Guess What? Obamacare WILL Raise Premiums.

I have no time to really study this article, verify what it says, and so on. But whatever problems there may be, at least we now have taken a step toward getting health insurance for everyone. I can not see that as a bad thing.

It is unrealistic - and political bullshit - to expect that a new program will be free of problems, particularly when one party has done everything it could to prevent passage in the first place. And problems can be corrected.

I'm willing to grant that Obamacare has serious problems. In many ways it is the worst of both worlds - free market and government programs. Obama erred when he stepped back and let Congress craft the law. It's chock full of pork and flaws.
But what else is there? In the current free market system, health insurance premiums routinely go up every year anyway. And each year we pay more and are covered less. Health costs also go up every year. Very fast. In my area some hospitals charge literally 10 times more than other hospitals here. Can we shop for the best price? No, because the doctor chooses the hospital, not the patient. Can we shop for doctors? Rarely, because our insurance only includes certain doctors and we can't use those "off list". In any case, the AMA tries to ensure that there are very few discount doctors working. Can we shop for insurance? No, because most of us have to take whatever our employer offers. Around the nation more and more hospitals are buying up medical practices, thus ensuring that their employee-doctors will feed them a steady stream of patients for their overpriced care. Sigh

And who pays for those without health insurance (about 25% of the workers in Texas)? We do (we, the government). And those without tend to go to expensive emergency rooms for routine treatment. They also postpone seeing doctors until a minor complaint becomes serious (and expensive). We (the government) could potentially save a lot of money with proper insurance for the poor.

I would certainly like to see a better national health insurance program than this one, but no one is offering it. We're screwed if it takes effect and screwed if it doesn't. Our entire health system needs a serious overhaul. But the medical lobby will not permit that to happen. Sigh.

By "free market" I mean the business model of medicine. Once upon a time, medicine was not a profit-making profession. Doctors were more like modern public school teachers - the pay was low and the hours were bad. But people went into medicine as a "calling", not to get rich. Hospitals were run as charities. But over time, the model changed. Hospitals are now run like any other corporation, to maximize profits. Doctors refuse to take patients who can't afford their high rates. And so on.

I don't blame the government (entirely) for our current mess. Modern medicine, like other Big Business, uses lobbyists to skew laws to increase profits. So much of our problem comes from choices made by the medical industry.

>Fewer people for individual policies meant higher premiums.
Yes, but even those who were getting group premiums also paid more. And, technically, since the insurance companies were getting more customers (from employer-paid polices), they should have been able to lower their rates for everyone, right? Especially since they were able to exclude "previous conditions" and to set maximum payment limits.

> If you look at the historical graphs, the rise of medical costs started taking off shortly after Medicare was in place.
Was that a cause? Or merely the coincidence of many new (and expensive) medical developments. And Medicare limits the amount the gov will pay, so why would medical costs go higher than what Medicare would pay? It's happening now, in the Austin area, since many doctors here refuse to take any Medicare patients because they say the gov doesn't pay enough. One side effect is that as the baby boom population needs more medical care, less is available. To those who only have Medicare, at any rate. One co-worker here moved his elderly mother from Houston to Austin, where 3 of her children live, but it took them months to find a doctor who would accept her as a new Medicare patient. I guess what I'm asking is why would Medicare raise costs when so many doctors (and hospitals) won't take Medicare?

Dear Gentlemen:

I'm addressing this to everyone in this conversation at once because I am pressed for time. I have an appointment.

I wish I could get my husband to tell you what the present state of medicine actually IS -- and not what the newspapers want you to believe.

The AMA represents THEMSELVES. No doctor actually believes they do anything for their members. Think of it more as a political organization out for their own interests rather than representing your average doctor.

What do doctors REALLY WANT?

TORTE REFORM.

Things cost what they cost because insurance is astronomical both for hospitals and doctors. If you don't think this is the biggest factor -- make it a point to price malpractice insurance (any specialty -- they're all outrageous premiums). Then, price office space. Price office equipment. Price employee salaries and benefits. And all that has to be paid BEFORE the doctor makes a dime to support his own family.

Now as for medicine as a "calling"...

Let me see...I can only speak from my point of view.

When I had my son...I went into labor a month early. As my husband drove me to the hospital -- I was made to feel that the fact that my baby was premature was an "inconvenience" to the great practice of medicine. His calling, if you will. Through my entire labor -- he kept looking at his watch. He had patients waiting...and he had "planned" for me to have my baby when I was supposed to. Early labor threw off the "great calling".

After the baby was delivered -- he ran out the door, and I DIDN'T SEE THE MAN FOR THREE ENTIRE DAYS. I sat in the hospital, ALONE AS USUAL...by myself.

What made it "worse" (not that I think men would "get it" quite the way a woman does) -- was the fact that the hospital had a "celebration dinner" for all the new moms and dads (their little way of being nice).
When I told the nurse "no thank you" (because of course, my husband wasn't going to be there) -- I was invited to attend BY MYSELF. Ah...I don't think so -- who wants to see happy couples when you're part of a couple except the other half is NEVER THERE?

I have spent every Chistmas, Birthday, Wedding Anniversary -- you name it -- ALONE. His "calling" you understand.

There comes a day when every mother of an autistic child finally "gets it" that something isn't "right" with the baby. When that day arrived -- I was in hysterics. I BEGGED AND PLEADED with him to take ONE DAY OFF because I was so upset. It is the ONLY TIME in 35 years of marriage that I WAS THE ONE WHO NEEDED HIM. Guess what? His "calling" AS USUAL came first. I sat and cried BY MYSELF for the entire day...and actually several days afterwards. If I recall correctly -- he caught up with me about four days later -- on the fly(as the saying goes).

Oh yes, the myth of the doctor's so-called sacred "calling"...I'd laugh except it caused me too many tears over the course of my marriage. If you think my situation is unique...talk to other doc's wives.

I love you guys, so don't misunderstand and think my bitterness is directed at any of you -- but I'm the only "expert" on that subject here. The myth of the "sacred calling" SUCKS. And the thought that there isn't "enough" dedication is ludicrous beyond belief.

--Debutante

Hi y'all! I've been AWOL for quite a bit.. nice to see the new digs!

Personally, I lean more towards Bob's libertarian views on this. But, I can see where there is room for a nationwide "safety-net" that could greatly reduce what we spend on health care/insurance each year.

I have always been a proponent of a nationwide catastrophic pool. Let's say everyone puts in 2% of their gross wages to a pool to cover catastrophic medical expenses. Let's stipulate it would be enough to cover any medical expense over $15000 in a single year.. That figure may be unrealistic, but with a pool of 300 million people, I don't think so.

Anyway.. each American would be responsible for medical bills under the kick-in amount for catastrophic coverage.

This would be administered through private insurers, who would get the chance to sell you "gap" coverage - i.e. insurance to cover any amounts before the catastrophic coverage kicks in.

Now, remember their risk is very low.. they will never be dinged for a high cost This coverage would be cheap.

Some people would tend to not get any gap coverage at all. Some employers would gladly pay 100% for gap coverage.

Here's the point: The funding for day-to-day medical coverage that really costs us would revert back to a personal decision. Families may decide to forego gap coverage and simply see a physician assistant at Walgreen or CVS for colds and flu and sniffles.

Government coverage for the poor would be much cheaper as well, since a $100 per month premium for gap insurance is a lot less than $800 for a premium the poor family may not even use.

Jerry

P.S. Nice to see you all still around and kicking!

Hi Jerry. Good to see you back!

Bob

Bob wrote:
>So before 1965, there were never any doctors who were in it for the money? I would really like to see the evidence for that.
---I didn't select 1965 as the date when medicine became big business. It was a transition from the late 19th century into modern times. I'm not sure that there was a specific year, but a steady worsening over time.

>There were plenty of medical advances before 1965. Why didn't costs go up before then?
---The reverse question is why would costs go up after 1965? The vast majority of citizens were not on Medicare. I can see costs going up as more people got insurance post WW2 (a very large number), but it doesn't seem to me that the number of old folk in 1965 was all that large. At least by comparison to today.

>Patients aren't paying, so they go to the doctor more often for minor complaints that they would have previously handled on their own.
---The insurance programs that I've had (and those I know about from friends) are not exactly "no pay". Co-payments for doctors and meds can build up pretty fast. My current doctor co-pay is $30 for GP and $35 for specialist. Most meds cost me $30. So a trip for a minor upper respiratory tract infection or some such with a couple of prescriptions can easily hit $100. I had some outpatient surgery a few years ago. Insurance only paid 80%, so my various doctor and med co-pays and such ended up being something like $5000. For a minor procedure. Someone making minimum wage couldn't afford such, even if they had insurance, and most minimum wage worker don't have any. At least in Texas.

---If the make-patients-pay-and-they-will-spend-less idea was valid, I'd think that insurance companies would be fighting to lower medical costs, since they're the ones paying. But they don't seem to care. Possibly because high medical costs mean that most people can't afford good medical care without insurance.

>Obamacare is being paid for partly by reducing the Medicare budget by $700 million a year. So it is only now that doctors are starting to refuse new Medicare patients.
---Around here they were turning away Medicare patients BEFORE Obamacare.