Obamacare: Start All Over Again?

It's a complex subject. But comparing what we spend on healthcare to life expectancy can be misleading. Lifestyle choices have much more to do with life expectancy than quality or expense of healthcare.

Getting buy-in from young, healthy people is the real thorn in this plan. It's not an easy call for them.

http://www.pressherald.com/news/natio...

It's funny how I keep hearing the youngsters don't want to buy into this plan but its all coming out of the mouths of aged, overweight, lazy, alcoholic, medicare-addicted cigarette smoking tea-bagger types.

Many young and healthy won't be paying anything because they're covered under their parents insurance up to 26 years. Then if you are low wage earner or at poverty level you will be subsidized unless you live in an obstructionist Red state that is idiotically refusing to accept federal Medicaid dollars. So expect some migration to Blue states because of the austerity instilled by the Red state mentality, forcing their indigent and ill to migrate. And of course all the while blaming the migration on the Blue states.

That cartoon speaks volumes and echo's what is still an excellent overview of how most other industrialized nations have crushed America in terms of health care for their citizens:

http://www.pbs.org/wgbh/pages/frontli...

The above reinforces Oshin's comments about U.S. healthcare spending as a percentage of GDP.

Not to be left out is Tom Tomorrow's latest take on the Republicans' very helpful role in health care reform (also appears in the print edition of the Indy):

http://www.dailykos.com/story/2012/07...

Oh the hypocrisy.

Repeal Romneycare and enact single payer.

"Lifestyle choices have much more to do with life expectancy than quality or expense of healthcare."
-- Botany

One of the reasons health outcomes around the world (as measured in part by life expectancies) are so good compared to the U.S. is because ... preventative health care leads to healthier lifestyles and it is affordably available in other countries.

Preventative health care may not help outliers such as addicts that won't/can't quit. But early preventative medicine can really impact outcomes by helping to change patient lifestyles in areas like diet, excercise, smoking, alcohol, etc. before they really get out of hand.

Doing this for large segments of the population is the trick. This is bang for the buck thinking and is just as important for our economy as is wringing efficiency by using computers/technology, etc.

Single payer, like many other countries have, would be nice. But I don't know if we have the political will to do it. Besides, the insurance lobby is incredibly powerful and can buy politicians.

Americans' weird view of health care as a commodity plus the notion that those who aren't materially successfull don't deserve good health care has something to do with it too.

And old farts on Medicare probably don't care so long as they have theirs (remember how Republicans tried to use them as a wedge?).

"According to the World Health Organization (WHO), the United States spends more .... (and) our life expectancy in the United States is 42nd in the world."

This made me laugh. As Mark Twain said - there are three types of lies; lies, damn lies, and statistics. Hopefully yours weren't intentional and we are just talking about the later.

Do we spend more on healthcare than any other country? Of course. Why "of course"? Well, the fact that 57 of the last 79 years the Nobel Prize for Medicine was offered it went to researchers here in the US may have something to do with it (we spend a ton more on medical research than other countries). Or the fact that, despite our higher smoking and obesity rates, we still have a higher life expectancy than anyone else, when you control for accidents/murder, may have something to do with it too.

You get what you pay for, and good medicine isn't cheap. Until we enslave doctors (over 80% have considered quitting due to the ACA), healthcare will always be a commodity. You have to pay for a service that someone else provides. If you don't, they are a slave. You have no more of a right to a doctor's services as you do Walt Disney's. And healthcare especially won't get cheaper if the government is controlling it.I mean .. the government couldn't even get good enough actuaries together to implement the long term care portion of the ACA!!

As to the author's request for specifics: the mandate that all of us must buy healthcare is as insulting as Bloomberg's decision that people can't choose their own soft drinks. To tell you what you must buy is to tell you that they are smarter, and that they know what's best for you and your family (that worked out well when they banned saturated fats and we switched to trans fats ... or back when the government told Galileo what shape the world was).

By forcing companies to accept the unfit and unhealthy, you are in turn setting us all up for higher costs - as we have already seen. Obama promised a $2,500 drop in cost for the average family, and since he took office, costs have gone up 15%! These companies aren't stupid, and are going to pass their costs on to the healthy consumers.

No amount of short term good that comes from a law can outweigh even the slightest amount of forsaken freedom. And yes, telling me that I must spend my money to buy health insurance is taking away my freedom.

The government, like us, is fallible - namely because it is made of "us", and not robots. But when they turn a highly contentious issue not yet completely thought out into law they, are pretending to be infallible - especially when the action comes from the Federal Government instead of the states.

Our health care system isn't perfect, but taking away our freedoms by way of telling us what we have to buy isn't the way to fix it - and neither is skewing the truth and using statistics that only serve your cause in order to make a point.

In our noble quest to ascertain “good” and “better” we attempt to make it reasonably objective. You don't think life-expectancy accurately reflects the effectiveness of healthcare? The U.S. Ranks 37th in overall healthcare performance (1). When judged against six other industrialized nations, we “rank last on safety and do poorly on several dimensions of quality (2).” Among all industrialized nations, the U.S. Ranks last in preventable deaths and 34th in infant mortality (3). Whether you prefer lies, damn lies, or statistics, take your pick, none are flattering.

As for your statement: “despite our higher smoking and obesity rates, we still have a higher life expectancy than anyone else, when you control for accidents/murder.” Sounds like orc mischief to me. Citation please.

(1)http://www.photius.com/rankings/who_world_health_ranks.html
(2) http://www.nejm.org/doi/full/10.1056/...
(3)http://esa.un.org/unpd/wpp/Excel-Data/mortality.htm

Medical research does have “something to do with it.” The U.S. spends 30 billion in biomedical research a year. That equates to $100/citizen where it is estimated $8,000 is spent on each American every year for healthcare. If we compare this to other countries that spend $5,000/citizen in total healthcare and $30/citizen in research, we find the U.S. actually spends less in research as a percent of healthcare expenditures (5, 6).

For fun we can ignore the facts and pretend your position is valid. Let us reflect on what the 30 billion has bought recently. I remember two new medications making headlines, a new diet pill and treatment for erectile dysfunction. New promising cancer treatments were announced but overshadowed by the decrease in the manufacturing of such agents, which has lead to shortages nation-wide as pharmaceutical companies dictate supply independent of demand. The HPV vaccine gains national attention but is blocked by conservative opponents, and it turns out some vaccines do not actually vaccinate, in contradiction to their (allegedly manipulated) stated efficacy. America's role in medical research and innovation can be a source of pride (sometimes).

Now, let's look at the DPMA survey you mention (4). The question asks: “How do current changes in the medical system affect your desire to practice medicine?” It is true that 83% of physicians say they are thinking about quitting, but among those surveyed only 11% were hospital-based. This is hardly representative of the population. The number merely reinforces what we already know: More doctors are being forced out of private practice. However, this is a failure of the current healthcare system where nearly 1/5 are without health insurance, a lack of coverage for preventable care, reduced reimbursements, countless other factors, and has been evident long before Obama cared. Question 7 goes on to ask for blame in “current problems” and attributes it to both public and private sectors as “ninety-five percent say medicine is becoming too controlled by large corporations.” You say: “over 80% have considered quitting due to the ACA,” but the ACA isn't mentioned until question 26. In this question they are asked “what would most improve medicine?” Repeal of the ACA is ranked number two. They believe that not doing something that hasn't been done yet will be an improvement over the current state of healthcare. Please explain to me to how this is a rational form of thought.

(4)http://www.doctorsandpatients.org/resources/85-physician-attitudes-survey-june-2012
(5)http://www.psoriasis-cure-now.org/medical-research-funding-level-by-country-world-psoriasis-day-challenge/
(6)http://www.politico.com/news/stories/0512/75851.html

When you mention freedom, do you mean mine or yours? Do you mean freedom of healthcare or freedom from healthcare? Do you really believe the dumbo ride is an accurate comparison to a mammogram? Do people die if they can't afford to ride Dumbo? The healthcare decisions you make directly affect my ability to receive essential, life-saving, cost-effective treatment. Your affinity (or enmity) for Dumbo will have no relevance. Everyone in this country receives healthcare whether they are private-pay, insured, illegal, poor, lazy, or otherwise. Everyone! Millions of people receive healthcare services for which they do not pay. They are not being asked to buy something they neither want nor need; they are being asked to pay for something they have been receiving for free or, with 100% certainty, will receive some form of healthcare in the future. Yeah, freedom. I would like to be free from the irresponsible and ignorant.

P.S. Mark Twain is quoting Benjamin Disraeli.

As a general rule Republicans don't believe medical school should be subsidized, so doctors end up spending years--if not decades--paying back student loans. Democrats have the trial lawyers in their back pockets, so insurance rates for doctors go through the roof so they can protect themselves from frivilous lawsuits. In such a financially hostile environment why would anybody want to become a doctor?

Any wonder we are in the mess we're in? Obamacare is simply the end result of a dyfunctional system supported by voters who never get the message that they need to change the way they vote.

P.S. Less doctors means higher prices and longer waits in the emergency room. Eventually, people die while waiting for the overworked doctor who has to make Sophie's Choice on who gets treated and who is left to die. Scary stuff.

". or back when the government told Galileo what shape the world was"
-- Promulgator

False. It was the Catholic Church that told Galileo what to think, not the government. Getting such a fundamental fact wrong calls into question your other assertions such as ...

"Obama promised a $2,500 drop in cost for the average family, and since he took office, costs have gone up 15%!"

Two points: First, since most of the provisions of ACA have not gone into effect, your attempt at correlation fails. Second, you fail to compare that asserted increase to previous cost increases. I wonder why.

"No amount of short term good that comes from a law can outweigh even the slightest amount of forsaken freedom."

Really? You can't be serious. One can only conclude that you vehemently oppose the First Amendment.

"But when they turn a highly contentious issue not yet completely thought out into law they, are pretending to be infallible "

Really(again)? Would you like to cite some examples where someone advocating for the ACA claims to be "infallible"? You're not very well anchored in the real world are you?

"Our health care system isn't perfect, but taking away our freedoms by way of telling us what we have to buy isn't the way to fix it"

Interesting. Did you know that one of the first acts of the very first congress was to require sailors to buy health insurance? There were at least 20 "founding fathers" in that congress and the bill was signed by the President who happened to be ... wait for it ... George Washington.

They were a bunch is freedom hating commies, don't you think?

What were the comparative insurance rates back then?

Good to see a healthy discussion here. Regarding the provisions in Obamacare that promise to lower costs in the future, there are exactly zero in the bill that are proven cost controllers and only a piddling few that might save costs, fraud prevention being at the top of this list. Perhaps it's counterintuitive, but electronic medical record keeping does not save money, although it does improve qualtiy (prescription fill error rate in the VA is an order of magnitude lower than the general rate which about 7% -yikes!). Preventive medicine is also a mixed bag in terms of the data, managed care has never been shown to save money, the list goes on. The much ballyhooed ACOs are a complete fantasy.

That said, I much prefer to have this legislation in place than not, as it does improve a few of the more egregious shortcomings of the current "system". In the end, however, we will only get true cost controls and savings when we implement a single comprehensive plan for everyone paid through a single agency. Some variation of this approach is used in every wealthy nation, all of which have much better health outcomes than we do while paying, as you note, about half of what we do.

Obamacare makes healthcare more accessible and more expensive for all. Once Obama caved into the insurance lobbyists it was all over.

The single payer system died because the special interests run the federal Govt. The Democratic congress (2008-2010) proved to be as corrupt as the Republican Congress.

Time for a new type of Government. With the internet we don't need people to represent us in D.C.. We can represent ourselves online.

Here you go Jeffrey:

Onerous:
- Borrows and spends money we do not have to subsidize out of control health care costs, thus further driving those costs up.

- Concentrates more power (money, decisions, etc.) into Hospital networks, Insurance companies and HMOs - along with massive unfunded growth of federal government bureaucracies (100,000+ new federal employees and 270 new departments in the first 5 years alone).

Specific alternate solution.
1. It would be 10 times less expensive to *give* every American $10,000 on a "health card" that they could use to shop for best care at lowest price with a rule that up to $3000 of that $10,000 could be given to the card holder at the end of the year to be used for any legal purpose they pleased. This would create an immediate, massive self interest in finding best care for lowest cost but....

2. We would need a law that forced insurance companies and health care networks/providers to transparently post the costs of all care publicly, along with a national web site to rate doctors and hospitals on service levels and outcomes - so the consume with the $10,000 card for their premiums to gain basic, more accurate decisions information.

3. Allow insurance to be sold interstate - which will create huge, immediate competition among the variousl insurance companies and force them to provide higher service levels at competitive prices.

For profit health insurance has led to this type of abuse at ratepayers expense.
http://sickforprofit.com/ceos/

Go Obama! YAY!

'Single Payer' seems the best. Reform and the result known as Obamacare was market based and heavy on the capitalist approach. So I don't know why the conservatives are against it. I do know that if republicons have their way they will, like everything else they touch for too long, screw it up.

Replacing the documented & admitted drug using liar and felon in the White House in November is the best start to advancing the health care system in America. Obama could care less about whether or not you receive health care. As usual, he wants to say the things you want to hear believing it will secure your vote. Obama is simply a smooth talking pimp! How can anyone possibly believe anything Obama has to say, he lies about everything, he and his surrogates know he is lying and they don't care.

Romney has the business experience and knowledge to take the right steps to turn our economy around and develop a health care system that benefits everyone and a system most of us would likely accept. Look at Obama's actions since he was elected. Obama is taking America down, piece by piece; and as a socialist this is what his goal has always been. Obama cares no more about your well being than he does about America! I don't care what color your are, vote with your brain in November to secure the future of America! If unemployment continues as it has been for the past 40 months where is all the tax money going to come from to pay for all the "freebies" Obama wants to give to everyone? Sure, impose more tax on the richest among us - that will still not pay for what Obama wants to give away! Obama is anti-American and his record is clear proof to define him in this manner!

whatsinsb; TSK, TSK, TSK you certainly are brainwashed, why so much hatred.

rblacumbre - Disgust with anti-American Obama yes, "hatred" no. Is there anything I wrote that was not accurate? Unemployment is one of our primary problems, agreed? Obama has 106 fund raisers and not one (1) meeting with his phony "Job Council" as of this date. Maybe Jeff Immelt (GE Corporation), the Czar, is too busy outsourcing his corporations jobs overseas to meet with this Council to try and figure out how to create jobs in the USA. Using the old question: Are Americans better off today than we were four years ago? Excluding the health care law (that I don't agree with), what has Obama done to improve America during his first term that should lead anyone to believe he deserves a second term?

If Nancy Pelosi and Obama were on a boat in the middle of the ocean and it started to sink, who would be saved?
Answer: America !
Jimmy Fallon

whatsinsb - You forgot he's a Monster too. Like a great contributor to the Indy (JohnLocke) would say prove it with facts, your personal opinion and hearsay doesn't count. Most Americans like what President Obama has done that's why he'll get 4 more (my opinion).

rblacumbre - I'll ask you again, is there anything I wrote about Obama that was not accurate?

What's the difference between Obama's cabinet and a penitentiary?
Answer: One is filled with tax evaders, blackmailers,and threats to society. The other is for housing prisoners.
> >>>>>--David Letterman

whatsinsb - NOT ONE THING YOU WROTE IS ANYWHERE CLOSE TO ACCURATE. David Letterman (a great Democrat) would agree with me.

"Replacing the documented & admitted drug using liar and felon " -whatsinsb-

Felon? How so? (By the way, I'm not voting for Obama nor Romney so I'm not being partisain)

Clausen - Admitted possession of cocaine (felony) which Obama writes in his book that he also used.

Bush has a full blown coke addiction. JFK was on methamphetamine and Nixon was an alcoholic. Your point?

Point taken. When I read your post, I thought you were saying he's a convicted felon. I misinterpreted it. Thanks for clarifying.

Aside from their shortcomings, neither Bush, Nixon and especially JFK, were ever as anti-American as Obama.

But, they are no longer the concern. The immediate concern is Obama and his actions that are taking the USA down. Some will say he's inexperienced, incompetent, ignorant, etc. I don't agree. Obama knows exactly what he is doing as he systematically puts the screws to this country. It's only been since Obama's been around that we now have to pay the Russians for a ride into space in order to reach the International Space Station - talk about outsourcing.

Obama wants to make substantial cuts to our defense budget. Why does Obama cut our military knowing it will place the USA at greater risk? "Constitutional Professor" Obama. "BS I say." He certainly lied his way through that issue leading people to believe he knew what he was talking about. All Obama knows about the Constitution is that he wants to do what he can to eliminate it and have everyone dependent on the government. If the government does anything for you it is only because it is paid for by those that work and are taxed.

Why did or does the Obama administration have an agreement with the Mexican government to ensure, via the consulate, that Mexican nationals are aware of the availability of food stamps and other "freebies" provided by the USA? Mexicans and Americans should never forget, Obama and Holder lie and hide the truth about "Fast & Furious." American law enforcement personnel as well as hundreds of Mexicans are dead as a result of this program.

If Obama ran a corporation the same way he has run (not lead, as he's definitely not a leader) the USA, he would have been shown the door out of the building. We need a knowledgeable, experienced, pro-American leader in the White House to pull us out the funk we've been driven into by Obama.

Mitt Romney is that person that can turn our country around.

whatinsb, were you this concerned when Bush' policies we're taking us down? I think not given your plug for Romney. I think what is deplorable is your the fact that your partisanship blinds you to the real critricisms of Obama that people have (NDAA, Drug War) all of which your man Romney would continue. Instead you trot out the neardeath horses once again, that only make the GOP look like a tent full of clowns.

Tell us more whatsinsb we didn't know all that.