Lizard King
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Post by Lizard King on Jan 23, 2014 13:59:22 GMT -5
The housing bubble had to burst - there was a limit to the cognitive dissonance that could collectively inform absurd transactions of liquid capital for depreciating assets. It was evident well in advance that it was going to happen, that millions of suckers up and down the country could be taken for a ride and were being taken for a ride, but that the ride was coming to an end pretty soon because, like any good Ponzi scheme, it needed increasing numbers of fresh suckers joining the ride to fund its continuation.
The healthcare bubble is a different animal, because the 'sucker' here isn't generally the patient themselves; the sucker is ultimately the government. You can advance the proposition that private insurers like Blue Cross Blue Shield are suckering the patients through an insurance scam - there was a story a while back about how that particular family of insurance companies was stockpiling eyewatering sums of reserve capital, far above requirements set by the insurance commissioners of the several states. But the biggest sucker is the government, and one of the most significant developments of PPACA - one of the biggest flashing neon signs of its disastrous idiocy - is its explicitly backstopping all the other suckers through its 'risk corridor' provisions (arguably, through its subsidy provisions as well). I know - those are scheduled to phase out after a couple of years (or, put another way, after the Obama presidency). But if the implementation of PPACA has been noteworthy for anything, it has been an absolute disregard for the law as it was written. As it stands, there is a decent chance that the individual mandate will join the employer mandate, the CLASS provision, and the restriction on (if not the redefinition of) catastrophic plans as a 'temporary' administrative fix to PPACA. One of the many ways in which Obamacare is unlike 'Romneycare' is that its eponym actually does identify the person most responsible for the form it bears in reality - the elected person in government who arguably had the least input on its crafting in the legislature.
Now, I would dearly like to believe that the torrent of deficit spending that can only be swelled, quite dramatically, be this massive introduction of moral hazard to the healthcare market would indeed prove impossible to continue - it just might be that there will be sufficient political will in 2014 to put in place the representative actors to materially transform it, although the most optimistic projections I've seen would return perhaps 54 Republicans to the Senate for the session starting in January 2015 (whether those 54 Republicans would find 6 Democrats open to radically transforming PPACA, or indeed follow Reid's lead and simply reform Senate rules to make that an unnecessary procedural step, is another question). But I really can't be sure of that. And I'm puzzled to see you seem to be, because you've elsewhere seemed entirely unconcerned about deficit spending now or projected into the future. On that basis, why do you think the government is going to stop funding the healthcare insurance it's guaranteeing for every sucker in the reformed system?
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djAdvocate
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Post by djAdvocate on Jan 23, 2014 14:23:09 GMT -5
The housing bubble had to burst - there was a limit to the cognitive dissonance that could collectively inform absurd transactions of liquid capital for depreciating assets. It was evident well in advance that it was going to happen, that millions of suckers up and down the country could be taken for a ride and were being taken for a ride, but that the ride was coming to an end pretty soon because, like any good Ponzi scheme, it needed increasing numbers of fresh suckers joining the ride to fund its continuation.
The healthcare bubble is a different animal, because the 'sucker' here isn't generally the patient themselves; the sucker is ultimately the government. You can advance the proposition that private insurers like Blue Cross Blue Shield are suckering the patients through an insurance scam - there was a story a while back about how that particular family of insurance companies was stockpiling eyewatering sums of reserve capital, far above requirements set by the insurance commissioners of the several states. But the biggest sucker is the government, and one of the most significant developments of PPACA - one of the biggest flashing neon signs of its disastrous idiocy - is its explicitly backstopping all the other suckers through its 'risk corridor' provisions (arguably, through its subsidy provisions as well). I know - those are scheduled to phase out after a couple of years (or, put another way, after the Obama presidency). But if the implementation of PPACA has been noteworthy for anything, it has been an absolute disregard for the law as it was written. As it stands, there is a decent chance that the individual mandate will join the employer mandate, the CLASS provision, and the restriction on (if not the redefinition of) catastrophic plans as a 'temporary' administrative fix to PPACA. One of the many ways in which Obamacare is unlike 'Romneycare' is that its eponym actually does identify the person most responsible for the form it bears in reality - the elected person in government who arguably had the least input on its crafting in the legislature.
Now, I would dearly like to believe that the torrent of deficit spending that can only be swelled, quite dramatically, be this massive introduction of moral hazard to the healthcare market would indeed prove impossible to continue - it just might be that there will be sufficient political will in 2014 to put in place the representative actors to materially transform it, although the most optimistic projections I've seen would return perhaps 54 Republicans to the Senate for the session starting in January 2015 (whether those 54 Republicans would find 6 Democrats open to radically transforming PPACA, or indeed follow Reid's lead and simply reform Senate rules to make that an unnecessary procedural step, is another question). But I really can't be sure of that. And I'm puzzled to see you seem to be, because you've elsewhere seemed entirely unconcerned about deficit spending now or projected into the future.
i don't know how you got that idea. i have defended deficits in economic downturn before, but never in a growing economy. they are unconscionable (sic).
On that basis, why do you think the government is going to stop funding the healthcare insurance it's guaranteeing for every sucker in the reformed system?
i thought we discussed this guarantee issue yesterday, no? i disagree that there is a guarantee of anything, unless you think that mandate and guarantee are synonyms.
i think 54 is quite optimistic. but 50 isn't. the result will be the same. anything regarding changes in the law will be vetoed by Obama. so it is 2017 you should be thinking about.
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Lizard King
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Post by Lizard King on Jan 23, 2014 15:46:23 GMT -5
The Federal government has had its chance to blame the insurance company boogeymen and the recalcitrant majority of states for the troubles of Obamacare. It has very much pulled its punches in that arena, because it absolutely has to have their assistance in the long-term for healthcare reform to be viable. By the same token, the more manifest the economic pressures created by PPACA become, the more likely I find it that the Federal government will expand its implicit guarantee to an actual one, much as it did with Fannie Mae and Freddie Mac during the housing bubble collapse, and for the same reason - there isn't enough spin out there to deflect enough political damage onto the other actors and away from the people who enacted the law. In this case, every one of those people still in government and relying on voters to stay there is a Democrat - that's a uniquely bad position for a political party to be in, and it means that the only practical limit to the spigot of subsidy support for the most obvious/immediate victims of this dunderheaded legislation is the level of resistance the Republican Party can offer.
Democrats shut down the government to protect this legislation last year, before the exchanges even opened. Are they really going to be less extreme in their defense of it as it continues to rollout? There's certainly a measure of chutzpah in Nancy Pelosi's breezy assurance that Democrats are going to run on a platform of supporting Obamacare and win, but this also is a genuine strand of thinking in the Democratic hierarchy. They are all in on this. You say the bubble has to burst: I tell you that any Democrat concerned with short-term political power has to keep it going.
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djAdvocate
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Post by djAdvocate on Jan 23, 2014 15:49:58 GMT -5
The Federal government has had its chance to blame the insurance company boogeymen and the recalcitrant majority of states for the troubles of Obamacare. It has very much pulled its punches in that arena, because it absolutely has to have their assistance in the long-term for healthcare reform to be viable. By the same token, the more manifest the economic pressures created by PPACA become, the more likely I find it that the Federal government will expand its implicit guarantee to an actual one, much as it did with Fannie Mae and Freddie Mac during the housing bubble collapse, and for the same reason - there isn't enough spin out there to deflect enough political damage onto the other actors and away from the people who enacted the law. In this case, every one of those people still in government and relying on voters to stay there is a Democrat - that's a uniquely bad position for a political party to be in, and it means that the only practical limit to the spigot of subsidy support for the most obvious/immediate victims of this dunderheaded legislation is the level of resistance the Republican Party can offer.
Democrats shut down the government to protect this legislation last year, before the exchanges even opened. Are they really going to be less extreme in their defense of it as it continues to rollout? There's certainly a measure of chutzpah in Nancy Pelosi's breezy assurance that Democrats are going to run on a platform of supporting Obamacare and win, but this also is a genuine strand of thinking in the Democratic hierarchy. They are all in on this. You say the bubble has to burst: I tell you that any Democrat concerned with short-term political power has to keep it going. you'd think so. after all, they have caved on virtually every major policy debate in recent memory. but then again, so has the GOP. no, i think this is permanent, phoenix. i know you and Paul keep insisting that this "disaster" will catch up to Democrats, and they will capitulate, but i just don't think so. i think they are going to go to the mat for this one. i have not seen ANY movement on the Democratic side on this issue in 4 years. none.
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Lizard King
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Post by Lizard King on Jan 23, 2014 16:10:53 GMT -5
In the context of the current discussion between us, over the last few posts on this thread, you were the one saying that the bubble had to burst: I'm the one saying the only way that will happen is if Democrats admit that the 'reform' hasn't worked, and I'm the one saying that they won't do this - instead, what they'll do is funnel more and more money into propping the structure up so that they can maintain the illusion of functionality by artificially inflating certain metrics which they will falsely assert are proxies for success.
Democrats have virtually ensured significant losses in 2014 that will leave the GOP in a stronger national position than in 2010, which really should have been the high-water point with a less dogmatic party in the White House and Senate majority. They have placed themselves in serious jeopardy of being entirely marginalized as the minority party, when that arises, by changing the rules of the Senate so that they could rush through friendly judicial appointments to stymie numerous challenges to the law. They have recklessly disregarded precedent on the limits of executive power, inviting the Roberts Court to rebuke the President in a manner seldom contemplated by SCOTUS. They have disregarded important and necessary work that they should have been doing to chase this hare. Most damningly of all, they have spent so much time spinning and rationalizing and maneuvering to get and keep the law on the books that they have done a truly wretched job of actually putting the thing into practice - it is frankly astonishing now that supporters like Jonathan Chait are crowing now that the only problems facing the law are the ones right-wing commentators were talking about in 2009. Apparently, the new measure of success is that the self-inflicted wounds the Obama administration has sustained on this since October weren't in themselves fatal (yet).
All of this indicates that they are not only going to the mat, but over the cliff, for PPACA. That's exactly why I say the cost curve won't bend downward - the counterfactual claim that it would have been worse will be the desperate Hail Mary play of a team with no other options, but it won't be supported by an actual reduction in costs. Magnificently, even if they were able to finagle some measure that gave the appearance of cutting costs overall, it would be in the context of really substantial cost-shifting onto the public - which, of course, is what's going to bite Democrats politically. That sticker shock is not only baked in, it's baked in repeatedly to keep re-energizing opposition to Obamacare and the Democratic Party with which it will be identified. A cynical Republican genius could not have masterminded a better tool to wound Democratic prospects than PPACA.
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djAdvocate
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Post by djAdvocate on Jan 23, 2014 16:32:18 GMT -5
In the context of the current discussion between us, over the last few posts on this thread, you were the one saying that the bubble had to burst: . i was talking about health insurance inflation, phoenix. did you misunderstand me?
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djAdvocate
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Post by djAdvocate on Jan 23, 2014 16:38:02 GMT -5
All of this indicates that they are not only going to the mat, but over the cliff, for PPACA. That's exactly why I say the cost curve won't bend downward -
i think it will. i just don't think it will have anything to do with the PPACA. it will have to do with more fundamental economic factors like disposable income.
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Lizard King
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Post by Lizard King on Jan 23, 2014 16:55:02 GMT -5
Then you think healthcare is a free market, essentially, in which healthcare services find their price point based on factors of supply and demand?
Manifestly, demand for healthcare services is not only not a positive correlate to the cost of those services, it's actually pretty well negatively correlated with that cost. Socialization of costs - the inflation of costs on more-affordable items more commonly demanded by more consumers to offset the shortfall in receipts from more-expensive items more rarely demanded by consumers typically unable to cover the costs of the service - is the fundamental reason why a healthcare market oriented along fee-for-service lines has inescapable inflation as long as service delivery isn't rationed.
Insofar as Obamacare reduces the degree to which rationing of compensation for care can take place, it exacerbates this effect. It does so in a context of introducing additional costs to all elements of the healthcare market, moreover.
You seem to be asserting that, if enough people can't afford health insurance two, three, five, fifty years down the line, then everything in the system will adjust cheaper to enable them to access it. That manifestly isn't what happens. Right now a significant section of the uninsured population are healthy people who choose to remain uninsured because the cost of insurance is too great - this doesn't lower the cost either of insurance or of healthcare delivery, in fact it increases both as insurers and providers try to compensate for the lack of healthy individuals in the pool. I don't see how you understand this longstanding widespread trend to reverse itself.
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Lizard King
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Post by Lizard King on Jan 23, 2014 17:00:35 GMT -5
I didn't, but what drives the inflation in service costs in the healthcare sector is the vagaries of reimbursement rates from insurers.
If a given hospital gets x% of revenue from insurer A, reimbursing at 70% of billed amount, y% from insurer B, reimbursing at 40% of billed amount, and z% from insurer C, reimbursing at 95% of billed amount, and if that hospital has no control over the size of x, y, and z but can reasonably predict their values over a period of time, then the only way it has to break even is to vary billed amount. Given that all the insurers have, as you've noted, a vested interest in driving their cost down (and in fact, the hardest bargainer in that market is the biggest: the government), the hospital is obliged to drive its cost up.
In other words, health insurance inflation can't be thought of as some coincidental external phenomenon that government policy has to contend with: health insurance inflation is a direct and indirect consequence of government policy on healthcare, and this is abundantly more true in a post-PPACA regulatory environment. The things PPACA does to the healthcare market - inverting the structure of the risk pool for insurers; increasing the overhead on insurers and providers; mandating additional coverage for insureds - all directly increase costs. The things PPACA does to cover its own costs in inflicting these extra costs on everybody in the market all indirectly increase costs. To endorse PPACA is to endorse sustained healthcare inflation: the Democratic Party cannot remain wedded to the one without remaining wedded to the other.
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djAdvocate
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Post by djAdvocate on Jan 23, 2014 18:52:26 GMT -5
Then you think healthcare is a free market, essentially, in which healthcare services find their price point based on factors of supply and demand?
Manifestly, demand for healthcare services is not only not a positive correlate to the cost of those services, it's actually pretty well negatively correlated with that cost. Socialization of costs - the inflation of costs on more-affordable items more commonly demanded by more consumers to offset the shortfall in receipts from more-expensive items more rarely demanded by consumers typically unable to cover the costs of the service - is the fundamental reason why a healthcare market oriented along fee-for-service lines has inescapable inflation as long as service delivery isn't rationed.
Insofar as Obamacare reduces the degree to which rationing of compensation for care can take place, it exacerbates this effect. It does so in a context of introducing additional costs to all elements of the healthcare market, moreover.
You seem to be asserting that, if enough people can't afford health insurance two, three, five, fifty years down the line, then everything in the system will adjust cheaper to enable them to access it. That manifestly isn't what happens. Right now a significant section of the uninsured population are healthy people who choose to remain uninsured because the cost of insurance is too great - this doesn't lower the cost either of insurance or of healthcare delivery, in fact it increases both as insurers and providers try to compensate for the lack of healthy individuals in the pool. I don't see how you understand this longstanding widespread trend to reverse itself.
interesting. so, you are saying that if, say, 80% of the insurance market will no longer to be able to afford premiums, and opt out of the system, that this will cause more inflation? that pricing won't respond to this, at all? that it will continue unabated as if the participants in that market were immaterial? sorry if i missed your point., but that is how i read it.
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djAdvocate
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Post by djAdvocate on Jan 23, 2014 18:54:26 GMT -5
The things PPACA does to the healthcare market - inverting the structure of the risk pool for insurers; increasing the overhead on insurers and providers; mandating additional coverage for insureds - all directly increase costs. The things PPACA does to cover its own costs in inflicting these extra costs on everybody in the market all indirectly increase costs. To endorse PPACA is to endorse sustained healthcare inflation: the Democratic Party cannot remain wedded to the one without remaining wedded to the other. incidentally, i am not especially interested in the ACA. i am more interested in the megatrend of health insurance. to the degree these subjects overlap, you have my attention- but when you start talking about the arcane details of how the ACA affects supply, my mind starts to wander. just FYI. if you care. edit: don't misread this as abuse of you for being interested in understanding it, and wanting to discuss it. i think it is a good thing to know about. i just have a lot on my plate right now, and this one doesn't really rise to the level of burning interest for me. i am glad it does for you and others, and i trust that you will advise others that are interested of your positions.
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AgeOfEnlightenmentSCP
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Post by AgeOfEnlightenmentSCP on Jan 30, 2014 8:03:51 GMT -5
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AgeOfEnlightenmentSCP
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Post by AgeOfEnlightenmentSCP on Jan 30, 2014 8:09:14 GMT -5
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Lizard King
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Post by Lizard King on Jan 30, 2014 8:33:26 GMT -5
Interesting it may be, but three months behind the times it certainly is.
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AgeOfEnlightenmentSCP
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Post by AgeOfEnlightenmentSCP on Jan 30, 2014 14:18:28 GMT -5
Interesting it may be, but three months behind the times it certainly is. Well, that's what makes it interesting. The last three months have manifest the 'concerns' expressed. Basically, we're at the conclusion of the projection now- and everything they feared has come to pass-- and more.
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AgeOfEnlightenmentSCP
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Post by AgeOfEnlightenmentSCP on Jan 31, 2014 13:31:20 GMT -5
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AgeOfEnlightenmentSCP
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Post by AgeOfEnlightenmentSCP on Jan 31, 2014 13:37:00 GMT -5
ObamaCare regulates restaurant menus- at customer expense of course...
Now, I would be fine with just saying, "NO!" to this, but for those of you totally obsessed with the idea that there must be an alternative-
HERE IS THE ALTERNATIVE:
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Post by EVT1 on Jan 31, 2014 14:37:08 GMT -5
Riiiight. Because before evil Obamacare the free market was all into paying for sick children with special care needs. Perhaps this tidbit from the article is important: "Patients being denied specialty treatment at the hospital by insurance providers on the Washington health benefits exchange. No news at all- this is what happens when you try to fix a shitty healthcare system and let the insurance companies be a part of it when they should have been kicked to the curb.
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Post by AgeOfEnlightenmentSCP on Jan 31, 2014 14:40:37 GMT -5
Riiiight. Because before evil Obamacare the free market was all into paying for sick children with special care needs. Perhaps this tidbit from the article is important: "Patients being denied specialty treatment at the hospital by insurance providers on the Washington health benefits exchange. No news at all- this is what happens when you try to fix a shitty healthcare system and let the insurance companies be a part of it when they should have been kicked to the curb. There's only one problem with your spin: the story is about children who had the specialty care paid for by private insurers prior to ObamaCare.
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Post by EVT1 on Jan 31, 2014 16:01:17 GMT -5
Are the new insurers not private? What changed? What part of Obamacare legislated insurers to deny treatments they were previously paying for? It's a one sided opinion piece- and something is rotten in Denmark. But I think Obamacare sucks as a solution if it makes you feel better. Doesn't make me a conservative either.
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Post by Deleted on Feb 2, 2014 16:03:12 GMT -5
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AgeOfEnlightenmentSCP
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Post by AgeOfEnlightenmentSCP on Feb 2, 2014 16:19:40 GMT -5
Are the new insurers not private? What changed? What part of Obamacare legislated insurers to deny treatments they were previously paying for? It's a one sided opinion piece- and something is rotten in Denmark. But I think Obamacare sucks as a solution if it makes you feel better. Doesn't make me a conservative either. Do they write their polices, or have the policies been dictated by government? The fact is that people are being dropped from existing policies because government meddling has outlawed them; and driven up costs as a result of requiring coverage people don't want causing coverage they have and need to be canceled, or cost prohibitive.
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Post by AgeOfEnlightenmentSCP on Feb 2, 2014 16:20:28 GMT -5
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workpublic
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Post by workpublic on Feb 3, 2014 10:25:46 GMT -5
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Post by EVT1 on Feb 3, 2014 21:01:10 GMT -5
Wow- so it seems the insurance companies and providers as well are eager to bring on single payer.
That's the part related to PBP's post- the government may mandate certain things be covered- but they do not write the policies or set the reimbursement rates between insurance companies and providers. Should have know this would happen- it is being sabotaged from every angle. Have at it- only a matter of time before people realize private insurance is not needed.
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Post by rockon on Feb 4, 2014 15:39:01 GMT -5
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Post by workpublic on Feb 4, 2014 15:49:24 GMT -5
sounds like to me that there will be rationing of care due to it. providers padded insurance claims to cover under paying medicaid, I guess they will pad claims for non exchange plans to cover under payments from exchange plans(or not except exchange patients). and cash payers will also see increases in costs. so folks on exchange plans will have less places available to go for services. this(WestMED not taking exchange patients) sounds like providers causing an issue, not insurance companies? the huge issue at weschester medical is the administration. they take huge increases in salary/bonuses while slashing headcount(the old lazy easy way to prop up the bottom line). there once top of the line care has fallen lately with layoffs of critical staff and nurses etc. the head of it(Isreal) just wanted to(don't know if he did) create a high paying political patronage job, while firing nurses the medical center is now just one of many quasi govt/non profit/private/taxpayer subsidized political payoff boondoggle crony capitalism NYS thing everyone in power or on the fringes in NYS are completely corrupt. the westchester DA and the one before her have mob connections for crying out loud. the governor/county/local officials allow the Hasidim to rob the school districts/towns/looks the other way on criminal issues in rockland blind for the block vote. we got an assembly man who voted against legalizing medical marijauna who was arrested for possession of marijauna. he has now had an epiphany(after he joined a hedgefund investment group that specializes in medical marijauna businesses) and now is strongly pushing for MM. we got a police chief in weschester who has kiddie pron on his computer and doesn't deny it. NY politics/real estate/law enforcement/EPA/etc are an inbred mess for the benefit of the very few to the detriment of the overwhelming majority.
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Lizard King
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Post by Lizard King on Feb 4, 2014 16:09:06 GMT -5
Eeeeeeeeeeeeeeeeeeeeh....
They do set rates of Medicare reimbursement to providers, though. Indeed, IPAB - created by PPACA - has the luxury of being able to do so without Congressional involvement (precisely for the purpose of artificially holding down reimbursement rates below what would be politically acceptable to Congressional representatives actually answerable to their constituents). And Medicare reimbursement rates set a bar for private insurers.
Also, government has done rather more with PPACA than simply mandate coverage for a raft of apparently essential items like pediatric dental care for grandparents - although that would be quite enough of a meddle on its own. There's a whole bunch of things that PPACA makes insurers do that add substantially to their costs, and a whole bunch of other things that compromise how well insurers can pass those costs onto premium-paying insured parties. The design of reform is to put the squeeze on providers - it's just that, in a dynamic market, people get creative when their livelihood is on the line and find alternatives the central planners didn't anticipate.
You mean 'before people realize fee-for-service paradigms necessarily drive healthcare inflation.' I really don't believe Obamacare successfully sets a stage for single-payer, even if it might have been conceived in some circles as an Alinskyite Trojan horse to that end.
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Post by Lizard King on Feb 4, 2014 16:10:16 GMT -5
workpublic liked his own post. What witchcraft is this?
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Post by workpublic on Feb 4, 2014 16:52:25 GMT -5
i wanted to edit it but hit the wrong button nice catch!
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