Seaward wrote:
And neither do you, clearly, if you actually believe the estimations for one, and tie them to the ACA for another.

 Frazzled wrote:
Then why are you wasting time replying to him?

 Easy E wrote:
Sebs, this whole thread is just a conservative echo-chamber. I'm honsetly surprised this thread is even still open considering it hasn't been anything meaningful for the last 15+ pages. It's just been a lot of...Grrrr... and Arrrrgghhhh.... and gnashing of teeth.

Now that the site is mostly working, I can't wait to see the new Conservative pivot on this issue.

 whembly wrote:
Never said that it wasn't the problem... but, don't lay problems on the deficit solely on Medicare/Medicaide's expenditures.

If you want to argue that it's an attempt to do those things... be my guest. But it's mostly political horse gak.

What BS? I've been against the PPACA since Day Numero Uno dude... Consistently I would think.

I think I earned that badge of honor here in Dakka.

 sebster wrote:
Yeah, I use the estimates given by people who estimate these numbers for a living, and accept their statements that the ACA has played a significant role. It's downright crazy of me, I should just be reading anecdotes from political pundits and using those to reinforce whatever political position I came in to this believing.

Pretty much, yeah. It's been kind of fascinating to watch the Memento style nature of conservative debate on ACA. Every fifteen minutes there's a new all important reason ACA is failing, and the problem of 15 minutes ago is just entirely forgotten, and all the while they just get angrier and more frustrated.

Well guess what conservatives are now ignoring, focusing as they are entirely on some individuals paying more for insurance. They're ignoring their earlier point, that a major factor is what the system costs everyone in total. Well that cost is being kept in check.

An estimated seven out of every 10 physicians in deep-blue California are rebelling against the state’s Obamacare health insurance exchange and won’t participate, the head of the state’s largest medical association said.

“It doesn’t surprise me that there’s a high rate of nonparticipation,” said Dr. Richard Thorp, president of the California Medical Association.

Thorp has been a primary care doctor for 38 years in a small town 90 miles north of Sacramento. The CMA represents 38,000 of the roughly 104,000 doctors in California.

“We need some recognition that we’re doing a service to the community. But we can’t do it for free. And we can’t do it at a loss. No other business would do that,” he said.

California offers one of the lowest government reimbursement rates in the country — 30 percent lower than federalMedicare payments. And reimbursement rates for some procedures are even lower.

...

 whembly wrote:
Doctors boycotting California's Obamacare exchange

An estimated seven out of every 10 physicians in deep-blue California are rebelling against the state’s Obamacare health insurance exchange and won’t participate, the head of the state’s largest medical association said.

“It doesn’t surprise me that there’s a high rate of nonparticipation,” said Dr. Richard Thorp, president of the California Medical Association.

Thorp has been a primary care doctor for 38 years in a small town 90 miles north of Sacramento. The CMA represents 38,000 of the roughly 104,000 doctors in California.

“We need some recognition that we’re doing a service to the community. But we can’t do it for free. And we can’t do it at a loss. No other business would do that,” he said.

California offers one of the lowest government reimbursement rates in the country — 30 percent lower than federalMedicare payments. And reimbursement rates for some procedures are even lower.

...

Just illustrating to the defenders of the PPACA that we were mislead in every possible way.

 whembly wrote:
Doctors boycotting California's Obamacare exchange

An estimated seven out of every 10 physicians in deep-blue California are rebelling against the state’s Obamacare health insurance exchange and won’t participate, the head of the state’s largest medical association said.

“It doesn’t surprise me that there’s a high rate of nonparticipation,” said Dr. Richard Thorp, president of the California Medical Association.

Thorp has been a primary care doctor for 38 years in a small town 90 miles north of Sacramento. The CMA represents 38,000 of the roughly 104,000 doctors in California.

“We need some recognition that we’re doing a service to the community. But we can’t do it for free. And we can’t do it at a loss. No other business would do that,” he said.

California offers one of the lowest government reimbursement rates in the country — 30 percent lower than federalMedicare payments. And reimbursement rates for some procedures are even lower.

...

Just illustrating to the defenders of the PPACA that we were mislead in every possible way.

 dogma wrote:

 whembly wrote:
Doctors boycotting California's Obamacare exchange

An estimated seven out of every 10 physicians in deep-blue California are rebelling against the state’s Obamacare health insurance exchange and won’t participate, the head of the state’s largest medical association said.

“It doesn’t surprise me that there’s a high rate of nonparticipation,” said Dr. Richard Thorp, president of the California Medical Association.

Thorp has been a primary care doctor for 38 years in a small town 90 miles north of Sacramento. The CMA represents 38,000 of the roughly 104,000 doctors in California.

“We need some recognition that we’re doing a service to the community. But we can’t do it for free. And we can’t do it at a loss. No other business would do that,” he said.

California offers one of the lowest government reimbursement rates in the country — 30 percent lower than federalMedicare payments. And reimbursement rates for some procedures are even lower.

...

Just illustrating to the defenders of the PPACA that we were mislead in every possible way.

That seems to be a California problem, rather than a national problem.

 whembly wrote:

Nope... I hearing/seeing elsewhere buddy.

St. Louis Region, Cleveland Clinic, Seatle and Houston are the ones seeing that... Although, the Houston one seems to be more of merges of medical groups.

 whembly wrote:

EVEN THEN dogma... would you say that at the very least, Californians were lied to?

 Seaward wrote:
Here's a question for you: how many revisions have these experts of yours made as to their estimates on the cost of the ACA and its effects?

That's certainly one incorrect way of looking at it, indeed. A more rational approach might be to acknowledge that there can be multiple problems with a program as large as this.

 whembly wrote:
Nope... I hearing/seeing elsewhere buddy.

 sebster wrote:

 Seaward wrote:
Here's a question for you: how many revisions have these experts of yours made as to their estimates on the cost of the ACA and its effects?

Here's the CBO estimate on Medicare in 2009 and again in 2013.


You have no fething clue what you're talking about.

Automatically Appended Next Post:

 whembly wrote:
Nope... I hearing/seeing elsewhere buddy.

Nah, dude, per the article it points out the problem of California's low rate of pay by comparing it to the much higher rates in other states.

 whembly wrote:
Chill dude... I think everyone is getting mixed up here... You're talking about Medicare (mainly the elderly).

We're talking about everyone else.

The rising cost that EVERYONE is harping about is the increased monthly premiums per month and that the plans are drastically different (worse in some cases).

Drastically different than what the Democrats/Obama has stated would happen.

Huh?

It's two fold Seb... Doctors are not participating in the State/Federal exchange because the red-tape is much higher and that the reimbursement rates are much lower.

 sebster wrote:

 whembly wrote:
Chill dude... I think everyone is getting mixed up here... You're talking about Medicare (mainly the elderly).

We're talking about everyone else.

The rising cost that EVERYONE is harping about is the increased monthly premiums per month and that the plans are drastically different (worse in some cases).

Drastically different than what the Democrats/Obama has stated would happen.

I'm not just talking about medicare, I'm talking about the cost of the entire system to the country as a whole, which is predicted to be much lower in total.

I could go and get those numbers, again, but I get the distinct impression no-one is listening, because they've rather doggedly decided to ignore that reality. And that was my point in the first place - when ACA was first announced you guys were falling all over yourself to respond to claims about affordable healthcare now being available that someone had to pay ("free healthcare isn't free"). Now we're years on and the cost control parts of the bill are doing as they were expected to do, that argument has just been abandoned entirely. Instead you talk about the cost to individuals in specific circumstances.

Which isn't an unreasonable point, by the way. But by talking purely about that and just ignoring the overall cost or the importance you guys once placed on that, it's showing a level of dishonesty that makes this conversation a waste of time.

http://www.nber.org/papers/w19700?utm_campaign=ntw&utm_medium=email&utm_source=ntw

Why have health care costs moderated in the last decade? Some have suggested the Great Recession alone was the cause, but health expenditure growth in the depths of the recession was nearly identical to growth prior to the recession. Nor can the Affordable Care Act (ACA) can take credit, since the slowdown began prior to its implementation.

Instead, we identify three primary causes of the slowdown: the rise in high-deductible insurance plans, state-level efforts to control Medicaid costs, and a general slowdown in the diffusion of new technology, particularly in the Medicare population.

A more difficult question is: Will this slowdown continue? Here we are more pessimistic, and not entirely because a similar (and temporary) slowdown occurred in the early 1990s. The primary determinant of long-term growth is the continued development of expensive technology, and there is little evidence of a permanent slowdown in the technology pipeline. Proton beam accelerators are on target to double between 2010 and 2014, while the market for heart-assist devices (costing more than $300,000) is projected to grow rapidly.

Now the researchers add that accountable care organizations and “emboldened insurance companies” may be successful in limiting healthcare cost inflation going forward. But their best guess is that healthcare costs will grow at GDP plus 1.2% over the next two decades. That’s lower than previous estimates and half the historical growth rate, but “still on track to cause serious fiscal pain for taxpayers and workers who bear the costs of higher premiums.”

Oh, and here is an interesting bit on how paying for expensive technology that delivers little benefit drives cost growth: “For example, proton beam accelerators that cost hundreds of millions of dollars to install, have no established benefits to patients over traditional treatment options, are expected to more than double in number between 2010 and 2014.”

Update: Here is the part of the report that directly deals with the Obamacare issue:

One explanation for the decline in health care spending growth, popular among Democrats, is the implementation (or anticipation of the implementation) of the Affordable Care Act (ACA) of 2010 (Unger, 2013), with David Cutler (2013) concluding that “…the ACA is a significant part of the reason” for the downturn, and Council of Economic Advisors stating that ‘the available evidence suggests that the ACA is contributing to these trends’ (CEA, 2013).

The problem with this explanation is thus far, cost-saving effects of the ACA have been mixed. Some characteristics of the ACA increase costs, such as the extension of insurance coverage to dependents up to age 26. One accountable care organization (ACO) pilot reduced costs by less than 2 percent (Colla et al., 2012), although a private Massachusetts initiative was able to save substantially more (McWilliams, et al., 2013; Song et al., 2012).

Most importantly, the cost-saving components of the ACA are not yet fully implemented, and thus cannot explain why health care cost growth began to moderate in 2006, when Barack Obama was still a senator from Illinois.

However, two other features of the ACA may have made a difference a few years after the start of the slowdown. The first is rule changes in Medicare that were phased-in starting in 2010, such as lower payments to Medicare Advantage plans and other providers ($17 billion over three years) as well as reduced payments to hospitals with poor quality measures ($230- $280 million per year starting in 2012). These changes may have reduced national spending growth by 0.2 percentage points in the past 3 years (CEA, 2013). Furthermore, there are spillover effects of reductions in Medicare payments rates onto commercial plans—as Medicare rates change, commercial rates change in the same direction (Clemens and Gottlieb, 2013; White, 2013). While the magnitude of these effects is still debated, payment reductions in Medicare could have been mirrored by payment reduction in private plans, with current estimates suggesting dollar-for-dollar reduction spillovers.

The second is anticipatory effects among providers and insurers who are preparing for competition through the new health exchanges and alternative payments models. While this is possible—as the private Massachusetts initiative indicates—we don’t see direct and widespread evidence of cost-saving strategies being adopted by providers, nor do we see evidence from Massachusetts that private health care costs are growing more slowly there than in the rest of the country.

Huh?

It's two fold Seb... Doctors are not participating in the State/Federal exchange because the red-tape is much higher and that the reimbursement rates are much lower.

No, really, per your article, it talks about the issue in California, and it describes the problem there by giving the much higher rates elsewhere in the country. Which makes it a California problem - they are paying much less than is sustainable for the industry.

Now, it may well be that there's other problems, I'd be shocked if there weren't. But none of that comes up in the article, and that's all I was saying.

David Martosko wrote:'A public safety disaster': Obamacare could force THOUSANDS of volunteer fire departments to close

Volunteer fire departments all across the U.S. could find themselves out of money and unable to operate unless Congress or the Obama Administration exempts them from the Affordable Care Act.

'I thought the kinks were worked out of Obamacare at the first of the month, Central Florida volunteer firefighter Carl Fabrizi told Sunshine State News.

'Man, oh, man, this could potentially destroy some real good companies in Florida.'

The U.S. Department of Labor takes the term 'volunteer' literally, but the IRS says volunteer firefighters are technically employees if they're on the job more than 30 hours per week, making them subject to Obamacare's employee-mandate rules


Firefighters battled a blaze in the aftermath of a Nov. 18 tornado in Washington, Illinois. The vast majority of U.S. firefighters are community volunteers


Wildfires like this August 2013 disaster near Banning, California bring volunteer firefighters out of the woodwork to risk their lives

Since the Obamacare law doesn't specifically carve out an exemption for them, fire departments where 50 or more people work – either as volunteers or officially as employees – are expected to provide health insurance for every one of them.

In towns with more than one volunteer fire department, all the staffers will likely be lumped together for tax purposes, pushing many municipalities above the 50-worker threshold.

That could cost departments of life-savers hundreds of thousands of dollars each year. Those that dump their volunteers into the federal insurance exchanges would still have to pay an annual $2,000 fine for each 'employee' after the first 30.

'I can tell you right now we can’t afford it,' East Derry, Pennsylvania Fire Company Chief Edward Mann told the Patriot-News. 'While a volunteer fire department may not have a payroll, the rest of it isn’t free. The only part that is free is the labor.'

Mann's concerns are likely to get at least some attention in Washington: He's also the state fire commissioner in Pennsylvania, where 97 per cent of fire departments are fully or mostly staffed by volunteers. That's the highest percentage in the U.S.


Employees? Volunteer firefighters count toward an employer's worker totals under the Affordable Care Act, since the law doesn't carve out a exception for them


'A public safety disaster': Volunteer fire departments could close down unless the government exempts them from Obamacare



Nationally, the Federal Emergency Management Agency reports that volunteer fire departments make up 71 per cent of America's 1 million firehouses. Another 16 per cent are 'mostly volunteer.'

It's unclear how many of those departments involve at least 50 people, making the potential impact of the Affordable Care Act's latest unintended consequence difficult to calculate.

But the International Association of Fire Chiefs has asked the Internal Revenue Service to let all volunteer departments off the hook. The federal government has taken no action so far.

'If the IRS classifies volunteer firefighters and emergency medical personnel as employees in their final rule, fire departments may be unintentionally forced to comply with requirements that could force them to curtail their emergency response activities or close entirely,' the organization said in a statement.

A U.S. Treasury Department spokesperson said in a statement that the agency has 'received a number of comments concerning volunteer firefighters and other volunteers in response to proposed regulations issued last December.'

'We are taking those comments into account as we work toward issuing final regulations on the employer-responsibility provision' of the Affordable Care Act, the spokesperson said.

But Bill White, a volunteer firefighter for 50 years and leader of the Dive Rescue Specialists in Scott Township, Pennsylvania, said an IRS rule that officially makes volunteers subject to Obamacare employer mandates would be a disaster.

'We're barely paying the bills that we have now,' he told the Scranton Times-Tribune

Pennsylvania Republican Rep. Lou Barletta fired off a letter to the IRS last week.

'Obamacare has raised more questions than it has answered,' Barletta said in a statement.

'First, are volunteer firefighters considered employees and therefore subject to the employer mandate under Obamacare? And second, how should volunteer time be counted to see if they’re working 30 hours?'


Aftermath: On Dec. 4 a home in London Township, Mich. was reduced to cinders -- and volunteers kept the blaze from spreading to forests or other houses


Even big municipalities like Jersey City, New Jersey need volunteer firefighters. This November 27 fire destroyed a downtown store and damaged three others

'Does it mean when a volunteer is wearing a beeper or carrying a fire department cell phone? Does it include downtime at the station house? Listening to a scanner?'

'If Obamacare is the law of the land, then so is the law of unintended consequences,' he said, 'and there seems to be a lot of that going around these days. Just like the flu.'

New York Republican Rep. Chris Collins had his own evaluation of the rule for the IRS, writing in a letter to Acting Commissioner Danny Werfel that it will produce 'a public safety disaster.'

 whembly wrote:
Obama will just *tweak* the PPACA IRS rules to exempt the volunteers.

 Dreadclaw69 wrote:

 whembly wrote:
Obama will just *tweak* the PPACA IRS rules to exempt the volunteers.

I'm just awake and I read that as Obama will just *twerk* the rules. I need more coffee

...
The out of pocket caps on consumer spending only apply to costs incurred on drugs that are included on a plan’s drug formulary. This is the list of medicines that the health plans have agreed to provide some coverage for.

If the drug isn’t on this formulary list, then the patient could be responsible for its full cost (with little or no co-insurance to help offset that cost). Moreover, the money they spend won’t count against their deductibles or out of pocket limits ($12,700 for a family, $6,350 for an individual).

These are the ways that Obamacare cheapens the health coverage in order to pay for all of its expensive mandates. Obamacare is a throwback to the old HMO model of the 1990s, which promised a broad package of coverage for primary care benefits like vaccines, and routine doctor visits. But to pay for these benefits, the Obamacare plans skimp on other things – principally the number of doctors you’ll have access to, and also, the number of costlier branded drugs that make it onto formularies.
...

 whembly wrote:
No, You Can't Keep Your Drugs Either Under Obamacare

...
The out of pocket caps on consumer spending only apply to costs incurred on drugs that are included on a plan’s drug formulary. This is the list of medicines that the health plans have agreed to provide some coverage for.

If the drug isn’t on this formulary list, then the patient could be responsible for its full cost (with little or no co-insurance to help offset that cost). Moreover, the money they spend won’t count against their deductibles or out of pocket limits ($12,700 for a family, $6,350 for an individual).

These are the ways that Obamacare cheapens the health coverage in order to pay for all of its expensive mandates. Obamacare is a throwback to the old HMO model of the 1990s, which promised a broad package of coverage for primary care benefits like vaccines, and routine doctor visits. But to pay for these benefits, the Obamacare plans skimp on other things – principally the number of doctors you’ll have access to, and also, the number of costlier branded drugs that make it onto formularies.
...

Knew this was coming...

Saw it a mile away.

Maybe... just maybe that'll put a damper on drug companies from reformulating their drugs to extend their patent. I doubt it though...

If the drug isn’t on this formulary list, then the patient could be responsible for its full cost (with little or no co-insurance to help offset that cost). Moreover, the money they spend won’t count against their deductibles or out of pocket limits ($12,700 for a family, $6,350 for an individual).

 Ouze wrote:

If the drug isn’t on this formulary list, then the patient could be responsible for its full cost (with little or no co-insurance to help offset that cost). Moreover, the money they spend won’t count against their deductibles or out of pocket limits ($12,700 for a family, $6,350 for an individual).

This has applied to virtually every private insurance plan in the country pre-ACA. Thanks, Obama.

jamesk1973 wrote:
A lot of elderly folks take some of the drugs not on that list. They are going to be pissed when they have to start paying for them.

 Ouze wrote:

jamesk1973 wrote:
A lot of elderly folks take some of the drugs not on that list. They are going to be pissed when they have to start paying for them.

That sounds like the non-socialist, bootstrappy option.

 Ouze wrote:

jamesk1973 wrote:
A lot of elderly folks take some of the drugs not on that list. They are going to be pissed when they have to start paying for them.

That sounds like the non-socialist, bootstrappy option.

 Easy E wrote:

 Ouze wrote:

jamesk1973 wrote:
A lot of elderly folks take some of the drugs not on that list. They are going to be pissed when they have to start paying for them.

That sounds like the non-socialist, bootstrappy option.

Yeah, I thought that would be what Libertarians and Conservatives wanted?

Daniel Halper wrote:Missouri School District Hit With $150,000 Bill for Obamacare



"The Affordable Care Act could cost the Jefferson City public schools more than a $150,000," said the news anchor.

"This came to light at last night's board meeting when district officials told board members they would have to pay health insurance for substitute teachers," says the other anchor.

"They knew it was coming, they just didn't exactly know how they were going to handle it. As small business around the nation have seen it coming, and they've been wondering how they will accommodate the Affordable Care Act. Just like them, the district is also asking that question. The district could limit subtitutes to 28 hours per week, or face paying six thousand dollars per person for health benefits for at least 25 individuals who are on the rolls and qualify. If they don't comply with the new federal law, the district would be fined millions of dollars by the federal government. While district officials didn't go as far as saying the federal government is hurting more than helping, I was told the $150,000 dollar cost is about the same cost as three teachers in the district, to put it into perspective," the reporter explains.

 Alfndrate wrote:
Except that Libertarians are for health care reform, but they're for it at the smaller state level.

 cincydooley wrote:

 Alfndrate wrote:
Except that Libertarians are for health care reform, but they're for it at the smaller state level.

I'm also for the idea proposed by Christopher Buckely in his book Boomsday

It never occured to me that substitute teachers would be subject to the insurance thing under this. Thats....sort of a big deal....

 cincydooley wrote:

 Alfndrate wrote:
Except that Libertarians are for health care reform, but they're for it at the smaller state level.

I'm also for the idea proposed by Christopher Buckely in his book Boomsday

It never occured to me that substitute teachers would be subject to the insurance thing under this. Thats....sort of a big deal....