Obamacare and hospitals

mariebailey, MSN, RN · Nov 2, 2014

I supported & do support Obamacare, but I was not naive enough to believe it could be implemented flawlessly. Such a major change in policy will inevitably be plagued by setbacks & obstacles in the first several years. What I'm basically saying is we should wait patiently. Let's all check back with each other in a decade or two, so we can have a more informed debate.

Not_A_Hat_Person, RN · Nov 2, 2014

Medicare Part D was a huge mess when G. W. Bush implemented it. There was nothing close to the level of vitriol that has developed over ACA.

pmabraham, BSN, RN · Nov 4, 2014

Good day:

You don't have a free lunch without someone being forced to pay for it especially when instituted by a corrupt and immoral government. My entire household will be voting with Obamacare in mind tomorrow morning as will many American households. When You Vote Tomorrow Vote Against These Democrat Senators Who Shoved Obamacare Down Our Throats - Conservative Infidel Conservative Infidel

Obamacare was shoved down our throats by the democrats (100% partisan) based on lies they knowingly told the American public. Lie, you can keep your doctor. Lie, you can keep your health care insurance. Lie, families will save at least $2,500 per year. Lie, it will be affordable for all. Lie, it will cut down on ER visits. Lie, there will be no death panels. Lie, you will not be forced to pay for abortions if murdering innocent babies in the womb is against your conscience. Lie, Obamacare will not increase the deficit, and more.

I'm sorry when I hear someone state they believe in Obamacare because the President and Democrats have admitted they lied; selling anything on a lie is fraud. Someone believing in something sold fraudulently to me is mind boggling. In any event, many of us will be out there tomorrow voting to let the liberals and progressives know we remember and they will be held accountable one way or the other for their outright lies.

Thank you.

MunoRN, RN · Nov 4, 2014

Competition? I don't think so. This is a third-party, in an arbitrarily manner, deciding what prices should be. Competition would entail the consumers themselves determining what they will pay for based on not just price, but quality, outcomes, convenience, etc.

So instead of people using insurance everyone would pay all their costs out of pocket? How would that work given the highly variable costs of healthcare? I don't know too many people who can afford the typical six-figure hospital bill without insurance.

The plans are weeding out providers who charge too much??? 70% of California physicians aren't taking the exchange plans. It sounds more the like the providers are weeding out the plans that don't pay enough.

Exactly, that's how a market system works. The consumers, including those who represent groups of consumers such as insurers, offer a price, and providers who don't want to take that price are left out. How else should it work?

There is one way we could have cost controls without limiting what doctor you can see to this degree, single payer, although I doubt that's what you're intending.

MunoRN, RN · Nov 4, 2014

Good day:
You don't have a free lunch without someone being forced to pay for it especially when instituted by a corrupt and immoral government. My entire household will be voting with Obamacare in mind tomorrow morning as will many American households. When You Vote Tomorrow Vote Against These Democrat Senators Who Shoved Obamacare Down Our Throats - Conservative Infidel Conservative Infidel
Obamacare was shoved down our throats by the democrats (100% partisan) based on lies they knowingly told the American public. Lie, you can keep your doctor. Lie, you can keep your health care insurance. Lie, families will save at least $2,500 per year. Lie, it will be affordable for all. Lie, it will cut down on ER visits. Lie, there will be no death panels. Lie, you will not be forced to pay for abortions if murdering innocent babies in the womb is against your conscience. Lie, Obamacare will not increase the deficit, and more.
I'm sorry when I hear someone state they believe in Obamacare because the President and Democrats have admitted they lied; selling anything on a lie is fraud. Someone believing in something sold fraudulently to me is mind boggling. In any event, many of us will be out there tomorrow voting to let the liberals and progressives know we remember and they will be held accountable one way or the other for their outright lies.
Thank you.

Actually the promise was that the average family would save $2500/year under Obamacare, and actually the average family saves closer to $7,000/year with an Obamacare plan.

There are no death panels.

Obamacare specifically prohibits insurers from spreading abortion coverage costs to plans without abortion coverage.

Obamacare actually has a net negative effect on the deficit (it decreases the defecit compared to before).

SC_RNDude · Nov 5, 2014

So instead of people using insurance everyone would pay all their costs out of pocket? How would that work given the highly variable costs of healthcare? I don't know too many people who can afford the typical six-figure hospital bill without insurance.
Exactly, that's how a market system works. The consumers, including those who represent groups of consumers such as insurers, offer a price, and providers who don't want to take that price are left out. How else should it work?
There is one way we could have cost controls without limiting what doctor you can see to this degree, single payer, although I doubt that's what you're intending.

As a reminder to you, I would have people pay for most of their healthcare out of a HSA. And insurance to cover the big ticket items. Please don't bother to pick that apart as you and I have gone around and around on this before. If you want to do so for others' sake, knock yourself out, but I won't be participating.

I would be interested to discuss how do you think a single-payer system be sustainable? How would costs be controlled? How much would each person put in towards that?

toomuchbaloney · Nov 5, 2014

http://www.healthcare-now.org/wp-content/uploads/2008/09/0312friedman.pdf

Single-payer health care is the only sustainable way forward | Physicians for a National Health Program

With private health insurance, health-careexpenditures are largely fixed with respectto income and, therefore, are a heavierburden on the poor and middle classes thanon the wealthy. By linking health-careexpenditures to income, a tax-funded singlepayersystem would provide savings for all
Americans below the wealthiest top 5%.

The single-payer system would be paid for by avariety of taxes. The Tobin tax is a tax on financialtransactions that would raise revenue whilediscouraging the types of speculative finance thatled to the current economic crisis. The remainingrevenue would come from taxes targeted at thosebest able to pay, including those with high incomesand with incomes from property (including capital
gains, dividends, interest, profits, and rents).

SC_RNDude · Nov 5, 2014

I see that the redistribution of pharmco profits is part of the plan. Wow!

As for the taxes, don't you think that hefty taxes on high income earners, the Tobin Tax, new taxes on property income, etc. might change the behavior of those being taxed? What I'm getting at is that those taxes aren't going to raise anywhere close the funding that they are projecting.

And these are just funding questions. What would single-payer do for quality of care?

toomuchbaloney · Nov 5, 2014

I see that the redistribution of pharmco profits is part of the plan. Wow!
As for the taxes, don't you think that hefty taxes on high income earners, the Tobin Tax, new taxes on property income, etc. might change the behavior of those being taxed? What I'm getting at is that those taxes aren't going to raise anywhere close the funding that they are projecting.
And these are just funding questions. What would single-payer do for quality of care?

Given how much our outcomes have suffered under our current profit steeped system we certainly wouldn't want it to be more depressed. However, most of the single payer systems have outcomes which are better than ours even though we have the best trained staff, the nicest facilities, and some of the greatest technology.

wirehead · Nov 5, 2014

I wonder if you hear and remember republican lies also?

You mean all those republicans that just won back the senate??? The people have spoken!! I'm sure all those affordable ACA premiums and its positive effect on healthcare had nothing to do with the huge loss of the democratic party today, NOT!

SC_RNDude · Nov 5, 2014

Given how much our outcomes have suffered under our current profit steeped system we certainly wouldn't want it to be more depressed. However, most of the single payer systems have outcomes which are better than ours even though we have the best trained staff, the nicest facilities, and some of the greatest technology.

And which single-payer system has a similar demographics, geography, economy, legal system, etc. as us? Do any of those systems use any healthcare innovations that were the result of our "profit steeped system"?

wirehead · Nov 5, 2014

MunoRN

$81/month average premium, I'd love to see a reliable source for that #. The ACA expanded Medicaid, that's why there are less people uninsured, ever see a Medicaid patient get an appointment with a decent doctor in a timely manner??? Medicaid reimbursement doesn't cover the cost of the toilet paper rolls in the hospital bathroom. Hospitals are not better off!! As for those who have purchased plans through the exchange, what good is coverage with insane premiums, deductibles, and copays??

I remember Obama during his debate with Romney state that while he is POTUS the sequester will not happen!! Didn't see him work very hard to prevent that. Not only is Medicare reimbursement going down, but remember when its budget was cut to pass the ACA? Sure value based care should be rewarded, but the system is not able to handle all the newly insured so more volume and less healthcare workers equals disaster. While adequate CNA staffing is important, they do not provide skilled care, adequate nurse/patient ratio's are way more important.

I guess the American public agrees that the ACA isn't working considering the election results. At the end of the day, working together will get things done, this country has been so divided the past 6 years. I know all of us on this board want to advance our profession and focus on priority one, the best possible patient outcomes.