dagblog - Comments for "The Beginning of the End for Obamacare"

I think that things will

rmrd0000 — Sat, 16 Nov 2013 20:38:56 +0000

In reply to It's worth noting that the

I think that things will settle down and in the final analysis, it will be a choice between folks trying to get people healthcare and other people who just want you to plan a funeral if you're sick. So I'm not yet pessimistic about 2014. Better that this is happening now.

The angioplasty story changed

rmrd0000 — Sat, 16 Nov 2013 20:35:17 +0000

In reply to One of my favorite topics

The angioplasty story changed with the science. A blocked vessel was viewed as a bad thing.there was a move to open all vessels if possible. Studies were conducted to assess the impact of this treatment. The open all vessels did not work in patients with angina that was stable. Practice is changing

There are people with chronically occluded vessels who benefit from having those old vessels opened. In fact you may even dissect an occluded vessel and re- enter it to place a stent. Previously these vessels were thought to be just a part of the damage done by coronary artery disease with no good therapy available.

I think it is important to constantly question medical practice and the efficacy of therapy one problem that is encountered is that techniques improve over time, drug therapy changes, etc. The results of what was done five years ago does not apply to what is being done today. The observation that fewer people improve with angioplasty that expected is part of the ongoing quality analysis that is needed.

I think the angioplasty situation is much different than the low testosterone clinics popping up all over. There is essentially anecdotal data without full analysis of possible harm.

You buy insurance as an

Peter Schwartz — Sat, 16 Nov 2013 19:47:46 +0000

In reply to To be clear, here's where I

You buy insurance as an individual and use it as an individual, but you pay as a statistic.

One of my favorite topics

artappraiser — Sat, 16 Nov 2013 19:45:44 +0000

In reply to It may be that the stereotype

One of my favorite topics and, I would argue, not as straightforward as most imagine. That all depends on the quality of preventive care. If you have a system that is not profit motivated, like NHS, it works. If your preventive care practitioner is susceptible to influence of the medical industrial complex, though, watch out, the patient could be worse off health-wise (entering a cascade of treatments causing iatrogenic illness and then counter-treatments,) while at the same time spending a lot more health care dollars.

Men have actually been a target of a lot of this in the last couple of decades. They would get all the expensive cardio tests recommended by their doc and then have gotten all kinds of dubious treatments from those results, like angioplasties which later became highly criticized treatments. Preventive care has to go back to: first, do no harm.

To be clear, here's where I

artappraiser — Sat, 16 Nov 2013 19:27:55 +0000

In reply to I've read a lot over the

To be clear, here's where I am coming from: all insurance is maddening and sucks. It doesn't seem fair that a very safe teen driver should have to pay a hell of a lot more for car insurance than a careless 40-something driver, but that's the way insurance is, it tars people with attributes of tribes.

It may be that the stereotype

rmrd0000 — Sat, 16 Nov 2013 19:24:52 +0000

In reply to I've read a lot over the

It may be that the stereotype of men not going to doctors for preventive care is the truth.The goal should not be to penalize women but to encourage men to use preventive measures for a number of diseases.

I've read a lot over the

artappraiser — Sat, 16 Nov 2013 19:16:03 +0000

In reply to That could be the reason so

I've read a lot over the years with evidence that women use health care services much more than men, and it's not just accountable to maternity care. Most people have anecdotals that concur, i.e., even within a family that's reasonably health-care oriented, many women have an annual gynecology appt. for pap smear and then the mammograms as well, while men don't go see a urologist once a year, their G.P. handles the sex parts stuff once every few years. (And that's without getting into the stereotype of guys who just refuse to use goddam doctors...)

It's worth noting that the

Peter Schwartz — Sat, 16 Nov 2013 18:55:49 +0000

In reply to The Beginning of the End for Obamacare

It's worth noting that the Obama-Clinton "fix" to this problem seems to be sowing even more confusion in the hinterland and insurance commissioners and companies are rebelling--if WaPo's story is to be believed.

If we lose big in 2014--and things aren't running smoothly--watch out below.

I'm not sure either. Just

Peter Schwartz — Sat, 16 Nov 2013 18:53:11 +0000

In reply to I'm not sure if the economics

I'm not sure either. Just wondering why this became one of the essential services that all plans must cover. Seems a little odd because there are plenty of people who know they will never use this benefit, unlike other benefits that will probably never be used, but always could end up being used, e.g., hospitalization for cancer treatment.

It's possible that maternity benefits are so expensive the companies need to spread the cost as widely as possible and have it borne by people who will never use it.

Just as happens with all benefits. Those who never use their benefits are always paying for those who use benefits. Otherwise, the premiums would be sky high(er), or the insurance companies would go broke quickly.

One way around this might be to allow for an opt out, but make it a permanent opt out. Or an opt-out for an especially long period to avoid people opting out until the moment before they needed the coverage. The bargain would be: It's fine if you don't want to pay for this benefit. We understand, but in return, you have to give up your access to this benefit forever, or for a long time.

(Of course, this still doesn't address the needs of people who get pregnant accidentally and want to keep the child, of whom there are many. I don't think we want the insurance company trying to decide whether a pregnancy was on purpose or an accident. So it's possible that a blanket requirement to pay for this benefit is the only reasonable recourse. Then again, I'm not sure what happens now when someone isn't carrying maternity coverage, under a pre-ACA plan, and gets pregnant. Does she or the couple have to pay for this care out of pocket? Lots of questions; few answers.)

Men who wanted to have kids or thought they might have kids (in whatever way that might happen) wouldn't opt out.

Everything about universal

rmrd0000 — Sat, 16 Nov 2013 17:32:55 +0000

In reply to I was saying that if you want

Everything about universal coverage is a land mine. You gain prescription drug coverage, wellness visits and hospitalization. We are not going to single payer in the near future unless a dramatic change occurs in Congress. Do you see any solution to the deductibles given the coverage gains?