but what seems to be that might be a fundamental flaw in your reasoning is the apparent assumption (which I may definitely be misreading, it's late and I'm tired) that the hospitals and insurance companies actually give a shit about the non-fiscal outcomes of their decisions.

Nope, that's why I worded this the way I did:

... because the hospital can say "Well, if you actually went through with your threat, everyone would be pretty screwed and it'd come down to who could better convince people was the bad guy of the situation."

Although that should be edited to "it'd come down to who could better convince the people who the bad guy of the situation was." Or something like that.
The "everyone would be pretty screwed" bit covers both providers that might actually care and those who are just saying that as the basis for planning to spin it in their favor.

[GlyphGryph]

Again, this is not about single insurance companies saying that those who are insured can't go to this certain hospital. This is about if all insurance companies said "fuck that place" at once. I was taking an extreme situation to show that, even in that extreme situation where the bargaining power would be at its maximum, it's still not fully in the insurance companies' hands.

Of course not - otherwise it wouldn't be bargaining. But this is a market, and it follows the rules of a market. If one insurance company says "fuck that place", the others will usually follow suit to remain competitive - continuing to pay high prices is not a good business strategy. It's the same reason so many different airlines are simultaneously moving to smaller seats on their new planes - you can only afford to pay more when your competition is doing the same.

Still, it's not supposed to give them absolute power over hospitals - but being able to do this DOES give them significant bargaining power. Most hospitals run on pretty slim margins - even a 10 or 15% reduction in patients can be deadly, and if a few major insurers drop them until they lower their prices, they are running a real risk. They would much rather make "less" money than "no" money, and every single client they lose because an insurer refuses to cover them at that hospital is money out of the hospital's pocket.

It's the reason why doctors take medicare at all. Doctors do NOT have to accept medicare patients, but the medicare patients get in because some patient is better than no patient, even knowing they will have to accept medicare's ultra-cheap prices and their return will be less than with another insurer.

[mainiac]

In case you think that insurance companies can't just unilaterally cut large geographic areas out of their networks, here's a glimpse of a dispute that spilled into the public eye:
http://delong.typepad.com/annmariemarciarille/2013/10/hospitals-v-insurers-mississippi-version.html

tl;dr those hospitals better cut costs in the next 60 days if they want to keep operating.

[Sheb]

And well, the fact that hospital do charge insurance companies way less than individuals, and charge less to some companies than to others prove that insurance companies can bargain.

To me it seems you're trying to argue the sky cannot possibly be blue.

Anyway, MSH, got more info on those Moral Monday things? Never heard of them before, is it a strictly NC thing?

[Max White]

You know if you had publicly owned hospitals that were primarily state funded and not for profit this wouldn't even be an issue.

[mainiac]

You know if you had publicly owned hospitals that were primarily state funded and not for profit this wouldn't even be an issue.

Yuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuup

[freeformschooler]

We do kind of have those in some places. They can't deny anyone treatment and can't force hurt homeless folk to foot the bill so its a point of contention sometimes for the hospital owners (the local one threatened to throw a dying man out cause he didn't have insurance or money but that didn't happen thankfully).

[Chaoswizkid]

Of course not - otherwise it wouldn't be bargaining.

Did that really even need to be said?

If one insurance company says "fuck that place", the others will usually follow suit to remain competitive - continuing to pay high prices is not a good business strategy.

I'm not sure that that's true. Why aren't all of the hospitals pretty much shut down, then? We've already been over how individual insurance companies refuse service to hospitals, by your logic that means that all of the other insurance companies will also refuse service. This isn't the case, though. They'll likely do something else to remain competitive than all follow suit and shut out hospitals together.

Still, it's not supposed to give them absolute power over hospitals - but being able to do this DOES give them significant bargaining power.

Yeah. I know. The point was that I wasn't confident that the insurance companies would have a significant enough impact to lower the cost of healthcare to a rate comparable to other countries.

Now, the insurance companies don't have to go that drastic and caregivers are likely to negotiate, but I don't believe the effect would have a significant enough impact on the cost of healthcare in the US to have it more closely resemble the cost of healthcare in other comparable countries.

Most hospitals run on pretty slim margins - even a 10 or 15% reduction in patients can be deadly, and if a few major insurers drop them until they lower their prices, they are running a real risk.

Woah, didn't know that. That is seriously very surprising. Not the 10% to 15% reduction in patients bit (which I would just assume they would cut personnel and other services until they could deal with the lower amount of patients), but the slim margins bit. Can you provide a link? Unless the slim margins bit was about the 10% to 15% reduction, then nevermind.

In case you think that insurance companies can't just unilaterally cut large geographic areas out of their networks, here's a glimpse of a dispute that spilled into the public eye:
http://delong.typepad.com/annmariemarciarille/2013/10/hospitals-v-insurers-mississippi-version.html

tl;dr those hospitals better cut costs in the next 60 days if they want to keep operating.

The real back story is that BCBS holds a near monpoly in some of  Mississippi's health insurance markets.

Which means, for the state of Mississippi, that BCBS is pretty much all of the insurance companies. This isn't even disagreeing with what I said, because I said that it wasn't reasonable, which it's not because the governor stepped in to avoid a crisis. The rest of the article just supports what else I said: that it would come down to who could spin who into the bad guy. BCBS is saying the HMA is, and the HMA is probably saying that BCBS is (but that's left out of the article).

And well, the fact that hospital do charge insurance companies way less than individuals, and charge less to some companies than to others prove that insurance companies can bargain.

To me it seems you're trying to argue the sky cannot possibly be blue.

That said, I'll admit I don't actually know enough about how their negotiations work and how much power they do exert. The fact that prices are drastically different for different insurance companies is confusing to me. Maybe they do have a lot more power than I give them credit for, but I just don't see how they have those essential bargaining chips considering that healthcare is a necessary service and that it has a geographical significance, to say nothing of doctors having the most powerful lobby which they can use to influence our government.

Damnit, Sheb, this quote was even in response to YOU. I'm not saying they can't bargain, I'm not misunderstanding what bargaining means, I was just not confident that they could bargain the prices down significantly (significantly being "comparable to other countries"), while also acknowledging the fact that, given evidence I couldn't explain with my position, that I was potentially wrong. Which I was.

Jeez, guys, come on. Why are you trying to jump on stuff that I said like 3-4 pages ago in a conversation that already ended? This even started by Gryph quoting me saying that RedKing should go back and read the conversation to better understand what was being said and where we were currently. Instead, I try to clarify by quoting a piece of what I said, and after that it was just me repeatedly quoting other things that I said in different posts because I was following a logical progression but each of you were just picking at what bit I quoted at the time.
Seriously, can we stop this? If you want to quote what I've been saying in the past couple of pages and argue with it, at least go back and read the previous conversation so you get the whole picture so I don't have to keep defending my points by going back and quoting my posts some more. If you do, by the way, please keep in mind how the conversation even ended, which was Mainiac explaining (because I was asking for an explanation) that under the ACA that insurance companies would have a lot more bargaining power, which I understood and conceded the point.

[MetalSlimeHunt]

Anyway, MSH, got more info on those Moral Monday things? Never heard of them before, is it a strictly NC thing?

Yes.