3502

My employer-provided “gold plan” equivalent came in around $8000/year for me (my contributions plus employer contributions). It is, of course, increasing for next year. I’m thinking he must have had a pretty cut-rate policy wherever he was going through in the past.

3503

You misunderstood. Poor people weren’t dying. They were getting medical help. Obviously the system has failed on every level if these things are happening.

How can you lose employment insurance while pregnant? Isn’t it illegal to fire pregnant women in the USA? If it isn’t so, that’s insane (and so sorry that happened to you, btw)…

It’s not illegal to fire pregnant women anywhere that I’m aware of. If they live in a right-to-work state they can fire them for anything.
You wore blue today. You’re fired.

As long as the reason isn’t: “You’re black” or “you’re a woman” they can ditch you. Of course it’s pretty easy to come up with any other reason to fire someone if you don’t like black people or women when the rest of the menu is “everything”. You might have to pay some of their unemployment for a bit, unless your state allows you to deny them that too (again, pretty easy to do if you just “document” some obscure violation of the company handbook or whatever).

Edit: Of course all of that varies from state to state drastically. But as someone who has been in a “right-to-work” state their whole life, I can tell you it should be “right-to-fire” because that’s basically what it amounts to. Not having to unionize isn’t a bad thing, but having effectively no rights as a worker is pretty bullshit.

3504

I doubt I would be able to get insurance without the ACA. I’m 56, type 2 diabetic, and have hypertension. Either they wouldn’t offer me insurance or it would be so expensive I couldn’t afford it. I’d have to hope I made it to 65 so I could get healthcare from the government.

Even with the ACA my plan isn’t that great. I have a $6500 deductible. But I do get some labwork out of it and it’s there in case I need hospitalization or some kind of expensive ongoing treatment. Don’t take away the ACA. Change it if you have to, but don’t get rid of it. It’s sorely needed by millions.

3505

My information comes from a survey of American College of Emergency Physicians, who, with all due respect to your experience, I think are in better position to judge these things. It’s been wildly reported and here is a WSJ article
In case, its behind the paywall here is a snippet.

Emergency-room visits continued to climb in the second year of the Affordable Care Act, contradicting the law’s supporters who had predicted a decline in traffic as more people gained access to doctors and other health-care providers.

A survey of 2,098 emergency-room doctors conducted in March showed about three-quarters said visits had risen since January 2014. That was a significant uptick from a year earlier, when less than half of doctors surveyed reported an increase. The survey by the American College of Emergency Physicians is scheduled to be published Monday.

Medicaid recipients newly insured under the health law are struggling to get appointments or find doctors who will accept their coverage, and consequently, wind up in the ER, ACEP said. Volume might also be increasing due to hospital and emergency-department closures—a long-standing trend.

There was a grand theory the law would reduce ER visits,” said Dr. Howard Mell, a spokesman for ACEP. “Well, guess what, it hasn’t happened. Visits are going up despite the ACA, and in a lot of cases because of it.”

The health law’s impact on emergency departments has been closely watched because it has significant implications for the public. ER crowding has been linked to longer wait times and higher mortality rates.

“As people gain access to affordable, high-quality coverage, they are more likely to get the right care when they need it,” said Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services. “For people who have utilized emergency rooms for nonemergency care in the past, we are continuing to work to reach out and provide information on how to best use their new coverage.”

I love the government guys response. “Oh right education is going really change people behavior.”. I don’t have a problem with sick poor people seeing doctors. I think it is a good thing and probably will save us money. I do have a problem with poor person making an unneeded visit to the emergency room for say her child who has a fever because there is no financial incentive for her to make an appointment to see her primary care physician.

I’ll agree that ACA has been great for people with a chronic disease. It is also been good for poor people who either get Medicaid, or heavily subsidized premiums and co-pays.

What it hasn’t been good for is the self-employed well person, especially young ones. A typical Bronze plan has $6,850 deductible, and other than routine doctor visits, you get almost nothing for your premium which range from $250-750/month (roughly double for a family) depending on location. Break a leg, spend a couple of nights in the hospital, you are out $6,850. For a lot of working/middle-class people in this country, there isn’t a lot of difference between $6,850 hospital bill and $200,000 bill they can’t afford either one. Which is why the people signing up for ACA are predominately are poor.

The administration hasn’t really given us the true cost of ACA to the taxpayers yet. I bet when they do, it will be sticker shock.

3506

My roommate for several years was Yale nursing-school trained nurse midwife. Her practice charged $3,000 for delivery (less for poor people) that’s in expensive Hawaii. Typical midwife charge in the rest of the country is $2,000 for in-home delivery which I think is pretty small compared to the cost of raising a child. She told me for normal deliveries there is no difference in outcomes between giving birth at a hospital with a doctor, and nurse midwife.

But because we are so conditioned to having somebody else pay for out medical care, the concept of actually shopping around for medical care is totally foreign to us. So we have our babies in hospital at cost 10x of what need to be paying. ACA takes the insanity a step further a mandates maternity coverage even for men, and 50±year-old woman.

3507

Medicaid recipients newly insured under the health law are struggling to get appointments or find doctors who will accept their coverage, and consequently wind up in the ER, ACEP said. Volume might also be increasing due to hospital and emergency-department closures—a long-standing trend.

So let’s look at what your article actually says versus what I said. Visits are increasing, but we weren’t talking about visits, we were talking about charges. That’s not the same thing. Second, it specifically says Medicaid recipients are struggling to find appointments. If you followed the conversation at all, you would actually notice I mentioned ACA DOES NOT, i repeat, DOES NOT, and never did address the supply side of the equation very well. This is not the first time I’ve said this, and it’s also a criticism I have of the ACA.

So please do respect my experience. You’re information does not, in anyway, say ACA caused an increase of costs. What it does say is it didn’t cause a decrease in the number of visits to the ER. And a lot of people in the industry could have told you that because we know that the plan never involved supply as much as it need to. ACA did not encourage more nurses and physicians to start practicing or accept medicaid patients. It does not do much to increase the classroom sizes for nursing programs even when there is a shortage of nurses. It does nothing to stop the flow of medical students going into expensive specialties where they can make a lot more money instead of being affordable and much needed family practitioners.

there isn’t a lot of difference between $6,850 hospital bill and $200,000 bill they can’t afford either one. Which is why the people signing up for ACA are predominately are poor.

This is a silly statement, especially if you claim to be representing well-off young people and small businesses.

3508

Quite the opposite. You might be in the developed country where this is more common by far. In pretty much every other developed country public healthcare and inexpensive private insurance ($60 monthly here for a 40 years old male) shopping around is way more foreign. In developing countries it is more common, though.

As for in-home delivery: different points of views, different outlooks. The doctors I know (a couple dozen between family and family friends, at least 4 who worked at maternity sections at hospitals) balk at the idea of not going to a hospital to give birth (several conversations on those lines the last years, with all the new-age, all-natural nonsense becoming more common). They regard the idea as backwards and risky, unless you have done a lot of otherwise not necessary checkups to make sure the baby is coming perfectly ok, and even then there can be unforeseen complications that can endanger the life of the baby or mother unless at a well equipped hospital.

3509

Isn’t this to be expected, though? When you are trying to spread out the costs, that means that healthy people, especially younger ones, will be paying more because before they were paying less.

As to predominantly poor people signing up, that’s what I would expect. Most people who get healthcare through work are not going to change that, so what’s left are people who fall into the cracks, and those people are likely to be poorer.

The actuarial tables are a terrible way of determining premiums. When that is the primary cost determination, you exclude sick people and people without means from a basic human need. Healthcare really does need a socialized approach. My biggest criticism of the ACA is it doesn’t go far enough. Why not cut defense spending by 20% and put that savings into socialized healthcare?

3510

This is a survey of whether ER physicians perceived a change in volume in their department. But the relevant metric is actually the number of visits per patient.

As hospitals merge and emergency rooms close, you would expect each remaining department to see increased volume even if ER utilization is constant. And as the US population increases, you would expect to see increased aggregate utilization even if individual use is stable.

3511

How much of the increased visits and medical costs due to unattended needs that for the first time can be attended to?

3512

Just an FYI, may emergency rooms are a money losing department. It’s expensive to run one of those with very little return. I’m not surprised some of them are closing, especially when so many groups have been using them as their only source of care.

3513

Ok that is a fair point. Although logically if visits are increasing but costs aren’t then we are seeing more less critical/expensive cases in ER, right?

I was reacting to this statement.

I have to agree on the ACA front. For some reason, the Democrats are just incompetent in defending their stance well in this area. The bulk of Americans opposed to ACA don’t seem to understand they already pay for the uninsured in the most inefficient and difficult way possible. If you have commercial insurance, you’re footing most of the bill for the uninsured who don’t pay and the financial aid for those who can’t pay. If you pay taxes, you’re paying for Medicare and Medicaid.

I agree most people don’t understand. However, I see no evidence that ACA has changed the bolded statement at all. . Do you? Now if ER visits had decreases as was one of the selling points of ACA, than you could have made the case that ACA resulted in more people getting health care, at no additional cost because we are providing care more efficiently but that isn’t what happened. As you point ACA did nothing to increase the supply of medical care, and while there is some surplus of supply in medical care in the country (lots of MRI machines, and surplus of hospital beds in parts of the country.) In most of the pressing needs primary care doctors, nurse etc. there is shortage, and ACA did nothing to help it.

[INDENT]there isn’t a lot of difference between $6,850 hospital bill and $200,000 bill they can’t afford either one. Which is why the people signing up for ACA are predominately are poor.[/INDENT]
This is a silly statement, especially if you claim to be representing well-off young people and small businesses.

I happen to fall into the category where I can afford $6,850 medical but a $200K would really hurt. For that reason I have medical insurance.
A 24 year old free-lance designer, making $80K with $200K in undergrad/grad school debt, and a car loan, and credit card debt is in a different position. For them they may understandable feel they are just better skipping the $250/month $3k in insurance premiums. A 200K medical would certainly cause them to file bankruptcy, but a $6,850 deductible may also result in a bankruptcy filing. So why not just save the $3K a year a gamble they’ll stay healthy, most of the time they will.

3514

Let me clarify what I meant by that statement. If an uninsured person who hasn’t seen a physician in over twenty years shows up at the ER because their Type II diabetes is out of control and their body is deteriorating, what formula can I successfully use to track the extra expenses that were incurred because they didn’t seek medical care earlier to get that under control. And if i could get those costs into a numerical number the masses would accept, how would I explain to you, a commercially insured patient that your premiums are actually higher than they should be because of a scenario like this. Or you as a tax payor are paying for services like this through the government backed products or in the form of financial aid that the not for profit hospitals are writing off or all the other programs designed to help with this.

Essentially you’re already paying for their care but I can’t track it very well. If they’re insurance, it’s easier to track but it will take years to catch up. The fact they didn’t get care for twenty years isn’t fix because today they have insurance. The damage is done. The benefit is long-term.

I happen to fall into the category where I can afford $6,850 medical but a $200K would really hurt. For that reason I have medical insurance.
A 24 year old free-lance designer, making $80K with $200K in undergrad/grad school debt, and a car loan, and credit card debt is in a different position. For them they may understandable feel they are just better skipping the $250/month $3k in insurance premiums. A 200K medical would certainly cause them to file bankruptcy, but a $6,850 deductible may also result in a bankruptcy filing. So why not just save the $3K a year a gamble they’ll stay healthy, most of the time they will.

This is why you have to force them to get insurance. There are entire groups of people that would prefer to gamble and let everyone foot the bill. I don’t find that acceptable. Why should I have to pay for your hospital visit because you decided you want to spend 3k on a TV instead of health insurance. It’s not that different from vehicle insurance. There will still be people who get around the system, but a large portion of the population have insurance because they have to and generally they obey the law.

The one group you’re missing are the blissfully ignorant middle-class/small business group who run around talking about how cheap their insurance is and then wind up with a huge bill they can’t pay because they were grossly under-insured. This group was essentially pushed into viable products and remain relatively angry about because they weren’t aware or still don’t believe they had purchased a sub-par product. There are articles out there still that talked about some insurance products that you would pay couple hundred a month but maxed out at less than 10k. 10K isn’t going to do much for you if someone has to crack your chest open and bring you back to life.

Look, I have a lot of criticisms about ACA. It’s not perfect. But pre-existing conditions, getting rid of life-time maximums (remember when you were so chronically sick that your insurance company just decided not to pay for you anymore), expanding the coverage to college students/26 year olds (a group notorious for juts gambling with their finances because they have nothing to lose and what do they care if someone foots their bill), yearly max out of pockets are more common now, copays or “free” visits for preventative care… ACA has done a lot for this country.

But yes, for the person who saw a physician once a year, the sticker shock of a monthly bill seems incredible… but no one walks out the door and expects to wind up in the ED. They sure seem happy that they have one around when that happens, and if everyone gambled like they did, we wouldn’t have as many as we do today which, as someone else pointed out, is shrinking because a lot of those departments are money sucks.

3515

Perhaps so, but southern farms not only don’t offer good pay, but they have never offered good pay. Since the founding of the nation, they have hardly ever paid enough for white citizens to want to work them. First there were slaves working them, then oppressed black citizens with no education and no alternatives, and then illegal immigrants. Few good farm jobs for Americans have ever been lost to immigrants. Few if any domestic factory jobs are being lost to illegal immigrants, and the same applies to technical jobs, office jobs, creative jobs, and management jobs, among others.

The people who are currently being agitated by Trump’s demagoguery have infinitely more to fear from robots and from cheap foreign goods than they do from illegal immigrants in this country.

3516

I think the problem is the concerns with illegal immigration, visa abuse and outsourcing are all being mangled together with ideas of rapists, drug addicts/pushers and a general fear of foreigners. It’s almost impossible to have viable, logical discussions about these problems and not run into the crazy almost immediately.

I will say though, to say that office jobs and tech jobs aren’t being threatened I think is misguided. No, it’s not the illegal immigrants (along with legal) in the fields, but look at what happened to Disney World and their visa’s tell me there isn’t something there worth looking at.
Link

There are several cases of this. So I think the problem is there are legitimate discussions to be had and studies needed but it’s overshadowed by the anger and fear mongering.

3517

I think a very small percentage of people shop for cost in healthcare in either the US or Europe. About the only people that do have high deductible heath insurance. Clearly there are many times when we don’t want people doing comparison shopping if somebody has heart-attack the cost should be the last consideration. On the other hand having a baby is something we should encourage people to shop around for along with many routine procedures like a knee-replacement.

Pregnancy is one of these things you have plenty of time to do meaningful comparison shopping and obviously price should not be the primary concern but also shouldn’t completely ignoring. We’ve been having babies for millions of year before the hospital. Even the worse place on earth like Sub-Sarahan Africa 99% of the woman survive it and develop countries the number ranges from 99.95% to 99.998%. If it cost $10k to have a baby at the hospital and $2K at home, then there needs to evidence its a lot more effective. If in the US we used non-hospital birth methods we’d save more than $30 billion/year. But right now there is almost no incentive for anybody but wanna be hippies to do so. By mandating coverage ACA makes it worse.

3518

Or to put it another way, modern medicine can reduce one’s maternal mortality rate by a factor greater than 200.

In terms of bang for the buck, that’s far better than, say, getting cutting edge treatment for lung cancer or an acute heart attack.

Medical economists prefer to talk about NNT, the number of patients who need to be treated in order to save one life. For modern obstetrics, you need to treat about 100 pregnant women in order to prevent one pregnancy related death. That’s actually much better than many other types of preventive care, for example screening mammography.

So, yeah, I think it’s worth the expense.

3519

Bush PAC lawyer lays down the smack on trump, also files a case with the FEC due to trump using corporate resources for election purposes (which is illegal).

Late last week, Donald Trump attorney Alan Garten sent a cease and desist letter to a wealthy Florida businessman named Mike Fernandez. Fernandez had paid for an ad in the Miami Herald that described Trump as a " narcistic BULLYionaire." Garten threatened legal action against Fernandez – a letter he also sent to James Robinson, the treasurer of Jeb Bush’s Right to Rise leadership PAC. On Wednesday, Charlie Spies, the D.C. based counsel to Right to Rise, sent an absolutely amazing response letter to Garten.

Dear Mr. Garten:

On behalf of our client, Right to Rise PAC, Inc. (“RTR”), we write to respond to your December 4th, 2015 letter, in which you state your intentions to “seek immediate legal action” against RTR should it produce and disseminate certain political communications that “directly and personally” attack your client, Donald Trump. Please be aware that RTR is a federal “Leadership PAC” that has never produced, and has no plans to produce, advertisements against your client, or any political candidate for that matter. As a Leadership PAC, RTR was organized to raise money to support conservative candidates through direct contributions. In fact, RTR has made almost $300,000 in contributions since its creation in January 2015. Unlike your client, we only support conservative candidates.

It is possible you are confusing RTR with any number of federal independent expenditure-only committees (i.e. “Super PACs”) that have exercised their First Amendment rights to educate the public about your client’s public statements and stances on important public policy issues. We suggest you consult the Federal Election Commission’s (“FEC”) website (www.fec.gov) to familiarize yourself about the differences between Leadership PACs and Super PACs, or perhaps skim through the Supreme Court’s decision in Citizens United v. FEC or the D.C. Circuit’s decision in Speechnow.org v. FEC. They are both very helpful and might clear up some of your confusion.

In addition, although RTR has no plans to produce any advertisements against your client, we are intrigued (but not surprised) by your continued efforts to silence critics of your client’s campaign by employing litigious threats and bullying. Should your client actually be elected Commander-in-Chief, will you be the one writing the cease and desist letters to Vladimir Putin, or will that be handled by outside counsel? As a candidate for President, your client is a public figure and his campaign should, and will, be fact-checked. The ability to criticize a candidate’s record, policies and matters of public importance lies at the heart of the First Amendment, as courts have repeatedly recognized. If you have the time between bankruptcy filings and editing reality show contracts, we urge you to flip through the Supreme Court’s decision in New York Times v. Sullivan. If your client is so thin-skinned that he cannot handle his critics’ presentation of his own public statements, policies and record to the voting public, and if such communications hurts his feelings, he is welcome to purchase airtime to defend his record. After all, a wall can be built around many things, but not around the First Amendment.

Lastly, in light of your confusion over the difference between Leadership PACs and Super PACs, we have to assume you may also be unaware of the FEC’s prohibition on a federal candidate’s use of corporate resources for campaign purposes. Although your client may think he is above the law and be accustomed to using lawsuits to bail out his failed business deals, the Federal Election Campaign Act and the FEC’s Regulations nonetheless apply to him and his campaign. Perhaps the attached complaint, filed today, will serve as a reminder of your client’s legal obligations under federal election laws. Just as your client is attempting to quickly learn the basics of foreign policy, we wish you personally the best in your attempts to learn election law.

Cordially,
Charles Spies

3520

One interpretation of “They are both very helpful and might clear up some of your confusion” is, of course, “we recognise your petty threats for being worthless”.

3521

LOL

I’m generally not a fan of snark, but for the Donald I’ll make an exception. That was better writing than a good Daily Show episode.