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Thread: ACA, rising healthcare costs, and shortage of doctors

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    ACA, rising healthcare costs, and shortage of doctors

    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

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    Re: ACA, rising healthcare costs, and shortage of doctors

    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.
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    Re: ACA, rising healthcare costs, and shortage of doctors

    Quote Originally Posted by Diogenes View Post
    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.
    Then Romney's the man?

    AUSTAN GOOLSBEE: I think the world vests too much power, certainly in the president, probably in Washington in general for its influence on the economy, because most all of the economy has nothing to do with the government.

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    Re: ACA, rising healthcare costs, and shortage of doctors

    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.
    Total tax rates- People living in poverty: 16.2%. The median American: 27%. Working people who make over $140k/year: 31%. The top 1%: 30%. Super rich investors: around 15%. Help the democrats retake the house.

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    Re: ACA, rising healthcare costs, and shortage of doctors

    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.

    AUSTAN GOOLSBEE: I think the world vests too much power, certainly in the president, probably in Washington in general for its influence on the economy, because most all of the economy has nothing to do with the government.

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    Re: ACA, rising healthcare costs, and shortage of doctors

    Quote Originally Posted by teamosil View Post
    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.

    AUSTAN GOOLSBEE: I think the world vests too much power, certainly in the president, probably in Washington in general for its influence on the economy, because most all of the economy has nothing to do with the government.

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    Re: ACA, rising healthcare costs, and shortage of doctors

    Quote Originally Posted by Boo Radley View Post
    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.

    Last edited by Neomalthusian; 08-09-12 at 01:33 PM.
    "The knowledge and prudence of the poor themselves, are absolutely the only means by which any general and permanent improvement in their condition can be effected." - Thomas Malthus

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    Re: ACA, rising healthcare costs, and shortage of doctors

    Quote Originally Posted by Neomalthusian View Post
    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.

    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.

    AUSTAN GOOLSBEE: I think the world vests too much power, certainly in the president, probably in Washington in general for its influence on the economy, because most all of the economy has nothing to do with the government.

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    Re: ACA, rising healthcare costs, and shortage of doctors

    Quote Originally Posted by Boo Radley View Post
    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.
    Last edited by ttwtt78640; 08-09-12 at 02:21 PM.
    “The reasonable man adapts himself to the world: the unreasonable one persists to adapt the world to himself.
    Therefore all progress depends on the unreasonable man.” ― George Bernard Shaw, Man and Superman

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    Re: ACA, rising healthcare costs, and shortage of doctors

    Quote Originally Posted by Boo Radley View Post
    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.
    Last edited by Neomalthusian; 08-09-12 at 02:26 PM.
    "The knowledge and prudence of the poor themselves, are absolutely the only means by which any general and permanent improvement in their condition can be effected." - Thomas Malthus

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