ObamaCare Info

[leahjade]

We have an economic system under which we NEED a significant and growing portion of our workforce to fill low wage positions

These jobs were never meant to support a family! These jobs were meant to be taken by students, housewives, retired people who have insurance through parents, spouses, etc. To earn a living wage you must either get an education or learn a trade, it's as simple as that. You can't expect McDonalds and Walmart to pay $20 an hour and offer a whole array of benefits. Then your hamburger would cost $15 and your paper towels would cost $5 a roll. And how would that be helping the poor???

 

[mikek]

well since i pay 1291 a month for health insurance ( been paying our own for 18 years)on a low income........ i attempted to log on the exchanges just to see what the rates would be on this new plan that i am not sure how i feel about yet...cause honestly dont like goverment running things as it is........ and my state of NJ exchange isnt working....cant get past step 3 in setting up accound .. and been on hold for 30 minutes just to type in a chat question............... this should be fun...............maybe i will try later.......... after work........ for you guys from NJ got a flash back feeling to our old department of motor vehicles .......

same here- paying through the nose in NJ and trying to get on the website to see my options.

And while i understand the system is overloaded on day one, what moron didn't see that coming and figure out a way to work it? perhaps add 5 states a day to the system for a couple weeks. Maybe go by alphabetical order. Something. Rent resources from google/amazon/akatami/whoever. This is silly.

Also- i think it's a a band omen when there's already confusing directions and issues setting up an account - STEP ONE- lol:

The username is case sensitive. Choose a username that is 6-74 characters long and must contain a lowercase or capital letter, a number, or one of these symbols _.@/-“

so I try
firstlast@gmail.com
first.last@gmail.com
FirstLast@gmail.com
First.Last@gmail,com
none work.

finally get FLast## to work.

I'm not all that good at English, so maybe i misunderstood the instructions. But probably many of us trying the system are going to be grammar challenged.

I'm still trying to understand what the directions really mean. But apparently your user name MUST contain a #? And perhaps @ and . break things?

 

[leahjade]

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...

These problems are not the fault of the school district! You can spend a million dollars per student in an inner city school and if that child has no parental support and no desire to work to better themselves, you'll just be throwing money down the toilet.

 

[pilferk]

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.

None of it. The entirety of the "cut" (which wasn't really) was the reduction of the premium and some reduction of administrative costs they added in.

There has been some movement to cut reimbursement rates (again)...largely based on a decreased revenue stream from tax collection..but none of it related to the ACA. But there is also a refinement in submission processes coming (someday..they keep pushing it back) for providers, moving them (us) from ICD9 coding to a more specific ICD10 code set (and this probably isn't the forum to explain ICD 9/10 coding..suffice to say they represent diagnosis OR (with the CM's) procdures performed.

What does that last bit mean? It means that,sometimes, there is an ICD9 code that could have a higher reimbursement rate on it, but can be divided into 2 codes..one with a higher reimbursement rate, one with a lower reimbursement rate. By doing this, the govt saves some money, and they get a more accurate picture of patient care. Hospitals can't upcode....unless they want massive fines and their medicare status put in jeopardy.

Medicare, as it stands, basically covers costs..maybe a little bit less. But it's a survivable difference if everyone else is paying standard commercial/HMO reimbursement rates and it's not a difference that is going to drastically increase costs. That's even considering the growing Geriatric population (which, FYI, is a huge stressor on providers).

Medicaid is a different story. That almost never covers costs: inpatient, outpatient or clinic. Even with the clinics moving toward a more Nurse Practitioner (NP) or Physicians Assistant (PA) based model. It's better than nothing..but given the % of patients many hospitals see on Medicaid, it creates a sizeable gap that has to somehow be bridged. I can tell you, right now, that's being bridged through higher charges to everyone else.

And self pay? National average is about .05 on the dollar for all self pay COSTS. That means, for every 100 in costs you incur for that population..you're getting about $5 from that segment of your patient population. Essentially, you're giving that care away for free, but still have to cover the costs it incurs in your office, hospital, or whatever.

Most non-profit/charity hospitals end up with those self pay patients making up between 10% and 15% of their patient population. The "for profits" drop it down to somewhere between 5 and 8%, on average, and their collection is a bit higher (for various reasons) but it's still a big money gap to bridge.

With the Advantage care stuff...Yes, it sort of does mean nothing changed. When the Bush era congress and admin passed the Advantage Care provisions for Medicare (in 2001), it was stated during that time frame that the intention was always to phase out the premium price tag...it just hadn't gotten done yet, and there was no time table to do it, legislatively. The ACA just enacted a specific time table, and tied the "savings" to the act for the purpose of the CBO cost accounting. Basically, they moved one pile of money from one thing over to another...with no real effect on the user/consumer.

That administration/congress did it with the thought that private industry would be better at administering the plans....and be more efficient. They SHOULD be able to make a profit on same dollar for dollar claims, because of the economies of scale and infrastructure in place. BUT, they would need a premium to cover startup costs...so the government said "Hey, we'll pay you more now so that, down the road, we can pay the same..but get better results".

 

[leahjade]

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 difference is that I didn't know there was a free ride out there for me. Dumb as I was - I could've gotten financial aid, food stamps, welfare etc. but instead I thought I had to take out loans, and work full-time while going to school full-time. Trouble is now that there is a whole network of people out there telling their friends, children etc how to get into all kinds of programs for free stuff! I heard my niece (who is an unwed mother) telling her pregnant friend at a cookout last week how to get free healthcare, utility help and Section 8 housing. Thirty years ago that teenager would have had to work two jobs, get child support or marry the father! We make it far too easy.

 

[mikek]

These jobs were never meant to support a family! These jobs were meant to be taken by students, housewives, retired people who have insurance through parents, spouses, etc. To earn a living wage you must either get an education or learn a trade, it's as simple as that. You can't expect McDonalds and Walmart to pay $20 an hour and offer a whole array of benefits. Then your hamburger would cost $15 and your paper towels would cost $5 a roll. And how would that be helping the poor???

I have to agree with this. If you can't survive as a crew person at McDonalds or Walmart then become a manager or LEAVE. The problem is people can't leave because there aren't enough good jobs- that's the problem. McDonalds isn't the devil, the fact that the economy stinks so you can't leave McDonalds is the problem.

When i was a kid, like much of america, I worked at McDonalds. I actually worked 40hrs a week my senior year of HS and all that summer to earn some college cash. I didn't need insurance. When my kids are old enough to work i dont think they need to make $10-20 an hr at mcdonalds or wally world and get benefits.

People as a whole (sure there will be exceptions) shouldn't work in a McDonalds cooking on the grill for 5 or 10 years without a promotion or moving on to another job.

 

[pilferk]

These problems are not the fault of the school district! You can spend a million dollars per student in an inner city school and if that child has no parental support and no desire to work to better themselves, you'll just be throwing money down the toilet.

Again, reality vs theorycrafting. And, once more, I'd leave "desire" out of it. Because there is plenty of that. Plus...again..I'm not espousing throwing money at the problem. You're the one that keeps doing that. I'm simply pointing out that it exists.

These are the realities of the world we live in. However you would like to place blame (rightly or wrongly), they are what they are. There have been plenty of materials published on the subject (some of which support some of your positions, some which directly refute your other positions).

If you don't like the realities, work to change them (like I do, constantly). Change the system BEFORE you remove the underlying support.

Til then..this is the world we live in.

 

[pilferk]

These jobs were never meant to support a family! These jobs were meant to be taken by students, housewives, retired people who have insurance through parents, spouses, etc. To earn a living wage you must either get an education or learn a trade, it's as simple as that. You can't expect McDonalds and Walmart to pay $20 an hour and offer a whole array of benefits. Then your hamburger would cost $15 and your paper towels would cost $5 a roll. And how would that be helping the poor???

Well, at least not since the late 70's, early 80's. When minimum wage was actually a sustainable living wage, even if it was only marginally sustainable.

There are not enough people, in the categories you list, to be the entire impetus of the jobs you're talking about. And there is not enough competition, given the economy, in the labor market to drive up the labor cost to a sustainable level for those jobs to support a family. So you're in a really bad catch 22 right now.

Add to that there is an overly large labor pool, who's good paying (and good benefit) manufacturing jobs have all gotten on a boat and are not coming back. Those folks will take anything with a paycheck, right now, because they want to work...so employers are not exactly starving for applicants.

All that, combined, means we have a VERY large "underemployed" segment of the population right now. It's the dirty little secret the fed unemployment numbers don't tell you. And it's one nobody seems to have a good answer for....

Honestly, our problem is that we have to FIND a new direction for our economy. Manufacturing, as we know it, is gone and not likely to return. Service jobs work as a stop gap..but you have to have people who can spend money to be "served" for them to be worthwhile. And there are simply not enough with means to support the service industry/retail industry as it stands right now. Look at the retail numbers....they're terrible. "Flat" is considered a success story right now.

 

[leahjade]

If you don't like the realities, work to change them (like I do, constantly).

You are certainly not the only one. Our middle class family gives a chunk of our ever-dwindling income to charity, helps with food bank, volunteers with church programs for the poor and supports political candidates we feel will change this system. So I certainly am allowed to state my opinions since I put my money where my mouth is. I also work for a non-profit, so every day I deal with the problems of urban decay (which most have been caused by an entitlement system gone wild). So I'm not proposing removing the underlying support, I suggest not adding to the problem with more programs that will tax the middle class to death. I just heard a commercial this morning offering free high speed internet to anyone who is on food stamps. We do not need any more "freebie programs" and bureaucracies to support them.

 

[pilferk]

You are certainly not the only one. Our middle class family gives a chunk of our ever-dwindling income to charity, helps with food bank, volunteers with church programs for the poor and supports political candidates we feel will change this system. So I certainly am allowed to state my opinions since I put my money where my mouth is. I also work for a non-profit, so every day I deal with the problems of urban decay (which most have been caused by an entitlement system gone wild). So I'm not proposing removing the underlying support, I suggest not adding to the problem with more programs that will tax the middle class to death. I just heard a commercial this morning offering free high speed internet to anyone who is on food stamps. We do not need any more "freebie programs" and bureaucracies to support them.

I'm sure you do. And I would never pretend to be the only one.

But, as yet..the system and the realities remain unchanged. So we have more work to do, you and I (and others), and all the while we have to live in the world as it exists. Opinions are great, and they're a great impetus for change (especially when acted on)...but they don't instantly change what IS.

And again, I'm not here to argue the entitlement programs merits. I'll leave that to others. As I have said: Argue the merits/pitfalls of Obamacare til you're blue in the face..and you'll never ever hear a peep out of me.

But if you try to change reality into "how I wish it was"...we part company. You can't simply ignore the fact that these people require care, and the costs of that care need to be covered, somehow...or else you refuse them care, and they die.

Whatever path got them there (real or surmised), whatever their issues (real or surmised)....you come to that same endpoint.

 

[mikek]

...

There are not enough people, in the categories you list, to be the entire impetus of the jobs you're talking about. And there is not enough competition, given the economy, in the labor market to drive up the labor cost to a sustainable level for those jobs to support a family. So you're in a really bad catch 22 right now.....

While i agree entirely with you about underemployment - in the 80's and 90's there were more than enough kids, moms that worked lunch time but wanted to be home for kids and retired folks looking for something to do to run the McDonalds that i worked at. Others looking for a second job on an interim basis often worked the closing shift. Some special needs folks worked the lobby. There were managers that made it their career. out of the 50-100 people that worked in a store perhaps 2-3 early morning and 2-3 closing shift folks were earning their primary pay working at mcdonalds and probably needed public assistance for the issues they had that left them that way. It was far from a huge percentage "stuck"

There's a problem today that people are getting stuck in these jobs where you can't afford to feed your family.

More complex then that is that there's a nutty imbalance or something where I'd even say there's a problem that maybe trade type jobs can't afford to feed their family's but i can't begin to figure that out. Someone posted a great link way up higher that explored income levels in certain areas. I see in my zipcode the median is 100k! how does the car mechanic afford to live here?! it's crazy.

 

[pilferk]

While i agree entirely with you about underemployment - in the 80's and 90's there were more than enough kids, moms that worked lunch time but wanted to be home for kids and retired folks looking for something to do to run the McDonalds that i worked at. Others looking for a second job on an interim basis often worked the closing shift. Some special needs folks worked the lobby. There were managers that made it their career. out of the 50-100 people that worked in a store perhaps 2-3 early morning and 2-3 closing shift folks were earning their primary pay working at mcdonalds and probably needed public assistance for the issues they had that left them that way. It was far from a huge percentage "stuck"

A LOT has changed in the past 20 years-ish. Big box retail EXPLODED, service industry likewise went nuts..with marginal hiccups. All that access to cheap credit and home equity sent people into spending frenzies.

Which created a LOT of excess low wage employment opportunities.

So, while in the 80's and early 90's, I'd agree with you...in 2013 the numbers tell another story. A LOT of the "economic growth" we've seen (especially lately) has been in the lower third of the jobs categories...meaning the low wage positions. And the contraction has all been in the median wage positions.

Which leaves us in something of a mess....

And I agree...it might not be a huge % who are stuck. But then, it's not a huge percentage of uninsured we're talking about. Roughly 15% of the population....

There's a problem today that people are getting stuck in these jobs where you can't afford to feed your family.

It's getting worse because there's less to "graduate" to...the middle wage/income jobs are largely the ones that have disappeared. Where, before, you might be able to make the leap from, say, McDonalds to a manufacturing job (with similar education levels required) that payed pretty well..that's not the case any more. In fact..you're more likely to go the other way, given the labor market (from middle wage to lower wage).

More complex then that is that there's a nutty imbalance or something where I'd even say there's a problem that maybe trade type jobs can't afford to feed their family's but i can't begin to figure that out. Someone posted a great link way up higher that explored income levels in certain areas. I see in my zipcode the median is 100k! how does the car mechanic afford to live here?! it's crazy.

The problem with the trade jobs, now, is the lack of consistency in local work. It can rain jobs for a month..and then the work dries up for 3 or 4. Lots of that is the fact retail has hit a ceiling, and there's not a lot of expansion going on. Maintenance is nice, but I'm not sure it pays the bills every month. New construction and reno is, from what I've heard, much more lucrative.

And that 100k income is now considered pretty much middle class, if it's the sole income in the house. Maybe slightly upper middle.

Where...even 15 years ago...that was considered upper middle by a fair margin.

 

[leahjade]

"nice" anecdotal info

Give me anecdotal stories from doctors and nurses over studies and statistics any day. Any good prosecutor would much rather have eye witness testimony that studies from "experts" that can be bought or sold to the highest bidder. Statistics are usually skewed in the direction of whom is paying for the study.


And surprise, surprise the Obama care website doesn't even work - they weren't prepared for a lot of people signing on??? Is this who we want handling our life and death health decisions? This is going to be a bumpy ride!

By mid-morning, the healthcare.gov site declared "the system is down at the moment," and directed would-be participants to contact a call center if they need help immediately.

 

[pilferk]

Give me anecdotal stories from doctors and nurses over studies and statistics any day. Any good prosecutor would much rather have eye witness testimony that studies from "experts" that can be bought or sold to the highest bidder. Statistics are usually skewed in the direction of whom is paying for the study.

For a single instance or occurance of something (like a crime)? Yup, eye witness. And the more of them, the better. But given the choice between an eye witness and security footage..they'll take the objective footage over a subjective eye witness, too. Precisely because the eye witness can make mistakes, misremember, or flat out lie.

For observing, predicting, or summarizing a homogenized, massive group?

Sorry, data is king. Because, at it's core, it's pure. It might not show causals, and it's interpretations can be suspect. But the numbers, themselves, say exactly what they say.

For homogenized group activity, the exceptions are whats often noticed, commented on, and remembered by the individual. That's just the way the human brain works, and processes information.

And that's the difference between theory and science. The brain will construct a theory...then science (specifically the scientific method) will prove or disprove it.

If you prefer anecdotes...then that's where we'll part company. I daresay it's where you'll part company with most people. Because what you see, and what you remember, and even the way you view your experience is colored by your own ideology, your own opinions, and your own batch of experiences. And that may, or may not, be an accurate reflection of reality.

Data, largely, isn't colored by those things.

 

[pilferk]

Anyway...time for me to move on. It's starting to get a little repetetive....and I'm not really interested in tail chasing.

 

[leahjade]

Data, largely, isn't colored by those things.

Yep it is - it happens every day in drug studies, supplement studies etc. Depends who is footing the bill.

In a paper published online Tuesday in PloS Medicine researchers from Children's Hospital Boston report that when studies linking beverages to health are funded entirely by industry, the conclusions are four to eight times more likely to support the sponsor's commercial interest than studies with no industry funding.

/QUOTE]

Anyway...time for me to move on.

Me too. Some of us have jobs to go to so we can support the masses who want free healthcare, free Obama phones, free food stamps ......

 

[pilferk]

Yep it is - it happens every day in drug studies, supplement studies etc. Depends who is footing the bill.

In a paper published online Tuesday in PloS Medicine researchers from Children's Hospital Boston report that when studies linking beverages to health are funded entirely by industry, the conclusions are four to eight times more likely to support the sponsor's commercial interest than studies with no industry funding.

Me too. Some of us have jobs to go to so we can support the masses who want free healthcare, free Obama phones, free food stamps ......

Before I go...

You're talking about interpretation of data...not the data itself. Big difference.

 

[pryncess527]

Me too. Some of us have jobs to go to so we can support the masses who want free healthcare, free Obama phones, free food stamps ......

They are actually free Reagan phones

 

[annaaidan99]

Anyway...time for me to move on. It's starting to get a little repetetive....and I'm not really interested in tail chasing.

No! You made the most sense!

 

[eliza61]

You are certainly not the only one. Our middle class family gives a chunk of our ever-dwindling income to charity, helps with food bank, volunteers with church programs for the poor and supports political candidates we feel will change this system. So I certainly am allowed to state my opinions since I put my money where my mouth is. I also work for a non-profit, so every day I deal with the problems of urban decay (which most have been caused by an entitlement system gone wild). So I'm not proposing removing the underlying support, I suggest not adding to the problem with more programs that will tax the middle class to death. I just heard a commercial this morning offering free high speed internet to anyone who is on food stamps. We do not need any more "freebie programs" and bureaucracies to support them.

And you automatically assume that the government was paying the free high speed internet?

Just as a fyi, The free internet service are provide by internet access companies in exchange for keeping certain tax credit. The providers do not have to offer them, it is no different than you supporting a charity and then writing off the donations on your income tax.

So this program does not cost you a dime so why is it a problem?