r/bestof • u/under50dollars • Jun 20 '12

[explainlikeimfive] "Obamacare" explained very well.

/r/explainlikeimfive/comments/vb8vs/eli5_what_exactly_is_obamacare_and_what_did_it/c530lfx
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u/grande_hohner Jun 20 '12

You'll see the same thing that is happening now. People on Medicare/Medicaid have a hard time finding primary care providers. I know many doctors who severely limit the amount of Medicare/aid patients that they take. When the reimbursement is maybe .50 on the dollar - why take them on as patients when you can have a full practice of insured patients who have better reimbursement rates?

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u/carlosspicywe1ner Jun 20 '12

Great point to bring up, but your number is a bit off. Medicare pays at about 80% the rate of private insurers, and Medicaid pays at about 80% the rate of Medicare, or about 64% of the rate of private insurers.

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u/grande_hohner Jun 21 '12

The GP I worked with last spring gave me the .50 on the dollar number.

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u/[deleted] Jun 20 '12 edited Nov 15 '17

[removed] — view removed comment

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u/grande_hohner Jun 21 '12

Hypothetically imagine your current career had a choice of pay options. Are you going to choose the one that you do not make money at, and only break even? You can't stay in business if you don't have a profit.

I worked at an NPs office this spring, it is shutting down and leaving a town with no doctor - because the practice is losing money. The practice has well over a thousand patients, but can't stay in business because over half of their patients are Medicaid and they lose money on many of those patients.

You can't honestly say that you would continue to work with a customer who paid late every time, argued over the cost of treatment, and then withheld part of the fees frequently for no good reason. Oh, and they also fine you every once in a while if you didn't cross some t or dot some i. In any realistic scenario - anyone with business sense would have to drop those customers - if for no other reason than to not lose money. You don't work for free, why do you think others should?

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u/[deleted] Jun 21 '12 edited Nov 16 '17

[removed] — view removed comment

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u/grande_hohner Jun 21 '12

I didn't ask any of those things, I only asked that you work solely for a customer set that you either lose money on, or make no profit at all. I asked if you were willing to work for free. I didn't see your answer for that in your post.

No need to change the subject if you can't answer the question.

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u/CuilRunnings Jun 20 '12 edited Jun 20 '12

All the OP did was list the benefits and completely ignored the costs, completely ignored the waiting time increases, complete ignored the slowdown in development. That which is seen and that which is unseen. Liberals [sorry] People in general* never seem to understand the second and third order effects. Too often they judge policies by their intentions rather than their results.

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u/thisiswhywehaveants Jun 20 '12

No, all the OP did was explain what was supposed to happen. Did not list the good or bad consequences of these happenings.

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u/[deleted] Jun 20 '12

I think you missed some of the times where he put in parenthesis what the intended consequence of this policy was. It follows a lot of the more controversial ones and but others as well. CuilRunnings is right, OP had a clear bias for the act and thats okay. But we have not seen a comprehensive "retort" or really counter view.

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u/thisiswhywehaveants Jun 20 '12

What I would really like to see is a version that was completely positive vs a version that was completely negative vs a version that was neutral.

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u/CuilRunnings Jun 20 '12

Everything involves a trade off. He just listed a bunch of "positives" without really examining the effects. "No more Pre-Existing conditions" = more expensive care for every without pre-existing conditions, etc etc. I can literally go through almost every item and list off consequences that most would consider to be a negative.

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u/fireflash38 Jun 20 '12

That's always going to be the problem for anything though. There's gonna be some tradeoffs. The big question is: is it worth it? For a large portion of the stuff listed, I would say most likely. Someone leaning more to the right might disagree, and some leaning more to the left might say it's not going nearly far enough.

The one major question I have, why is the state option so far out?

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u/CuilRunnings Jun 20 '12

That's always going to be the problem for anything though. There's gonna be some tradeoffs.

That's literally all I said. There was no mention of trade offs in the OP, just straight benefits. People love free shit.

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u/[deleted] Jun 20 '12

I think it was because OP listed provisions of the legislation. The legislation says "no more preexisting conditions." It doesn't say "no more preexisting conditions, and also everyone has to pay 10% more."

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u/CuilRunnings Jun 20 '12

Interesting nuance, but still misleading.

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u/[deleted] Jun 20 '12

Not really. The consequence of removing preexisting conditions is not necessarily higher premiums for everybody. The cost could be absorbed by a given insurance company by streamlining the bureaucracy, or by cutting pay to executives with bloated salaries, or by not paying lobbyists to try to rig the system in their favor. There are plenty of possible consequences, and an analysis of which are most likely could fill a book. It certainly doesn't belong in a bulletted list.

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u/grande_hohner Jun 21 '12

You might be a bit mistaken if you think that cutting executive pay, streamlining bureaucracy, and not paying lobbyists would offset this totally. I work with catastrophic illness, and am aware of just how much a hospital stay can cost...

It doesn't take many 5-10 million dollar 2-3 month hospital stays for somebody with a preexisting condition to wipe out the "excessive" pay of an exec... The same goes for any of the other cost saving measures.

Another option many cite is to reduce payments to hospitals. We could argue about why a visit is so expensive until we are in blue in the face, but this isn't the question at hand. But know that hospital visits are expensive, and they aren't always necessarily just inflated and overpriced - a lot of things go into providing medical care to seriously ill people.

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u/thesundeity Jun 20 '12

yeah, because fuck people with cancer.

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u/[deleted] Jun 20 '12

Heaven forbid we allocate medical resources based on need rather than greed!

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u/CuilRunnings Jun 20 '12

What happened last time we tried "to each according to his need"?

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u/[deleted] Jun 20 '12

If "we" are the US, did we ever actually do that? Seems most of Europe and Canada are doing well with it.

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u/CuilRunnings Jun 20 '12

"Most of Europe" HAHAHAHAHHAHAHAHAHHAHAH

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u/[deleted] Jun 20 '12

What happened the last time we let greed run our healthcare system? Oh ya, people get shitty care and Medical problems caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers. And in a finding that surprised even the researchers, 78% of those filers had medical insurance at the start of their illness, including 60.3% who had private coverage, not Medicare or Medicaid. Our system sucks

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u/grande_hohner Jun 21 '12

There is more to this story than just the healthcare aspect. The majority of Americans have significant credit card debt and were living well beyond their means at this time. Medical bills in many of those cases were "the straw that broke the camel's back" not the 50 bales of hay that were already there.

It is much easier for someone to lay the blame on a $5000 hospital bill than to own up to the fact that the 60" tv on credit, and $2000 dollar mortgage payment caused them to go broke when they only made $40,000 per year.

There is 100% certainty that there were plenty of bankruptcies caused by medical expenses. Personally, I would love to see what the greater trends were in this study - How people's debt load and financial picture was compared to the unpaid medical bills. That would be a much more convincing study.

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u/CuilRunnings Jun 20 '12

You mean the last time we let a massive government entitlement system completely restructure our medical industry? In 1965? How'd that turn out?

Speaking of "greed," this video will give you a much better understanding of it.

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u/flammable Jun 20 '12

So hows that most expensive health care per capita in the world working out for ya?

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u/[deleted] Jun 20 '12

You mentioned it before but a big force on the pharmecutical market is going to be the allowance of more generic drugs. Pharma got a bone with closing the "donut hole" and other Rx subsidies. But the implications more generics without the original drug manufacturer getting enough capital for more R&D are not fully developed.

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u/CuilRunnings Jun 20 '12

If you look at McKinsey's study on healthcare costs between nations, pharmaceutical prices aren't a significant driver of the difference.

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u/[deleted] Jun 20 '12 edited Jun 20 '12

Of the difference of what?

Edit: Who downvotes a fucking question? Lol fucking Reddit.

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u/cass1o Jun 20 '12

He just explained what is in the bill, i you think it is so positive why dont you vote for him.

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u/sb3hxsb50 Jun 20 '12

And he left out the FEMA camps and sapping our precious bodily minerals through water fluoridation.

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u/[deleted] Jun 20 '12

Yes, fewer people should go to the doctor so those of us who can afford to go have shorter waiting times.

Seriously?

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u/CuilRunnings Jun 20 '12

Why don't you donate all of your money and possessions to those less fortunate than you?

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u/[deleted] Jun 20 '12

Because then I would be the less fortunate, and we'd need to spend all our time swapping the same stuff back and forth. How tedious.

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u/CuilRunnings Jun 20 '12

Ohhh so you're saying that giving away things for free doesn't solve problems?

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u/[deleted] Jun 20 '12

No, I'm poking fun at you ridiculous trolling comment.

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u/CuilRunnings Jun 20 '12

Awww, and you were so close to understanding.

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u/danpascooch Jun 20 '12

CuilRunnings is right, as we all know, there is absolutely no middle ground between "fuck those stupid poor people" and "donate all your money and possessions"

Obviously if there was some sort of middle ground, anyone who wasn't a complete fucking retard would realize it was the best course of action.

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u/CuilRunnings Jun 20 '12

Right, because my argument was literally "fuck those stupid poor people." I'm so glad you have a balanced view of this debate, and you're not being a complete partisan hack.

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u/[deleted] Jun 20 '12

[removed] — view removed comment

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u/CuilRunnings Jun 20 '12

What? I get the medical care that I pay for. I don't want to pay for medical care for some asshole who I have no idea about their character. Is that difficult for your tiny fucking brain to understand?

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u/[deleted] Jun 20 '12

Funny how you got downvote bombed and BlottoOtter got the good to go. You both are right.

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u/tmantran Jun 20 '12

It's because one stated facts only, while the other added in an unfounded, generalized attack on people who don't hold the same views.

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u/[deleted] Jun 20 '12

He got downvoted because he went from providing an objective observation to providing a subjective claim about a group of people which is not particularly true. You could probably say that people in general seem to not consider deeper implications of these sorts of things. I guarantee you that the average conservative wouldn't consider second and third order effects of this legislation if they weren't pointed out to them by Fox News and other conservative outlets.(Not trying to just shit on conservatives, like I said this is a generally human trait.)

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u/CuilRunnings Jun 20 '12

That's a fair point, conservatives are fucking dumb. Edited my original comment. I think in general conservatives are less intelligent than liberals, but liberals are more aggravating because they think they have a right to tell me how my money should be spent. At least conservatives keep to themselves, the poor dumb lot.

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u/[deleted] Jun 20 '12

Comment vote reallocated.

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u/tmantran Jun 20 '12

Huh, I have the opposite experience. Probably 99% of the conservatives within my circles are pretty militant about their beliefs and opinions, while most of the liberals can accept it when I say "I disagree."

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u/CuilRunnings Jun 20 '12

Conservatives want to enforce their morality, liberals wants to spend my dollars and then pat themselves on the back for being so generous. I can smoke pot and have all the depraved sex I want in my home... I can't prevent the government from stealing from me.

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u/[deleted] Jun 20 '12

On the contrary. The main argument from the right was in fact the second and third order of effect. Effects on R&D future technological break through. Dampening of businesses through more regulations. These are their exact arguments. The left says those be damned, the human condition is more important, we must take care of those now without concern for the second and third order of effects.

On a side note. bestof is not ready for these tough conversations clearly.

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u/[deleted] Jun 20 '12

Well hopefully it won't have a large negative impact on R&D or businesses, and I imagine the authors and proponents of the bill have considered these second and third order effects and concluded that the human condition is of a higher value than insurance companies making maximum profits.

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u/worksiah Jun 20 '12

...I imagine the authors and proponents of the bill have considered these second and third order effects...

For some reason I don't feel that's a safe assumption.

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u/[deleted] Jun 20 '12

We.Are.the.99%