The Affordable Care Act

[Tom Storer]

[moldyfigg]

Single payer is the only good approach. Get the insurance companies with their huge profits, marketing and executive salary expenses out and have everyone covered under Medicare. The tax will be mush less than what insurance companies want considering every person who gets a paycheck pays the premium. Just like Social Security. Old, young, healthy, sick - it's the only sane answer.

[walto]

Never could have passed anything as sensible as that in this (dumbfuck) country, Clint.

[Mr. Met]

I checked out the ACA online. Yeah, it sucks that all of those people Tom talked about can't get healthcare. But 30 million more people will. And the plans are easy to follow...

[Mr. Met]

[Dr Dave]

Don't miss the comments.

[Tom Storer]

There's a fair amount of questionable information in those comments, though. For example, one person says:

"From what I gather, it will be those individuals just over 400% FPL who will likely be the most adversely impacted.
IOW, many millions will not be able to afford the insurance, since they will get no subsidies, and remain in essentially “the same boat” they are in today.
Except that now they will be “fined” or punished for not being able to afford the coverage."

From what I've read, those who cannot be insured under ACA will be people earning under 138% FPL (Federal Poverty Level) in the states that did not expand Medicare to cover up to that income point (for that is the level at which ACA subsidies kick in). In other words, people who earn too much to qualify for Medicare but not enough for ACA subsidies. However, those people, while unable to obtain insurance through ACA, will be poor enough that they will not have to pay a penalty for being uninsured.

Subsidies end at 400% FPL, and people from that point on are liable to see their premiums increase if they are currently purchasing private healthcare rather than through an employer. So some people will indeed have to pay more, in exchange for many millions finally getting health insurance.

Edit: Jonathan Chait of has this to say:

"But the current Republican line does suggest a way out: if Republicans “win” a promise to negotiate the budget, with the debt ceiling not being subject to the outcome of the negotiations. That this has actually been Obama’s goal all along, and the thing Republicans have been trying to avoid, does not mean Republicans can’t talk themselves into it. The negotiation would probably end in a stalemate, or possibly a few small changes, but by the time it was finished the crisis would be over and conservative activists would have moved on to other issues — a new Obama scandal, maybe.

"The insistent talking point that Obama won’t negotiate is a preposterous form of propaganda. But it has been taken up by a number of eager conservative pundits who seem to actually believe it. What if conservatives can be made to believe their own talking point — to believe that forcing Obama to negotiate the budget is the party’s actual goal here? Conservative self-delusion got us into this crisis. It could also get us out."

[Coda]

The ACA is extending the time for when you need to sign up, but only for a day or so. It's good to know that everyone who wants insurance has a pathway to high quality plans. There are subsidies available on a scale, up till your salary hits $45K USD for a family of four. I don't know how this translates back to a federal poverty level mentioned by Tom but my assumption is this is middle class 'average' wages.

Massachusetts has had this program, or almost the same for about 10 years now. When I was in to see my Dr for my annual physical back in November he said he really expects no impact to his practice. He said he's about 50-50 between MA insured and Medicaid.

Everyone should be thrilled regardless of party affiliation.

[LennyH]

Coda,

You're being serious?

Just checking.

[Coda]

well, yeah. I'm serious. I am concerned about the real cost but feel that we could and should make appropriate changes that expand coverage. It will cost more, it always does. If we could offset cost increases through savings in other programs it would work. We do need to reprioritize how we spend money as there is a TON of waste in the system. This is one area where we should spend.

Now ask me about where to cut and I turn back into your favorite lovable evil Tea Party member.

[LennyH]

I hear you, Coda.

I work in healthcare. We're one of the biggest healthcare software providers in the world. I'm working on a new product now that, hopefully, will help more successfully manage the way people need to be cared for over time. People are starting to think a lot more about preventive and predictive healthcare. I'm stating this from memory but, IIRC, the cost of healthcare has risen by 9% or more every year since the mid 70s. It's been more like 4% since 2009. Hopefully that's a good sign. Up until now, healthcare has been very volume based. The more tests a doctor or hospital does, the more money they make. If a doctor screws up, they actually make more because of all of the follow up needed to account for that. There's a lot more talk about accountability now and, believe it or not, Medicare has lead the way in trying to create that atmosphere. Like paying a fair amount for a procedure but not paying more for extra, unnecessary work. And keeping patients out of the hospital, in part, by caring for them at home (it seems like this would be more expensive but not necessarily). I hope it works.

I think we should all hope that Obamacare works. I talk to my dad way too much about this subject and I know that his attitude is that he's wishing for failure, which is a shame. Regardless of whether we were enthused about the idea in the first place, we should all hope that it helps.

I happened to talk to the CEO of one of the largest healthcare systems in my area recently and he lamented the situation in their ER, meaning dealing with people who have no insurance in that way. Some people try to make an argument that that's a reasonable way to deal with the uninsured but that notion is absurd. We all pay for that and it sucks for everyone.

Anyway...I hope things are improving.

[Coda]

‘Twas the night before Christmas, when all through the House
Not a Democrat was stirring, not even Nancy Pelosi, the louse.

The health care bill was hung by the chimney with care,
In hopes that Senate Democrats soon would be there.

The American people were nestled all snug in their beds,
While visions of defeating Obamacare danced in their heads.

But Pelosi in her kerchief, and Harry Reid in his cap,
Hoped their caucus wouldn’t bolt home for a long winter’s nap.

When out on the Hill there arose such a clatter,
Reid sprang from his bed to see what was the matter.

Away to his office he flew like a flash,
And threw himself on the bill, which was done slapdash.

All 2,000 pages looked like the new-fallen snow.
“What’s really in the bill? No one will ever know!”

When, his wondering eyes filled with mist
At the eye-rolling sight of eight tiny extortionists,

Reid jumped up, so lively and quick,
He knew in a moment their payoffs must click.

More rapid than eagles his bribers they came,
And he whistled, and shouted, and called them by name!

“Now Landrieu! Now Lincoln! Now Lieberman and Nelson!
On Dodd! On Feingold! On Sanders and Levin!

Here’s your payoff! Now go do the deed!
And vote for this sucker in our hour of need!”

He told them that his back was to the wall,
And he told them, “Now go! And dash away all!”

So back to their states the extortionists flew,
With their hundreds of millions, and other goodies, too.

And then, in a twinkling, Reid heard on the roof
Pollsters showing him the extent of his goof.

As he drew in his head, and was turning around,
Down the chimney President Obama came with a bound.

Having done no heavy lifting, he looked rested and ready
To sign this monstrous bill, even without Teddy.

A bundle of political threats he had flung on his back,
And he looked so smug, the thug, as he opened his pack.

His eyes, how they twinkled! His dimples, how merry!
His cheeks were like roses, his nose like a cherry!

His droll little mouth was drawn up like a bow,
He knew his fellow Dems; he knew how it’d go.

He was thin and skinny, not at all a jolly elf,
And Reid laughed when he saw him, in spite of himself!

A wink of his eye and a twist of his head
Soon told Reid he had nothing to dread.

Obama spoke not a word, which was unusual for him,
Ready to sign a bill that will make health care more grim.

“Higher premiums! Fewer doctors! Higher taxes and fees!
And this bill’s just the beginning - oh, what a tease!”

He sprang to his feet and bid Reid goodbye,
And went back to the White House in the bat of an eye.

But Reid heard him exclaim, and it sounded like a prayer:
“Happy Christmas to all, and to all ruined health care!”
(With my apologies to Clement Clarke Moore. And I hope I'm allowed to poke fun at this mess.)

[Monte Smith]

LennyH, I hope you don't work for Epic because if you do then my wife hates you.

[LennyH]

[Monte Smith]

The hospital she works at put in Epic a year or so ago. She says its one size fits all approach is bullshit and its authors know nothing about anesthesia. I cut her off there, as usually an hour long complaint would follow.

[LennyH]

I like it, Monte. Mostly because I'd like to keep my job for another decade.

[Monte Smith]

Aside from the user unfriendliness, Epic also has caused a drop in patient volume because the thing wastes a lot of time. Trainers told the hospital that would happen too, so why they bought it I do not know. Someone in charge is making money somehow.

[Coda]

EPIC was written in the late 80's. It's an IBM platform, server hog system that needs a serious do over. The owner is aligned to the White House so I wouldn't be surprised to see this beast touted as improvement over the current CGI (don't get me started) site.

[Monte Smith]

That doesn't surprise me, Coda. Carmen heard one rational more than any other as she wondered about the rush to EPIC: "We're going to need this when Obamacare comes in." $$$

[LennyH]

I'm not sure what it would have to do with Obamacare, specifically, Monte. The drive to get it in the first place might have been driven by "Meaningful Use", which incents medical facilities to make patient health records electronic. Federal dollars have been made available, in stages, and can be claimed by hospitals who make certain things digital. An example is something that I work on: If a hospital buys a system that allows them to scan certain patient records into a electronic document format and then also implements a system that makes those documents available so that patient records can be transferred to other hospitals as needed, to the patient, etc, then they can collect associated federal funds. This was part of the Federal stimulus. Hospitals have been very focused on getting these dollars for several years so that's benefited any software company that meets the requirements, like Epic or my company.

Even my doctor's office went electronic over the past year plus. As a patient, it seems like a big improvement over my doctor's old workflow, which was to pull out a blank piece of printer paper at the beginning of each visit and say "Ok, what medication are you on?". It was ridiculous. Not sure whether they had any Federal incentive for this, but the hospital system they are affiliated with would have. Now, the hospital system can access those records and, if I were at another hospital outside of the system or in another state or whatever, they could request my records and get them electronically.

This is good stuff, I think. Whether you agree that it makes sense to use Federal stimulus to drive something like this is another question. On one hand, if you're going to do a stimulus then it's nice to see the funds go to something like this, a modernization that was very slow to happen on its own. On the other hand, if you're trying to stimulate the economy then it's hard to make a case that the best way to do it is to make funds available that take several years for anyone to claim. Wasn't anything immediate about this program.

[LennyH]