patrick.net

At this point I'd rather go to all "out of pocket" like it was a long ago, or full-bore socialized medicine. What we have now is a Frankenstein combination of the worst aspects of both.

errc says

I don't need any bullshit scam "health" "insurance", because I properly fuel my body, hence I don't get sick

Don't know how old you are or what your ethnic background is, nor do I know your genetics. All I can say is that one serious accident and you're fucked financially; and there are very healthy people who eat raw food and walk everywhere who still come down with serious diseases.

I work with patients everyday who didn't smoke, weren't around smoke, and lived healthy, active lifestyles. They still come down with cancers, heart disease, kidney disease, etc. Remember that Euell Gibbons died from natural causes.

amen, sorry but at least when it comes to healthcare; everyone for themselves just doesn't work.

Maybe healthcare should be considered basic infrastructure. I think there's a case to be made for that. Especially since many diseases are contagious. In that case, "no man is an island."

But basic infrastructure isn't cheap. It will mean much higher taxes to pay for it. But it might be cheaper than private insurance given the Crony Capitalist "racket" it seems to have become.

errc says

I don't need any bullshit scam "health" "insurance", because I properly fuel my body, hence I don't get sick

errc says

I'm 30

"I'm 30" says it all. It's good to be young, immortal, and know everything. Everyone gets one shot at it, enjoy it while it lasts.

You will get sick no matter what you eat. You can lower the probabilities of certain diseases with good diet and keeping in shape, but you will get sick and you will need health care as dictated by your genetics and plain old luck. Young children get terrible diseases like cancer. Do you really believe it is caused by a 2 or 3 year lifetime of bad diet?

[...]

curious2 says

Bob2356: Young children do indeed get cancer, in fact twice as many get leukemia now as a decade ago. Not coincidentally, America does six times more C-T scans than a decade ago, each with the radiation of 1,000 X-rays. Plus, all those mammograms (breast X-rays) on women of child-bearing age. No other country does that. #1 risk factor for childhood leukemia is radiation. It can be cured, expensively, but side effects can be lifelong.

Where do you get your information? From the National Cancer Institute:

"Long-term trends in incidence for leukemias and brain tumors, the most common childhood cancers, show patterns that are somewhat different from the others. Incidence of childhood leukemias appeared to rise in the early 1980s, with rates increasing from 3.3 cases per 100,000 in 1975 to 4.6 cases per 100,000 in 1985. Rates in the succeeding years have shown no consistent upward or downward trend and have ranged from 3.7 to 4.9 cases per 100,000"

Be careful how you read your statistics. There was a big bunch of articles about this last year in the mainstream press, but as usual poorly reported. Children get 5 times as many ct scans as 15 years ago, not 10. This was from a study by the journal on radiology and only talked about IN THE EMERGENCY ROOM. Not all children in general. At leukemia rates of 3.3 to 4.6 per 100k correlating with emergency room visit ct scans is very tenuous. To deny children ct scans as a diagnostic tool based on this would be insane, ct used properly in the right situation is a lifesaver.

Everything is a compromise. Careful studies need to be done all the time as new technologies, medicines, and procedures emerge to quantify benefits vs risks. It's not all some gigantic conspiracy.

[...]

"So premiums will be too high to pay, and yet we will all be required by law to pay.'

'Am I misunderstanding something here?"

No, you have stated it very well. My Kaiser premiums are up to $804 per month now. That's for little ol' lonesome me. I have seven years to go before I qualify for Medicare. I never thought I would wish that I was older than I am. Will I be able to make it with health care coverage over the next seven years? That's totally unknown.

I can't get coverage elsewhere, because of a pre-existing condition. Kaiser has high-deductible plans that are cheaper; they make you apply as a newcomer, no acknowledgement of being a member for thirty+ years. They denied my application, saying that I don't qualify because of the pre-existing condition. They also included a note saying that if I DID switch plans, they might cancel on Dec. 31, 2013, at which point I would have to go on a "government-mandated" plan.

WTF is that?

I as a senior, a nurse, a grandparent can see some benefits of Obama care however there are many parts of it that come leaking out that have been placed in the law that are not good that we continually are finding out. Eventually yes our premiums will probably sky rocket. My grandson has a pre-existing condition with a father who has PTSD from fighting for our freedom in Irag, that lost his job due to the effects of PTSD and now is also fighting to get VA benifits and or other insurance because now he has a had a preexisting condition, now another one. I am a senior planning to retire, insurance that covers everything needed is not cheap, and both my husband and I have preexisting problems. I see what Obama wanted to do and appreciate it but what I and others do not like about it is that it was done behind closed doors without our congress even seeing the whole bill. NO ONE does that unless there is something wrong 'dishonesty' what is He hiding? Now getting to the facts of life in the medical field many doctors are retiring due to this bill, good doctors too! Requirements for hospitals to get grants and medicare payments to run their hospitals safely and giving good hospital care is effecting the hospital nursing staff, the patients and Drs. No, we do not mind working hard but decreasing our staffing with a ratio of 6 pt a nurse and insurance requirements of discharge earlier than the patient being well enough is not good. Fighting infections and less medical errors is very good, but nurses are dropping out now too, and many nurses are already retirement age. We have seen many patients come back to the hospital within 3-7 days just due to the fact they were sent home due to recommendations and mandates rather than the doctors diagnosis and plan of care. Offering hospitals incentives to get grants are hurting our patient care. Nursing is a gift and a knowledge that is special and pts are our only objective is GOOD PATIENT CARE but with the staffing level ratios exceptional nursing care as each pt deserves and should get is now very hard and alot of time not an asset anymore with some hospitals only the dollar signs are looked at to obtain computers, renovation to please the obama care plan and systems so they can get the payback leaving the nurses - doctors and patients back in the distance. It must be stopped. I again agree some parts are good. but feel the plan should be stopped and redone slowly looking at each problem carefully and asking the American people what they want.

I forgot to mention I have a sister who lives in Canada, while they get good healthcare usually but not always as some Drs here and there are butchers and are there for just the money The main problem with therr healthcare is the waiting time for that care. They have to wait for long periods to get anything done, including preventative medicine and tests AND even if it is an emergency heart problem.

NURSE FROM BMT TX says

I as a senior, a nurse, a grandparent can see some benefits of Obama care however there are many parts of it that come leaking out that have been placed in the law that are not good that we continually are finding out.

The idea was awesome, the execution wasn't the best. Not sure why they didn't do a "medicare" for all option.

elliemae says

Not sure why they didn't do a "medicare" for all option.

Pretty sure that Medicare for all (paying into it for coverage) was shot down in backroom deals by the insurance oligopoly because it was huge threat to their profits.

They understood that the government would actually be much more efficient than they are.

[...]

Patrick, most of Obamacare is yet to be phased in, particularly the mandate. Another feature that is coming is a cap on the yearly percentage increase in healthcare premiums. The insurance companies raised premiums significantly last year in anticipation of this cap. They spiked their revenue anticipating less revenue growth in the future. These are the reasons your premiums have increased without any increase in services.

Wow, Dr. Gruber replied to my email about his comic book about Obamacare:

Thanks for writing.

The important thing to recognize is that any premium effects of the ACA aren't realized yet. the 73% rise you are seeing has nothing to do with the ACA but rather rising underlying medical costs and/or price gouging by insurers. the ACA hopes to eventually deal with this but only after 2014.

Please don't buy the rhetoric that price increases in 2012 have anything to do with a law that doesn't have much of an impact until 2014!

Jon Gruber

On 3/12/2012 2:08 PM, Patrick Killelea wrote:
> Hello Dr. Gruber,
> I just read your comic book "Health Care Reform" and while the book is
> pretty good, the ACA has so far made my life much worse rather than better.
>
> My own nongroup Blue Shield of California family premiums went up 73% in
> one year, and that's not due to any medical condition on our part. Just
> pure price gouging by insurers, which the ACA seems to have encouraged.
> All California insurers seem to have raised rates by about that amount
> in the last year or two. There is definitely no competition in that
> oligopoly. See this graph of my premiums:
>
> http://realestate.patrick.net/?p=602077
>
> Why is there no limit to what insurers can charge in premiums? Requiring
> insurers to spend 80% on health care costs just encourages them to pay
> much more for everything, so that their 20% is 20% of a bigger number.
>
> I don't expect a reply, but I have to let you know that the ACA is
> definitely not working for me.
>
> Patrick Killelea
> Menlo Park, CA
> p@patrick.net

--
Jonathan Gruber
Professor of Economics
MIT Department of Economics
50 Memorial Drive, E52-355
Cambridge, MA 02142
phone: 617-253-8892
fax: 617-253-1330
e-mail: gruberj@mit.edu
web: http://econ-www.mit.edu/faculty/gruberj/

[...]

wthrfrk80 says

At this point I'd rather go to all "out of pocket" like it was a long ago, or full-bore socialized medicine. What we have now is a Frankenstein combination of the worst aspects of both.

You sir, summed up the entire debate and I am entirely in agreement with you.

errc says

Seeing as how individuals are not allowed to purge student loans in bankruptcy (or even death),

No, actually death is one of the ways you can have a student loan discharged. Someone just needs to get a copy of the Death Certificate to the lender. See here.

Apparently you could have your loans discharged in bankruptcy hearings still but only in very rare circumstances.

Discharges are possible for total and permanent disability, school closure before completion of your program, and some other reasons. Check the link above.

On this subject. To be fair, it would be nice to remember that this disasterous legislation was NOT what Obama or the majority of the Democrats wanted. If we remember the debate, we would be better off remembering how the Republicans completely stonewalled any attempt to reform health care. Olympia Snow was just about the only Republican who would actually compromise (even if only slightly) in order to create this disasterous legislation.

Obama ran against a mandate. Hillary ran on the prospect of a mandate. Obama was forced to accept legislative reality. That reality was that he was dealing with Republican and Conservative Democrat legislators who were unwilling to even come to the table to consider any reform of our broken health care system. The Republicans and the Conservative Democrats held the entire process hostage until this pig of a bill was created out of the scorched earth left behind by the Republicans and Conservative Democrats.

Our only hope is if Obama gets re-elected and there are enough reasonable legislators elected who are serious about creating a real health care reform bill that would actually benefit the citizens of this country.

I'm not holding my breath. The entire process that gave birth to this mutant monster taught us how much the Republicans and Conservative Democrats hate "the common folk" and how much they love the health insurance cartels who we dare call "insurers." And the entire process showed how easily it is to manipulate dumb white conservative voters who hate Obama (for reasons that they can't quite specify *wink*) who still "want our country back." (Back from whom? Eh? Racist much?)

If we get Rick Santorum, expect the continued march toward fascism that we have been on since at least 1980 to speed up dramatically. If we get Romney expect that the march will continue, but that it might only take a little longer to acheive the true totalitarian segregated state that is the vision of the conservative power elite for anyone who doesn't belong to the 1% who control everything. If we get Obama and another whacko conservative congress, expect that the march toward fascism will continue, but that it would be only slightly slower than under Romney.

If some miracle of conscious intelligent thought sweeps over the general American voter simultaneously accompanied by another miracle that the choices for legislative office holders actually have the interests of the common citizens at heart, then we might have a prayer at a chance of emerging from the dark ages of American Corporate Fascism. Only then might we see a true reform of our disasterous health care system that benefits everyone.

Again, I'm not holding my breath.

Well, simcha. It's unamerican to defend the prez and pretend that he's not 100% responsible for everything that has occurred in the past 3 years.

Uh, correction here: Obama never considered or brought forth the single-payer option that a majority of Americans would support. The efforts to include it in the debate were squashed by the administration.

The insurance, drug, and medical companies got what they wanted, and bankruptcy's number one cause is still medical expenses.

monkframe says

Uh, correction here: Obama never considered or brought forth the single-payer option that a majority of Americans would support. The efforts to include it in the debate were squashed by the administration.

The insurance, drug, and medical companies got what they wanted, and bankruptcy's number one cause is still medical expenses.

Single payer would never have passed in the Senate and everyone knows it. Obama couldn't afford that level of embarrassment.

Latest hot rumor is the hard left wants the current bill killed just as badly as the hard right. Conservatives get their way for now and liberals preserve the issue for future elections (same as abortion) hoping to get another bite at the apple in 15-20 years when there's another Democrat in the White House. That's been the historical pattern since the end of World War II.

Wacking Hut says

Patrick, most of Obamacare is yet to be phased in, particularly the mandate. Another feature that is coming is a cap on the yearly percentage increase in healthcare premiums. The insurance companies raised premiums significantly last year in anticipation of this cap. They spiked their revenue anticipating less revenue growth in the future. These are the reasons your premiums have increased without any increase in services.

Most large companies are waiting to see what the Supreme Court does with it. That's also why there hasn't been a lot of hiring.

Obama caves at a moment's notice. Political expediency rules the man. The people need a fighter in the White House, not a triangulator.

As I said, the current bill hands big business everything it wants: higher prices, no cost containment, and a small penalty for those who don't buy into the plan. If I were 20-something, I might pay the penalty and blow it off, who needs to be bled dry by bloodsucking corporations whose object is NOT to pay claims?

And the Supreme Court will be deciding by June whether even this plan is thrown aside.

[...]

Typical, progressive denial.

You made your bed patrick, now lay in it.

But don't fret, we will get rid of Obamacare, and get things back to normal.

Just to help educate those with their heads in the sand.... when you get govt. involved in an industry, the cost to consumers goes up.

Examples:
-Housing
-Education
-Medical

Medical costs were much lower in the past, before Obamacare, medicare, medicaid.

Once govt. is involved prices soared.

So, ya, you got what you wanted, so be joyous.

curious2 says

If you have an opportunity to visit Mexico, the full retail cash price there for the same or equivalent drugs is usually less than Americans' insurance copay. Also, they generally don't require prescriptions, which saves even more $. Federal law prohibits bringing back meds from Mexico,

God Bless American Crony Capitalism!

The worst thing about Obama/Romey-Care is that it prevented real reform.

The only way to fix the health care industry is to do the following:

1. Kill all rent-seeking health insurance companies.

2. Run a zero-net profit/loss nation-wide health insurance program. Such a program could offer different tiers or packages, but it should only do a few to keep things simple.

3. Have a single payer system with the same price for all people. Of course, each doctor could set their own price and adjust for cost-of-living, but each patient gets the same price.

4. Eliminate all administrative waste by having a single, national software system for maintaining all medical records that even small practices can access. This is a large one-time investment, but it is miniscule compared to the costs of the status quo. Of course, we need heavy Constitutional protection on the rights of people to access, correct, and restrict access to their records.

Any health care reform package that doesn't do all of the above is a bandaid at best.

Dan, I can tell you what's gonna happen.

Both parties want to get rid of this: conservatives for obvious reasons and liberals because they despise how their own people in the House and Senate turned on them.

My prediction would be that SCOTUS shoots the mandate in the head, leaving the preexisting condition and allowance for adult children clauses in place. Conservatives will relax and liberals will lick their wounds, knowing the issue is preserved for fundraising in future races. That's what they do with abortion and gay rights. It's nothing but a game.

Fifteen or twenty years from now, something will happen that results in Democrats winning Congress and the White House back and they'll get another opportunity at sausage making.

This is how it works.

It's a center-right nation.

curious2 says

bob2356 asks

Where do you get your information?

Admittedly I do rely on the press because I cannot personally count every childhood leukemia on my own, but your quote from cancer.gov is based on data that are at least five years old:

http://www.cancer.gov/cancertopics/factsheet/Sites-Types/childhood

The article below, also from 2007, projected thousands of future cancers caused by the CT scans performed that year alone:

http://archinte.ama-assn.org/cgi/content/abstract/169/22/2071

Since then, CT scan rates have continued to increase.

Also, CT scans are certainly not the only form of radiation:

http://www.gaia-health.com/articles351/000396-xrays-double-cancer-children.shtml

Also your post includes incorrect assumptions and misquotes, with the result that you end up arguing with a straw man. I didn't say anything about how many CT scans children get, I said Americans get 6 times as many as a decade ago.

You said twice as many children get leukemia as a decade ago and Americans get 6 times as many ct scans pretty much in the same sentence. I assumed you were tying that together somehow as well as obliquely referencing the recent reporting of the increase in children's ct scans in emergency rooms. So these were just two totally unrelated statements that had no bearing on each other? Sorry I misread, most people would have assumed they went together.

Both my article and your article both say that leukemia rates are pretty much stable within a fixed range since the mid 80's, so why is this a straw man? The statement that twice as many children get leukemia as a decade ago is simply not true.

As per the thousands of additional deaths from cat scans "study", so what? Without any reference to how many people are helped by cat scans it's totally irrelevant. Just taking the number of cat scans and projecting it out sounds like a senior medical school student doing scut work for some publish or perish professor to me. As opposed to a serious study with meaningful results.

Yes invasive radiation should be avoided whenever possible. Hell, sunlight should be avoided whenever possible. Yes there is more invasive radiation than is absolutely needed, although with the current malpractice climate everyone errs on the side of caution rather than having to stand up in court and explain why they didn't take a ct scan or xray. But overall the benefits far outweigh the risks of cat scans and xrays. If avoiding radiation means dying here and now to avoid a statistical increase in the possibility of cancer later I'll take my chances. You are free to make your own choice.

[...]

Dan, you hit it on the head. Anything short of a nationalized and streamlined system is a bandaid at best. It won't happen any time soon though. The 1% who control both parties in power won't allow it to happen.

simchaland says

Dan, you hit it on the head. Anything short of a nationalized and streamlined system is a bandaid at best.

That is crazy. Can you explain to me how such a system would not be swamped.

Once everyone has health insurance everyone is going to be inclined to use their insurance and hence the demand for medical care is going to go through the roof. There are not enough hospitals, doctors, nurses to handle that kind of load.

curious2 says

First of all, you say that childhood leukemia rates are "pretty much stable," when in fact they have been increasing.

Ok I give up, here is the quote from both your article and mine.

"Incidence of childhood leukemias appeared to rise in the early 1980s, with rates increasing from 3.3 cases per 100,000 in 1975 to 4.6 cases per 100,000 in 1985. Rates in the succeeding years have shown no consistent upward or downward trend and have ranged from 3.7 to 4.9 cases per 100,000"

I don't read "shown no consistent upward or downward trend" or "ranging up and down" for the last 25 years as increasing for the last 10. Could you explain how you do?

The term I have been using is invasive radiation, meaning all types of invasive radiation although I sometimes just say cat scan out of lazyness. You were the one who said C-T scans in the first place, look at your original post.

I agreed there are some some excess. What is the straw man in that? If you really think that concerns about medical malpractice doesn't drive a lot of them you don't know anything about medicine or law.

I read the New Yorker article, I quoted the article extensively here at patrick.net years ago. Did you read far enough to get to the parts where they talk about the cleveland and mayo clinic. Those very tightly run organizations aren't doing any excess anything. The average is somewhere between those McAllen and the Cleveland/Mayo clinics.

My bottom line is that there is some unnecessary invasive radiation procedures, but the vast majority are legitimate diagnostic procedures whose value far, far outweighs the small risk of cancer. I don't know how to make that simple statement any clearer. If you feel invasive radiation exists as profit making scam that will give you cancer then you are free to refuse any and all diagnostic radiation. At 30 that's a pretty easy to stand by, so how you hold out at 70.

[...]

gromitmpl says

simchaland says

Dan, you hit it on the head. Anything short of a nationalized and streamlined system is a bandaid at best.

That is crazy. Can you explain to me how such a system would not be swamped.

Once everyone has health insurance everyone is going to be inclined to use their insurance and hence the demand for medical care is going to go through the roof. There are not enough hospitals, doctors, nurses to handle that kind of load.

All systems are finite and require allocation of finite resources to users who have infinite demand. If we can manage the Internet, we can manage health care.

A nation-wide health care system does not imply that people don't pay for health care. You are confusing health care reform with the idea of insurance that pays 100% of the costs. A nation-wide health care system does not even require an insurance function. Hell, people buy health insurance not as insurance but simply as a way not to get fucked over by unreasonable overcharging. A $100 bill to an insurance company would be a $10,000 bill to an uninsured person.

Can a national and streamline system be sustained. Of course it can. You have to be an ignorant fool to argue otherwise since such systems do exist and run in other countries like the U.K. and Canada. Will such a system make everybody happy all the time? Of course not. People wouldn't be happy with a health care system unless they never got sick, never aged, and never died. But that doesn't mean you cannot create an optimal system.

Even without any insurance function, a nation-wide single payer system with streamlining of the medical industry would reduce health care costs considerably. Administrative costs alone account for a good chuck of health care costs. Advertisements of drugs accounts for another large chunk, and ads are a zero-sum game that serve no legitimate medical purpose as the doctor, not the patient, should be deciding what drugs to use in a treatment.

Add to those savings the elimination of price gouging -- the real reason people get insurance -- by having fix prices for services at a given location, and the typical American could afford a high level of health care without any freaking insurance. So insurance is just the icing on the cake.

"This is how it works.

It's a center-right nation."

No, it's a center-right government, the nation is considerably to the left of the politicians.

monkframe says

No, it's a center-right government, the nation is considerably to the left of the politicians.

Agreed. Most Americans are for gay rights, legalized marijuana, social safety nets, the single payer system, and free speech.

Restricting the freedom of individuals is more of a government interest than a citizen interest.

The way medicare works is people pay for supplemental policies, that cover premium cost services. I think even if you want bare bones, you pretty much need a minimal supplemental policy.

So "medicare for all" would not have killed the insurance companies. But it would have forced them to limit their business to the supplemental policies.

I do tend to agree that Obama has been a wimp. Politically, the whole Tea Party movement (which was possible because he was a black President with a middle name of Hussein), might have made it impossible. But I would have like to see him try and fail, I think.

Although the preexisting conditions coverage is an important breakthrough.

monkframe says

No, it's a center-right government, the nation is considerably to the left of the politicians.

I agree too. We drift toward fascism.