Affordable Care Act a HIT!!!! 7 million goal achieved; 8 million now signed up!
- Thread starter YerDugliness
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Jim Rosenthal
Supporter
I agree with Steve.
And also this: as to differing with the "other side"- guys, there IS no other side. We are all on the "other side". This defines a lot of the problem. We are quarreling with ourselves. This is an argument that invariably produces two losers, and no winners.
And also this: as to differing with the "other side"- guys, there IS no other side. We are all on the "other side". This defines a lot of the problem. We are quarreling with ourselves. This is an argument that invariably produces two losers, and no winners.
Interesting article, Al...however, the claim that was made by Fox News? Network that 27 revisions to the law were made without the requisite action by congress is suspect simply due to the biased nature of FN?N.
Admittedly I have not read in detail the actual law; however, I do wonder if the law contained the actual dates that were "adjusted" or whether those were simply administrative issues that could be addressed without congressional review. Either way, I would think moving the target date so that businesses were given more time to meet the requirement would be an action that would be applauded by most of the conservative contingent here on the forum...as long as it was not an outright unilateral change to the law. I would need more info on that.
I am always suspicious of inflammatory information provided by FN?N because of that organization's apparent self- appointed status as the opposition to the liberal leanings of the current administration...blame my training in debate if you like, but the veracity of the source is suspect, IMHO, even if it does not seem so to those who adhere to the position taken by the organization.
As for Administrative actions, as long as they are supported by the authority granted to the POTUS, I support them regardless of whom they benefit, since our congressional representatives can't seem to get their heads out of their asses to read the writing on the wall. Like most of us Americans, I'm tired of the political gridlock and applaud ANY action to provide relief from that useless bickering.
Cheers!!!
Doug
Exactly the reason I expressed my appreciation for the nature of Steve's post! Disagreement is not, IMHO, necessarily a bad thing as long as the discussion is cordial...that was not always the case in the past and I agree with Al, this thread has remained pretty cordial.
As for all being on the same side...I'm not convinced about that...but I agree in large part with Jim C that it is still too early to be able to determine that. Just like our cars always seem to need some "fettling" (isn't that British for "fine tuning??), the implementation of this program will probably need some fine tuning. I will never benefit from the ACA, IMHO, but if they do proceed to penalize those who choose to enroll in a program that offers better than normal benefits ("Cadillac plans" ??), it will probably be to my detriment. As long as the plan is implemented in a manner that benefits more than it punishes, though, I will still support it even if it "punishes" me for my choice of plan.
Cheers!!
Doug
So you think Charles Krauthammer puts a slant on the truth? I doubt it. He used to be a liberal. Do you accept as fact the drivel that comes out of ABC, CBS, NBC, CNN? They all carry Obamas water. I tend to look a foreign news to compare and then believe 1/3 of it.
No, they are suspect, as well...particularly CNN. I do like BBC...the Brits have no horse in our race so no need for spin.
Cheers!
Doug
Exactly my thoughts. The Brits are OK for people that talk funny!
Why thanks Al! (I think).
FYI, to us (well, me), the BBC can be a tad left of centre and does enjoy guerrilla tactics against the elected Government of the day which I suppose is preferential to being a straight out mouthpiece. But who does jerk their editorial chain? :shrug:
T. Bliar took great exception to BBC critique of his 'management style' and went some way down the road to trying to control their output, but of course, he failed.
What we here in the UK should respect is that the great BBC was (and possibly still is if the overseas content hasn't been axed on economic grounds), for many years, a beacon of freedom in a world of totalitarianism and that for millions, the BBC has no peer.
FYI, to us (well, me), the BBC can be a tad left of centre and does enjoy guerrilla tactics against the elected Government of the day which I suppose is preferential to being a straight out mouthpiece. But who does jerk their editorial chain? :shrug:
T. Bliar took great exception to BBC critique of his 'management style' and went some way down the road to trying to control their output, but of course, he failed.
What we here in the UK should respect is that the great BBC was (and possibly still is if the overseas content hasn't been axed on economic grounds), for many years, a beacon of freedom in a world of totalitarianism and that for millions, the BBC has no peer.
Pat
Supporter
Doug, you need to brush up on your civics. Congress can modify or repeal (with executive approval, inaction or veto override) laws once passed. Refer to Article VI, Clause 2, of the U.S. Constitution.
Comments referring to "GEE-Dub's reign of terror" may leave one to conclude that your venom to the previous president certainly matches or exceeds any exhibited here by others towards the current one.
As for "personal experience" with government health care, as a retired veteran, my wife and I are the beneficiaries of care provided by the VA. It certainly provides one insights to federally provided medical services.
For example, last year an unknown number of U.S. military veterans are dead within 30 days of contracting Legionnaires' disease in a Veterans Affairs hospital in Pittsburgh. Aside from their family members, few people seem to be outraged. If that doesn't grab your attention, perhaps this will: VA officials in charge when those men were dying from a preventable illness received more than $100,000 in performance bonuses.
In the Dayton, Ohio VA facility veterans had received invasive dental work from VA Dentist, Dwight M. Pemberton, who failed to change latex gloves between appointments and did not sterilize dental equipment properly. Two new former patients have tested positive for hepatitis B.
You probably didn't hear about it but Veterans' Affairs official covered up the fact that almost 2,000 veterans were kept waiting months to see a doctor at a Phoenix VA hospital. Even worse, 40 or so died while waiting for health care that they had earned through their military service.
VA physicians are asked to participate in a process to a process explicitly rationing health care to individual patients. You see Federal law does not provide for equal "entitlement" to care for all veterans.
The fact is the ACA was passed based on a body of lies. And yes, I for one think that's a bad thing. But veterans being treated worse than animals in a shelter makes me furious.
The fact that there is vague (at best) accountability in the bureaucracy that is our government, makes me fearful.
Too Tired to Care About VA Scandal? | RealClearPolitics
Phoenix VA Hospital scandal: 40+ vets die on secret PHX VA waiting list, CNN reports - ABC15 Arizona
Pressure grows for firings over Atlanta VA scandal | www.wsbtv.com
Pat
Supporter
Steve, you have a well thought out and interesting array of suggestions. I hope somebody does something with them.
One question though, in discussing the ACA with a physician friend, his contention is the ACA mandate on preexisting condition coverage is one of the act's serious flaws. That discourages healthy people from getting plans and incents people not to get plans until their conditions are often much more serious and therefore produce less effective medical outcomes at far greater expense.
He'd also eliminate the mandate and instead provide incentives to buy insurance such as allowing a standard deduction for individuals purchasing their own insurance. A 2007 Lewin Group study that found the policy would reduce the number of uninsured by 9.2 million. This far exceeds the ACA enrollment. Add your suggestions of portability and durability (no cancellation when the policy is maintained a-la-HIPA) to that, and you would boost the numbers further. Cut the "junior gets coverage under parents plan" from 26 to 24 and you add another 8 million potential purchasers into the marketplace.
We also had an interesting discussion of government reimbursement rates and malpractice insurance and litigation but the forum rules about profanity limit discussion. Hint: one local attorney is running TV ads citing physicians by name seeking those with poor outcomes as potential litigants. Given that, why would anybody take on high risk patients or specialize in high risk procedures, regardless of the potential benefits?
Jim Rosenthal
Supporter
I've worked in the VA medical care system. It sucked then, and it sucks now. It is primitive, underfunded, undermanaged, and incompetent. I work in a hospital in the D.C. area which serves an impoverished immigrant population and where most of what we need is either broken or missing much of the time. A year or two ago, we had an ER physician whose fellowship required that she spend much of the time working in a VAMC ER in D.C. What she told me about the working conditions where she was made me MUCH more appreciative of what we had, and relieved not to be working where she did. The VA is a joke. All the scandals and firings in the world will not improve the massively incompetent and corrupt bunch of fools who run the VA. They should get their own medical care, by law, in their own facilities. Then things MIGHT improve.
Pat, your correct that the preexisting condition mandate is a potential fatal flaw. The goal of the ACA was to get young people to sign up (of face a penalty) to offset that. The reality is the penalty isn't significant enough and young people aren't signing up in numbers hoped for.
Much like Jim, I've worked in a VA hospitals during training, 2 in fact. One was actually a very good VA as it was staffed by physicians from a university hospital across the street. Care was pretty good. The other VA......not so much. One interesting observation: any hospital is only as good as its ancillary staff. If the cleaning people suck, so will the hospital. The staff make or break a hospital as much or more than the MD's. This has sunk many an inner city hospital with good medical staff. The VA that I referred to that was pretty good had the same access to hiring staff as the university hospital next door. VA employee benefits are as good and maybe better in some instances. Yet, it seemed like the VA went out of its way to hire morons whereas the university hospital had great staff. Why is that? It seems like the federal govt can't help but hire an idiot even when talent is beating it's door down.
And yes, Keith, fairly accurate for the early 70's.
You may be correct...AT THIS TIME. AFAIK the penalty for non-compliance is small the first year, greater the second year, and gets very expensive thereafter. We knew this going in, just as we knew the penalty for employers not complying was phased in much the same way.
As I said, we need more time to judge exactly how effective this law will be. It is certainly too early to declare the law ineffective.
Cheers!!!
Doug
The whole healthcare system in the US is fragmented, it seems from where I am standing that someone needs the power and the balls to pull the whole system under one umbrella. Then apply funding via a tax stream that affects everyone equally ( food, fuel etc) and just put it on a plate as it is. Is this simplistic approach that far out of bed ?
Bob
Bob
Not simplistic at all Bob. The problem with a large govt run entity is that even when it looks good on paper, large govt run programs like this tend to be very inefficient corrupt and wasteful. Despite our fragmentation, if you need a total hip replacement in the US there's no waiting list. If you need an MRI there's one down the block that will get you in today. Market forces make it relatively efficient but the more the govt meddles in it the less efficient it becomes.
Turning it over to the feds results in loss of individual freedom, choice, and of course personal responsibility. Our society seems more and more willing to give up the first 2 because they're too lazy to deal with the latter.
The best analogy I give people is the US post office vs FedEx. If you need to get something overnight and it's critical to your business where do you go? When I ask this nearly everyone says FedEx. No one says USPS. Market forces force FedEx to be competitive and not get lazy. Companies like Airborne Express go belly up because they can't compete. If Airborne was federally run it would never have closed (much like the USPS never closes, it just raises rates faster than inflation). Congress would have simply voted to throw more money at it to keep it open. It's closure was devastating to a town in Ohio but it's closure was necessary. Free market forces efficiency due to competition and eventually a better company rises to take its place. You take that away and inefficient programs never die. The federal govt has never closed an entitlement program it started. I have little confidence it can run healthcare any better than it runs the VA system.
Turning it over to the feds results in loss of individual freedom, choice, and of course personal responsibility. Our society seems more and more willing to give up the first 2 because they're too lazy to deal with the latter.
The best analogy I give people is the US post office vs FedEx. If you need to get something overnight and it's critical to your business where do you go? When I ask this nearly everyone says FedEx. No one says USPS. Market forces force FedEx to be competitive and not get lazy. Companies like Airborne Express go belly up because they can't compete. If Airborne was federally run it would never have closed (much like the USPS never closes, it just raises rates faster than inflation). Congress would have simply voted to throw more money at it to keep it open. It's closure was devastating to a town in Ohio but it's closure was necessary. Free market forces efficiency due to competition and eventually a better company rises to take its place. You take that away and inefficient programs never die. The federal govt has never closed an entitlement program it started. I have little confidence it can run healthcare any better than it runs the VA system.
This is exactly the UK experience, however, I still believe that there are a number of entities vital to the nation that should be run by the State. My 'musts' would include transport, healthcare and utilities to name three.
Despite it's detractors, the NHS has an absolutely marvellous fund of dedicated people who treat their careers as vocational and just because the admin, management and political meddling have conspired to make it a leaky boat doesn't mean we should give up on it.
Our British Railways was also manned by dedicated people who made the railways run on time even during the war. Can Private Enterprise do it now? No. If it means paying more tax for an integrated and unified transport system then so be it.
I believe it is absolutely possible to achieve efficiency in State run enterprises but it takes good people with dedicated political masters.
I don't have an answer, but if I were younger and fitter I would find one.
Despite it's detractors, the NHS has an absolutely marvellous fund of dedicated people who treat their careers as vocational and just because the admin, management and political meddling have conspired to make it a leaky boat doesn't mean we should give up on it.
Our British Railways was also manned by dedicated people who made the railways run on time even during the war. Can Private Enterprise do it now? No. If it means paying more tax for an integrated and unified transport system then so be it.
I believe it is absolutely possible to achieve efficiency in State run enterprises but it takes good people with dedicated political masters.
I don't have an answer, but if I were younger and fitter I would find one.
Jim Rosenthal
Supporter
Which VA, Steve? Sounds like University of MD and the VAMC next door. Although I am sure that isn't the only VAMC next to a university teaching hospital.
I should modify my statement; I have never personally seen a VAMC that was worth a pinch of shit. There are good ones, from what I hear, but in most cases they are not up to the standard of a decent modern hospital, private or university.
What appalled me about the VAMC that my physician friend described was that it was the Washington, D.C., VAMC- right in the backyard of the national capital. Just like Walter Reed and the terrible scandals there about how they treated servicemen and women returning from the Middle East. If you read Robert Gates' book about his tenure as Secretary of Defense, you get some idea of his outrage at how these places were running- or not running, to be sure.
I agree with Keith that some things are too crucial to be left to the private sector, but I wonder if letting the government run medical care is a good idea. I don't think so; I think a partnership between the government and private industry and nonprofits and academia is the best way. The details of that remain to be seen; certainly our first steps as embodied in the ACA are not, to me, promising. I suspect we have the worst of all possible worlds in that legislation, although if they prove me wrong I will be happy to say so, and happy with the results.
I should modify my statement; I have never personally seen a VAMC that was worth a pinch of shit. There are good ones, from what I hear, but in most cases they are not up to the standard of a decent modern hospital, private or university.
What appalled me about the VAMC that my physician friend described was that it was the Washington, D.C., VAMC- right in the backyard of the national capital. Just like Walter Reed and the terrible scandals there about how they treated servicemen and women returning from the Middle East. If you read Robert Gates' book about his tenure as Secretary of Defense, you get some idea of his outrage at how these places were running- or not running, to be sure.
I agree with Keith that some things are too crucial to be left to the private sector, but I wonder if letting the government run medical care is a good idea. I don't think so; I think a partnership between the government and private industry and nonprofits and academia is the best way. The details of that remain to be seen; certainly our first steps as embodied in the ACA are not, to me, promising. I suspect we have the worst of all possible worlds in that legislation, although if they prove me wrong I will be happy to say so, and happy with the results.
+1 Jim,
The new VA hospital was completed during my radiology residency at Parkland in Dallas and we had rotations in the state-of-the-art radiology department. Despite great "bricks and mortar", rotations were always dreaded by residents. I believe it was due to the perception of a lack of incentive/motivation by the VAMC staff at a Gov operated facility. The patient waiting lines were just as long in the new hospital than that seen in the old hospital, and there was the perception that nobody cared.....8 to 5 "and I'm out of here" was the perception. I fear that many US hospitals will spiral into this mentality if Gov controlled. Hope not.
The new VA hospital was completed during my radiology residency at Parkland in Dallas and we had rotations in the state-of-the-art radiology department. Despite great "bricks and mortar", rotations were always dreaded by residents. I believe it was due to the perception of a lack of incentive/motivation by the VAMC staff at a Gov operated facility. The patient waiting lines were just as long in the new hospital than that seen in the old hospital, and there was the perception that nobody cared.....8 to 5 "and I'm out of here" was the perception. I fear that many US hospitals will spiral into this mentality if Gov controlled. Hope not.
