Obamacare is worthless


I’d certainly be happy to be wrong in this instance, but doesn’t this mean that we’re relying on the goodwill of the (profit-motivated) insurance industry to make patient-oriented outcomes happen? Without some outside pressure on them, there will be always be someone providing useless cut-rate insurance to suckers (incidentally raising riskier patient’s premiums) or tying patients up in bureaucratic hell (as has been described upthread by @mrcjhicks and @ShivaX and others). Not to mention all the people that the industry simply won’t cover at all due to them being too poor or having too many health issues to be profitable. By the time you put in regulations to force the insurance industry to do all those things (and I’m sure there’s even more I’m not mentioning), there’s very little in the way of “free market” left in it. So why bother with all the overhead of a separate insurance industry at all? A single payer system will assuredly not be perfect or solve all these problems, but it has got to be much simpler and efficient.

OK, now, having said all that, it’s probably not politically feasible to do single payer without a political Tunguska event. So we may well be stuck with the inefficiency of a private insurance industry, in which case what @Nesrie has described about comprehensive care becoming important to them is a promising step. I’d like to see amendments to the ACA that make that kind of approach mandatory, which I see as the next evolution of the essential benefits clause.


The author of that article tweeted out this:

Then gets aptly rebutted by many (but not all) replies on his own Twitter feed.
And also here (sorry twitter haters)


New? Krugman has been telling everyone that Ryan is fraud in wonk’s clothing for years.


The debasement of Paul Ryan:

Ryan, at one point during the AHCA negotiations, got down on one knee and begged Rep. Don Young (Alaska) to support the bill. Young did not agree.


Our local childrens hospital, the biggest one between LA and SF, has made arrangements with the Fresno Unified School District to put clinics in some of the schools. Something like 10-12 of them. I have never heard of anything like this before.


@Scuzz that is interesting. It looks like a combined effort to service under served areas according to this article.



For reasons I don’t pretend to understand the children’s hospital and the largest community hospital system in the area (2 hospitals and teaching hospital) are currently at war with each other and this may be part of the children’s hospital trying to move into a new area.


Well what they’re describing in the article sounds more like an attempt to provide access to communities that are challenged. I mean it’s true healthcare systems can include a few hospitals and a lot of clinics, but hospitals themselves can’t really relocate to serve areas like clinics can.

What’s interesting too is there are already two comments on this article from polar opposite sides of the political spectrum.

Wow, send your kid to school and they receive breakfast, lunch, healthcare. What next? Barbershop?

This is a great plan for Fresno Unified Schools. Until all these clinics are built, though, it would be good to have a full time nurse at ALL school sites.

When I was in school, we had a school nurse but you didn’t use that provider for maintenance kind of care.


I remember having a nurse at my schools as well.

Fresno Unified is a huge school district and has really had a rough go of it the last 25 years or so. The “money” in town has moved on to a couple other border school districts.


I just wanted to add my own anecdote similar to the ones @mrcjhicks laid out.

It’s not that pre-ACA was a complete horror-show, but if you were not employed by a reasonably-large firm it was pretty difficult to get anything that covered too much. And if you had a pre-existing condition (no matter how small), you could forget about that.

I’ve got a type of arthritis that causes a build-up of bone around my big toe. It sort of looks like a bunion, but it’s actually a little worse than that common ailment. It’s pretty much treated by chiseling away some of the bone growth, which then means a couple days off my feet in recovery and then a couple months wearing sandals of something as the foot heals. No big deal, as medical issues go. The first surgery I had for this - way back in 1998 - was probably on the order of $8K; outpatient; probably took 20 minutes; local anesthesia. It’s about as minor as you can get and still call it “surgery”.

When I started my own business a year or two afterwards, I went to a number of providers looking to get a high-deductible HSA type of thing. Every single one of them either turned me down for coverage because the foot thing was likely to recur some 15 or so years in the future. Eventually I got a plan through a relatively major provider, but they wrote into the contract that the plan would absolutely NOT, ever, ever, ever cover any surgery to my feet.

And that kind of goes into a common theme that has been percolating under the surface of the ACA/AHCA coverage for the last week or so. ACA was a huge boon to entrepreneurs. If I had not (eventually) found coverage for myself, I would not have been able to start my own company… and the fact that the ACA has made it a lot easier for people with minor (or major) pre-existing conditions to get coverage allowed a large number of folks to strike off on their own. Employer-provided health insurance can sometimes be a yoke as much as a benefit.


Just a reminder that not only is the thread title damn near offensive to a lot of people (namely anyone who benefited from Obamacare, maybe even had their life saved by the changes), but it’s also no longer even the topic of half of the conversation here.

Can we please change it? Anyone? Bueller?


That would require an administrator, as the @ElGuapo moniker is defunct, and I don’t think Guap can change it himself.


And changing thread titles is Wrong! Just like Conservatism is Wrong!

Ignore the way that my strict adherence to thread title originalism is sort of like a conservative principle or two!


Here’s a new thread to discuss the definitely not worthless ACA.


Was under the impression the title was a joke title.


Read the first post in the thread. Sadly, no, it wasn’t.


One wonders if this has to do with outpatient billing practices.


What does that even mean? You usually can’t go to your physician’s office and get your lab work done… they don’t have an in-house lab unless it’s a big clinic. A number of the outpatient departments have machines associated with them, very expensive machines hyperbaric chambers and MRI machines. It’s way more than just codes.


The most recent of my 5 knee surguries wasn’t done at the hospital, but rather at an outpatient clinic, and my understanding was that it was in part due to it being more beneficial to the doctor/doctor’s practice to be able to bill from their associated clinic than at the hospital. This was a number of years ago, but there did (at least then) appear to be some significant financial incentives.

Of course, with the opacity of pricing, it’s very difficult to tell, but I wouldn’t be surprised if there is a profit motive here.


Well reimbursements change. Hospitals and clinics competing with each other is nothing new. You’ll sometimes see a favorable payment system for a clinic, physician based system and they’ll pop up all over the place, literally across the street from the hospital. the insurance companies, often the gov payors, will realize they’ve created a problem. While the hospitals have to take all cases, those that are profitable and those not, they’ve created a scenario where a certain profitable procedure is being leeched out of the hospitals making the system a lot less fair and reverse course. Suddenly all those clinics, like the ones that treated Kidney disease (I think that was a more or less common example) vanish.

So what happens if when the hospital system and the clinic system is own by the same company, the hospital can still take the profit losing cases and benefit from the procedures done at the clinic. Most of the systems where there is a clinic and hospital system combined has them as two or more entities, one heavily physician partner type led, different governing board… keeping the physician practices largely independent.