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ACA, rising healthcare costs, and shortage of doctors

ReformCollege

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Ever since the debate and passage of the ACA, it appears to me that the biggest issue in the debate is the rising cost of health care. But I feel like it's the issue that the ACA completely ignores. I have always maintained that making health coverage affordable is far more important than making sure everyone is insured. Healthcare contributes to 42.6% of all bankruptcies. Lowering the overall cost of health care across the board increases the stability of the system and benefits consumers on all ends of the spectrum. The poor and middle class would benefit the most from a drop in costs for the same reason they are hurt the most by increasing costs. A $12,000 premium is relatively very expensive for a family of four living on $60k a year. I'm not at all convinced that the major portions of the ACA will lower health care costs. Quite the contrary, it shifts costs from Americans 50 and older who consume a higher level of health care to newer workers under 40 who make less money (less years in their career) and often have many other costs such as a new mortgage, daycare, saving for college, etc. that older Americans don't have to assume. It also raises a moral question. Is it moral to force one group of people to pay more so another group can pay less? Wouldn't a better solution be to lower costs across the board so that both groups benefit?


I also want to discuss the shortage of doctors. The great paradox with the ACA is this. We already have an enormous shortage of physicians. I always here liberals complain about the pay of doctors in the U.S. as compared to the EU, but they never give a valid explaination as to why that is except for saying they are greedy. "What we’re looking at now is that there’s a shortage of somewhere around 90,000 physicians in the next 10 years, increasing in the five years beyond that to 125,000 or more,” says Atul Grover, MD, PhD, chief public policy officer of the Association of American Medical Colleges." The fact is, we don't have enough people becoming physicians in this country because school costs upwards of 200k+ and we do not have enough residency spots to train graduates.
So what does the ACA do about it? It cuts $1B from Medicare funds to residency hospitals. " Now there are going to be an additional 30M extra patients in the health care system with potentially less doctors to treat them.

We have to reverse this $1B cut. Then we need to increase the budget to teaching hospitals by at least another $2-3B. Maybe more. Residency programs are a huge part in training doctors. Making sure the program is well funded is vital to training good doctors. If we increase residency capacity, we would hopefully see our Medical Schools increase student enrollment to match this increase in demand. Enrollment in medical school has remained a constant of 67,000 for nearly 20 years, despite a rising demand for healthcare. A large barrier to Medical School is cost and affordability. If we provided a 20k grant to students in Medical School, it would only cost 1.36B yearly. But, it would hopefully drive up enrollment, while decreasing student debt by around 80-100k per doctor. Also, we should train more Nurse Practitioners. Nurse Practitioners are a fantastic way to alleviating the shortage of doctors while decreasing labor costs. Nurse practitioners are nurses who are qualified to see and treat patients under the "supervision" of a doctor. Nurse practitioners are often former nurses with years of experience in the field who want to practice medicine. N.P.s could see patients for routine checkups and minor to moderate medical issues. This decreases the cost of every day healthcare, increases the capacity of the system, and would direct the more well paid doctors to more critical health services. More doctors and N.P's would eliminate doctor shortages and decrease salaries via competition. It would also increase the capacity of our health care system to provide better care in low income rural areas, and take on millions of uninsured Americans.

Discuss
 
There was a good editorial comment in the WSJ called RomneyCare 2.0 that discusses many of the points you raise, and how the program has played out (disastrously) in Massachusetts.
 
The primary mechanism to control costs in the original ACA was the public option, but we had to give that up to calm down the tea party. Ultimately we still need it.
 
Cost control will be minimal with ACA, but having people insured, thus able to pay for services should lower hospital costs, or at least keep them from growing. The $16 we pay for a bandaid today may not become $26. Also, the bill does try to encourage more general practicioners, though that is an uphill battle as specialists earn more.

Medicare has some problems, but even if those are fixed, it won't mean more doctors. Our aging population is the most likley to need health care. So, this plces a burden on the government, with not much for a healty population to off set the cost. UHC would help this greatly, along with other benefits, such as removing HC from being linked employment. But we've been unable to make that switch here. Until we do, these problems will continue to greater or lesser degrees.
 
The primary mechanism to control costs in the original ACA was the public option, but we had to give that up to calm down the tea party. Ultimately we still need it.

Very true, and many forget the role they played in derailing a better plan.
 
Cost control will be minimal with ACA, but having people insured, thus able to pay for services should lower hospital costs, or at least keep them from growing.

As always, that is a glaring contradiction and does not logically follow. "Having people insured" does not allow them to pay for services. It allows them to receive services and forces others to pay.

Medicare has some problems, but even if those are fixed, it won't mean more doctors. Our aging population is the most likley to need health care. So, this plces a burden on the government,

No, on the working generations.

obamacare-july-4-2.jpg
 
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As always, that is a glaring contradiction and does not logically follow. "Having people insured" does not allow them to pay for services. It allows them to receive services and forces others to pay.

No, pay for. The hospital actually gets paid, as opposed to recieving no money and having to hike up prices to pay for those who did not pay. And most will pay their own insurance premiums.

No, on the working generations.

obamacare-july-4-2.jpg

Whatever you're trying to say doesn't really respond to what you attach it to. I work, and I don't see anything to what you link.
 
Cost control will be minimal with ACA, but having people insured, thus able to pay for services should lower hospital costs, or at least keep them from growing. The $16 we pay for a bandaid today may not become $26. Also, the bill does try to encourage more general practicioners, though that is an uphill battle as specialists earn more.

Medicare has some problems, but even if those are fixed, it won't mean more doctors. Our aging population is the most likley to need health care. So, this plces a burden on the government, with not much for a healty population to off set the cost. UHC would help this greatly, along with other benefits, such as removing HC from being linked employment. But we've been unable to make that switch here. Until we do, these problems will continue to greater or lesser degrees.

Are you kidding me? Who do you think is going to be paying MORE so that those NOW unable to pay for insurance (or ER costs) get subsidized care? PPACA does not lower overall costs, it just shifts them around differently and RAISES them. Assume that the average poor person makes $20K/year and that their medical care insurance costs $4000/year. The AVERAGE poor person does not use ANY medical care in a typical year, so without PPACA they cost NOTHING to ANYONE else now. Under PPACA the AVERAGE poor person must pay 2% of their income ($400) in insurance to "the exchange" so the other $3,600 of their insurance premium cost is "on the house" (shared among all other insured people) or paid for directly by TAX MONEY.
 
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No, pay for. The hospital actually gets paid, as opposed to recieving no money and having to hike up prices to pay for those who did not pay. And most will pay their own insurance premiums.

That still is not a scenario in which any person (previously uninsured) is paying for health care services. The group of people who don't have insurance typically cannot afford it altogether, or could barely afford it, so under the new system you're (at best) making them poorer by forcing them to buy coverage they already can't afford, or (at worst) entitling even more of them to more services without the requirement to pay. In either case, no one is paying for his/her health care.

Whatever you're trying to say doesn't really respond to what you attach it to. I work, and I don't see anything to what you link.

The cartoon was just because I felt like it but I realize it's not related to the cost control mechanism discussion. Prior to that I said "no" it (Medicare) doesn't create a burden on the government, because the government assumes no burden. It (Medicare) creates a burden on the working. It will simply have to shut down the benefits, because it's beyond unsustainable.
 
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Are you kidding me? Who do you think is going to be paying MORE so that those NOW unable to pay for insurance (or ER costs) get subsidized care? PPACA does not lower overall costs, it just shifts them around differently and RAISES them. Assume that the average poor person makes $20K/year and that their medical care insurance costs $4000/year. The AVERAGE poor person does not use ANY medical care in a typical year, so without PPACA they cost NOTHING to ANYONE else now. Under PPACA the AVERAGE poor person must pay 2% of their income ($400) in insurance to "the exchange" so the other $3,600 of their insurance premium cost is "on the house" (shared among all other insured people) or paid for directly by TAX MONEY.

Isn't that the whole point of insurance? You pay a premium and socialize the losses. Where do you get 2%/$400 from?
 
That still is not a scenario in which any person (previously uninsured) is paying for health care services. The group of people who don't have insurance typically cannot afford it altogether, or could barely afford it, so under the new system you're (at best) making them poorer by forcing them to buy coverage they already can't afford, or (at worst) entitling even more of them to more services without the requirement to pay. In either case, no one is paying for his/her health care.

Not entirely true. There are those who can afford it, but choose not to. And we have always paid for it. Every single insured person and tax payer has been paying for it for a long, long time. A bandaid doesn't really cost $16 each. You can get an entire box for $2. Even if you were right, and you're not entirely, being able to give the hospital their money, no mater who it comes from, lowers the price for all of us.

The cartoon was just because I felt like it but I realize it's not related to the cost control mechanism discussion. Prior to that I said "no" it (Medicare) doesn't create a burden on the government, because the government assumes no burden. It (Medicare) creates a burden on the working. It will simply have to shut down the benefits, because it's beyond unsustainable.

I don't believe that is the case. Overall, it perfoms better than insurance. But, the public option would have been better than what we have now, and UHC better still.
 
Isn't that the whole point of insurance? You pay a premium and socialize the losses. Where do you get 2%/$400 from?

From the PPACA law that limits the "low income" payment requirement for the "exchange" policy premium amount. It is a complicated mess, to say the least, as it varies based on "geographic location" and all sorts of nonsense. The bottom line is that the PPACA fine and the premium amount required are based on income, so the low income people added are heavily subsidized so that they will HOPEFULLY choose the "exchange" policies rather than the fine. That $20K salary may NOW (or as of 2014) be qualified for Medicaid and pay nothing at all, I am unsure - but here are some links:

http://www.kff.org/healthreform/upload/7962-02.pdf

http://www.benefitspro.com/2012/05/23/what-to-know-about-the-ppaca-premium-tax-credit

http://www.ncsl.org/documents/health/HlthInsPremCredits.pdf
 
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Not entirely true. There are those who can afford it, but choose not to.

They exist, but I highly doubt in sufficient enough numbers to result in enough extra cash to entitle everyone to health insurance. That's the only money not in the game, right? The people who HAVE money but voluntarily CHOOSE not to use it to buy insurance. But I repeat, no one is suddenly "paying for" their health care due to PPACA, and no one can "afford their health care" due to PPACA. That is disingenuous. PPACA just entitles more people to an outcome and doesn't address the underlying problem, which has always been that the care itself is priced too high.

And we have always paid for it. Every single insured person and tax payer has been paying for it for a long, long time. A bandaid doesn't really cost $16 each. You can get an entire box for $2. Even if you were right, and you're not entirely, being able to give the hospital their money, no mater who it comes from, lowers the price for all of us.

Not in the overall sense. Prices go up for all of us the more people have access but don't pay. How do I know? Because it's already been this way, and prices have continually gone up.

I don't believe that is the case. Overall, it perfoms better than insurance.

Using what standard of measurement? How can you not believe that's the case? It's no contest.

Medicare funding runs short by 2024, trustees say
 
Not entirely true. There are those who can afford it, but choose not to. And we have always paid for it. Every single insured person and tax payer has been paying for it for a long, long time. A bandaid doesn't really cost $16 each. You can get an entire box for $2. Even if you were right, and you're not entirely, being able to give the hospital their money, no mater who it comes from, lowers the price for all of us.



I don't believe that is the case. Overall, it perfoms better than insurance. But, the public option would have been better than what we have now, and UHC better still.

The vast majority of those added to the roles of the insured due to PPACA will be HEAVILY subsidized by tax money, that is why PPACA does not start (in full) until AFTER the last congressional election of Obama's next term. This is going to be a HUGE expense that will likely dwarf Medicaid as a money pit, but will buy many votes. See links in post #13. Yes they can!
 
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It seems the folks who are liberal on the issue of health care don't seem to want to admit the POSSIBILITY that we are trying to entitle ourselves to more care than we can pay for, individually OR collectively. In a scenario where we can't pay for the things we want to promise ourselves, we either go into debt chasing it, or we simply don't reward ourselves with the things we can't afford.

The liberal answer is "force someone to pay for all the excess."

The conservative answer is "don't give anyone the excess they won't pay for."
 
It seems the folks who are liberal on the issue of health care don't seem to want to admit the POSSIBILITY that we are trying to entitle ourselves to more care than we can pay for, individually OR collectively. In a scenario where we can't pay for the things we want to promise ourselves, we either go into debt chasing it, or we simply don't reward ourselves with the things we can't afford.

The liberal answer is "force someone to pay for all the excess."

The conservative answer is "don't give anyone the excess they won't pay for."

Of course we can pay for it. Morocco has been doing it for 30 years. Cuba manages to do it. Hell, lots of third world countries have been able to afford it.

But, with something like health care, even if we couldn't afford it, it'd still be better in my book for everybody to get 90% of what they need than some 100% and others 10%. It isn't like we're talking about sports cars or pools or something, we're talking about health care people need to live and be healthy.
 
Of course we can pay for it. Morocco has been doing it for 30 years. Cuba manages to do it. Hell, lots of third world countries have been able to afford it.

But, with something like health care, even if we couldn't afford it, it'd still be better in my book for everybody to get 90% of what they need than some 100% and others 10%. It isn't like we're talking about sports cars or pools or something, we're talking about health care people need to live and be healthy.


What about the pizza guy who says this is going to put him out of business?
 
Of course we can pay for it. Morocco has been doing it for 30 years. Cuba manages to do it. Hell, lots of third world countries have been able to afford it.

But, with something like health care, even if we couldn't afford it, it'd still be better in my book for everybody to get 90% of what they need than some 100% and others 10%. It isn't like we're talking about sports cars or pools or something, we're talking about health care people need to live and be healthy.

There is no limit to the "nice" things that a gov't can do, yet the federal gov't refuses to actually tax to pay for it, prefering instead to give stuff away now and pay for it (maybe) later. That indeed buys votes, especially from those sure that they will never be asked to pay for it. We now have 1/3 of the entire U.S. population getting some form of direct gov't assistance, yet spend over 40% more than we dare ask for in taxation at the federal level. That is insane.
 
What about the pizza guy who says this is going to put him out of business?

Does he have more than 50 full time employees? If not, it has no effect on him. If yes, then damn right he should be offering health insurance as compensation.
 
There is no limit to the "nice" things that a gov't can do, yet the federal gov't refuses to actually tax to pay for it, prefering instead to give stuff away now and pay for it (maybe) later. That indeed buys votes, especially from those sure that they will never be asked to pay for it. We now have 1/3 of the entire U.S. population getting some form of direct gov't assistance, yet spend over 40% more than we dare ask for in taxation at the federal level. That is insane.

That's false. As you know, the ACA decreases the deficit. It has taxes built right into it to pay for itself plus some.
 
Does he have more than 50 full time employees? If not, it has no effect on him. If yes, then damn right he should be offering health insurance as compensation.

What if the premiums rise (because the health care costs continue to rise) and the cost to insure those employees exceeds what their labor is worth? Or if the cost that he passes down to the customer turns them off from pizza and his sales plummet? Or he decides to fire the 25 employees the put him over the 50 employee cutoff? The road to hell is paved with good intentions.
 
Of course we can pay for it. Morocco has been doing it for 30 years. Cuba manages to do it.

Well if Morocco and Cuba can do it!!!

Hell, lots of third world countries have been able to afford it.

Underlying the feasibility of entitling the entire population to something is what the thing they're entitling actually costs there. Here a lot of it costs more than double what the next-most-expensive health care in the world costs. So obviously your comparison to these other countries ignores the differences in the cost of the medical.

But, with something like health care, even if we couldn't afford it, it'd still be better in my book for everybody to get 90% of what they need than some 100% and others 10%.

Everyone getting 90% could very well be ten times as expensive as some getting 100% and some getting 10%. It's as though money is infinite in your book.

It isn't like we're talking about sports cars or pools or something, we're talking about health care people need to live and be healthy.

Whether it's a need or luxury is irrelevant, because both cost money. And our collective need for our medical care costs more than we have. How do you reconcile that? You can't just go around looting people's bank accounts to pay for whatever "sounds better in your book." The astronomical costs of the underlying medical services have to be reined in somehow. PPACA makes this problem worse.
 
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What if the premiums rise (because the health care costs continue to rise) and the cost to insure those employees exceeds what their labor is worth? Or if the cost that he passes down to the customer turns them off from pizza and his sales plummet? Or he decides to fire the 25 employees the put him over the 50 employee cutoff? The road to hell is paved with good intentions.

Companies with more than 50 full time employees, that aren't eligible for exemptions, should have no problem at all offering health insurance. In many states they have already had to for decades.

Premiums will continue to rise until we have a public option, but at least the ACA puts some upper limits on how fast it can raise.
 
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