Ding.
Comment by Patterico (89e117) ? 2/1/2013 @ 1:01 pm
I?ll take the penalty/tax, thanks.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 1:03 pm
You?ll get nothing, and pay for it.
Comment by SarahW (b0e533) ? 2/1/2013 @ 1:04 pm
Exactly and sign up when I get seriously ill.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 1:06 pm
The high deductible health policy choice offered by my employer (that still protected against catastrophe and risk of an impossibly big outlay for care) which I got for a pittance in premiums was very satisfactory for many years. Under Obamacare that puppy?s no longer an option. Thanks Dems.
Comment by elissa (0a4492) ? 2/1/2013 @ 1:12 pm
?If you like your insurance you can keep it.?
Comment by Patterico (89b580) ? 2/1/2013 @ 1:19 pm
?Under Obamacare that puppy?s no longer an option.?
elissa ? A high deductible cat policy won?t count toward avoiding the penalty/tax under Obamacare, but I?m unclear whether insurance companies will still be permitted to write them.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 1:22 pm
They might be able to write them, but you?d still pay the penalty/tax.
Comment by Sammy Finkelman (d22d64) ? 2/1/2013 @ 1:26 pm
That cannot be true, Elissa. If you like your insurance, you can keep it. Obama said so.
Comment by JD (b63a52) ? 2/1/2013 @ 1:28 pm
Yes, we were lied to, and yes, we got Obamacare.
But the lies were irrelevant to passing Obamacare. It isn?t as if the public only supported Obamacare because of the lies? as we both know, the public didn?t support Obamacare, period. The public didn?t believe the claims Obamacare supporters were making (a majority of the public felt Obamacare would result in their having to pay more money for less care).
We got Obamacare because the Democrats in Congress decided that it was something they were going to force down our throats. They knew the numbers didn?t work and they didn?t care.
Comment by steve (369bc6) ? 2/1/2013 @ 1:28 pm
If the numbers don?t work now, just wait until we add 12,000,000 more to the rolls.
Comment by JD (b63a52) ? 2/1/2013 @ 1:31 pm
I?m unclear whether insurance companies will still be permitted to write them.
Me too, but my guess is that they?re not going to be allowed to, as Obamacare sets minimum standards that policies have to meet (such as offering ?free? contraceptive coverage) and catastrophic only plans won?t meet that standard.
Comment by steve (369bc6) ? 2/1/2013 @ 1:31 pm
?They might be able to write them, but you?d still pay the penalty/tax.?
Sammy ? I noted that in my comment. My question is whether HHS would prohibit insurers writing policies which allow people to do an end run around Obamacare given the differential between the size of penalty/tax and the anticipated premiums. Early on I heard they were going to prohibit such policies, but I have not heard anything in a couple of years.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 1:35 pm
daley?yeah, I don?t know either. I think probably not. The beauty of it was that it wasn?t strictly a ?we wash our hands of you until it?s a catastrophe/hospital? deal. You still filtered all dr?s visits, tests and emergency room visits through the plan to get the benefit of any negotiated prices with the provider that were lower than billed amount. They didn?t pay uniil the high dedudctible was reached, but you benefitted from the group rates on services.
Comment by elissa (0a4492) ? 2/1/2013 @ 1:35 pm
For anybody wanting an insurance primer, the cost is going up for four reasons:
1 ? the minimum level of coverage is going up (as everything including the kitchen sink will have to be covered), driving up the cost (you ?get? more, you pay more).
2 ? forcing people with coverage to subsidize the free and below market coverage provided to those without coverage (xx% of your premium pays for ?your? coverage, the balance of your premium dollars pays for someone else to get coverage),
3 ? eliminating waiting periods, prior period exclusions, lifetime caps on coverage and risk-based pricing increases the expectation of outlay, resulting in higher premiums, and
4 ? medical care just costs more every year. There are very few breakthroughs that lowers the cost of providing care.
Comment by steve (369bc6) ? 2/1/2013 @ 1:38 pm
4 ? medical care just costs more every year. There are very few breakthroughs that lowers the cost of providing care.
LASIK
Comment by JD (448fa8) ? 2/1/2013 @ 1:39 pm
Obama bends the health care cost curve down, in his mind, the same place where he splits atoms.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 1:46 pm
That?s one, can you name a second?
Also, Lasik isn?t usually covered by insurance, so allow me to modify my point to say that there is very little that lowers the cost of what is covered by insurance. And where the cost for a given procedure or drug does go down, it is usually because it was replaced by a more expensive drug or procedure.
Unfortunately, medical care isn?t like computers, where we can expect to get a better machine for relatively less money than the year before.
Comment by steve (369bc6) ? 2/1/2013 @ 1:48 pm
The cost of routine care would go down if the market weren?t distorted by price-fixing, and this distortion protected by removal of the true consumer from the cost of care.
Prudential planning should be rewarded with tax breaks that employers get now ? employers should pay you a wage. You decide how to allocate. Your insurance costs should be fully deductible. HSA?s grow tax free with contributions also deductible.
The insurance market is then regulated by the states to make sure it provides what it promises.
The truly indigent or disabled are covered in part or whole by programs that CANNOT dictate other fee arrangements and insurers are also forbidden to collude or prevent negotiation of individual treatment.
Comment by SarahW (b0e533) ? 2/1/2013 @ 1:52 pm
Steve ? the costs for many diagnostic and surgical services go WAY down when self-pay when the provider is not forbidden from a cash-schedule or direct negotiation. MRI, ultra-sound, etc. Plain old tort liability and professional standards still apply, so quality is uncompromised.
Comment by SarahW (b0e533) ? 2/1/2013 @ 1:54 pm
?And where the cost for a given procedure or drug does go down, it is usually because it was replaced by a more expensive drug or procedure.?
steve ? I think the movement of many surgical procedure away from hospital settings to specialized clinics or outpatient facilities has had an impact on costs, but that would have to be confirmed by some of the docs on the board. The Obama Admin. does not particularly support physician owned hospitals or surgery centers based on my understanding.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 1:55 pm
the costs for many diagnostic and surgical services go WAY down when self-pay when the provider is not forbidden from a cash-schedule or direct negotiation. MRI, ultra-sound, etc.
I make a distinction between the cost of the service and the amount you have to pay ? defining ?cost? in two different ways, and my referring to ?cost? refers to the cost incurred by the provider in providing that service. Negotiating a price break doesn?t result in a lower cost of providing the service, it merely shifts the costs to someone else?s pocket. It?s the flip side of Obamacare mandating that coverage for X or Y is ?free?? not charging someone for that specific coverage doesn?t mean it doesn?t cost the provider to provide that service.
The same may apply to the ?cost? of outpatient surgery. While the insurance company may not pay as much, I don?t know if the actual cost of providing the service is any less in a different environment. (I think it?s being done because the surgeons can have a stake in the facility and thus can make more for themselves).
Comment by steve (369bc6) ? 2/1/2013 @ 2:05 pm
?And where the cost for a given procedure or drug does go down, it is usually because it was replaced by a more expensive drug or procedure.?
steve ? How about laparoscopic surgery which has become so common for many surgeries over time. While it may involve a higher technology investment than more invasive surgery, how does the shorter recovery time/hospital stay affect overall cost?
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 2:06 pm
Based on this report http://ehbs.kff.org/pdf/2012/8345.pdf
the average cost for a family plan with employeer provided coverage is 15,700$ for 2012. If i assume 3% inflation it goes up to 17,1000 for 2015. This is for an employeer plan, I assume that buying a plan for an individual family is more expensive but I have no idea how much. It doesn?t really look like this is too far off from what we?re currently paying.
Comment by time123 (066362) ? 2/1/2013 @ 2:10 pm
?I make a distinction between the cost of the service and the amount you have to pay?
steve ? I thought you were trying to make an analogy to a manufacturing type business, that the ?cost of goods sold? in the health care industry only moves in one direction due to technology or research advances. What people actually pay, negotiate to pay, or the government pays for the goods and services are separate questions.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 2:12 pm
Time ? the employer gets a tax break, and gets to play an employee with that plan and keep him. The self-purchase family plan ? NO BREAK AT ALL, except you don?t pay the fine.
Comment by SarahW (b0e533) ? 2/1/2013 @ 2:14 pm
Steve, the better way is to remove as much market distortion as possible, preserve liberty and reward private prudence.
Comment by SarahW (b0e533) ? 2/1/2013 @ 2:15 pm
It doesn?t really look like this is too far off from what we?re currently paying.
Raise your hand if you are paying this much.
Comment by JD (448fa8) ? 2/1/2013 @ 2:17 pm
according to my W2 the cost of my health care package is 11K to my employeer. My monthly is sums up to about 2,500 so i?m at 13,5 total.
Comment by time123 (066362) ? 2/1/2013 @ 2:23 pm
?Nothing we?re going to do is going to fundamentally alter or eliminate the possibility of another mass shooting or guarantee that we will bring gun deaths down to a thousand a year from what we?re at now,? Biden said, according to a Politico report.
I think they are doing the same thing with healthcare
Comment by Neo (d1c681) ? 2/1/2013 @ 2:26 pm
LASIK is different because it is not covered so competition lowers prices. I believe all health are would be like that but for government subsidies.
Comment by Patterico (399c43) ? 2/1/2013 @ 2:29 pm
standard healthcare pricing reflects the fact that many, if not all, non-capitated payors discount their payments, such as only paying 80% of the total charges?
capitiated payors, of course, pay a flat rate, no matter what.
that is why you, if you are going to purchase treatment yourself, can negotiate a lower price. it?s also why you will often get a bill from a provider after receiving care, demanding that you pay the difference between what they charged and what they were paid by your insurer.
Comment by redc1c4 (403dff) ? 2/1/2013 @ 2:33 pm
It?s good to know that you?re content and sanguine about all this, time123, and that you believe you are not negatively affected by ACA as so many of us already know we are. Maybe out there some where you can find a few more pipple who are happy, too, and start a little Omamacare fan club. I don?t think you?re going to need a very big meeting room, though.
Comment by elissa (0a4492) ? 2/1/2013 @ 2:34 pm
about your EMR?s as mandated by Obamacare
yeah, the DEA thinks they are entitled to them without a warrant demonstrating probable cause?
Comment by redc1c4 (403dff) ? 2/1/2013 @ 2:36 pm
The ideal is that the entire population will be attended to under the VA.
It is bound to cut SocSec costs.
Comment by askeptic (b8ab92) ? 2/1/2013 @ 2:48 pm
My turnip has no blood.
Comment by mg (31009b) ? 2/1/2013 @ 2:50 pm
Redc1c4 its worse than that, really. Medicare not only drives pricing, and distorts insurance payouts, but insurers actually forbid free negotiation or cash-for-service pricing that is better that their contract reimbursement. Moreover 3rd party reimbursements are nororiously shell games with real cost often disconnected from reimbursement.
Comment by SarahW (b0e533) ? 2/1/2013 @ 2:51 pm
Why is it that the more we discover about the PPACA, the more that out-of-pocket, first-party, CASH is the solution to spriraling out-of-control health-insurance (and care) costs?
This is a problem created seventy years ago that is finally bearing bitter fruit.
Comment by askeptic (b8ab92) ? 2/1/2013 @ 2:54 pm
An extra 7000 out of the family budget? What difference does it make?
Comment by SarahW (b0e533) ? 2/1/2013 @ 2:59 pm
The bullet train of single payer is up and speeding towards the station!
Comment by Patricia (be0117) ? 2/1/2013 @ 3:00 pm
Patterico ? exactly why I picked that example.
Comment by JD (448fa8) ? 2/1/2013 @ 3:01 pm
Ditto 10. and 38. 
Comment by Joseph D (ece5cb) ? 2/1/2013 @ 3:09 pm
i was keeping it simple for the non-hc readers.
Comment by redc1c4 (403dff) ? 2/1/2013 @ 3:19 pm
SarahW ? if it?s true that health insurance purchased on the open market isn?t tax deductable, it seems like that?s something which should be fixed. (I don?t know, as I?ve always gotten insurance through an employer, so I?ve never had to find out.)
Comment by aphrael (009f82) ? 2/1/2013 @ 3:33 pm
I think our uruk hai is riffing off this;
http://www.motherjones.com/kevin-drum/2013/02/conservatives-shocked-discover-healthcare-america-really-expensive
Comment by narciso (3fec35) ? 2/1/2013 @ 4:11 pm
This is further proof, liberals think mathematics is a theory.
Comment by Kevin P. (1df29c) ? 2/1/2013 @ 4:48 pm
aphrael, you?re not getting the point. Obamacare was never meant to make health insurance more affordable.
Obamacare was meant to sabotage the last vestiges of whatever remains of the freemarket that hasn?t been killed off by all the other federal health insurance regulations since FDR?s new deal.
Obama and the Democrats intended this to fail so that they can get the single-payer system they always wanted.
It wasn?t intended to fix anything.
Barney Frank gives away the game. ?Saying we?ll do nothing until we get single-payer is a sure way never to get it.?
Yes, he says the best way to get single-payer is a ?strong public option.? But that doesn?t mean it?s the only way, as we are seeing.
Comment by Steve57 (104863) ? 2/1/2013 @ 4:50 pm
steve #15 ? one breakthrough that would lower the cost of providing care would be ?Loser Pays? ?
I don?t see our Pres?ent championing ?Loser Pays?, however ? (grin) ? he probably sees that as a racist personal attack ?
Comment by Alasdair (126343) ? 2/1/2013 @ 4:56 pm
Also see Jacob Hacker, Jan Shakowsky in 2009, and Obama in 2007,
Comment by narciso (3fec35) ? 2/1/2013 @ 4:57 pm
I wished it could have been a Happy Birthday for Andrew Brietbart today.
Comment by mg (31009b) ? 2/1/2013 @ 5:10 pm
#23: I don?t know. In addition to the capital costs of that and other device/technique improvements, I figure there?s also a chance that the quantity goes up, thus raising the costs.
#25, no to the manufacturing analogy. Yes to saying that lowering the ?cost? you?re charged for a particular procedure doesn?t mean that the costs of providing that procedure have gone down, only that those costs have been shifted to someone else to pay.
#30 While the consumer cost of Lasik has gone down, I don?t believe that?s the case with cosmetic surgery, which is also generally not covered by insurance. Nor, at least in my experience, has dental care which is often paid for on an out of pocket basis (the only dentists participating in my plan are ones I wouldn?t want to go to).
Comment by steve (e7e6c7) ? 2/1/2013 @ 5:19 pm
SarahW ? if it?s true that health insurance purchased on the open market isn?t tax deductable, it seems like that?s something which should be fixed. (I don?t know, as I?ve always gotten insurance through an employer, so I?ve never had to find out.)
aphrael, the problem is that once you start issuing tax deductions for purchasing health insurance on the open market, you further blow a hole in the alleged ?cost containment? of ObamaCare. But, you know, maybe that is just another bump on the road to single payer.
Comment by JVW (4826a9) ? 2/1/2013 @ 5:25 pm
It is kind of ironic that the Health Care reform outlawed true health insurance (#3) in favor of postpaid subsidized health services.
As is usual with the Blue ?safety net?, responsible people get penalized [um, taxed, and I denounce myself] and the deadbeats get the bennies.
Forward!
Comment by Kevin M (bf8ad7) ? 2/1/2013 @ 5:27 pm
Worst political class in history (and we?ve had some pretty bad ones), worst President in history.
Simply unbelievable.
Comment by SPQR (768505) ? 2/1/2013 @ 5:30 pm
You still filtered all dr?s visits, tests and emergency room visits through the plan to get the benefit of any negotiated prices with the provider that were lower than billed amount. They didn?t pay uniil the high dedudctible was reached, but you benefitted from the group rates on services.
And they kept that negotiated rate as low as possible so that your total stayed under their payment threshold.
This would be my ideal plan ? people focus on moronic things like whether a plan is 70/30 or 80/20, when the bulk of the savings occurs in the negotiated rate, even if the payments are 0/100 like you describe. And I?m covered if they have to scrape me off the pavement.
Comment by Kevin M (bf8ad7) ? 2/1/2013 @ 5:31 pm
SPQR?
Don?t know yet if he?s worse than Buchanan. A slide to civil war is pretty much the gold standard for worst.
Comment by Kevin M (bf8ad7) ? 2/1/2013 @ 5:33 pm
steve @50 ? Now you have totally lost me with your analysis. Your claim was that you could not think of one advance in drugs or medical technology which reduced costs.
You need to make up your mind what ?costs? you are talking about, the cost of providing a good or service or the ?cost? to the payor. Stop moving the goal posts.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 5:37 pm
Raise your hand if you are paying this much.
Two 59-year-olds on a gold-plated PPO (with PPO dental and glasses) ? $16K. I have to assume that two 40-year-olds with two kids and an HMO ought to be substantially less ? I could get an HMO plan TO-DAY for under $10K.
Comment by Kevin M (bf8ad7) ? 2/1/2013 @ 5:38 pm
typo. two 30-year-olds and two kids.
Comment by Kevin M (bf8ad7) ? 2/1/2013 @ 5:39 pm
This is further proof, liberals think mathematics is a theory.
And they think mathematics ends with arithmetic. I do wish one had to divide two numbers in one?s head in order to vote.
Comment by Kevin M (bf8ad7) ? 2/1/2013 @ 5:41 pm
I?ve always addressed the cost of providing the service. Who pays is a political shell game. Sorry if you haven?t been able to figure that out.
Comment by steve (e7e6c7) ? 2/1/2013 @ 5:44 pm
?aphrael, the problem is that once you start issuing tax deductions for purchasing health insurance on the open market, you further blow a hole in the alleged ?cost containment? of ObamaCare.?
JVW ? You can deduct premiums for individually purchased health insurance on Schedule A, subject to the 7.5% threshold of income base limit for medical expenses, the same way you can include the employee contribution of to purchasing employer sponsored health insurance. You can also deduct it elsewhere as a self-employed individual.
Nasty complications set in though if you get reimbursements from the insurance plan, which the IRS requires you to offset against the expense.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 5:47 pm
?I?ve always addressed the cost of providing the service. Who pays is a political shell game. Sorry if you haven?t been able to figure that out.?
steve ? You did exactly the opposite in comment 50 and emphasized it by disagreeing with the manufacturing example, talking about increasing the number of procedures performed from comment #23 and focusing on shifting payments.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 5:51 pm
?I?ve always addressed the cost of providing the service.?
steve ? Cost to who, the provider or payor, whoever that may be?
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 5:52 pm
Let me try s l o w e r
Medical providers incur a certain cost providing health care. Hospitals have fixed and variable costs, doctors incur costs (including an hourly rate for their time), drug companies have production costs of developing and manufacturing pills and so on. This is what I have been referring to as ?cost?.
My argument, which I think I have been consistent in arguing, is that these costs (1) with few exceptions, don?t go down, and (2) most of the argument over health care/insurance/Obamacare is over who has to pay those costs.
Comment by steve (e7e6c7) ? 2/1/2013 @ 6:06 pm
I understand that if I like my doctor, I can keep him. But if I don?t like my President, must I keep him ?
Comment by Elephant Stone (30e04f) ? 2/1/2013 @ 6:31 pm
No, you can?t, and you have no choice in the matter.
Comment by narciso (3fec35) ? 2/1/2013 @ 6:39 pm
Comment by Elephant Stone (30e04f) ? 2/1/2013 @ 6:31 pm
Hereby nominated for post of the week.
I?ve written about this before.
In 1960 a heart attack was treated by telling the person to stay in bed and rest. By 1970 one stayed in a special ?intensive care unit? to be monitored for life-threatening complications such as unstable heart rhythms. By 1980 people were having surgery to treat or prevent heart attacks. By 1990 even more people were having angioplasty. In inflation-adjusted dollars I don?t know if an angioplasty in 2013 is cheaper than surgery in 1980 or not. It certainly isn?t cheaper than being told to stay home and rest in the 1960?s when these fed programs were started.
Likewise kidney failure in 1960 was cheap, one died. Then dialysis came along and kidney failure treatment became expensive. Kidney transplants are cheaper in the long run (last time I heard anyway), but not cheap.
Genital herpes was not considered a common issue in 1970, now Valtrex is advertised as essentially a daily vitamin for all the otherwise healthy, smiling young folk who need to take it forever, and that nasty HIV hadn?t been heard of yet, but the cost of meds alone to treat it is in the $10,000+/yr.
A child with leukemia in 1960 died, now most live with treatment that involves a lot.
There are some advances that decrease cost, such as an angioplasty instead of open heart surgery, and laparoscopic gall-bladder surgery instead of an open, but as much of the advance in medicine is being able to treat what was once untreatable, one should expect the cost to increase.
But that is only a small part of the miriad of issues.
Comment by MD in Philly (3d3f72) ? 2/1/2013 @ 7:08 pm
?My argument, which I think I have been consistent in arguing, is that these costs (1) with few exceptions, don?t go down?
steve ? fine, except that you have not really addressed the specific examples of potentially lower costs offered in this thread, outpatient surgery, laparoscopic surgery and Lasiks.
The price paid by the payors, whoever they are, is a separate issue.
Comment by daleyrocks (bf33e9) ? 2/1/2013 @ 7:12 pm
MD, there are lots of things that cost less, too.
Get a bleeding ulcer today, and the treatment is generally non-invasive. In 1960, OMG. And many ulcers are solved with antibiotics before they get that far.
Break a femur in 1960 and you might well lose the leg; today you get a titanium replacement. Cost? Depends on what you count, but the cost of not having a leg is pretty high in lost productivity just to start with.
As far as ?death? costing little, again the living person may pay lots of taxes every year, which stop soon after death, even assuming that their contributions to society don?t count for government beancounters. Not all sick people are senile. Saving the productive is an investment, not a cost.
Then there are steroids, vaccines, statins, this/that/and the other-blockers, and lost of things that keep people active and unsick for years after they would otherwise succumb. Again, this may ?cost? but be quite cost-effective.
For every dialysis there?s another thing that makes up for it.
Comment by Kevin M (bf8ad7) ? 2/1/2013 @ 7:54 pm
*host
Comment by Kevin M (bf8ad7) ? 2/1/2013 @ 7:55 pm
I will do like most drivers in Texas do.. buy insurance a month before they have to have car registered, show the required proof of liability insruance, then cancel for 11 months, renew the 12th month..
Comment by Ric Mann (d9c7e5) ? 2/1/2013 @ 8:00 pm
Wonder what it costs to become a health insurance company for a month.. sign my family up,check the 1040 box in 2014 for ?covered? and go ?bankrupt? on April 16th? *it is what most insurance companies will do in about 3 years anyway.
Comment by Ric Mann (d9c7e5) ? 2/1/2013 @ 8:09 pm
As far as ?death? costing little, again the living person may pay lots of taxes every year, which stop soon after death, even assuming that their contributions to society don?t count for government beancounters. Not all sick people are senile. Saving the productive is an investment, not a cost.?
Then there are steroids, vaccines, statins, this/that/and the other-blockers, and lost of things that keep people active and unsick for years after they would otherwise succumb. Again, this may ?cost? but be quite cost-effective.
Comment by Kevin M (bf8ad7) ? 2/1/2013 @ 7:54 pm
Oh, I agree 100% with you on this. In fact, I generally distrust anything that talks about ?cost effectiveness? in medicine (especially when talking about treating or letting die) because I don?t think they take such larger considerations into account.
But in this discussion, for example, the focus is only on what it costs for insurance and medical care, not what people and society get in return.
I guess, for example, one can look at health care costs as a percentage of GDP, but no one talks about the total GDP that was made possible by the health care.
Comment by MD in Philly (3d3f72) ? 2/1/2013 @ 8:12 pm
What did I say wrong in #71 and #72?
Comment by Rich Mann (777abd) ? 2/1/2013 @ 8:25 pm
This is further proof, liberals think mathematics is a theory.
Comment by Kevin P. (1df29c) ? 2/1/2013 @ 4:48 pm
? They believe in unintelligent design.
Comment by Icy (15c060) ? 2/1/2013 @ 8:32 pm
Comment by Rich Mann (777abd) ? 2/1/2013 @ 8:25 pm
If you are wondering why I did not make any reference to your posts, please do not assume anything was meant by it. There are at least 2 reasons that have nothing to do with your posts:
1) I think slow and type slower. I know I started on #73 before you posted #72, and maybe before #71 as well.
2) I was responding to something I had already posted on.
Comment by MD in Philly (3d3f72) ? 2/1/2013 @ 8:33 pm
Ric, you have to file, with your taxes, a statement on which months you had insurance3 and pay a pro-rated penalty for the months you didn?t. You can lie, of course, but the IRS may catch you at it.
Comment by Kevin M (bf8ad7) ? 2/1/2013 @ 8:43 pm
Maybe I will search out a LASIK facility that will discuss their actual costs of a procedure. In 2000, Better Half paid $5500 for both eyes. It now costs around $3000. The earlier prices were even higher. I cannot imagine that their costs have continue to go up while the price to the customer continues to go down. Maybe they had insane margins in 2000, and are just barely scraping by now.
Comment by JD (b63a52) ? 2/1/2013 @ 8:43 pm
My guess is that the economics of LASIK is more like that of consumer electronics, a new something that is neat but nobody needs to have. At first it is really pricey and only a few can afford, but as popularity increases and the overhead of production decreases the cost comes down.
I imagine cornea transplants, which have been around a lot longer, have not decreased in price, as it is something only a limited number of people get and only when they must.
Comment by MD in Philly (3d3f72) ? 2/1/2013 @ 8:51 pm
Also competition. When lasik was new there were relatively few who could do it, now the availability/supply is much greater.
Comment by MD in Philly (3d3f72) ? 2/1/2013 @ 8:52 pm
And boobs. Boobs are cheaper.
Comment by JD (b63a52) ? 2/1/2013 @ 9:20 pm
I think also that preventative care has driven up cost. My friends and I who have had breast cancer think, geez, they have spent millions following up on us! It would have been cheaper (for insurance companies) to find the tumor late enough to do us in.
Comment by Patricia (be0117) ? 2/1/2013 @ 10:01 pm
Can?t wait until our media darlings such as Andrea Mitchell-DNBC and David Gregory-DNBC, etc to start telling us how great the cost savings are and how wrong oppostition to Obama Care was over the next few years.
Comment by Ipso Fatso (1e3278) ? 2/2/2013 @ 4:13 am
As my tax biz has gone full tilt this week, noticed that in box 12 of every W2 is a new entry coded ?DD?, which is the amount of health care an employer pays for the taxpayer. There?s no reason to tell anyone that unless at some point in the future it?s taxed as income. The word is ?inevitable?.
Also rumored that the IRS as per Obama will lag refund payments to make the books look better, if only short-term. NY state did that in the 1990s but people complained and it was stopped after 2 years of nonsense. The IRS has delayed filing and refund payments anyway if you claim credits for higher education, energy-related home improvements and most other tax credits.
Comment by Bugg (ba4ca9) ? 2/2/2013 @ 5:17 am
I said there were ?very few? breakthroughs that lowered the cost of providing care. The examples you cite fall into the category of ?very few? and nowhere near enough to push down overall spending.
Think of medical spending in this way: #patients X #procedures per patient X $cost of each procedure. Given an increasing population (normal population growth, people living longer and Obamacare adding to the rolls), and a population that is generally unwilling to take care of themselves in a way that preempts the need for care later in life, and the first 2/3 of the equation results in a higher number. The ?cost? of providing care would have to go down for a lot more than the relative handful of examples to keep overall costs just stable. Since Lasik, etc., are the exception rather than the rule, we end up with the situation we have, health care costs on an ever-increasing trajectory.
Comment by steve (e7e6c7) ? 2/2/2013 @ 6:08 am
An additional thought, FWIW, a lot of medicaid goes to nursing home care subsidies. This will continue to rise not only because of an aging population, but because of smaller families and other social factors (mobility, etc.) that erode
the ability and willingness of families to take care of their own.
Comment by MD in Philly (3d3f72) ? 2/2/2013 @ 6:42 am
well duh
From Reuters:
The Obama administration?s chief officer for Medicaid said the program has made years of progress in enrollment and will become more accessible next year under the reform law, even in states that do not participate in the coming expansion.
?As enrollment barriers are eliminated, participation rates of eligible people increases and the uninsured rate for individuals declines,? Medicaid director Cindy Mann said
Comment by elissa (1c0cc3) ? 2/2/2013 @ 7:31 am
Since Lasik, etc., are the exception rather than the rule,
Being an exception is the key. They are generally outside the standard insurance plans, and actually have to compete in a market.
You casually dismissed outpatient surgical centers above, but are another example of costs being driven down.
Comment by JD (b63a52) ? 2/2/2013 @ 7:35 am
Remember who is writing the rules;
http://spectator.org/archives/2010/06/04/the-empress-of-obamacare
Comment by narciso (3fec35) ? 2/2/2013 @ 8:12 am
The Obama Adminstration has no respect for the rule of law and no intention of keeping its already vague promises when it comes to topics like immigration. Why should what Obama?s methods and intentions for ObamaCare be any different?
Comment by DRJ (a83b8b) ? 2/2/2013 @ 8:21 am
Laws are for the little people,DRJ. They have some transforming to do.
Comment by JD (b63a52) ? 2/2/2013 @ 8:38 am
You can continue to nitpick and come up with a couple more examples, but when the exceptions are but (and I?m guessing) .001% of total medical costs, they?re not going to bend the cost curve too much.
Comment by steve (e7e6c7) ? 2/2/2013 @ 8:48 am
Repeal of McCarran (the fellow who they based Sen. Geary on/Ferguson, which blocks interstate insurance sales would have been a good start.
Comment by narciso (3fec35) ? 2/2/2013 @ 9:10 am
Everyone should just agree with what steve says. He cares more. It is a fact that costs have come down in some aspects ? LASIK, surgical outpatient centers, boob jobs, cosmetic surgeries in general. Ironically, that which makes them exceptions to your rule is what is good about them, and should be more emulated, not casually dismissed as exceptions, or what you think to be profit driven for owners.
Comment by JD (b63a52) ? 2/2/2013 @ 9:37 am
The Obama Adminstration has no respect for the rule of law
Well, the very fact its Secretary of the Treasury, who also therefore is the head of the IRS, is known to have cheated on his taxes, yet still got confirmed by our wonderful, beautiful system, does send a good message: That the IRS deserves all the respect that its current bigwig gave it awhile back.
I don?t like the idea of cheating and dishonesty, but if America is going to end up like a bigger version of Greece ? where many people are idiotically leftwing (and therefore boozy and giddy about all the entitlements provided by taxes) but no less notorious for also BSing on their tax returns ? we might just as well follow the custom of ?when in Athens, do as the Greeks do.?
Comment by Mark (68549d) ? 2/2/2013 @ 9:44 am
The Ken Burns programs on Prohibition demonstrate vividly what happens when poorly constructed and draconian laws are not considered sane and are therefore dis-respected by the general public. Prohibition was the poster child for unintended consequences. Prohibition opened wide the door for the criminal underworld with all its violence and graft to work with increasingly crooked local pols to provide (or overlook) product that was not legal? but was desired by the people. One of the program?s sections is aptly titled ?Everybody?s a Lawbreaker?, which shows how, as prohibition stumbled on, almost any citizen could find ways to obtain alchohol for home use and knew of not so secret underground social places where they could enjoy it with others. Millions of regular Joes and Janes from all walks of life did eventually casually and cavalierly ?break the law? about liquor, believing (quite properly) that the law was stupid and did not deserve their respect or deserve to be obeyed. This was the first serious mass law-breaking as response to political legislation in a nation that had pretty much obligingly gone by the rules up till then.
I suspect something very similar and black marketish will happen regarding both avoidance of Obamacare rules and obtaining/providing needed medical services, ahem, privately. Any draconian gun laws which are passed will unleash the same black market forces and graft that ultimately doomed Prohibition and make violent crime even worse. But our ?betters? don?t get it. I don?t think their desired goal of lousy, restricted, NHS-style single payer medical care will avoid the unintended consequences, either.
Yes, alchoholism was/is a societal problem just as gun violence and the high price of medical care are societal problems. But the lesson of prohibition is that the wrong government mandated ?cure? can be way worse and affect much more than just those with the problem or disease.
Maybe if Dems were more conversant with math and history?..
Comment by elissa (1c0cc3) ? 2/2/2013 @ 10:41 am
Elissa,
A good illustration, but one difference is that ?anybody? can be part of the bootleg alcohol stream; to provide medical care (other than providing bottles of pills without the safeguards of a pharmacist) requires training and an enforceable license.
Pity the first doc/dentist whoever that gets caught running afoul of ObamaCare, their practice location will be behind bars.
While all realize the problems with prohibition, the problems of alcohol abuse result in much misery as well. Of course, alcohol does not need to be imported from out of the country, and the relative social stigma (or lack thereof) made it more imaginable for the ?typical family? to break the law than heroin, cocaine, crystal meth, and to a lesser degree pot.
But many a spouse or child would have liked alcohol to be outlawed, though they know it is just a wish, not a workable solution.
Comment by MD in Philly (3d3f72) ? 2/2/2013 @ 10:57 am
As the local radio station says, when Obamacare goes into effect, where will Canadians go for their health care.
Maybe setting up a medical/surgical practice in Costa Rica would be a good idea, the old idea of ?getting some fresh air? by the ocean or in the mountains combined with 21st century medicine, at lower cost than in the US anyway.
Lots of Spanish speakers who can go in and out of the country ?easily? go to the Dominican republic for breast cosmetic surgery because of the decreased costs.
No, I don?t know if there is any overlap with other ?business opportunities? in the DR.
Comment by MD in Philly (3d3f72) ? 2/2/2013 @ 11:02 am
More house calls, maybe?
Comment by elissa (1c0cc3) ? 2/2/2013 @ 11:13 am
MD?when our close-knit little neighborhood suffered a ?once a century? flood a while back most of us were stranded from the outside world for a few days without electricity while sloshing through river water laying sandbags to protect property, trying to keep generators going, checking on each other, sharing food, etc. A neighbor, a doctor, got someone from his practice to come in as close as possible in a Hummer and he went out to meet it in his hip-waders because he needed to peform a critical surgery. When he returned home that night, again via the Hummer shuttle, he brought extra supplies and he came around and gave any of us who wanted/needed one a free tetanous shot.
Comment by elissa (1c0cc3) ? 2/2/2013 @ 11:33 am
Good comments, MD and elissa. I hope none of us become dependent on our neighbors for basic necessities ? although I fear we?re all closer to that now, thanks to Obama ? but it?s nice to know we live among people who will help.
Comment by DRJ (a83b8b) ? 2/2/2013 @ 11:45 am
?A good illustration, but one difference is that ?anybody? can be part of the bootleg alcohol stream; to provide medical care (other than providing bottles of pills without the safeguards of a pharmacist) requires training and an enforceable license.?
MD in Philly ? In the insurance industry it is illegal for insurers to charge different customers different prices for the same product. A group health (employer provided) policy is rated and priced differently than an individually purchased health insurance policy. From an insurance perspective, they are not the same product.
On the medical side, I don?t know what, if any, rules govern the differential pricing seen in the marketplace for providers of healthcare goods and services.
Comment by daleyrocks (bf33e9) ? 2/2/2013 @ 11:56 am
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