Obamacare is worthless

Politics and religion
341

[quote=“Strollen, post:334, topic:73916”]
Now by all accounts MRI are way way better than X-rays and they save lives. The problem is that most of the time when Dr. orders an MRI scan, he already has a pretty good idea of what is wrong from the X-Ray.[/quote]

I can’t think of any situation where an MRI is made redundant by an Xray. An Xray won’t show anything at all if you have tumor in your brain, an acute stroke, a slipped disk, or a torn ligament - to name four very common uses for MRI.

Now, it’s true that a good diagnostician might not even need any studies at all to decide that you have a tumor somewhere in the brain, some sort of stroke, or a slipped disk somewhere. So if the doctor also decides that the tumor is going to kill you regardless or back surgery is pointless, then you could just skip imaging altogether. But if someone is planning an active intervention, they need to know where to operate. And MRI (or CT) is pretty much an absolute requirement.

As to whether you should operate on a grade IV brain tumor or a tiny slipped disk… well, that’s a different question entirely. In America, the answer is generally yes.

[quote]the total capitals cost of MRIs in the US is over $150 billion or about $500/person
The other 10,000 machine with a cost of $100 billion is spread over about 2 billion people (EU, Japan, and the upper middle class in the rest of the world) or about $50/person[/quote]

I think your denominator is off.

The US has 35.5 MRI machines per million people. Japan actually has more, 46.9 per million. Western Europe averages around 10-20.

In short, other Western countries do spend less, but not by a factor of ten. And I don’t think healthcare systems in the developing world are good points of comparison.

Eh, you’d be surprised. Hospitals will order more MRI machines when demand exists (i.e. waiting times grow too long). Whereas doctors write a prescription for an MRI, and often don’t really care where the patient gets it (much to the dismay of the hospital).

It’s true that doctors want MRI capability for patients in the hospital, but that’s a smaller and smaller share of total exams done, because Medicare pays less and less for inpatient exams. Hence, inpatient machines are often the last to get upgraded. The growth, profits, and competition are in the outpatient centers.

342

Yeah, there’s a very common case when an MRI is not needed: When you have detected the condition with a cheaper test. And there are many asymptomatic conditions where you are better off not detecting it (or not treating it, but that’s a more difficult decision). There’s such thing as over-testing, and papers I’ve read point to the US as the country where it’s more common. Whether to do a certain test or not has to be considered in light of the patient symptoms, and you should never overreach. There are conditions you don’t want to detect. It’s a complex issue, but I think you might be fascinated by it’s implications. Let me pull up a quick google search for you (warning, didn’t read the whole thing, it was just the first result).

Point is, there’s certainly no scarcity of MRI here, even if we have about 4 times less machines per population as the US.

343

So Paul Ryan had to deal with this, lol

344

Insert Nelson “Ha ha” gif here.

These idiots are going to reap the whirlwind if (as seems likely) they repeal the ACA without actually replacing it with something even more progressive. But they couldn’t just make a couple of changes around the edges and rename the law, noooo. Nothing less than repeal will satisfy the ideological purists.

345

The problem is that the only parts that more than a trivial handful want to repeal, are the parts that make it actually function.

Like, everyone wants insurance companies to have to give coverage to people with pre existing conditions, but some folks don’t want people to be forced to get insurance.

But one doesn’t fucking work without the other! You can’t force insurance companies to take on sick people, without forcing everyone to get insurance, because then literally no one will get insurance until they are sick.

This point is simply fact. It does not depend upon political ideology.

So the GOP is put in a position where they are left trying to appease people who are idiots, and demand the impossible.

Good luck, dicks. Pretty sure that shit ain’t gonna work.

So what will happen is that they will either do nothing of significance, and get crucified for it… it they will do something which works, but fucks over millions of people, and THEN get crucified.

Or, a third option which may work, is that they will literally just rename the ACA, potentially improving it by actually adding in more socialist type features, and say they did it… And this may work, because the folks demanding the repeal of the ACA are generally too stupid to understand anyway. If their side did it, even if it’s literally exactly what Obama did, they’ll love it. Even if you point out the hypocrisy, they won’t care or acknowledge it.

So I guess we’ll see, but I bet it’ll be door number 3 I just laid out.

346

You’re too optimistic, but I"d be relatively pleased with that situation. Then you may see those states that declined to set up exchanges, and declined medicare expansion, take them now. And suddenly the percentage of uninsured drops further.

If that were to be the proposal I’d be going to the local offices of my senators to make sure they support it, because that is probably the best possible outcome with this congress.

347

I mean we’re already basically adding $9 trillion to he deficit as things are lining up, might as well get people healthcare with it.

348

WTF is up with your priorities. Healthcare?? I want an Army-issued Bradley Fighting Vehicle for every family in America to keep them safe from Mexican rapists, Muslim terrorists, and Hillary Clinton’s child-catchers.

349

You seem to be operating under the woefully mistaken assumption that a single person on that side of the aisle would care one iota if people start dropping dead without coverage.

Even if a handful of them might personally care a bit (though I’m dubious of even that by this point), none of them are allowed to care politically, lest they should get Primaried by a screeching, shit-vomiting Trumpista come 2018, which amounts to the same thing in the long run.

Though you are right that if the Republicans were to literally take the final, revised, Court-modified written form of the ACA and reprint it, word-for-word, replacing every instance of “ACA” with “Trumpicare,” the most deplorable 46% of Americans would have joy-orgies in the street celebrating their victory over the socialist evils of Obamacare.

Have I recently mentioned in P&R that I’m in a really good, stable place mentally right now?

350

If you look up the definition of Real America (which will be mandatory in all 2017+ editions of dictionaries), it’s just this quote.

351
352

Actually, here’s what it appears Paul Ryan’s Door # 3 will look like

Well, Ryan is proposing a $25 billion risk pool fund over a 10 year
period. That sounds like a lot, but it only averages $2.5 billion per
year (I presume it’s less the first few years, more later on via
inflation). According to this article by Ian Milhiser at Think Progress, to adequately cover 875,000 high-risk patients would have cost seven
billion per year…and that was in 2008. That’s 2.8x as much as Ryan is
proposing, and that was 9 years ago (10, if we assume the new plan
doesn’t go into effect until 2018). I have to imagine that $7B would be
up to at least $10B by then, and that’s for 875,000 patients…

…Now, Ryan himself admits that 8% of people under 65
have “the same type” of pre-existing condition that the questioner
has…in other words, batshit-expensive ailments like cancer/etc. 8% of
30 million is 2.4 million people. If it costs $10 billion per year for
875K, that’s a good $27.5 billion per year for 2.4 million of them. That’s eleven times as much as Ryan’s plan is promising.
Now, here’s the thing: Ryan claims that state-based high risk pools have “worked well”. Perhaps…IF they’re properly funded. If Ryan and the rest of the Republicans move the decimal point to the right by a notch, perhaps we can talk…

…There’s a simple reason why GOP loves high risk pools: Even if the total dollar amount remains the same, they can cut funding to HRP,
** sentencing those 5% to their doom without raising rates on everyone **
else. Isolate ‘em from the herd. It’s clever if you have no soul.

353

Most ACA haters (I don’t like it but I think it does somethings that have to be done, but doesn’t do others) will think any GOP “revision” a success if their premium somehow goes down or stays the same…and Hannity tells them it is good.

354

I wonder how many GOP controlled states that don’t have exchanges and refused medicare expansion would agree to those things under a GOP banner?

355

My guess for what the GOP will do is gut the provisions and funding so that ultimately all the insurers end up pulling out, and then constantly repeat the talking point that the ACA just collapsed by itself and conflate all the issues together. “We tried to cover pre-existing conditions, but all the insurers in the exchanges collapsed because Obamacare was so badly designed, literally we could have done!”

356

House Republicans have a plan!

357

More deviously, they will raid the social security payroll taxes to pay for it in the short term and then use that as an excuse to privatize social security too.

358

If we stop trying to play 3 card monte with who pays for health care and start focusing ways of reducing cost, we actually have a chance of bringing our health care cost down to the levels of other countries.

Here is one example

Twenty years ago, after decades of witnessing firsthand a dysfunctional health care system that “is bankrupting the country,” Dr. Keith Smith envisioned a self-sustaining, free market oriented health care facility that would operate completely outside the bounds of government control.

After selling the idea to a few physicians in the Oklahoma City area, Smith co-founded the Surgery Center of Oklahoma, a 32,535 square foot, state-of-the-art multi-specialty facility, owned and operated by approximately 40 of the top surgeons and anesthesiologists in the area…

Smith’s surgery center is so unique not only for its unparalleled success, but because it posts the prices of their services online. Everyone knows precisely what they will be charged when they walk in the door, offering a customers a complete diversion to the current market for health care in America…

When patients realize that their out-of-pocket costs will be less than the cost of meeting their deductible at a large hospital, “they are happy to pay our full bill,” Smith told TheDCNF. If patient’s compare the price of any surgery listed on the center’s website to what is traditionally paid in hospital systems, “they will find a ration of 10:1 or 6:1.” For example, “a $3,000 procedure at my facility could easily be a $30,000 liability for self-funded plans at a not-for-profit hospital,” Smith said.

359

I just looked up the prices at Surgery Center of Oklahoma for three random procedures: ACL repair, carpal tunnel release, and cataract surgery.

For the first two, the SCO charges more than what Medicare would have paid them, which means they likely charge more than what most insurance companies would have paid them.

For cataract surgery, the SCO actually charges more than what the average uninsured person would have paid.

So if your plan to bring down average health care costs is to eliminate the SCO, then I guess you have a good plan. Because the SCO is the medical equivalent of hearing a street peddler say, “For you, my friend, I have special price!”

360

[quote=“Strollen, post:358, topic:73916, full:true”]
If we stop trying to play 3 card monte with who pays for health care and start focusing ways of reducing cost, we actually have a chance of bringing our health care cost down to the levels of other countries.

Here is one example

Twenty years ago, after decades of witnessing firsthand a dysfunctional health care system that “is bankrupting the country,” Dr. Keith Smith envisioned a self-sustaining, free market oriented health care facility that would operate completely outside the bounds of government control.[/quote]

So, other countries keep costs down through government regulation and price controls, and the solution to bring the cost down to the levels of those countries is precisely doing the exact opposite those countries whose result you want to emulate have done?

Hint: the information in that article might not be exactly accurate.