Obamacare and hospitals

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Will non-profit or for profit hospitals stand to benefit more from Obamacare?

Specializes in Critical Care.
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.

We've never gone "around and around" on that before because you've never answered how what you're suggesting differs from how it already works. The purpose of insurance currently is to cover "big ticket items", that's why plans have deductibles. HSA's not only exist currently but they are more common than ever. If you want a system where people pay with their own money, or out of their HSA, up until they've paid some pre-determined yearly maximum (deductible) then I'm not sure what you're suggesting we should change.

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?

It's quite possible that regardless of the process we use to pay for it, our healthcare system is not sustainable. But in terms of which is more sustainable, which I'd interpret as meaning which costs less and has a lower rate of cost inflation, then single payer is more sustainable. The cost of operating an insurance system is about 12-14% of the total cost for a private insurance system, and 4-5% for a single payer system, based on what we currently pay to maintain both types of systems in the US. Medicare's cost inflation is also significantly lower than that of the private insurance system.

The total amount we put in as a country wouldn't change except for what we save in reduced overhead costs and if current trends continue the year-to-year increases would also be less.

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Specializes in Critical Care.
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"?

I would think the US is pretty comparable to the US. We already have our own single payer system so you don't have to look that far.

All of the current initiatives to entice better quality and value have come from CMS and it's related agencies, private insurers have been adopting them after they've been developed by CMS.

The recent innovation I'm most familiar with has been in cardiac cath techniques. I work with a Physician who's been the 'pioneer' in the US for much of these advancements, he first learned these techniques in Japan.

Do you believe it's the private insurance industry that's driving healthcare innovation?

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Specializes in Critical Care.
MunoRN

$81/month average premium, I'd love to see a reliable source for that #.

​Millions paying less than $100 per month for Obamacare - CBS News

(I was wrong, it's $82/month).

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??

Actually even if leave out people who are newly enrolled in medicaid the number of uninsured still dropped.

I'm all for doing away with medicaid. The only reason medicaid exists is because we want everyone to able to get at least some degree of healthcare, but we want to use a system that is specifically not designed to provide that. So we end up trying to reverse engineer a non-universal system to be universal, which leaves us with non-sensical fixes such as medicaid.

Medicaid proves a basic conservative premise of healthcare coverage doesn't actually work, which is that so long as hospitals and providers can't get paid primarily by well-paying private insurers, they will happily take a loss in caring for patients who can't afford private insurance, which obviously isn't actually the case.

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.

There's actually not a nursing shortage, and this seems to contradict something conservatives have been arguing for some time which is that nobody is getting less care because they have insurance. If giving more people insurance is potentially going to strain the system then it doesn't appear that could have been the case.

Regardless of that though I disagree that allowing more people to access healthcare is a problem, even if it means we need to figure out how to meet the demand. Should we just leave a portion of the population to suffer so that we don't strain the system? Who should be left out to keep the demand for services manageable?

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.

I for one welcome our new red overlords and actually support repealing obamacare if that's what they're able to do, although I'm curious what I can expect in it's place, maybe you could enlighten me.

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We've never gone "around and around" on that before because you've never answered how what you're suggesting differs from how it already works. The purpose of insurance currently is to cover "big ticket items", that's why plans have deductibles. HSA's not only exist currently but they are more common than ever. If you want a system where people pay with their own money, or out of their HSA, up until they've paid some pre-determined yearly maximum (deductible) then I'm not sure what you're suggesting we should change.

It's quite possible that regardless of the process we use to pay for it, our healthcare system is not sustainable. But in terms of which is more sustainable, which I'd interpret as meaning which costs less and has a lower rate of cost inflation, then single payer is more sustainable. The cost of operating an insurance system is about 12-14% of the total cost for a private insurance system, and 4-5% for a single payer system, based on what we currently pay to maintain both types of systems in the US. Medicare's cost inflation is also significantly lower than that of the private insurance system.

The total amount we put in as a country wouldn't change except for what we save in reduced overhead costs and if current trends continue the year-to-year increases would also be less.

Once again,

the consumer would pay for their own physician visits, lab tests, xrays, mammograms, birth control, prescriptions, vaccinations, colonoscopy, etc.

Insurance is for emergencies,cancer,etc.

HSA and insurance would not be tied to employment, and would stay with you for life. Unless you choose to move insurance companies. Insurance companies couldn't "fire" you unless you stopped paying. As employment benefit, employers would get out of managing your health and instead contribute money into HSA for you to pay for healthcare and insurance.

I could go on repeating myself, but do not wish to.

If you don't see how this is different then what we had before, or now, I don't know what to tell you.

Single-payer is "more sustainable". That doesn't sound very hopeful.

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I would think the US is pretty comparable to the US. We already have our own single payer system so you don't have to look that far.

All of the current initiatives to entice better quality and value have come from CMS and it's related agencies, private insurers have been adopting them after they've been developed by CMS.

The recent innovation I'm most familiar with has been in cardiac cath techniques. I work with a Physician who's been the 'pioneer' in the US for much of these advancements, he first learned these techniques in Japan.

Do you believe it's the private insurance industry that's driving healthcare innovation?

Our current single-payer system is not and never has served our whole population.

I did not say that all of healthcare innovation came from the US, or that none came from other countries. However, I would say that more comes from the US then any other single place, and that other countries benefit from it.

I did not say the private insurance drives healthcare innovation. I said profit does.

I suppose to a much lesser extent CMS drives innovation. But again, it is because of the financial considerations that go with it.

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Specializes in Critical Care.
Once again,

the consumer would pay for their own physician visits, lab tests, xrays, mammograms, birth control, prescriptions, vaccinations, colonoscopy, etc.

Insurance is for emergencies,cancer,etc.

Except for preventive care, consumers already pay for services with their own money/HSA funds, up until their yearly costs exceeds a manageable amount, at which point insurance kicks in. The amount they pay for on their own is their deductible, so should this amount generally be higher?

HSA and insurance would not be tied to employment, and would stay with you for life. Unless you choose to move insurance companies. Insurance companies couldn't "fire" you unless you stopped paying. As employment benefit, employers would get out of managing your health and instead contribute money into HSA for you to pay for healthcare and insurance.

I could go on repeating myself, but do not wish to.

If you don't see how this is different then what we had before, or now, I don't know what to tell you.

Single-payer is "more sustainable". That doesn't sound very hopeful.

I'm all for untying employers and health insurance, although I think we need to deal with medicaid first. Shifting everyone covered by employer group plans to the individual market would include a portion that would qualify for medicaid. Personally I'd prefer to put this people in "regular" insurance if we're going have a private insurer based system.

Given that HSA's already exist, both in the private market and in employer group plans, where employer contribute to your HSA, I'm not really how you would like to see them change.

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Our current single-payer system is not and never has served our whole population.

That's true -- it only serves our oldest and sickest population. Medicare would be a lot more robust (financially) and sustainable if we didn't restrict it to only covering the elderly and disabled.

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Specializes in Hospice, Palliative Care.

Good day:

BOOM, 27 democrat senators who voted for Obamacare kicked out of office; yes the midterms was a reflection of the American people being fed up with Obamacare.

Obamacare: Unpopular as Ever | National Review Online

More Evidence that the ACA Worsens the Deficit | National Review Online

Warning for Obamacare enrollees: 'Coverage doesn't mean care' » AEI

A Two-Tiered Health Care System Is Coming Faster Than You Think - Forbes

When anything is sold on lies, it is a fraud. Yes, republicans lie and democrats lie. When you have nurses and nursing students backing up lies as if they are ok while being a part of the most trustworthy professions around, it is sad.

Thank you.

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Our current single-payer system is not and never has served our whole population.

I did not say that all of healthcare innovation came from the US, or that none came from other countries. However, I would say that more comes from the US then any other single place, and that other countries benefit from it.

I did not say the private insurance drives healthcare innovation. I said profit does.

I suppose to a much lesser extent CMS drives innovation. But again, it is because of the financial considerations that go with it.

Oops, delete.

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That's true -- it only serves our oldest and sickest population. Medicare would be a lot more robust (financially) and sustainable if we didn't restrict it to only covering the elderly and disabled.

I must be missing something. Now, it is only providing care to the oldest and sickest, generally. But we are all paying in already. So, how is providing care for more people going to make it more robust financially and more sustainable?

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Except for preventive care, consumers already pay for services with their own money/HSA funds, up until their yearly costs exceeds a manageable amount, at which point insurance kicks in. The amount they pay for on their own is their deductible, so should this amount generally be higher?

I'm all for untying employers and health insurance, although I think we need to deal with medicaid first. Shifting everyone covered by employer group plans to the individual market would include a portion that would qualify for medicaid. Personally I'd prefer to put this people in "regular" insurance if we're going have a private insurer based system.

Given that HSA's already exist, both in the private market and in employer group plans, where employer contribute to your HSA, I'm not really how you would like to see them change.

How about I save everyone the trouble, and refer them to our conversation of October, 2013. It pretty much has everything I would say, and everything you would say in rebuttal:

Mandate; what's the alternative? - pg.4 | allnurses

Or, for any others who are interested in hearing more about this type of plan (that is from a healthcare economist, not politicians), here is another thread I participated in from October 2012. (I guess I'm a few days late this year). https://allnurses.com/nursing-activis...268-page2.html

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Specializes in Critical Care.
How about I save everyone the trouble, and refer them to our conversation of October, 2013. It pretty much has everything I would say, and everything you would say in rebuttal:

Mandate; what's the alternative? - pg.4 | allnurses

Or, for any others who are interested in hearing more about this type of plan (that is from a healthcare economist, not politicians), here is another thread I participated in from October 2012. (I guess I'm a few days late this year). https://allnurses.com/nursing-activis...268-page2.html

I take it you're referring mainly to this post:

Once again, here is an alternative to Obamacare in a simplified form.

Instead of buying insurance that covers everything, you buy a "catastrophic" insurance policy for things such as seriois illness, emergencies, etc. Much like homeowners insurance.

This policy stays with you as long as you want and is not tied to your employment.

You can buy this policy across state lines, = competition.

You have a HSA that carries over and stays with you for a lifetime.

HSA can be used for routine care, premiums for the above policy, etc.

You decide where the money goes from HSA, which = competition for your healthcare $$$ which = better quality, value, and innovation in healthcare services.

Medicaid can still exist for the poor.

In short, a system in which I decide where my money goes will be of better value and quality then what we had before and certainly better then what the ACA is provide us.

Which still leaves the same questions:

We already have a system where your own money, either from your ACA or regular bank account, pays for costs up until a point then insurance kicks in. You can already buy a catastrophic plan which covers costs exceeding around $13,000 for a family. Is that amount too low? Given that the average household income is around $52,000 a year, I'm not sure it's realistic to argue that they should be paying more than $13,000 a year out of their own pocket in addition to the amount required to cover their insurance for what exceeds that amount.

You can already buy "multi-state" plans and states can also establish compacts under the ACA to establish standardized regulations to ease cross-state insurance plans. How would you change what already exists?

And again, people already pay for services up to a limit and decide how they spend that money, either out of an HSA or regular funds, so what would change?

Unless we're going to change our total healthcare costs, by reducing services, reducing payments, etc, we still have to somehow put the same amount of money into the system. It would be great to say that everyone can just pay less, the problem is that for every person who pays less, someone else has to pay more in order to be able to write the same check for healthcare every year.

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