Court rRuling on Obamacare

[flabbybody]

You guys do know that the rest of the developed and civilised world thinks that you're utterly crazy about Obamacare, right?

people here fall into 2 camps.
those who get employer based coverage and don't want Obamacare to muck things up for them. These are the Americans who essentially believe "hey I got a good plan through work and my wife and kids are covered so fuck everyone else"
The rest of us who have to buy our own insurance or live life without coverage (the unemployed and underemployed) stand to benefit from its implementation. Problem is no one really understands how the damn thing will work (including Obama), so we're in a state of confusion. Probably a year from now we'll know more.... just don't dare get sick til then, or wait it out til you're eligible for Medicare (65 years old)

[paulclifford]

>You guys do know that the rest of the developed and civilised world thinks that you're utterly crazy about Obamacare, right?

Civilized?

Most patients in the UK, Canada, and Brazil (to pick 3 arbitrary examples of the "civilized world") loathe their nationalized healthcare systems, and with good reason: Poor quality of medical outcomes, and long waiting times.

The first is often caused by the second, especially in the case of cancer, a disease that doesn't respect government directives to wait.

Average wait time to see a specialist in the UK (including, of course, a surgeon): about 18 weeks, with a "maximum legal waiting period" of 26 weeks. Apparently, you have the right to "file a complaint" against the NHS if you wait longer than 26 weeks . . . if you're still alive, of course.

These sorts of waiting times are similar in Canada and Brazil, and with similar kinds of medical outcomes. In Canada, for example, which in some ways has an even more oppressively centralized healthcare system than the UK, mortality rates for breast, prostate, and colon cancers are about 16% higher than in the US. This is due to: long waiting times to see specialists; shortage of diagnostic screening equipment; and decisions by "cost-efficiency" panels not to make available the latest, cutting-edge drugs, therapies, and medical devices — most of which come from the US where there's still a big incentive to innovate in these areas — because they are always initially very expensive. So in the interests of "keeping Canada's healthcare costs down," you ladies with breast cancer, and you guys with prostate cancer, will simply have to die . . . . OR, as many have done in the past, seek treatment elsewhere — like south of the border in the US, for example. This latter strategy is getting to be increasingly popular in all countries with increasingly centralized healthcare systems: it's called "medical tourism."

There are countless news stories and documentaries that reveal a standard of care that is nothing short of scandalous. Routine neglect of elderly patients, cancer patients writhing in agony because their pain medications were not administered, clinicians eating patient food while patients starve, nurses ignoring patients desperate to use the toilet—all are commonplace. Most disgusting of all is the recent scandal that involuntary euthanasia is being performed on the elderly — sometimes from the general incompetence of a highly bureaucratized system, but also for the hard-nosed reason of having to free up more beds for younger, tax-paying patients.

http://www.telegraph.co.uk/health/he...HS-trusts.html

13,000 died needlessly at 14 worst NHS trusts
The needless deaths of thousands of NHS patients will be exposed in a report this week.

The NHS’s medical director will spell out the failings of 14 trusts in England, which between them have been responsible for up to 13,000 “excess deaths” since 2005.

Prof Sir Bruce Keogh will describe how each hospital let its patients down badly through poor care, medical errors and failures of management, and will show that the scandal of Stafford Hospital, where up to 1,200 patients died needlessly, was not a one-off.

* * * * * * * * * * * * * * *

http://www.dailymail.co.uk/news/arti...ents-year.html

Top doctor's chilling claim: The NHS kills off 130,000 elderly patients every year

— Professor says doctors use 'death pathway' to euthenasia of the elderly
— Around 29 per cent of patients that die in hospital are on controversial 'care pathway'
— Pensioner admitted to hospital given treatment by doctor on weekend shift

NHS doctors are prematurely ending the lives of thousands of elderly hospital patients because they are difficult to manage or to free up beds, a senior consultant claimed yesterday.

Professor Patrick Pullicino said doctors had turned the use of a controversial ‘death pathway’ into the equivalent of euthanasia of the elderly.

He claimed there was often a lack of clear evidence for initiating the Liverpool Care Pathway, a method of looking after terminally ill patients that is used in hospitals across the country.

Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an ‘assisted death pathway rather than a care pathway’.

He cited ‘pressure on beds and difficulty with nursing confused or difficult-to-manage elderly patients’ as factors.

Professor Pullicino revealed he had personally intervened to take a patient off the LCP who went on to be successfully treated.

He said this showed that claims they had hours or days left are ‘palpably false’.

In the example he revealed a 71-year-old who was admitted to hospital suffering from pneumonia and epilepsy was put on the LCP by a covering doctor on a weekend shift.

Professor Pullicino, a consultant neurologist for East Kent Hospitals and Professor of Clinical Neurosciences at the University of Kent, was speaking to the Royal Society of Medicine in London.

He said: ‘The lack of evidence for initiating the Liverpool Care Pathway makes it an assisted death pathway rather than a care pathway.

‘Very likely many elderly patients who could live substantially longer are being killed by the LCP.

‘Patients are frequently put on the pathway without a proper analysis of their condition.

‘Predicting death in a time frame of three to four days, or even at any other specific time, is not possible scientifically.'"

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Here's a better example of "civilized":

http://www.dailymail.co.uk/news/arti...rm-Circle.html

Transformed: The failing NHS trust taken over by private firm has one of the highest levels of patient satisfaction

— Hinchingbrooke Hospital is ranked one of the highest for patient happiness and waiting times
— It was on the verge of going bust when it was taken over by Circle last year
— It is the first NHS trust to be run entirely by a private firm

The first NHS trust to be run entirely by a private firm has one of the highest levels of patient satisfaction in the country.

Hinchingbrooke, a hospital in Cambridgeshire with 160,000 patients, was on the verge of going bust when it was taken over by Circle last year.

But NHS figures show it is now ranked as one of the highest for patient happiness and waiting times.

The company running the trust has slashed losses at the hospital by 60 per cent and will soon begin to pay off burgeoning debts built up over years of mismanagement. The takeover deal, which saved the hospital from closing down, is seen as a blueprint for the future of many NHS trusts.

The George Eliot Hospital in Warwickshire is already considering adopting the model."

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[The George Eliot Hospital apparently did not adopt this model. It was one of the 14 NHS Trusts exposed in the Telegraph article above.]

[Anyway, this is someone's idea of "the rest of the civilized world"? Looks uncivilized to me.]

[flabbybody]

thanks for an informative post paulclifford.

my wealthy Canadian friends and family fly here to see New York specialists when they have anything more serious than a cold. They run from their free health care and gladly pay cash for high quality US doctors. Then they'll tell me with a straight face how America needs get on board with national healthcare and join the rest of the "civilized" countries.

"so why is your triple bypass surgery being done in Manhattan when it would be free back home in Vancouver?" duh, cuz I can afford it

[trish]

Of course if you're wealthy enough and your condition is serious, you'll fly anywhere to receive the best care the world can offer. National healthcare is for those who can't afford care.

[paulclifford]

>>"so why is your triple bypass surgery being done in Manhattan when it would be free back home in Vancouver?" duh, cuz I can afford it

If you Google a phrase like "Middle Class and Medical Tourism" you'll see many links to articles on who it is, exactly, who takes advantage of relatively inexpensive air travel to countries providing lower cost, higher quality medical care for whatever ails them.

It isn't the very wealthy. It's mainly the middle class.

Additionally — and this is the important point — "waiting time" is a COST, as relevant as the money price, incurred by anyone demanding a product or service. If you asked a driver, for example, "Would you rather pay a market price of $5.00/gallon of gasoline, and be able to obtain it quickly, and at any time? Or would you rather pay a government mandated price-ceiling of $1.50/gallon, but be required to queue up for several hours, and obtain a mandated maximum amount of it only on Mondays, Wednesday, Fridays, or Tuesdays, Thursdays, Saturdays, depending on whether the first number on your license plate is odd or even?"

I believe most drivers would opt for the first. Because TIME is a cost to them, not just money. And most people would rather make economizing decisions on a personal, individual level, rather than have some third party make them for them.

So if someone's heart disease actually allows her to wait up to 26 weeks for "free" bypass surgery, that's great. But how many really believe the waiting time makes the procedure "free"?

[paulclifford]

>>>Of course if you're wealthy enough and your condition is serious, you'll fly anywhere to receive the best care the world can offer.

True enough. The very wealthy always have options that the less wealthy and the poor do not have. This is true by definition.

>>National healthcare is for those who can't afford care.

That's the sales pitch. But if you asked the poor, "Would you rather have crappy medical care that was free, or high quality medical care that was more expensive"? what would their answer probably be?

There are two main issues in healthcare that shouldn't be conflated: the quality of the healthcare outcome from the patient's point of view; and the cost in both time and money from the patient's point of view.

Despite some poorly constructed and interpreted statistical models to the contrary, the US is quite far ahead in the first issue even when compared with the advanced industrial economies of western Europe, Japan, Korea, Australia, and New Zealand. For example, if you subtract certain unfortunate events in US statistics that I believe have little or nothing to do with Americans' overall access to healthcare — i.e., suicides and high-speed automobile accidents (where the driver and passengers are dead immediately after the accident) — the US is at the top of the list in terms of 1) longevity, 2) positive outcomes from treatments for major illnesses like heart disease and cancer, 3) access to specialized elective surgeries that are non-cosmetic (hip replacements, knee replacements, prosthetic limbs, corrective vision surgery, etc., and 4) the US is even at the top of the list — surprisingly for many people — in infant survival (i.e., it has the lowest rate of infant mortality). This last deserves a little explanation.

It seems that many countries, including Europe and Asia, have a peculiar definition of what it means to be "born alive". In some countries, for example, if a baby if born severely underweight, undersized, or early, it is defined as "stillborn", because the chances are very great that it won't thrive even for the next 24-72 hours. Since these babies are defined as stillborn, they go into the "stillborn" statistics, and not the "infant mortality" statistics, which only includes babies that have thrived past a certain time period. Obviously, this practice — some would call it "manipulation", while others less generously might declare it to be "fudging the data" — has the effect of making it appear as if infant mortality is very low — lower than it really is, IF one counted every baby that showed any sign of life whatsoever (heartbeat, respiration, body movements that aren't merely reflex, etc.). This latter is actually the US standard, which, ironically, conforms to the standard suggested by the World Health Organization.

In sum: the reason infant mortality appears to be higher in the US than in many other countries is that US medical practice counts every baby.

Where the US doesn't compete so well with other countries is in the issue of cost. I think we all know that. There are several reasons for this that are pretty well understood: 1) When there's a great demand for something, the cost usually goes up. That makes intuitive sense, right? US medical care is expensive precisely because so many people like it and want to use lots of it. No mystery there.

The mystery is that with most other products — computers and smart phones, for example — providers usually respond to the great demand by expanding supply (in order to reap larger profits). Additionally — and very importantly — the possibility of getting fat profits usually acts as a reliable lure to new providers. The new providers compete amongst themselves, and with the established providers, and competition almost always results in lower prices for the buyer.

Which brings us to point 2)

The main problem with US healthcare — including health insurance — is the lack of competition. If you modeled the healthcare market along the same lines as the computer and smartphone markets, you'd have similar results in the first as you do in the second: lots of competition; lots of innovation; lots of improvements in access; lots of price-cutting. And the major benefits, of course, go to the buyer: she gets exactly what she wants, at (more or less) the price she wants, without having to compromise to someone else; and that someone else gets what he wants without having to compromise to her.

That's the main difference between economic transactions in the private market, and political transactions in the public one: if I vote Gary Johnson and you vote Barack Obama, we both cannot have our choice at the end of the election: the political process allows only one "product" to dominate; so now every Johnson voter must "consume" the political product known as Obama. Conversely, if I vote for an Android device by purchasing it, and you vote for an iPhone by purchasing it, neither one of us has to compromise or give up anything.

In beginning economics classes, it's common to talk of the market as a kind of "democratic voting process," in which each consumer "votes for a product or service with his or her dollars." But actually, it's the other way around: the political voting booth is really an imperfect model of the much more democratic private market. In the latter, everyone can (in principle) get what he or she wants without imposing that choice on everyone else. That's obviously not the case with decisions made via the voting booth.

Consider this:

I can get on my cellphone right now in New York City and call up L.L. Bean in Portland, Maine, and say, "Hello, L.L. Bean? I've been surfing your Website and I really like that plaid shirt. I'd like to order two of them. Here's my credit card number." It's that simple. I get what I want; L.L. Bean gets what they want. Transaction done!

Yet, I cannot get on my cellphone in New York City and call up BlueCross-BlueShield in Maine, and say, "Hello, BlueCross-Blueshield Maine? I've been surfing your Website and I really like one your policies. It covers me for exactly what I want, no more and no less; I like the premium and I like the deductible. I'd like to subscribe. Here's my credit card number." You know what they'll say? They'll say, "We cannot sell you a policy. The laws say that you have to live in Maine for that."

Imagine what such a policy would do to prices at L.L. Bean if the retail clothing industry had the same kind of laws as the insurance industry that restricted interstate commerce! If I were forced by law only to purchase clothing from New York retailers, they would be in the cozy position of charging much higher prices — because they would have a "captive" customer base. That I can freely seek lower prices and better merchandise literally anywhere imposes a powerful constraint on how high New York retailers would be willing to charge for clothing.

And that is precisely why almost everyone in the US can find shoes and pants and jackets that are pretty high quality (often very high quality) at whatever prices they think they can afford, yet they often cannot find health insurance that is high quality and affordable! For the simple reason of lack of competition.

I've already been too wonkish in this post. I'll just say that if the "wise ones" in congress were actually interested in getting more health insurance to more people at higher quality and lower prices, they would move to start abolishing the many laws — federal and state — that restrict and hamper competition between the states. A nice start would be to abolish the McCarren-Ferguson Act, which idiotically handed health insurance providers the power to form cartels within their home states, and thus create little pools of "captive consumers" who would literally have to move to another state to get a difference insurance policy from the ones being offered.

There are several other issues, too, that should be radically altered, but I'll leave the matter here for now.

[flabbybody]

I don't know what you do for a living paulclifford but I wish you were Obama's chief health care advisor

[paulclifford]

>>>I don't know what you do for a living paulclifford but I wish you were Obama's chief health care advisor

I appreciate hearing that, amigo!

For what it's worth, I just wanted to post the following:

http://www.cbsnews.com/8301-505267_1...care-repealed/

July 24, 2013 10:10 AM
CBS News poll finds more Americans than ever want Obamacare repealed

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The main problem today, in general, is that people instinctively grasp the fact that as consumers, they prosper in a free market; but as producers, they all want special protection from the free market by government.

The US no longer really has a "democracy", at least as I understand that term. I believe that ended around 1913, when some basic structural changes to the political system were made, specifically: the 16th amendment (federal personal income tax); the 17th amendment (direct voting of senators); and, of course, the implementing of a central bank (the Federal Reserve).

[paulclifford]

Reposted in "Zero Hedge":

http://www.zerohedge.com/news/2013-0...-and-your-life

10 Reasons Why Obamacare Is Going To Ruin Your Medical Care... And Your Life

by Elizabeth Lee Vliet, MD

Obamacare is a hodgepodge of new regulations, requirements, and penalties. I'd like to start by defining three terms, which, while obscure today, should begin to enter our everyday vocabulary as Obamacare continues to take effect:

Health insurance exchanges are the basket of qualified insurance policies that meet the new healthcare law requirements for expanded coverage. These may be set up by the states (many are refusing to do so, due to high cost and fear of bankrupting the state) or the federal government. The Exchanges are supposed to be fully operational by October 1, 2013, but it is questionable whether they will actually be in place by that deadline.

The individual mandate requires that individuals purchase health insurance that meets the new, expanded federal requirements. Individuals who do not comply face a financial penalty. Individuals who fall below minimum income levels will be eligible for taxpayer-funded subsidies to buy health insurance.

The employer mandate requires that businesses with more than 50 full-time employees must provide health insurance for all employees, and that insurance must meet the new standards set forth in the new law. Businesses that do not comply must pay a financial penalty for each employee, which for large companies can run into the millions of dollars annually. This is the piece of Obamacare that has been delayed by one year.

Selective Enforcement

Why delay one component of Obamacare and not the others? More specifically, why delay the employer mandate but not the individual mandate?

To answer that question, we must first understand this fact: Obama wants a single-payer healthcare system in the US.

This is not a secret:

Barack Obama, 2003: "I happen to be a proponent of a single-payer healthcare system for America, but as all of you know, we may not get there immediately."

Barack Obama, 2007: "But I don't think we will be able to eliminate employer-based coverage immediately. There is potentially going to be some transition time."

These quotes are not taken out of context. Anyone who has been paying attention knows that transitioning to a single-payer system has been Obama's and his cohorts' ultimate goal all along:

Rep. Jan Schakowsky (D-IL), 2009: "Next to me was a guy from the insurance company who then argued against the public option. He said it would not let private insurance companies compete. A public option would put the private insurance companies out of business and lead to single-payer. My single-payer friends, he was right. The man was right!"

Here, Rep. Schakowsky is suggesting that the "public option" will lead to their desired goal of a single-payer healthcare system. Single-payer proponents no longer use this term, since the public has clearly and consistently opposed it.

The "public option" has been renamed "Medicaid expansion," which serves the public-relations purpose of confusing the public and avoiding calling taxpayer-funded healthcare "single payer."

Jacob S. Hacker (Yale Professor), 2008: "Someone once said to me this is a Trojan Horse for single payer. It's not a Trojan Horse, right? It's right there! I am telling you. We are going to get there. Over time. Slowly. But we are going to move away from reliance on employer-based health insurance, as we should, but we will do it in a way that we are not going to frighten people into thinking they are going to lose their private insurance. We will give them a choice of public or private insurance when they are in the pool. We are going to let them keep their private insurance as long as their employer continues to provide it."

Hacker nicely sums up the underlying goals of Obamacare: not to increase competition or patient choice, but to drive people out of private insurance as a stepping stone to a government-run, single-payer system.

Stepping Stone to Single-Payer

Knowing Obama and his cohorts' goals, the purpose behind the delay of the employer mandate seems clearer: to hurry the "transition time" away from employer-based health insurance and to a single-payer system.

By forcing individuals to purchase compliant healthcare plans but not forcing employers to provide those plans, Obama is creating a swell of 10-13 million workers that must enroll in health insurance, but cannot obtain it from their employers. These workers thus have no choice but to use the government-controlled health insurance exchanges, or else pay a financial penalty.

This represents a doubling of the number of workers forced to get health insurance on the exchanges.

Remember, by enacting the dual mandates, Obamacare ostensibly was designed to ensure that its costs were borne by businesses, not taxpayers. But when the president decided to enforce only certain portions of the healthcare law and delay others, he shifted the cost of health insurance onto the backs of taxpayers.

This is all on top of the burdensome costs Obamacare has already created. Various studies have projected that private insurance premiums will rise between 20 to 60% in 2014, and some as much as 100%.

How long will the private-insurance market survive with such exploding costs? People will not be able to afford such massive premium increases. That seems to be the point: drive up costs and drive everyone into the arms of government-controlled medical care.

How Obamacare Affects You and Your Medical Care

The delay in the employer mandate is but one of dozens of negative impacts Obamacare will have on your medical services. As an independent physician, I've been discussing these issues with my patients for the past few years, helping them to prepare for what's ahead.

Here are the ten most important points that I tell my patients:

1. Your private insurance premiums will cost more and more each year.

2. You will lose the choices and flexibility in health insurance policies that we have had available up until now.

3. As reimbursements continue to drop, fewer and fewer doctors will take Medicare (for those 65 and older) or Medicaid (people younger than 65).

4. Fewer doctors accepting Medicare and Medicaid causes an increase in wait times for appointments and a decrease in the numbers and types of specialists available on these plans. Consumers would be wise to line up their doctors now. [NB: highly recommended]

5. Studies from various organizations and states have consistently shown that Medicaid recipients have longer waits for medical care, fewer options for specialists, poorer medical outcomes, and die sooner after surgeries than people with no health insurance at all. Yet an increasing number of Americans will be forced into this second-class medical care.

6. As more people enter the taxpayer-funded plans (Medicare and Medicaid) instead of paying for private insurance, the costs to provide this increased medical care and medications will escalate, leading to higher taxes.

7. With no eligibility verifications in place, millions of people who are in the US illegally will be able to access taxpayer-funded medical services, making longer lines, longer wait times, and less money available for medical care for American citizens… unless taxes are increased even more.

8. Higher expenditures to provide medical services lead to rationing of medical care and treatment options to reduce costs. This is the mandated function of the Independent Payment Advisory Board: to cut costs by deciding which types of medical services to allow… or disallow. If you are denied treatment, you have no appeal of IPAB decisions; you are simply out of luck, and possibly out of life. This is a radical departure from the appeals process required for all private health insurance plans. Further, the IPAB is accountable only to President Obama, and cannot be overridden by Congress or the courts. IPAB is designed to have the final word on your health. [NB: The Independent Payment Advisory Board is more popularly known as the "Death Panel."]

9. Under current regulations, if medical care is denied by Medicare, then a patient is not allowed to pay cash to a Medicare-contracted physician or hospital or other health professional. Patients who need medical care that is denied under Medicare or Medicaid will find themselves having to either: 1) look for an independent physician or hospital (quite rare these days); or 2) go outside the USA for treatment. [NB: This last is known as "Medical Tourism", and is gaining popularity. Panama and Belize have English-speaking clinics where Americans can pay cash and get their procedures and drugs that might be unobtainable except after long waiting periods in the US under the the new Affordable Care Act rules.]

10.Expect a loss of medical privacy. Beginning in 2014, if you participate in government health insurance, your health records will be sent to a centralized federal database, with or without your consent. [NB: The IRS will be tasked with implementing and enforcing key parts of Obamacare. They will have access to your healthcare information. Interestingly, the union that represents IRS employees recently declared that it does not want its members to be on Obamacare; they prefer their current health insurance plan. Seems to me, however, that we ought to be a "nation of laws, not of men"; so if an IRS employee can exempt himself from Obamacare, then I ought to be able to do so, too; conversely, if the government claims that Obamacare is good enough for me, then it ought to be good enough for those employees tasked with enforcing it.]

[broncofan]

I am not going to get involved in this debate yet since I want to see exactly how things pan out with the exchanges and ultimately the employer mandate. There is plenty wrong with that article since it supposes that a 2003 quote by Obama indicates a plan to undermine his own program to lead to a more comprehensive single payer system down the road. Typically people only tank something if they want it abolished (think Republicans working for regulatory agencies), not if they want to implement something even more sweeping.

One thing I don't understand is why critics of PPACA cannot seem to get the name right. How much literacy is required to remember those five letters or even the five words: Patient Protection Affordable Care Act.

When someone says Obamacare they sound about as intelligent as someone who calls the media the lamestream media.