ObamaCare Info

[Colleen27]

Pulling yourself up by your bootstraps takes more than just the will to do it. It takes solid bootstraps that won't break.

And "bootstrap" stories miss the point anyway... It is a systemic problem, not an individual one. We have an economic system under which we NEED a significant and growing portion of our workforce to fill low wage positions. An individual can pull themselves out of that situation with the right combination of hard work, skill, and good fortune but that doesn't change the underlying problem - the 40% of full-time low wage jobs that don't offer benefits, the additional percentage are excluded because they're part time, or those who are offered benefits at a cost that is entirely out of reach on their wage. So the question is whether we're comfortable with that low-wage segment of our society doing without adequate medical care, driving up costs for the rest of us by defaulting on medical bills they cannot afford and by postponing treatments until minor issues become serious and sometimes disabling, or whether we want to attempt to address the structural issues in our system that are leaving so many without coverage.

 

[pilferk]

And "bootstrap" stories miss the point anyway... It is a systemic problem, not an individual one. We have an economic system under which we NEED a significant and growing portion of our workforce to fill low wage positions. An individual can pull themselves out of that situation with the right combination of hard work, skill, and good fortune but that doesn't change the underlying problem - the 40% of full-time low wage jobs that don't offer benefits, the additional percentage are excluded because they're part time, or those who are offered benefits at a cost that is entirely out of reach on their wage. So the question is whether we're comfortable with that low-wage segment of our society doing without adequate medical care, driving up costs for the rest of us by defaulting on medical bills they cannot afford and by postponing treatments until minor issues become serious and sometimes disabling, or whether we want to attempt to address the structural issues in our system that are leaving so many without coverage.

Agree with much of that...though again, I'll refrain from the entitlement portions.

I ultimately adopted that final bootstrap analogy to tie it back to the posters anecdote, in actuality to try to demonstrate exactly your point. Not everyone has the same solid bootstraps. And homogenizing those solid bootstraps is impossible.

And you make the same point I have, previously. Either we provide care...and pay for it in one way or another....or we actually let people die. Not numbers, not theory crafted figments. Actual people.

It is really that simple.

For me, I have no issues with people's opinions differing on how the payments are made. And I stay out of them for a variety of reasons. But I can't get on board with going the true social Darwinism route.

On the topic of our economy...we seem to have moved too far toward a service based economy, and away from actual production. Part of that is the vanishing manufacturing sector.

The problem is we have to redirect our work force. I agree, there will always be a need for low wage device and retail jobs. But their pay typically increases, and their quality of life albog with it, when they have a large, working middle class to provide services for. Right now....that's not happening. Which only exaccerbates the problems.

 

[wen8jr]

you are right...there are countless stories. However, for those that dont have the luck as you put it, does not mean that it is the responsibility to the lucky to provide it for them. No where in the history of this country is it written that those who dont or can't will be provided for by those who did. To mandate that through government is outlandishly ridiculous and again, no more than wealth redistribution. Robin Hood is not the route we want.

Please note, I am not using the term Socialism in my quote as a statement here but I think the quote holds true:

The problem with Socialism(wealth redistribution) is eventually you run out of other peoples money ~ Margaret Thatcher

Spot on.

 

[wen8jr]

I mean...would you choose to be on subsidy?

Again, not to say there aren't system abusers and misusers. There are. But not nearly at the level people insist.

I completely disagree. I guess it depends on where you live. If you think that the majority who receive free healthcare would rather work - you are misled. I have worked in the healthcare business and a good 75% of the population in a large region of our state are on some kind of free government help. They do choose to be on subsidy and they chose not to better themselves. There is about 10% of the 75% that are ashamed to be on it and had to go to it. The remaining 65% make a career out of milking the system, they know just how to work it...spitting out more kids to get more, even foster parenting to get more, faking injuries, mental illness, etc. Most of these people are substance abusers as well.

That is very sad when I personally know someone with terminal cancer who fought for 3 years to get disability, was finally awarded and died 3 months later. Our system is entirely screwed up and this is going to make it worse because we keep providing for those who don't do a thing to help themselves or others.

 

[pilferk]

I completely disagree. I guess it depends on where you live. If you think that the majority who receive free healthcare would rather work - you are misled. I have worked in the healthcare business and a good 75% of the population in a large region of our state are on some kind of free government help. They do choose to be on subsidy and they chose not to better themselves. There is about 10% of the 75% that are ashamed to be on it and had to go to it. The remaining 65% make a career out of milking the system, they know just how to work it...spitting out more kids to get more, even foster parenting to get more, faking injuries, mental illness, etc. Most of these people are substance abusers as well.

That is very sad when I personally know someone with terminal cancer who fought for 3 years to get disability, was finally awarded and died 3 months later. Our system is entirely screwed up and this is going to make it worse because we keep providing for those who don't do a thing to help themselves or others.

Again, anecdote vs data.

You notice the abusers more. I have worked in healthcare, in an urban setting entrenched in poverty, for over a decade. We run a full featured, community backed, injury prevention program. I work closely with these communities, analyze our payor and injury data, as well as the national data of similar centers.

I've seen the countless studies on program abuse and we have applied much of that data to our practice.

It's simply not true. Not locally to me, and not nationally, overall.

I get it is frustrating to see the abusers, day after day. But the abuse is not as wide spread as you surmise. Yes, it happens.

Also, unless you are in each and every one of those living rooms, it's a tough task to say they chose not to better themselves.

 

[wen8jr]

Now, after 6 hours of sleep, I'm off to work for 10 hrs...to pay for others who won't or don't have to get out the bed - so they can make rounds at the doctor, hospital and pharmacies.

Oh wait, it is the 1st day of the month and their checks will be in the mail so I suppose it is shopping day today. I better not go shopping today - I'll get run over, pushed and shoved. Literally.

I guess the rounds to the doctor, hospital, pharmacies will be toward the mid to late month as they try to get pills to trade to others for more money or just make these visits because they are bored. Those who need real care can't get in timely because of this.

Maybe you have to live in areas where people sit on their butts, weight about 300lbs because they do nothing, but could get out and work. And maybe you have to be treated ill by them and their entitled attitude or see able bodied YOUNG people lined up for free cell phones that my tax money is paying for BEFORE you can see that everything about this country's welfare system is wrong and Obamacare just lends to it.

But what do I know. Maybe those of us who work are the idiots.

 

[wen8jr]

Again, anecdote vs data.

You notice the abusers more. I have worked in healthcare, in an urban setting, for over a decade. We run a full featured, community backed, injury prevention program. I work closely with these communities, analyze our payor and injury data, as well as the national data of similar centers.

I've seen the countless studies on program abuse and we have applied much of that data to our practice.

It's simply not true. Not locally to me, and not nationally, overall.

I get it is frustrating to see the abusers, day after day. But the abuse is not as wide spread as you surmise. Yes, it happens.

Simply not true? You can't speak for what I have seen and dealt with first hand in my area. Our state is well know to have the most obese and the most people on welfare and they are the most unhappy.

National figures and data should not come into play as it varies widely from area to area and one size does not fit all. That is why each state needs to make these decisions, not our federal government.

 

[pilferk]

Simply not true? You can't speak for what I have seen and dealt with first hand in my area. Our state is well know to have the most obese and the most people on welfare and they are the most unhappy.

National figures and data should not come into play as it varies widely from area to area and one size does not fit all. That is why each state needs to make these decisions, not our federal government.

I can't speak to your anecdotal experience.

I can tell you the numbers and percentages are not accurate nationally. And they would be extreme...to the tune of 60%...outlier data if they were accurate locally.

And we are talking about a national subject, here. Thus, my assertion was geared to that level of specificity. Both in my initial post, and in my replies.

Again, you notice the abusers more. And I get the frustration level.

Where are you? I'd be happy to analyze your local and regional data from the national trauma data and our other national sources.

 

[Colleen27]

Maybe you have to live in areas where people sit on their butts, weight about 300lbs because they do nothing, but could get out and work. And maybe you have to be treated ill by them and their entitled attitude or see able bodied YOUNG people lined up for free cell phones that my tax money is paying for BEFORE you can see that everything about this country's welfare system is wrong and Obamacare just lends to it.

It is interesting to see the gulf in perception of the poor in America, and I always wonder what is behind it... Is it seeing what we want to see, or a difference between urban and suburban/rural, or a regional perception?

I've lived and worked in one of America's poorest cities. Now I live in a small town in an economically struggling area - literally every one of the biggest industries in my community have taken hard hits in the last few years (manufacturing, construction, pleasure boating). I have seen a lot of poverty and experienced a bit of it myself, but my experience has been entirely different from what you describe. There's no rampant rudeness, and people are almost to a one ashamed to shop with their food stamp cards even when the whole town knows that the breadwinner was laid off with no notice, or that the wife is fighting cancer, or that the family just took in an extra child or two rather than let family members end up in the foster care system. But I acknowledge that it could be because I'm "one of them" in that sense - we do okay, but I've never been in a position where I'm an "other", where I appear wealthy or stand out from the norm in my area (unless you count being white in Detroit, but even that was a non-issue 99% of the time). And just as the well-off sometimes treat the working/lower class poorly based on appearances, I think the working poor sometimes hold certain biases and project a certain attitude towards the obviously well-off.

 

[annaaidan99]

And "bootstrap" stories miss the point anyway... It is a systemic problem, not an individual one. We have an economic system under which we NEED a significant and growing portion of our workforce to fill low wage positions. An individual can pull themselves out of that situation with the right combination of hard work, skill, and good fortune but that doesn't change the underlying problem - the 40% of full-time low wage jobs that don't offer benefits, the additional percentage are excluded because they're part time, or those who are offered benefits at a cost that is entirely out of reach on their wage. So the question is whether we're comfortable with that low-wage segment of our society doing without adequate medical care, driving up costs for the rest of us by defaulting on medical bills they cannot afford and by postponing treatments until minor issues become serious and sometimes disabling, or whether we want to attempt to address the structural issues in our system that are leaving so many without coverage.

This is the part I see people miss completely.

 

[leahjade]

Spend a week in an urban school setting, with a high poverty rate student body.

They don't have the access to the quality f education, the emphasis on secondary education

I find offense to this statement I have several friends who work in low poverty schools in Philadelphia. They are great teachers - as good or not better than any you'd find in suburban districts. And their districts spend much more per dollar per student than any school in our area, so again proving that government throwing money at problems does NOT work. The problem starts in the home - my one friend said that in her one class 80% of the students don't have fathers living in the home and all the students get free breakfast and lunch! Then when you mix drugs and alcohol into the mix you have a recipe for disaster. Responsibility has to start somewhere. I was the first child in our family to go to college, we had alcoholism, violence and family members in jail. I worked full-time, went to school at night and got my degree. Of course back then I didn't have the government to pay my housing, healthcare, phone, food etc. Who would want to work nowadays???
Suckers that we are - someone has to pay for all the handouts!

 

[annaaidan99]

I find offense to this statement I have several friends who work in low poverty schools in Philadelphia. They are great teachers - as good or not better than any you'd find in suburban districts. And their districts spend much more per dollar per student than any school in our area, so again proving that government throwing money at problems does NOT work. The problem starts in the home - my one friend said that in her one class 80% of the students don't have fathers living in the home and all the students get free breakfast and lunch! Then when you mix drugs and alcohol into the mix you have a recipe for disaster. Responsibility has to start somewhere. I was the first child in our family to go to college, we had alcoholism, violence and family members in jail. I worked full-time, went to school at night and got my degree. Of course back then I didn't have the government to pay my housing, healthcare, phone, food etc. Who would want to work nowadays??? Suckers that we are - someone has to pay for all the handouts!

The problem is that the focus keeps shifting to the welfare segment. The people who need help are the working poor.

 

[pilferk]

I find offense to this statement I have several friends who work in low poverty schools in Philadelphia. They are great teachers - as good or not better than any you'd find in suburban districts. And their districts spend much more per dollar per student than any school in our area, so again proving that government throwing money at problems does NOT work. The problem starts in the home - my one friend said that in her one class 80% of the students don't have fathers living in the home and all the students get free breakfast and lunch! Then when you mix drugs and alcohol into the mix you have a recipe for disaster. Responsibility has to start somewhere. I was the first child in our family to go to college, we had alcoholism, violence and family members in jail. I worked full-time, went to school at night and got my degree. Of course back then I didn't have the government to pay my housing, healthcare, phone, food etc. Who would want to work nowadays???
Suckers that we are - someone has to pay for all the handouts!

More anecdotes in place of data.

Teachers are great...but with class sizes bordering on the insane, their effectiveness is diminished. And teachers do not entirely define the quality of an education.

Ask those same teachers how many section of ap classes their schools offer? Ask what their graduation rate is? Ask what the focus of their guidance program is? Ask what their curriculum is focused on? And ask what their absentee rate is? If they are remotely close to their peer schools around the country, their answers will be interesting...


More money...much of it spent on security, and other programs...not educational aids or material, has marginal effect on quality of education according to most studies. In fact, cost per student in just about any setting has proven to be a bad predictor of success. Witness the work done in NJ and Washington, DC.


Certainly, the lack of focus on education in the home...for a variety of reasons...is a contributing factor, too. But chalking that up entirely to bad parenting isn't entirely accurate. It is tough when you have 2 parents working 60 hours a week at minimum wage jobs to find time to help the kids with their homework...

Language is also a potential contributing factor.

And nowhere did I say, or imply, that throwing money at the schools will solve their problems. Only that they do not have similar access or focus on secondary education.

The facts are the facts. And the data tells a much more accurate story.

And reality..as in, reality today, as it stands...and now how we would like to theory craft how it should be, is reality.

There is no period of adjustment to reset the problems that exist. No do over button.

So, we pay for their care, somehow...or we let them die. That simple.

Debate that obamacare isn't the right way to do it, and I bow out of the conversation.

Try to argue that we can ignore the problem, and we part company....

 

[manning]

The amount is possible to obtain with an overly large family...or on disability. In one scenario, you are caring for upwards of 8 people...which means 30k for the household isn't all that much. In the other...well, disability is a different discussion.


For many reasons. Firstly because government subsistence is just that. It's hardly prosperity. Secondly because it provides greater personal satisfaction to work. There are others...there are good studies out there about this. Largely, people able to work want to work.

I mean...would you choose to be on subsidy?

Again, not to say there aren't system abusers and misusers. There are. But not nearly at the level people insist.

Then you have that 28 year old who has no desire to work and thinks it's awesome that he gets $200 a month in free food (food stamps). He admits he has no desire to work.

 

[pilferk]

Then you have that 28 year old who has no desire to work and thinks it's awesome that he gets $200 a month in free food (food stamps). He admits he has no desire to work.

Ignoring that food stamps is a completely different program....and not really relevant (and...I'm not going to debate the pros and cons of specific systems):

But how many of those 28 year olds do you think there actually are?

A majority of them?

I suggest data shows they are the exception...by a lot...rather than the rule.

Once again, I'm not saying there are no examples of people who take advantage of the system. There certainly are.

Is your position that any system that has ANY abusers should be completely abandoned?

 

[wiigirl]

The problem is that the focus keeps shifting to the welfare segment. The people who need help are the working poor.

 

[pilferk]

The problem is that the focus keeps shifting to the welfare segment. The people who need help are the working poor.

You're right.

Many of those on some form of social assistance/welfare already receive healthcare as part of their package. We're already paying for that, in our taxes.

It's those NOT getting assistance who are traditionally considered "self pay"...ie: no insurance.

 

[annaaidan99]

Then you have that 28 year old who has no desire to work and thinks it's awesome that he gets $200 a month in free food (food stamps). He admits he has no desire to work.

The food stamp program is not relevant to the ACA.

 

[mikek]

It does not.

It has to do with he advantage care admins premium. Reimbursement won't change. The admins just won't be getting the extra 15 to 40 cents per dollar to pocket. It was always the plan for that extra to be cut, as the administrators passed startup phase...which is what that premium was meant to fund.

first pilferk- i LOVE your input and look forward to seeing your replies in this thread. It's nice to get some real facts from someone who knows somethign rather then trying to interpret crap on the internet.

Wanted to say if the plan all along was to cut the advantage care fees then obamacare didn't change anything then to cut cost it merely followed through with that they should have done anyway.

Also- do you know is any of the "savings to pay for ACA" tied to the perpetual line of cutting medicare reimbursement rates?

Personally, i dont think some Dr getting 17 bucks to treat an old person is going to get rich. So I think lets stop that lie and move on to some real thigns that might actually save some money.

 

[mikek]

Agree. Short term, nothing changes in terms of cost.

But even the costs that are effected are marginal, compared to some of the other, larger, more fixed costs ( the ever rising cost of malpractice insurance, for example).

But the op said there was nothing that addressed costs, which isn't exactly true.

to be clear i said nothing substantive/significant to address costs - or at least that's what i meant to say I specifically mentioned that there was somethings that nibbled around the edges.

Also- the person i was replying to implied (or perhaps i inferred- then sorry) that as a percentage of GDP this would help. If anything as a percentage of GDP will go up- while costs per service might go down due to efficiency and things you point out, the simple fact is when you finally allow another 10 million or whatever people to actually get a preventative care checkup each year there will need to be more resources that to pay for that- more dr's, more office buildings, more of the ubiquitous billing clerks. Just because they get paid closer to the right amount Dr's and hospitals aren't suddenly going to be able to serve 10% more people.

I just find it funny that they called it the affordable care act and then ignored costs. They should have named it the subsidized care act because that's all it really does in the big picture.

There needs to be grown up talks about how to cut costs. Should hospitals and Dr's be forced to eat all ensuing costs when they screw up? Should malpractice insurance get reformed? Is Viagra really something that society should pay for? If you are 85 should you be allowed to get a bypass? (If I need those things then HEC YEAH- but honestly i'm not sure what the answer is)