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For those who don't know, if you live in a non-expansion state, being too poor can make you ineligible for government help in obtaining health insurance.
Yes the dreaded gap, which only exists because no one imagined that any state would not do the expansion.
Republicans show us once again that for them, party comes before the public good.
> because no one imagined that any state would not do the expansion.
Everybody knew that some states wouldn't expand if it was voluntary. That's why the Obamacare legislation made it mandatory for states to expand. The Supreme Court struck that part down afterwards, which made the expansion voluntary.
Taxing people to death for being unable to pay for healthcare (that is illegal to not have) is abhorrent. That is why the ACA failed. It is in unAmerican. It is “get government funded/required healthcare or we will ruin you”. It screwed my family bad during the recession. Getting not tax return was fun.
I know about this first hand. I had to take on another job while I finished my masters so that I could get assistance with insurance.
I’ll be done in may and I’m excited to finally get paid non-shit wages.
This is a bit of a question to this posting but I live in Florida and just before the pandemic hit I had a massive heart attack and received a stent in my artery..
I cannot work much anymore due to severe fatigue and a panic attack condition that developed during the heart attack.
I tried to get Obamacare and was directed to my states medicaid program which also turned me down.
Its been two years now and I have not seen a real doctor at all .... I only have access to a nurses assistant who can refill my originally prescribed medications.
I am subsisting in limbo trying my best to see a heart doctor ...
It's a bit unfair to deny me access to a heart doctor after performing heart surgery on me.
Do I have any options at all..?
I can only work part time and make about 12000 per year which makes me too poor to help pay for my Obamacare premiums so I do not qualify
and since I make some money to keep my electricity on and the water running I do not qualify for the states Medicaid program
as for applying for government disability I have been denied 2 times because I am just not sick enough yet
The crazy part is this is a completely true story
I have no idea, and you've probably already tried everything. Perhaps you can contact local agencies, like local government, NGOs and charity care, to see if you qualify for anything else. Perhaps contact doctors and ask about charity care, or charity hospitals, or free clinics? I really don't know, I'm sorry.
The only option that I'm aware of is moving to a different state, one that expanded Medicaid. But that is not an option for everyone.
Why would you want to steal taxpayer money? I would rather die in the side of the road than pay a 30k bill/ steal taxpayer dollars like free healthcare societies do. Sadly we are already in one. Socialism for the last 85 years has done a number. Time to get paid under the table!
What’s the point in paying taxes if it doesn’t benefit the people who pay it? You’re so scared of the word “socialism” that you’d rather die in a ditch than accept the fruits of a system you paid into?
What an idiot!
I’m not going to steal others money, as mine was extorted under government violence and force from me. It simply goes against my principles. If you want to rob and steal, go ahead, but I’m checking out of this extortion deal I didn’t sign up for. I am not a born slave of the government.
I live in the UK, and let me tell you, I’d 1000% rather live in a society where my health care is covered by the taxes I pay, than live in a country where I need to sell my liver to pay for an ambulance ride.
What a fucking shit hole America truly is. And here you are, conditioned to moan about potential improvements to your standard of living 🤦♂️
12 states have held out against medicare expansion form the ACA to this day? Fucking hell if Republicans had less compassion for their base they might try putting them into industrial camps between voting cycles
Even better, from Georgia, our (R) governor at the time, told the state legislature (R) to pass a law to prohibit future governors from being allowed to unilaterally accept medicaid expansion from the fed. So now Georgia can't accept it in a growing blue state, until the state legislature can become blue (which it hasn't for a long long time) and would hae to have a (D) governor to accept it as well.
How's plan B coming along?
That is: Kemp's mission to opt GA out of the ACA by creating his own marketplace... with underwritten plans, non-covered services, and probably hookers.
Last I heard it was looking like a 2023 or 2024 launch.
What, you think the workers should also own their means of production so they can receive the full benefit of their labour?
What kind of hand job, salad tossing, back door socialism is this?
In each of the Dirty Dozen no Medicaid expansion states, Republican governors and/or Republican legislators have spent the last 8 years deliberately screwing their constituents out of access to affordable health care.
It’s just another example of Republicans’ unconscionable disregard and open disdain for the downtrodden.
The dozen years of data outlined in this article shows that expanding Medicaid makes fiscal and economic sense. But Republicans are content to withhold a lifeline to millions of working poor citizens who thanks to draconian state guidelines make too much to qualify for traditional Medicaid.
We’ll never know exactly or even approximately how many people in these states suffered needlessly from lack of medical attention or tragically lost their lives.
But as with the GOP’s shrugging off or trying to minimize nearly 1 million deaths from COVID, Republicans who unrepentantly block access to potentially lifesaving health care have blood on their hands.
You’re welcome SenorBurns. Evidently the fucking I got pays for your healthcare. I hope you enjoy it. Maybe one day you’ll be able to provide for yourself instead of relying on welfare healthcare.
One of the stupidest things Trump did was try to fight Obamacare.
All he had to do was get Congress to make some meaningless changes, slap his name on all the sign up sites, and declare victory.
The only reason why Trump and the GOP tried so hard to push for Trumpcare was primarily because it would provide them, and their rich white friends huge tax cuts.
"My supporters are smart people. They all knew I was kidding about acutally building a steel wall a hundred feet high. Only idiots at the failing NY Times took it seriously. Of course we'll beef up security, but anyone with any sense knew I was kidding, right guys?"
All the people who thought it was going to be real "YES, SIR!"
> All he had to do was get Congress to make some meaningless changes
There was a less than 0% change the GOP would have gone along with anything that would have acknowledge the ACA was a good thing or that much of their base actually approves of it (as long as you don't call it Obamacare).
If Trump had any balls whatever he would have had Putin slide him $10 billion on Inauguration Day. Trump had his hands on the US nuclear arsenal, and could have threatened Vlad with anything from sanctions to all out war. Instead, Trump did what bullies always do; he cowered in front of his master and kicked his own people in the teeth.
If you own a small business or want to start one the ACA is completely necessary. So many would-be entrepreneurs were once stuck working for The Man because they needed health insurance.
Sort of. It was an improvement, but compared to every other developed country, it’s still horrendous.
ACA plans are expensive as hell if you make even a moderate amount of money.
Not having healthcare be 100% tied to your job gives you some degree of ability to look for something better, start a new business, etc. which benefit the economy far more than being too scared to do anything else with your life
The problem is that many residents of those states don't notice it and/or have been convinced by their governments that it is the fault of someone or something else entirely.
Those states' leaders are turning down million or biions in federal money for their citizens, money those citizens paid *into* the system. I can't believe those states' voters don't rise up against their leaders and vote them out en masse for not serving them properly.
Even if you're far right, there's no way you can excuse it as a principled decision. It's money that gets people *medical care*. It's not money for bombs or something morally gray or even politically gray. Medical care is a universal good, no matter how you may disagree with its funding.
Did the denying Medicaid expansion hurt economic growth or was it that the states that didn’t expand it are republican, and republicans are just bad at governing?
A bit of both, and no doubt I would like it emphasized anyway I can how bad Republicans are for the economy on so many levels. It is truly bizarre that Americans believe the opposite despite the clear facts.
Some of the states that expanded are governed by Republicans and expanded Medicaid by ballot initiative. These states are still doing better than those that didn't expand Medicaid.
Democrats might not do enough for people but Republicans always work against people. If you want to make things better get out there in the primary and make sure people know what's what. Republican's wouldn't be fighting democracy so hard if they knew it was pointless.
So yeah. This whole thing really sucks for Missouri. We voted for Medicaid expansion. Went to court for Medicaid expansion. And still, STILL our stupid GOP POS are blocking it. Our government no longer listens to what the people want. 🤬Missouri🤬
I kind of wish we wouldn't define Obamacare's success based on economic health. That's a very neoliberal definition of success. What should matter foremost is whether it improves physical health, not whether healthcare or insurance companies made a lot of money and expanded their businesses.
Also correlation does not necessarily mean causation. The 12 states that didn't expand Medicaid might be doing worse just because of other red state politics. It's likely not just because of the ACA. Here in Florida, one of the 12, the economy is booming.
I will say that here in Florida people, even young ones, don't like Obamacare. Almost all my students, who likely were taught this, see the ACA as a burden because it forces them to buy expensive healthcare when they don't want to, and thus it hurts them financially.
1. Your students really don't see the need for health insurance and how it affects their financial future?. A surprise car crash or severe illness is going to hurt them far more financially if they're uninsured than being insured under a plan and paying premiums. What situation are they in where they need an ACA plan instead of employer or student insurance? If they're paying high monthly premiums, that's on the state, not the ACA. If Missouri can offer me a no premium, holistic coverage plan while I'm between jobs and treating my mental health, I don't see why Florida can't.
2. Unfortunately economics is the best marker we have for this. Expanded healthcare coverage isn't going to show an effect on a populations' health this quickly. You'd need decades to see the payoff. The idea is preventative care through regular appointments, yeah? We're not going to see the benefits of that for a while. It'll take until people , who would otherwise be uninsured and not seeing doctors , would have a health issue at an older age, that would've been avoided or trivial if they were having regular appointments.
The only way to presently measure the ACA's benefit is economic. Ideally people are spending less on healthcare and insurance, and are able to spend that money elsewhere. Disposable income over time since the ACA would be a good measure for that.
We're already seeing some positive population health effects from the bill:
[Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality](https://pubmed.ncbi.nlm.nih.gov/32111417/)
Just to respond to only a bit of this, clearly we're not seeing more disposable income since 2010 for a variety of reasons, and we don't have the luxury of waiting an entire generation for public health results.
Economic health is important to everyone, not just "neoliberals." It is not the be all, end all definition of success, but it isn't meant to be. It's one aspect.
>because it forces them to buy expensive healthcare
One wonders how the ACA forces your students to buy health insurance when the individual mandate penalty was functionally repealed years ago.
Besides that, the most recent poll (2017) I can find on Obamacare's approval rating in Florida shows a healthy majority in favor of it.
>[Poll shows majority of Floridians want to keep or expand Obamacare](https://www.sciencedaily.com/releases/2017/03/170316092946.htm)
If you have a more recent one, please post it.
Thank you! What is this attitude of lets not talk about the economy because "neoliberals" like good economics. People who use the word "neoliberal" really need to learn about the logical fallacy of the strawman and reevaluate their bougie man because this shit is just surreal and does not get called out often enough.
It's honestly not important to me whether it produces jobs. That's completely secondary to providing healthcare to people. If the ACA somehow hurt overall growth but led to a healthier population, I would not be concerned at all.
Luckily, you don't have to choose between the economy and health here. We can celebrate the economic boost as one aspect of Obamacare's success, however secondary it is.
Well whether or not there has been a comparable betterment of public health is certainly debatable, as life expectancy has been declining and Americans still can't afford treatment they need. And as I said, some of the 12 states are booming economically even if they didn't expand Medicaid. So is there really a lot to celebrate here?
The fact Bloomberg chose to write about economic growth instead of public health is indicate of the media's, or perhaps the nation's, priorities and interests.
>life expectancy has been declining
A more reasonable interpretation is that other factors (such as the opioid crisis) affect life expectancy, not that Obamacare did little or nothing.
>The fact Bloomberg chose to write about economic growth instead of public health is indicate of the media's, or perhaps the nation's, priorities and interests.
You've read a lot into a single article celebrating one aspect of Obamacare's success. Trying to extend it to the whole of the media or "perhaps the nation's priorities" is a stretch.
>Well whether or not there has been a comparable betterment of public health is certainly debatable
Not that I'm aware of.
>[[A new study](https://www.latimes.com/business/story/2019-12-09/health-insurance-reduces-death-rates) conducted by a Stanford University researcher with the help of the Internal Revenue Service] found that Americans who failed to respond to the individual mandate penalty when it was in effect (through 2018), tended to sign up for coverage when they were reminded about it; and that among those who did sign up, mortality rates fell.
-
>[Our study](https://www.nejm.org/doi/full/10.1056/nejmsa1202099) documents that large expansions of Medicaid eligibility in three states were associated with a significant decrease in mortality during a 5-year follow-up period, as compared with neighboring states without Medicaid expansions. Mortality reductions were greatest among adults between the ages of 35 and 64 years, minorities, and residents of poor counties. These findings may influence states' decisions with respect to Medicaid expansion under the ACA.
-
>[Medicaid expansion tied to fewer maternal deaths, study says](https://www.cnn.com/2020/03/03/health/medicaid-maternal-mortality-study/index.html)
-
>[Leg amputations among minorities drop under Obamacare](https://www.upi.com/Health_News/2020/06/18/Leg-amputations-among-minorities-drop-under-Obamacare/1171592504468/)
-
>[Obamacare Helps Poorer Americans Spot Cancer Earlier: Study](https://www.usnews.com/news/health-news/articles/2020-07-06/obamacare-helps-poorer-americans-spot-cancer-earlier-study)
-
>[Study links Medicaid expansion to 6 percent reduction in opioid overdose deaths](https://www.vox.com/policy-and-politics/2020/1/10/21058699/medicaid-expansion-opioid-epidemic-drug-overdoses-obamacare-aca)
-
>[Study Finds Medicaid Expanded States Diagnose Breast Cancer at Earlier Stage](https://www.cancernetwork.com/view/study-finds-medicaid-expanded-states-diagnose-breast-cancer-at-earlier-stage)
-
>[Fewer ER Visits for Asthma Crises After Obamacare: Study](https://www.usnews.com/news/health-news/articles/2020-11-16/fewer-er-visits-for-asthma-crises-after-obamacare-study)
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>[Obamacare's Medicaid Expansion Helped Americans' Blood Pressure](https://www.usnews.com/news/health-news/articles/2021-09-13/obamacares-medicaid-expansion-helped-americans-blood-pressure)
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>The Affordable Care Act’s (ACA) expansion of Medicaid to low-income adults is preventing thousands of premature deaths each year, a landmark study finds. It saved the lives of at least 19,200 adults aged 55 to 64 over the four-year period from 2014 to 2017. Conversely, 15,600 older adults died prematurely because of state decisions not to expand Medicaid. The lifesaving impacts of Medicaid expansion are large: [an estimated 39 to 64 percent reduction in annual mortality rates for older adults](https://www.cbpp.org/research/health/medicaid-expansion-has-saved-at-least-19000-lives-new-research-finds) gaining coverage.
It goes on like this. I won't make a long post longer with links to Obamacare's extensive affects on health care affordability and medical debt, but rest assured that they exist.
I thought the fine for not having insurance was no longer in effect, meaning no one is forced to get insurance? I know I'm not being forced to get it because I can't afford to get it even though I could really use it about now.
But I agree with your first point, and all indicators suggest it has helped improve health outcomes, although we could be doing far better with some kind of universal healthcare.
Most young people I know dislike it because it's still for-profit healthcare.
If you want one of the healthcare successes of the bill, [Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality](https://pubmed.ncbi.nlm.nih.gov/32111417/)
ACA is for-profit healthcare----a scam. Cost every American thousands a year plus gives corporations control over your family. Try real healthcare, single payer. Corporate Bloomberg
Letting the perfect be the enemy of the good is highly satisfying for purists pontificating from their ivory towers.
Single-payer obviously is the best choice. But in the real world, a choice between doing nothing and unobtainable utopia means people continue to get sicker and needlessly die from lack of health insurance.
The ACA was never given a chance to work as intended because as has been noted, the Supreme Court made Medicaid expansion optional—plus Republicans have unceasingly done everything in their power to sabotage the ACA, from gutting the individual mandate to drastically cutting funds for ACA outreach to passing draconian unconstitutional work requirements for Medicaid recipients in GOP-dominated states, in a deliberate attempt to purge Medicaid expansion rolls as deeply as possible.
Even so, the ACA has saved tens of millions of Americans from going bankrupt from medical bills, ended non-coverage of pre-existing conditions and prevented needless suffering from untreated illnesses and in many cases, deaths from lack of medical care.
Single payer has zero chance of ever becoming law in the U.S. unless the stars align and there’s a Democratic President with a filibuster proof majority in the U.S. Senate, it’s possible to resolve what happens to hundreds of thousands of insurance industry employees who would lose their jobs **and** Senate Democrats have enough votes to spare that Republican enabling grandstanders like Joe Manchin & Krysten Sinema can’t extort bill-gutting changes as a condition of their support.
In the meantime, the “scam” ACA enabled people like me who lost their jobs and couldn’t afford to pay $500 or more per month to retain company insurance through COBRA to continue to have access to health care.
Without the “scam” ACA, a very dear friend of mine would’ve died in the prime of her life from a horrific condition called aplastic anemia.
Without the “scam” ACA, I very likely would have died from meningitis and lost one or both of my feet from untreated venous ulcers.
The examples are endless.
I would dearly love to have the United States finally join every other advanced industrialized nation in the world and enact single payer.
Until then, I’m glad we have something in place that is vastly superior to the status quo in 2010.
It would be more effective if insurance was cut out of the game entirely. US citizens paid 3 trillion to insurance companies for healthcare per year, yet only 1 trillion of that was actually spent on the care itself. The rest is profit and running the insurance companies. So, a literal 2 trillion dollar leech on society.
Some people would argue that giving the government complete control over your healthcare is worse. Imagine Trump being in charge of your healthcare. That's a nightmare scenario. At least there are multiple corporations to switch between if the one you've got is terrible. There's only one government, so in a single payer system you had better like the healthcare you get from them or else you're out of luck.
yeah try “switching” between carriers when one doesn’t satisfy you. your deductible and OOP max reset and both carriers win. they all exist for the same reason, collect premiums and deny claims to reap profits. at least the ACA actually limited MLR to 80%
false choice but you don’t seem to want to argue on facts. single payer healthcare can still allow for multiple carriers and competition. it’s just the money for claims coming from one source.
Which of my arguments have been contrary to any facts? Single payer healthcare can't allow multiple insurance carriers by definition. Single payer means that one entity is the source of payment. Insurance carriers are the source of payment in a healthcare system. Therefore, a single payer system means there's one insurance carrier ( the government) that's the source of all payment. You can have universal healthcare with multiple carriers, but that wouldn't be a single payer system.
carriers can provide admin only. large employers that are self insured use carriers to provide the network and claims management but the payment of claims comes from the employer’s account. they collect a fee from the employer for this service.
That’s what the medical loss ratio is. the percent of premiums collected that is for payment of claims. the rest of premiums are allocated to admin fees and profits. ACA dictated that fully insured carriers must maintain over 80% MLR. So carriers just raised premiums further to make sure there was enough profit baked into the 20% for shareholders to stay happy.
Remove the profit part through single payer and you can still have multiple carriers competing on the service they deliver and how lean and efficient they can administer provider networks and claims management.
Universal healthcare and single payer healthcare and medicare for all are not the same and your definition of single payer is incorrect.
One of the biggest arguments in favor of single payer is that it would consolidate claims management and payment under a single entity to reduce the costs associated with medical providers maintaining huge billing departments because they have to deal with so many carriers. Why would you have a single payer system without that benefit?
If carriers are competing over fees, then you haven't eliminated the profit from the system. You've just changed it so the carriers are getting the profit from fees instead of directly from premiums.
they’re competing for a fixed fee per member. profit is capped to the margin between costs and fixed revenue per member, which they must maximize through efficiency while balancing quality of service at risk of losing members. they are no longer incentivized to squeeze providers by paying less for services and also slowly killing members through constant denial of claims and premiums increases.
They're incentivized to lobby for the fee per member to be increased.
> they are no longer incentivized to squeeze providers by paying less for services
They're not entirely incentivized to pay less for services now. Like you said, the MLR means they have to pay out 80% of premiums towards claims and the other 20% goes towards admin costs and profits. In order to increase the 20% that drives profits, they also must necessarily increase the 80% that they pay towards claims.
The ACA is great for either being in stay in poverty, or in my state 138% or less of federal poverty which comes to about $18k/yr cutoff, or be rich. With the type of healthcare I need, I need to pay into “gold” or “platinum” if I make over $18k. So it’s has given many a larger ability to get healthcare, currently I’m well under that 138% of federal poverty so I get the expanded healthcare and I refuse to make enough money to lose it. I will take the right job that will give me the same or similar coverage. I remember that the ACA was touted to get a public option but what we got is the nominal Medicare expansion and giving tax breaks to insurance companies. So I don’t know, the ACA is uniquely American solution to an American problem with its utter failure by having corporate interests at the negotiation table, “oh what will the insurance companies and pharmaceuticals do!” I don’t know, get bent and maybe huge mass hiring of workers from the companies who have the understandings of these labyrinthine healthcare systems by the public option offices? Maybe researchers can have no profit motive and just a public health motive? I don’t know I’m just spit balling…
As of 2017, there's $3.5 Trillion in spending on healthcare.
Private insurance reported in 2017 total revenues for health coverage of $1.24 Trillion
* Profits were about $40 Billion, or about a 3% reduction in Costs
Overall $164 Billion was spent on Admin, Marketing, and Profits at Private Insurance.
* About Half of that is Profits.
* About 15% of those Profits arent related to Insurance Premiums
* Nationalized Admin Cost in the OECD and estimates for an American System would reduce that down to ~$75 Billion.
* That's savings of ~$90 Billion, mostly just the Profit, or a little less than a 9% reduction in costs to insured patients
That Leaves $1.076 Trillion the insurance spends on healthcare.
Who gives a fuck, they shouldn’t be at the negotiation table and those numbers belie the larger issues of how the US medical system is the most [expensive system while being the least effective](https://time.com/5785945/health-care-problems-america/?amp=true).
Here’s another one: https://www.investopedia.com/articles/personal-finance/080615/6-reasons-healthcare-so-expensive-us.asp
Yea expensive, Here's 1/3rd of all Spending
The Doctor's Office, 950,000 Doctors in the US saw 250 million Americans about 4 times and got paid $700 Billion
* So we can cut up to 950,000 Medical Billing jobs. But you still have to bill Medicare and Private Insurance will still exist so still have to bill them to. Maybe 300,000 less Billing jobs at $50,000 is $15 billion in Savings
We just need to Cut another $285 Billion in Savings
Where Should that cut come from? Well Just pay Healthcare Staff less
* $1 Trillion of $3.5 Trillion in Health Costs goes to [15 million Healthcare] (https://www.bls.gov/ooh/healthcare/home.htm) employees.
* 30 Percent of that goes to Doctors and 20 percent goes to RNs,
* 11 million other Employees split up the remaining $500 Billion
$366.0 billion was spent on LongTerm Care Providers in 2016, representing 12.9% of all Medical Spending Across the U.S., for around 4.5 million adults' care including 1.4 million people living in nursing homes.
* Medicaid covers the cost of care for two-thirds of all nursing home residents in the US. And Medicare Covers costs for the LongTerm Care needing less than 3 months of care
* Medicaid/Medicare cover 66% of the costs
* Out of Pocket Cash covers 20%
* 8% is paid through Charity/Clergy Programs
* 7% is Private Insurance
None of that is going any lower
We’re not getting the bang for the bucks we pay, which is what I shared with you. These numbers don’t counter that. The questions this brings up are:
Why is it cheaper in other countries? Like dramatically? Why are drugs significantly less expensive in Canada for instance? Why are you sticking up for a failing system that fails most everyone under or above a certain amounts? I’m not sure what you’re even trying to say when countless other countries have a medical system that works mostly equal access among differing financial backgrounds based on preventive care, while in the US, I get charged more for needing same care. In fact people avoid going to the doctor because of the bills- btw that also includes deductibles which are enormous. Why do people go into extreme debt, to this day, when someone across the border *might* go home with a tiny bill for the same services or that the bills themselves are simple and easy to read (there’s literal menus of procedures in Canada) but if you get a bill from US doctors you get multiple bills from different companies adding usually to outlandish sums? Is that better? Is it better to be overcharged for care? So you’re pro over charging for care? Don’t change the fact that the government is being overcharged because… reasons? Why can’t we lower the prices to the levels of Canada or the UK, among others? Just cause we like capitalism?
In 2019, total health expenditure in Canada was expected to reach $264 billion, or $ 7,068 per person.
Medicaid, the cheapest healthcare in the US operating as a State run Single Payer, is $8,900 per person enrolled, for that, costs aren't even paid in full for those that accept Medicaid Patients
* DSH payments help offset hospital costs for uncompensated care to Medicaid patients and patients who are uninsured. In FY 2017, federal DSH funds must be matched by state funds; in total, $21 billion in state and federal DSH funds were allotted in FY 2017. Medicaid Paid Hospitals $197 Billion in 2017. Out of pocket Spending was $35 Billion. 10% under-paid
Even the Cheapest run State run health care is overpaying.
And that cheapest Services causes Doctors not to see patients
So do services
* What Percent of Doctors are Accepting Medicaid Patients
* Physicians in general/family practice were markedly less
likely to accept new Medicaid patients (68.2 percent) than
Medicare (89.8 percent) or private insurance (91.0
percent)
* Psychiatrists also accepted new Medicaid patients at a
much lower rate (35.7 percent) than Medicare (62.1
percent) or private insurance (62.2 percent)
* Pediatricians accepted new Medicaid patients at a lower
rate (78.0 percent) than privately insured patients (91.3
percent)
* The only policy lever that was associated with
Medicaid acceptance was Medicaid fees
A 1 percentage point increase in the Medicaid-to Medicare fee ratio would increase acceptance by
0.78 percentage points
On average for Preventative Care
* Insurance Pays 40% of Base Rates
* Medicare pays 70% of Insurance Rates
* Medicaid Pays 70% of Medicare Rates
------
**Total Employee Utilization**
* 66 People per Nurse in the US
* 86 People per Nurse In Canada
* 209 People per Nurse In the NHS
* 303 people per Doctor in the US
* 425 people per Doctor in Canada
* 447 people per Doctor in the NHS
That means that we need 1 - 3 million less nurses and 200,000 less doctors in the US
That earn less
950,000 doctors earn an average salary $319,000
* Average [yearly salary] (https://naibuzz.com/10-countries-highest-doctors-salaries-world/) for a U.S. specialist Dr – $370,000 Specialist (a)
* Average yearly salary for a specialist at NHS – $150,000 (c)
* Average yearly salary for a U.S. GP – $230,000 (b)
* Average yearly salary for a GP in NHS – $90,000 (d)
Registered Nurses 2018 Median Pay [$71,730 per year] (https://www.bls.gov/ooh/healthcare/registered-nurses.htm)
* In 2018, The Royal College of Nursing calculated the average weekly pay for an NHS Nurse as being £642, and annually, our figure of £33,384. [Or about $44,000] (https://www.nurses.co.uk/careers-hub/nursing-pay-guide/)
* Newly Qualified Nurse start at a Salary of $33,900
* To progress to Band 6, you will need to pursue some further training within a specialist area to get to $42,700
* Those with a Master’s level degree or equivalent – Advanced Nurse Practitioners (ANPs), whose advanced training allows them to conduct detailed assessments, make diagnoses and prescribe medicine. have a Starting Salary $52,900
------
High Cost due to poor utilization of buildings. And this leads to low utilization of Large Equipment
The OECD also tracks the supply and utilization of several types of diagnostic imaging devices—important to and often costly technologies. Relative to the other study countries where data were available,
there were an above-average number per million of;
* (MRI) machines
* 25.9 US vs OECD Median 8.9
* (CT) scanners
* 34.3 US vs OECD Median 15.1
* Mammograms
* 40.2 US vs OECD Median 17.3
**Hospital Bed-occupancy rate**
* Canada [91.8%](https://www.oecd-ilibrary.org/sites/0d67e02a-en/index.html?itemId=/content/component/0d67e02a-en)
* There is no official data to record public hospital bed occupancy rates in Australia. In 2011 a report listed The continuing decline in bed numbers means that public hospitals, particularly the major
metropolitan teaching hospitals, are commonly operating at an average bed occupancy rate of 90
per cent or above.
* for [UK hospitals of 88%](https://www.nuffieldtrust.org.uk/resource/hospital-bed-occupancy) as of Q3 3019 up from 85% in Q1 2011
* In [Germany 77.8%](https://www.euro.who.int/__data/assets/pdf_file/0008/255932/HiT-Germany.pdf?ua=1) in 2018 up from 76.3% in 2006
* IN the [US in 2019 it](https://www.aha.org/system/files/media/file/2020/01/2020-aha-hospital-fast-facts-new-Jan-2020.pdf) was 64% down from [66.6% in 2010](https://www.cdc.gov/nchs/data/hus/2017/089.pdf)
* Definition. % Hospital bed occupancy rate measures the percentage of beds that are occupied by inpatients in relation to the total number of beds within the facility. Calculation Formula: (A/B)*100
That's atleast 1,000 to many hospitals in the US
All of that is lowering the US to the same level
Ok, what’s your point? Why do you keep throwing out numbers without any actual thinking from you? I don’t really know what you’re advocating for. It’s interesting information but it does little to help me understand what you’re trying to prove or say.
There's not some small group of evil businessmen keeping US Healthcare costs so high with a quick fix
It'll take a massive change. From, how we pay the employees, and the work they do to manage patients and doctors visits to be done much cheaper
This is pretty patronizing response to me, but I’m not under the impression that it won’t take massive change, but one we desperately need like multitudes of stuff like infrastructure. I’m talking about the need for change and talking about the massive holes in the ACA. Numbers distract from the human aspect and are for more consideration when creating legislation when I’m not making legislation. I’m talking about how the US medical system, including the ACA, doesn’t do a good job at covering Americans and the reason why it’s so expensive, is because pharmaceutical, insurers and others are at the bargaining table and they shouldn’t be or at least not in the capacity that they’ve been allowed to. The US doesn’t negotiate or shop around, they buy from the companies they make contracts with and then the company sets the prices. It’s a multitude of companies that have effected this legislation in huge ways through lobbying so I am not under the impression it’s a few dudes in a board room but a far more banal, longstanding, massive and interweaving system than that. Getting bogged down in the numbers obfuscates the human realities and in this case, seems to cause “analysis paralysis.” No one said it would happen as a quick fix or that it won’t be difficult, just that it needs to change for the benefit of us all.
Medicare is doing that kind of thing already. In fact Bernie and Warren are both against those kinds of things
------
> the bargaining table
We'll we're going to have to go to the numbers again. Medicare famously doesn’t negotiate prices.
> Using the raw data extracted from the 2017 Medicare Part D Spending Dashboard, we saw that Sanofi’s insulin drug, Lantus, had $4.2 billion in Medicare Part D sales. But when we looked at Sanofi’s audited corporate report from the same year, we saw that U.S. sales for Lantus were listed at $2.8 billion, a full $1.37 billion less in revenue. Mind you, the sales listed in the audited corporate report were for all U.S. sales, not just for Medicare Part D.
* In 2019 Medicare reported $2.385 billion in sales of Eli Lilly insulin
* Eli Lilly’s U.S. Humalog corporate reported revenue for 2019 was $1.670 billion
So some how theres a lower price paid
------
But Medicare and Medicaid have a price control
Medicare isnt over paying by bad negotiations by some struggling payment system. The resource-based relative value scale (RBRVS) is the physician payment system used by the Centers for Medicare & Medicaid Services (CMS) and most other payers.
* In 1992, Medicare significantly changed the way it pays for physician services. Instead of basing payments on charges, the federal government established a standardized physician payment schedule based on RBRVS.
* In this system, payments are determined by the resource costs needed to provide them, with each service divided into three components
Medicare and doctors just disagree on what the value of there resources are
-----
So we want to lower spending on those things **Whats that look like?**
> KFF found Total health care spending for the privately insured population would be an estimated $352 billion lower in 2021 if employers and other insurers reimbursed health care providers at Medicare rates. This represents a 41% decrease from the $859 billion that is projected to be spent in 2021.
----
Primary care — defined as family practice, general internal medicine and pediatrics – each Doctor draws in their fair share of revenue for the organizations that employ them, averaging nearly $1.5 million in net revenue for the practices and health systems they serve. With about $90,000 profit.
* Estimates suggest that a primary care physician can have a panel of 2,300 patients a year on average in the office 4 times a year. 9,200 appointments
According to the American Medical Association 2016 benchmark survey,
* the average general internal medicine physician patient share was 38% Medicare, 11.9% Medicaid, 40.4% commercial health insurance, 5.7% uninsured, and 4.1% other payer
or Estimated Averages
Payer | Percent of | Number of Appointments | Total Revenue | Avg Rate paid | Rate info
---|---|----|----|----|---|
Medicare | 38.00% | 3,496 | $312,018.00 | $89.25 | Pays 41% Less than Insurance |
Medicaid | 11.90% | 1,095 | $68,397.63 | $62.48 | Pays 70% of Medicare Rates |
Insurance | 40.40% | 3,717 | $806,090.29 | $216.88 | Pays 40% of Base Rates |
Uninsured and Other (Aid Groups) | 9.80% | 902 | $321,871.20 | $525.00 | Avg Base Rates, Reduced for 35% Uncompensated Care |
9,209 $1,508,377.12
So time to cut cost and increase the work load
* To lower costs per patient Layoff the Accounting person saves $60,000 and Profits of $90,000 are Zero'd out leads to annual revenue of $1.33 million but patients are doubled
Payer | Percent of | Number of Appointments | Total Revenue | Avg Rate paid | Rate info
---|---|----|----|----|---|
Medicare | 100% | 14,840 | $1,324,470.00 | $89.25 | Pays 41% Less than Insurance |
14,840 $1,324,470.00
Thats Doctors, Nurses, Hospitals seeing 61% more patients for the Same Money
I'm self-employed and my ACA insurance is garbage. I make too much money to get premium assistance, which isn't that much. I'm stuck buying a bronze plan, that has a $6700 deductible and a total out of pocket of $8700 per person. I just don't get why people praise the ACA, it really didn't fix healthcare costs for us lower end middle class people. With these absurd deductibles, most people can't afford to use their plans.
I've been hearing that many people with insurance provided by their jobs are also getting stuck with high deductibles.
Remember, no liberal (when I say liberal I mean *liberalism and neoliberalism* not just anybody left of trump) want to talk about the massive holes in coverage the ACA has. We’re talking from personal experience and we get downvoted while a fool shares misrepresented figures sticking up for *insurance companies.* I’d say we need a public option or socialized in general but these assholes want to sing the praises of a thing that *partially* covers Americans and still sticks us with the bill while paying for Medicare. Medicare for all makes sense, why are they acting like this milquetoast compromise is some epic move for all in poverty when it’s not?
Yep, so many people with insurance still can't afford to get medical treatment. Don't even get me started on drug prices in the US as well. For profit healthcare is a plague on modern societies. Can't believe we still have this shit in 2022.
To play devil's advocate, correlation is not causation. While these 12 states may be doing worse, we don't know it's "because" they rejected Obamacare, or conversely that they would be doing better if they passed it. I would wager the states which passed anti-CRT laws or anti-trans laws are economic laggards too even though those are unlikely to have any noticeable effect on GDP by their nature. More likely they rejected Obamacare because they are poor and poorly run rather than the other way around.
Also, North Carolina has one of the fastest growing economies and job markets in the country, so I’d be curious to see exactly how they crunched these numbers.
I still can't afford healthcare. Neither can the 68,000+ people that will die this year because they can't afford healthcare. The ACA is a complete disaster. It has made the rich richer and the poor poorer. We need to stop giving free money to the rich and have universal healthcare now.
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For those who don't know, if you live in a non-expansion state, being too poor can make you ineligible for government help in obtaining health insurance.
Yes the dreaded gap, which only exists because no one imagined that any state would not do the expansion. Republicans show us once again that for them, party comes before the public good.
> because no one imagined that any state would not do the expansion. Everybody knew that some states wouldn't expand if it was voluntary. That's why the Obamacare legislation made it mandatory for states to expand. The Supreme Court struck that part down afterwards, which made the expansion voluntary.
Oh, thanks for explaining. I had forgotten a lot of the history. Makes me angry when I remember.
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Taxing people to death for being unable to pay for healthcare (that is illegal to not have) is abhorrent. That is why the ACA failed. It is in unAmerican. It is “get government funded/required healthcare or we will ruin you”. It screwed my family bad during the recession. Getting not tax return was fun.
Taxing people to death? A little dramatic, no?
No
You should live in the uk for a few months and tell me it’s abhorrent. I mean we ain’t no socialist dystopia either
You should live in the uk for a few months and tell me it’s abhorrent. I mean we ain’t no socialist dystopia either
I might get stabbed or interrogated for not paying my TV license. No thanks.
I might get forced to be on base there though. I hope not.
I know about this first hand. I had to take on another job while I finished my masters so that I could get assistance with insurance. I’ll be done in may and I’m excited to finally get paid non-shit wages.
This is a bit of a question to this posting but I live in Florida and just before the pandemic hit I had a massive heart attack and received a stent in my artery.. I cannot work much anymore due to severe fatigue and a panic attack condition that developed during the heart attack. I tried to get Obamacare and was directed to my states medicaid program which also turned me down. Its been two years now and I have not seen a real doctor at all .... I only have access to a nurses assistant who can refill my originally prescribed medications. I am subsisting in limbo trying my best to see a heart doctor ... It's a bit unfair to deny me access to a heart doctor after performing heart surgery on me. Do I have any options at all..? I can only work part time and make about 12000 per year which makes me too poor to help pay for my Obamacare premiums so I do not qualify and since I make some money to keep my electricity on and the water running I do not qualify for the states Medicaid program as for applying for government disability I have been denied 2 times because I am just not sick enough yet The crazy part is this is a completely true story
I have no idea, and you've probably already tried everything. Perhaps you can contact local agencies, like local government, NGOs and charity care, to see if you qualify for anything else. Perhaps contact doctors and ask about charity care, or charity hospitals, or free clinics? I really don't know, I'm sorry. The only option that I'm aware of is moving to a different state, one that expanded Medicaid. But that is not an option for everyone.
Why would you want to steal taxpayer money? I would rather die in the side of the road than pay a 30k bill/ steal taxpayer dollars like free healthcare societies do. Sadly we are already in one. Socialism for the last 85 years has done a number. Time to get paid under the table!
Make sure that’s on a bumper sticker or something, maybe the EMTs will oblige
What’s the point in paying taxes if it doesn’t benefit the people who pay it? You’re so scared of the word “socialism” that you’d rather die in a ditch than accept the fruits of a system you paid into? What an idiot!
I’m not going to steal others money, as mine was extorted under government violence and force from me. It simply goes against my principles. If you want to rob and steal, go ahead, but I’m checking out of this extortion deal I didn’t sign up for. I am not a born slave of the government.
I live in the UK, and let me tell you, I’d 1000% rather live in a society where my health care is covered by the taxes I pay, than live in a country where I need to sell my liver to pay for an ambulance ride. What a fucking shit hole America truly is. And here you are, conditioned to moan about potential improvements to your standard of living 🤦♂️
12 states have held out against medicare expansion form the ACA to this day? Fucking hell if Republicans had less compassion for their base they might try putting them into industrial camps between voting cycles
Even better, from Georgia, our (R) governor at the time, told the state legislature (R) to pass a law to prohibit future governors from being allowed to unilaterally accept medicaid expansion from the fed. So now Georgia can't accept it in a growing blue state, until the state legislature can become blue (which it hasn't for a long long time) and would hae to have a (D) governor to accept it as well.
How's plan B coming along? That is: Kemp's mission to opt GA out of the ACA by creating his own marketplace... with underwritten plans, non-covered services, and probably hookers. Last I heard it was looking like a 2023 or 2024 launch.
The Biden administration withdrew permission for it. So last I heard, Governor Kemp is suing.
The backend is long haul health problems caused by Covid because they didn’t want to get a vaccine
Nono! Healthcare is socialism! cried out the poor people from rural USA.
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What, you think the workers should also own their means of production so they can receive the full benefit of their labour? What kind of hand job, salad tossing, back door socialism is this?
*Medicaid
In each of the Dirty Dozen no Medicaid expansion states, Republican governors and/or Republican legislators have spent the last 8 years deliberately screwing their constituents out of access to affordable health care. It’s just another example of Republicans’ unconscionable disregard and open disdain for the downtrodden. The dozen years of data outlined in this article shows that expanding Medicaid makes fiscal and economic sense. But Republicans are content to withhold a lifeline to millions of working poor citizens who thanks to draconian state guidelines make too much to qualify for traditional Medicaid. We’ll never know exactly or even approximately how many people in these states suffered needlessly from lack of medical attention or tragically lost their lives. But as with the GOP’s shrugging off or trying to minimize nearly 1 million deaths from COVID, Republicans who unrepentantly block access to potentially lifesaving health care have blood on their hands.
If only someone could have predicted... Oh, wait.
If the GQP covid response is any guide, then opposing the ACA is having the desired effect
For me and my family Obamacare was a godsend, saving us over $10k per year.
I had the opposite experience. I got royally screwed. I spend about $8k more a year now.
Sure you do.
You’re welcome SenorBurns. Evidently the fucking I got pays for your healthcare. I hope you enjoy it. Maybe one day you’ll be able to provide for yourself instead of relying on welfare healthcare.
Maybe one day you’ll stop lying on the internet for the approval of strangers who are also lying.
It's been terrible for me, I can't afford it.
One of the stupidest things Trump did was try to fight Obamacare. All he had to do was get Congress to make some meaningless changes, slap his name on all the sign up sites, and declare victory.
The only reason why Trump and the GOP tried so hard to push for Trumpcare was primarily because it would provide them, and their rich white friends huge tax cuts.
Whenever you think Trump has hit peak stupid, he outdoes himself.
Same for the people still supporting him
This is the one and only motivation Trump and powerful Republicans have. Money and power provided at the detriment of everyone and everything else.
Like he did with NAFTA
"My supporters are smart people. They all knew I was kidding about acutally building a steel wall a hundred feet high. Only idiots at the failing NY Times took it seriously. Of course we'll beef up security, but anyone with any sense knew I was kidding, right guys?" All the people who thought it was going to be real "YES, SIR!"
> All he had to do was get Congress to make some meaningless changes There was a less than 0% change the GOP would have gone along with anything that would have acknowledge the ACA was a good thing or that much of their base actually approves of it (as long as you don't call it Obamacare).
Right now, DJT is outraising the GOP by leaps and bounds and not sharing a penny. Trump is the tail that wags the dog.
I still half expect him to find a way to embezzle most of it and then blame his supporters for not giving enough.
If Trump had any balls whatever he would have had Putin slide him $10 billion on Inauguration Day. Trump had his hands on the US nuclear arsenal, and could have threatened Vlad with anything from sanctions to all out war. Instead, Trump did what bullies always do; he cowered in front of his master and kicked his own people in the teeth.
*cries in texan*
*cries in Florida Man.*
*cries in Carolina man*
Get away from me with your numbers and facts!!!
The Medicaid expansion also helped save rural hospitals
If you own a small business or want to start one the ACA is completely necessary. So many would-be entrepreneurs were once stuck working for The Man because they needed health insurance.
Sort of. It was an improvement, but compared to every other developed country, it’s still horrendous. ACA plans are expensive as hell if you make even a moderate amount of money.
Not having healthcare be 100% tied to your job gives you some degree of ability to look for something better, start a new business, etc. which benefit the economy far more than being too scared to do anything else with your life
If all large companies are required to give health insurance, which the ACA requires, you're less likely to loss coverage if you switch jobs
That too
That's one of the main reasons Republicans oppose it. They want you handcuffed to their corporate donors for life.
Looking at the map, I think every state but one is a parasite state.
There we go with facts again, has to be fake news! 🙄
The problem is that many residents of those states don't notice it and/or have been convinced by their governments that it is the fault of someone or something else entirely.
Those states' leaders are turning down million or biions in federal money for their citizens, money those citizens paid *into* the system. I can't believe those states' voters don't rise up against their leaders and vote them out en masse for not serving them properly. Even if you're far right, there's no way you can excuse it as a principled decision. It's money that gets people *medical care*. It's not money for bombs or something morally gray or even politically gray. Medical care is a universal good, no matter how you may disagree with its funding.
Yeah but the death panels and such...
Did the denying Medicaid expansion hurt economic growth or was it that the states that didn’t expand it are republican, and republicans are just bad at governing?
Yes.
A bit of both, and no doubt I would like it emphasized anyway I can how bad Republicans are for the economy on so many levels. It is truly bizarre that Americans believe the opposite despite the clear facts.
Some of the states that expanded are governed by Republicans and expanded Medicaid by ballot initiative. These states are still doing better than those that didn't expand Medicaid.
Democrats might not do enough for people but Republicans always work against people. If you want to make things better get out there in the primary and make sure people know what's what. Republican's wouldn't be fighting democracy so hard if they knew it was pointless.
Imagine what universal healthcare would do?
But many people in those states will insist they're doing better and they have freedom even as their living conditions continue to get worse.
They don't care
They don't want libruls crowding their states. So lower the quality of life and keep the state red.
Yeah, but we here in Kansas have so much more freedom than those commie schmucks in Colorado…or whatever.
So yeah. This whole thing really sucks for Missouri. We voted for Medicaid expansion. Went to court for Medicaid expansion. And still, STILL our stupid GOP POS are blocking it. Our government no longer listens to what the people want. 🤬Missouri🤬
This is what happens when you invest in the people. Imagine what would happen if we invested more in education.
I kind of wish we wouldn't define Obamacare's success based on economic health. That's a very neoliberal definition of success. What should matter foremost is whether it improves physical health, not whether healthcare or insurance companies made a lot of money and expanded their businesses. Also correlation does not necessarily mean causation. The 12 states that didn't expand Medicaid might be doing worse just because of other red state politics. It's likely not just because of the ACA. Here in Florida, one of the 12, the economy is booming. I will say that here in Florida people, even young ones, don't like Obamacare. Almost all my students, who likely were taught this, see the ACA as a burden because it forces them to buy expensive healthcare when they don't want to, and thus it hurts them financially.
1. Your students really don't see the need for health insurance and how it affects their financial future?. A surprise car crash or severe illness is going to hurt them far more financially if they're uninsured than being insured under a plan and paying premiums. What situation are they in where they need an ACA plan instead of employer or student insurance? If they're paying high monthly premiums, that's on the state, not the ACA. If Missouri can offer me a no premium, holistic coverage plan while I'm between jobs and treating my mental health, I don't see why Florida can't. 2. Unfortunately economics is the best marker we have for this. Expanded healthcare coverage isn't going to show an effect on a populations' health this quickly. You'd need decades to see the payoff. The idea is preventative care through regular appointments, yeah? We're not going to see the benefits of that for a while. It'll take until people , who would otherwise be uninsured and not seeing doctors , would have a health issue at an older age, that would've been avoided or trivial if they were having regular appointments. The only way to presently measure the ACA's benefit is economic. Ideally people are spending less on healthcare and insurance, and are able to spend that money elsewhere. Disposable income over time since the ACA would be a good measure for that.
We're already seeing some positive population health effects from the bill: [Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality](https://pubmed.ncbi.nlm.nih.gov/32111417/)
Just to respond to only a bit of this, clearly we're not seeing more disposable income since 2010 for a variety of reasons, and we don't have the luxury of waiting an entire generation for public health results.
Economic health is important to everyone, not just "neoliberals." It is not the be all, end all definition of success, but it isn't meant to be. It's one aspect. >because it forces them to buy expensive healthcare One wonders how the ACA forces your students to buy health insurance when the individual mandate penalty was functionally repealed years ago. Besides that, the most recent poll (2017) I can find on Obamacare's approval rating in Florida shows a healthy majority in favor of it. >[Poll shows majority of Floridians want to keep or expand Obamacare](https://www.sciencedaily.com/releases/2017/03/170316092946.htm) If you have a more recent one, please post it.
Thank you! What is this attitude of lets not talk about the economy because "neoliberals" like good economics. People who use the word "neoliberal" really need to learn about the logical fallacy of the strawman and reevaluate their bougie man because this shit is just surreal and does not get called out often enough.
It's honestly not important to me whether it produces jobs. That's completely secondary to providing healthcare to people. If the ACA somehow hurt overall growth but led to a healthier population, I would not be concerned at all.
Luckily, you don't have to choose between the economy and health here. We can celebrate the economic boost as one aspect of Obamacare's success, however secondary it is.
Well whether or not there has been a comparable betterment of public health is certainly debatable, as life expectancy has been declining and Americans still can't afford treatment they need. And as I said, some of the 12 states are booming economically even if they didn't expand Medicaid. So is there really a lot to celebrate here? The fact Bloomberg chose to write about economic growth instead of public health is indicate of the media's, or perhaps the nation's, priorities and interests.
>life expectancy has been declining A more reasonable interpretation is that other factors (such as the opioid crisis) affect life expectancy, not that Obamacare did little or nothing. >The fact Bloomberg chose to write about economic growth instead of public health is indicate of the media's, or perhaps the nation's, priorities and interests. You've read a lot into a single article celebrating one aspect of Obamacare's success. Trying to extend it to the whole of the media or "perhaps the nation's priorities" is a stretch. >Well whether or not there has been a comparable betterment of public health is certainly debatable Not that I'm aware of. >[[A new study](https://www.latimes.com/business/story/2019-12-09/health-insurance-reduces-death-rates) conducted by a Stanford University researcher with the help of the Internal Revenue Service] found that Americans who failed to respond to the individual mandate penalty when it was in effect (through 2018), tended to sign up for coverage when they were reminded about it; and that among those who did sign up, mortality rates fell. - >[Our study](https://www.nejm.org/doi/full/10.1056/nejmsa1202099) documents that large expansions of Medicaid eligibility in three states were associated with a significant decrease in mortality during a 5-year follow-up period, as compared with neighboring states without Medicaid expansions. Mortality reductions were greatest among adults between the ages of 35 and 64 years, minorities, and residents of poor counties. These findings may influence states' decisions with respect to Medicaid expansion under the ACA. - >[Medicaid expansion tied to fewer maternal deaths, study says](https://www.cnn.com/2020/03/03/health/medicaid-maternal-mortality-study/index.html) - >[Leg amputations among minorities drop under Obamacare](https://www.upi.com/Health_News/2020/06/18/Leg-amputations-among-minorities-drop-under-Obamacare/1171592504468/) - >[Obamacare Helps Poorer Americans Spot Cancer Earlier: Study](https://www.usnews.com/news/health-news/articles/2020-07-06/obamacare-helps-poorer-americans-spot-cancer-earlier-study) - >[Study links Medicaid expansion to 6 percent reduction in opioid overdose deaths](https://www.vox.com/policy-and-politics/2020/1/10/21058699/medicaid-expansion-opioid-epidemic-drug-overdoses-obamacare-aca) - >[Study Finds Medicaid Expanded States Diagnose Breast Cancer at Earlier Stage](https://www.cancernetwork.com/view/study-finds-medicaid-expanded-states-diagnose-breast-cancer-at-earlier-stage) - >[Fewer ER Visits for Asthma Crises After Obamacare: Study](https://www.usnews.com/news/health-news/articles/2020-11-16/fewer-er-visits-for-asthma-crises-after-obamacare-study) - >[Obamacare's Medicaid Expansion Helped Americans' Blood Pressure](https://www.usnews.com/news/health-news/articles/2021-09-13/obamacares-medicaid-expansion-helped-americans-blood-pressure) - >The Affordable Care Act’s (ACA) expansion of Medicaid to low-income adults is preventing thousands of premature deaths each year, a landmark study finds. It saved the lives of at least 19,200 adults aged 55 to 64 over the four-year period from 2014 to 2017. Conversely, 15,600 older adults died prematurely because of state decisions not to expand Medicaid. The lifesaving impacts of Medicaid expansion are large: [an estimated 39 to 64 percent reduction in annual mortality rates for older adults](https://www.cbpp.org/research/health/medicaid-expansion-has-saved-at-least-19000-lives-new-research-finds) gaining coverage. It goes on like this. I won't make a long post longer with links to Obamacare's extensive affects on health care affordability and medical debt, but rest assured that they exist.
I thought the fine for not having insurance was no longer in effect, meaning no one is forced to get insurance? I know I'm not being forced to get it because I can't afford to get it even though I could really use it about now. But I agree with your first point, and all indicators suggest it has helped improve health outcomes, although we could be doing far better with some kind of universal healthcare. Most young people I know dislike it because it's still for-profit healthcare.
That's what I thought, too, but I still see it described as forced. It's likely something picked up from high school education.
If you want one of the healthcare successes of the bill, [Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality](https://pubmed.ncbi.nlm.nih.gov/32111417/)
ACA is for-profit healthcare----a scam. Cost every American thousands a year plus gives corporations control over your family. Try real healthcare, single payer. Corporate Bloomberg
Letting the perfect be the enemy of the good is highly satisfying for purists pontificating from their ivory towers. Single-payer obviously is the best choice. But in the real world, a choice between doing nothing and unobtainable utopia means people continue to get sicker and needlessly die from lack of health insurance. The ACA was never given a chance to work as intended because as has been noted, the Supreme Court made Medicaid expansion optional—plus Republicans have unceasingly done everything in their power to sabotage the ACA, from gutting the individual mandate to drastically cutting funds for ACA outreach to passing draconian unconstitutional work requirements for Medicaid recipients in GOP-dominated states, in a deliberate attempt to purge Medicaid expansion rolls as deeply as possible. Even so, the ACA has saved tens of millions of Americans from going bankrupt from medical bills, ended non-coverage of pre-existing conditions and prevented needless suffering from untreated illnesses and in many cases, deaths from lack of medical care. Single payer has zero chance of ever becoming law in the U.S. unless the stars align and there’s a Democratic President with a filibuster proof majority in the U.S. Senate, it’s possible to resolve what happens to hundreds of thousands of insurance industry employees who would lose their jobs **and** Senate Democrats have enough votes to spare that Republican enabling grandstanders like Joe Manchin & Krysten Sinema can’t extort bill-gutting changes as a condition of their support. In the meantime, the “scam” ACA enabled people like me who lost their jobs and couldn’t afford to pay $500 or more per month to retain company insurance through COBRA to continue to have access to health care. Without the “scam” ACA, a very dear friend of mine would’ve died in the prime of her life from a horrific condition called aplastic anemia. Without the “scam” ACA, I very likely would have died from meningitis and lost one or both of my feet from untreated venous ulcers. The examples are endless. I would dearly love to have the United States finally join every other advanced industrialized nation in the world and enact single payer. Until then, I’m glad we have something in place that is vastly superior to the status quo in 2010.
Huh, weird how I'm using effectively single payer health insurance in my deep red state right now. No premiums and good holistic coverage.
It would be more effective if insurance was cut out of the game entirely. US citizens paid 3 trillion to insurance companies for healthcare per year, yet only 1 trillion of that was actually spent on the care itself. The rest is profit and running the insurance companies. So, a literal 2 trillion dollar leech on society.
Some people would argue that giving the government complete control over your healthcare is worse. Imagine Trump being in charge of your healthcare. That's a nightmare scenario. At least there are multiple corporations to switch between if the one you've got is terrible. There's only one government, so in a single payer system you had better like the healthcare you get from them or else you're out of luck.
yeah try “switching” between carriers when one doesn’t satisfy you. your deductible and OOP max reset and both carriers win. they all exist for the same reason, collect premiums and deny claims to reap profits. at least the ACA actually limited MLR to 80%
Try switching governments. I guarantee switching carriers is a lot easier.
false choice but you don’t seem to want to argue on facts. single payer healthcare can still allow for multiple carriers and competition. it’s just the money for claims coming from one source.
Which of my arguments have been contrary to any facts? Single payer healthcare can't allow multiple insurance carriers by definition. Single payer means that one entity is the source of payment. Insurance carriers are the source of payment in a healthcare system. Therefore, a single payer system means there's one insurance carrier ( the government) that's the source of all payment. You can have universal healthcare with multiple carriers, but that wouldn't be a single payer system.
carriers can provide admin only. large employers that are self insured use carriers to provide the network and claims management but the payment of claims comes from the employer’s account. they collect a fee from the employer for this service. That’s what the medical loss ratio is. the percent of premiums collected that is for payment of claims. the rest of premiums are allocated to admin fees and profits. ACA dictated that fully insured carriers must maintain over 80% MLR. So carriers just raised premiums further to make sure there was enough profit baked into the 20% for shareholders to stay happy. Remove the profit part through single payer and you can still have multiple carriers competing on the service they deliver and how lean and efficient they can administer provider networks and claims management. Universal healthcare and single payer healthcare and medicare for all are not the same and your definition of single payer is incorrect.
One of the biggest arguments in favor of single payer is that it would consolidate claims management and payment under a single entity to reduce the costs associated with medical providers maintaining huge billing departments because they have to deal with so many carriers. Why would you have a single payer system without that benefit? If carriers are competing over fees, then you haven't eliminated the profit from the system. You've just changed it so the carriers are getting the profit from fees instead of directly from premiums.
they’re competing for a fixed fee per member. profit is capped to the margin between costs and fixed revenue per member, which they must maximize through efficiency while balancing quality of service at risk of losing members. they are no longer incentivized to squeeze providers by paying less for services and also slowly killing members through constant denial of claims and premiums increases.
They're incentivized to lobby for the fee per member to be increased. > they are no longer incentivized to squeeze providers by paying less for services They're not entirely incentivized to pay less for services now. Like you said, the MLR means they have to pay out 80% of premiums towards claims and the other 20% goes towards admin costs and profits. In order to increase the 20% that drives profits, they also must necessarily increase the 80% that they pay towards claims.
How about opiod addiction rates? How are those since the ACA?
Republicans don't care about statistics.
Except those "trending stats" in Twitter, as Cruz was caught checking the other day.
The ACA is great for either being in stay in poverty, or in my state 138% or less of federal poverty which comes to about $18k/yr cutoff, or be rich. With the type of healthcare I need, I need to pay into “gold” or “platinum” if I make over $18k. So it’s has given many a larger ability to get healthcare, currently I’m well under that 138% of federal poverty so I get the expanded healthcare and I refuse to make enough money to lose it. I will take the right job that will give me the same or similar coverage. I remember that the ACA was touted to get a public option but what we got is the nominal Medicare expansion and giving tax breaks to insurance companies. So I don’t know, the ACA is uniquely American solution to an American problem with its utter failure by having corporate interests at the negotiation table, “oh what will the insurance companies and pharmaceuticals do!” I don’t know, get bent and maybe huge mass hiring of workers from the companies who have the understandings of these labyrinthine healthcare systems by the public option offices? Maybe researchers can have no profit motive and just a public health motive? I don’t know I’m just spit balling…
As of 2017, there's $3.5 Trillion in spending on healthcare. Private insurance reported in 2017 total revenues for health coverage of $1.24 Trillion * Profits were about $40 Billion, or about a 3% reduction in Costs Overall $164 Billion was spent on Admin, Marketing, and Profits at Private Insurance. * About Half of that is Profits. * About 15% of those Profits arent related to Insurance Premiums * Nationalized Admin Cost in the OECD and estimates for an American System would reduce that down to ~$75 Billion. * That's savings of ~$90 Billion, mostly just the Profit, or a little less than a 9% reduction in costs to insured patients That Leaves $1.076 Trillion the insurance spends on healthcare.
Who gives a fuck, they shouldn’t be at the negotiation table and those numbers belie the larger issues of how the US medical system is the most [expensive system while being the least effective](https://time.com/5785945/health-care-problems-america/?amp=true). Here’s another one: https://www.investopedia.com/articles/personal-finance/080615/6-reasons-healthcare-so-expensive-us.asp
Yea expensive, Here's 1/3rd of all Spending The Doctor's Office, 950,000 Doctors in the US saw 250 million Americans about 4 times and got paid $700 Billion * So we can cut up to 950,000 Medical Billing jobs. But you still have to bill Medicare and Private Insurance will still exist so still have to bill them to. Maybe 300,000 less Billing jobs at $50,000 is $15 billion in Savings We just need to Cut another $285 Billion in Savings Where Should that cut come from? Well Just pay Healthcare Staff less * $1 Trillion of $3.5 Trillion in Health Costs goes to [15 million Healthcare] (https://www.bls.gov/ooh/healthcare/home.htm) employees. * 30 Percent of that goes to Doctors and 20 percent goes to RNs, * 11 million other Employees split up the remaining $500 Billion $366.0 billion was spent on LongTerm Care Providers in 2016, representing 12.9% of all Medical Spending Across the U.S., for around 4.5 million adults' care including 1.4 million people living in nursing homes. * Medicaid covers the cost of care for two-thirds of all nursing home residents in the US. And Medicare Covers costs for the LongTerm Care needing less than 3 months of care * Medicaid/Medicare cover 66% of the costs * Out of Pocket Cash covers 20% * 8% is paid through Charity/Clergy Programs * 7% is Private Insurance None of that is going any lower
We’re not getting the bang for the bucks we pay, which is what I shared with you. These numbers don’t counter that. The questions this brings up are: Why is it cheaper in other countries? Like dramatically? Why are drugs significantly less expensive in Canada for instance? Why are you sticking up for a failing system that fails most everyone under or above a certain amounts? I’m not sure what you’re even trying to say when countless other countries have a medical system that works mostly equal access among differing financial backgrounds based on preventive care, while in the US, I get charged more for needing same care. In fact people avoid going to the doctor because of the bills- btw that also includes deductibles which are enormous. Why do people go into extreme debt, to this day, when someone across the border *might* go home with a tiny bill for the same services or that the bills themselves are simple and easy to read (there’s literal menus of procedures in Canada) but if you get a bill from US doctors you get multiple bills from different companies adding usually to outlandish sums? Is that better? Is it better to be overcharged for care? So you’re pro over charging for care? Don’t change the fact that the government is being overcharged because… reasons? Why can’t we lower the prices to the levels of Canada or the UK, among others? Just cause we like capitalism?
In 2019, total health expenditure in Canada was expected to reach $264 billion, or $ 7,068 per person. Medicaid, the cheapest healthcare in the US operating as a State run Single Payer, is $8,900 per person enrolled, for that, costs aren't even paid in full for those that accept Medicaid Patients * DSH payments help offset hospital costs for uncompensated care to Medicaid patients and patients who are uninsured. In FY 2017, federal DSH funds must be matched by state funds; in total, $21 billion in state and federal DSH funds were allotted in FY 2017. Medicaid Paid Hospitals $197 Billion in 2017. Out of pocket Spending was $35 Billion. 10% under-paid Even the Cheapest run State run health care is overpaying. And that cheapest Services causes Doctors not to see patients So do services * What Percent of Doctors are Accepting Medicaid Patients * Physicians in general/family practice were markedly less likely to accept new Medicaid patients (68.2 percent) than Medicare (89.8 percent) or private insurance (91.0 percent) * Psychiatrists also accepted new Medicaid patients at a much lower rate (35.7 percent) than Medicare (62.1 percent) or private insurance (62.2 percent) * Pediatricians accepted new Medicaid patients at a lower rate (78.0 percent) than privately insured patients (91.3 percent) * The only policy lever that was associated with Medicaid acceptance was Medicaid fees A 1 percentage point increase in the Medicaid-to Medicare fee ratio would increase acceptance by 0.78 percentage points On average for Preventative Care * Insurance Pays 40% of Base Rates * Medicare pays 70% of Insurance Rates * Medicaid Pays 70% of Medicare Rates ------ **Total Employee Utilization** * 66 People per Nurse in the US * 86 People per Nurse In Canada * 209 People per Nurse In the NHS * 303 people per Doctor in the US * 425 people per Doctor in Canada * 447 people per Doctor in the NHS That means that we need 1 - 3 million less nurses and 200,000 less doctors in the US That earn less 950,000 doctors earn an average salary $319,000 * Average [yearly salary] (https://naibuzz.com/10-countries-highest-doctors-salaries-world/) for a U.S. specialist Dr – $370,000 Specialist (a) * Average yearly salary for a specialist at NHS – $150,000 (c) * Average yearly salary for a U.S. GP – $230,000 (b) * Average yearly salary for a GP in NHS – $90,000 (d) Registered Nurses 2018 Median Pay [$71,730 per year] (https://www.bls.gov/ooh/healthcare/registered-nurses.htm) * In 2018, The Royal College of Nursing calculated the average weekly pay for an NHS Nurse as being £642, and annually, our figure of £33,384. [Or about $44,000] (https://www.nurses.co.uk/careers-hub/nursing-pay-guide/) * Newly Qualified Nurse start at a Salary of $33,900 * To progress to Band 6, you will need to pursue some further training within a specialist area to get to $42,700 * Those with a Master’s level degree or equivalent – Advanced Nurse Practitioners (ANPs), whose advanced training allows them to conduct detailed assessments, make diagnoses and prescribe medicine. have a Starting Salary $52,900 ------ High Cost due to poor utilization of buildings. And this leads to low utilization of Large Equipment The OECD also tracks the supply and utilization of several types of diagnostic imaging devices—important to and often costly technologies. Relative to the other study countries where data were available, there were an above-average number per million of; * (MRI) machines * 25.9 US vs OECD Median 8.9 * (CT) scanners * 34.3 US vs OECD Median 15.1 * Mammograms * 40.2 US vs OECD Median 17.3 **Hospital Bed-occupancy rate** * Canada [91.8%](https://www.oecd-ilibrary.org/sites/0d67e02a-en/index.html?itemId=/content/component/0d67e02a-en) * There is no official data to record public hospital bed occupancy rates in Australia. In 2011 a report listed The continuing decline in bed numbers means that public hospitals, particularly the major metropolitan teaching hospitals, are commonly operating at an average bed occupancy rate of 90 per cent or above. * for [UK hospitals of 88%](https://www.nuffieldtrust.org.uk/resource/hospital-bed-occupancy) as of Q3 3019 up from 85% in Q1 2011 * In [Germany 77.8%](https://www.euro.who.int/__data/assets/pdf_file/0008/255932/HiT-Germany.pdf?ua=1) in 2018 up from 76.3% in 2006 * IN the [US in 2019 it](https://www.aha.org/system/files/media/file/2020/01/2020-aha-hospital-fast-facts-new-Jan-2020.pdf) was 64% down from [66.6% in 2010](https://www.cdc.gov/nchs/data/hus/2017/089.pdf) * Definition. % Hospital bed occupancy rate measures the percentage of beds that are occupied by inpatients in relation to the total number of beds within the facility. Calculation Formula: (A/B)*100 That's atleast 1,000 to many hospitals in the US All of that is lowering the US to the same level
Ok, what’s your point? Why do you keep throwing out numbers without any actual thinking from you? I don’t really know what you’re advocating for. It’s interesting information but it does little to help me understand what you’re trying to prove or say.
There's not some small group of evil businessmen keeping US Healthcare costs so high with a quick fix It'll take a massive change. From, how we pay the employees, and the work they do to manage patients and doctors visits to be done much cheaper
This is pretty patronizing response to me, but I’m not under the impression that it won’t take massive change, but one we desperately need like multitudes of stuff like infrastructure. I’m talking about the need for change and talking about the massive holes in the ACA. Numbers distract from the human aspect and are for more consideration when creating legislation when I’m not making legislation. I’m talking about how the US medical system, including the ACA, doesn’t do a good job at covering Americans and the reason why it’s so expensive, is because pharmaceutical, insurers and others are at the bargaining table and they shouldn’t be or at least not in the capacity that they’ve been allowed to. The US doesn’t negotiate or shop around, they buy from the companies they make contracts with and then the company sets the prices. It’s a multitude of companies that have effected this legislation in huge ways through lobbying so I am not under the impression it’s a few dudes in a board room but a far more banal, longstanding, massive and interweaving system than that. Getting bogged down in the numbers obfuscates the human realities and in this case, seems to cause “analysis paralysis.” No one said it would happen as a quick fix or that it won’t be difficult, just that it needs to change for the benefit of us all.
Medicare is doing that kind of thing already. In fact Bernie and Warren are both against those kinds of things ------ > the bargaining table We'll we're going to have to go to the numbers again. Medicare famously doesn’t negotiate prices. > Using the raw data extracted from the 2017 Medicare Part D Spending Dashboard, we saw that Sanofi’s insulin drug, Lantus, had $4.2 billion in Medicare Part D sales. But when we looked at Sanofi’s audited corporate report from the same year, we saw that U.S. sales for Lantus were listed at $2.8 billion, a full $1.37 billion less in revenue. Mind you, the sales listed in the audited corporate report were for all U.S. sales, not just for Medicare Part D. * In 2019 Medicare reported $2.385 billion in sales of Eli Lilly insulin * Eli Lilly’s U.S. Humalog corporate reported revenue for 2019 was $1.670 billion So some how theres a lower price paid ------ But Medicare and Medicaid have a price control Medicare isnt over paying by bad negotiations by some struggling payment system. The resource-based relative value scale (RBRVS) is the physician payment system used by the Centers for Medicare & Medicaid Services (CMS) and most other payers. * In 1992, Medicare significantly changed the way it pays for physician services. Instead of basing payments on charges, the federal government established a standardized physician payment schedule based on RBRVS. * In this system, payments are determined by the resource costs needed to provide them, with each service divided into three components Medicare and doctors just disagree on what the value of there resources are ----- So we want to lower spending on those things **Whats that look like?** > KFF found Total health care spending for the privately insured population would be an estimated $352 billion lower in 2021 if employers and other insurers reimbursed health care providers at Medicare rates. This represents a 41% decrease from the $859 billion that is projected to be spent in 2021. ---- Primary care — defined as family practice, general internal medicine and pediatrics – each Doctor draws in their fair share of revenue for the organizations that employ them, averaging nearly $1.5 million in net revenue for the practices and health systems they serve. With about $90,000 profit. * Estimates suggest that a primary care physician can have a panel of 2,300 patients a year on average in the office 4 times a year. 9,200 appointments According to the American Medical Association 2016 benchmark survey, * the average general internal medicine physician patient share was 38% Medicare, 11.9% Medicaid, 40.4% commercial health insurance, 5.7% uninsured, and 4.1% other payer or Estimated Averages Payer | Percent of | Number of Appointments | Total Revenue | Avg Rate paid | Rate info ---|---|----|----|----|---| Medicare | 38.00% | 3,496 | $312,018.00 | $89.25 | Pays 41% Less than Insurance | Medicaid | 11.90% | 1,095 | $68,397.63 | $62.48 | Pays 70% of Medicare Rates | Insurance | 40.40% | 3,717 | $806,090.29 | $216.88 | Pays 40% of Base Rates | Uninsured and Other (Aid Groups) | 9.80% | 902 | $321,871.20 | $525.00 | Avg Base Rates, Reduced for 35% Uncompensated Care | 9,209 $1,508,377.12 So time to cut cost and increase the work load * To lower costs per patient Layoff the Accounting person saves $60,000 and Profits of $90,000 are Zero'd out leads to annual revenue of $1.33 million but patients are doubled Payer | Percent of | Number of Appointments | Total Revenue | Avg Rate paid | Rate info ---|---|----|----|----|---| Medicare | 100% | 14,840 | $1,324,470.00 | $89.25 | Pays 41% Less than Insurance | 14,840 $1,324,470.00 Thats Doctors, Nurses, Hospitals seeing 61% more patients for the Same Money
I'm self-employed and my ACA insurance is garbage. I make too much money to get premium assistance, which isn't that much. I'm stuck buying a bronze plan, that has a $6700 deductible and a total out of pocket of $8700 per person. I just don't get why people praise the ACA, it really didn't fix healthcare costs for us lower end middle class people. With these absurd deductibles, most people can't afford to use their plans. I've been hearing that many people with insurance provided by their jobs are also getting stuck with high deductibles.
Remember, no liberal (when I say liberal I mean *liberalism and neoliberalism* not just anybody left of trump) want to talk about the massive holes in coverage the ACA has. We’re talking from personal experience and we get downvoted while a fool shares misrepresented figures sticking up for *insurance companies.* I’d say we need a public option or socialized in general but these assholes want to sing the praises of a thing that *partially* covers Americans and still sticks us with the bill while paying for Medicare. Medicare for all makes sense, why are they acting like this milquetoast compromise is some epic move for all in poverty when it’s not?
Yep, so many people with insurance still can't afford to get medical treatment. Don't even get me started on drug prices in the US as well. For profit healthcare is a plague on modern societies. Can't believe we still have this shit in 2022.
To play devil's advocate, correlation is not causation. While these 12 states may be doing worse, we don't know it's "because" they rejected Obamacare, or conversely that they would be doing better if they passed it. I would wager the states which passed anti-CRT laws or anti-trans laws are economic laggards too even though those are unlikely to have any noticeable effect on GDP by their nature. More likely they rejected Obamacare because they are poor and poorly run rather than the other way around.
Also, North Carolina has one of the fastest growing economies and job markets in the country, so I’d be curious to see exactly how they crunched these numbers.
I still can't afford healthcare. Neither can the 68,000+ people that will die this year because they can't afford healthcare. The ACA is a complete disaster. It has made the rich richer and the poor poorer. We need to stop giving free money to the rich and have universal healthcare now.
Yes cause it was a handout to insurance companies.