ObamaCare

[illynifan34]

Under ObamaCare, a single committee—the United States Preventative Services Task Force—is empowered to evaluate preventive health services and decide which will be covered by health-insurance plans.

The task force already rates services with letter grades of "A" through "D" (or "I," if it has "insufficient evidence" to make a rating). But under ObamaCare, services rated "A" or "B"—such as colon cancer screening for adults aged 50-75—must be covered by health plans in full, without any co-pays. Many services that get "Cs" and "Ds"—such as screening for ovarian or testicular cancer—could get nixed from coverage entirely.

That's because mandating coverage for all the "A" and "B" services will be very costly. In 2000, the Congressional Budget Office estimated that the marginal cost of similar state insurance mandates was 5%-10% of total claims. Other estimates put the cost of mandates as high as 20% of premiums.

Why can't insurance companies decide for themselves what they will cover and then I can decide which insurance company is right for me based upon how I feel I match to their coverage. I hate being treated as an idiot.

[IntenselyOrange]

Originally Posted by DaytonIllini

I'd argue that the current system works best when it comes to advances in most areas of medicine. After all, the US ranks first in the world by most of these measures. If you are diagnosed with breast or prostate cancer in the US, you are much more likely to survive 5 years (in some diseases 20-30% more likely) than if you are diagnosed with the same disease in Canada or Europe. And while lead-time bias accounts for some of this, it doesn't account for the majority of the difference.

But we allow ourselves to be hoodwinked into thinking there is some grave flaw in our current system. There is not. Sure we have more pre-term child birth than they do in Scandinavia but if you give birth at 30 weeks there is no country in the world where your child has a better chance of surviving to adulthood. That is a SOCIAL problem, not a HEALTHCARE problem. And it is exactly the people that have so utterly failed to deal with social problems who are now claiming that they will solve our healthcare "problem". It is an absurd situation. It is a bit akin to delegating tasks to your worst worker. A worker with a history of failure in almost every task he is assigned.

Sure we have huge cost problems but that is a function of improper incentives and simply too much money paid per unit of healthcare. Can we get more for less? Of course. Does a nurse really need to make 68K? No. Does a doctor need to make $200K-2.5M? No. But reordering our healthcare program into some government dictated system won't work.

Europe is mostly socialized but almost no innovation comes from them. Almost all the innovation they have is made to take advantage of our markets or are really our companies that they have bought (see Roche purchase of Genentech).

I'm pretty sure Roche was #1 in oncology before acquiring Genentech. #2 is Novartis, right? But yes, they make all of their money off of us and do much of their research here also. However, those at Genetech have large enough egos as it is - no need to make them bigger .

[DaytonIllini]

Originally Posted by IntenselyOrange

I'm pretty sure Roche was #1 in oncology before acquiring Genentech. #2 is Novartis, right? But yes, they make all of their money off of us and do much of their research here also. However, those at Genetech have large enough egos as it is - no need to make them bigger .

Your knowledge of the pharm business far exceeds mine. The price controls in foreign countries essentially acts as a tariff on our businesses (through higher insurance rates for our employees). I see this as a major problem in the world's account balance. It's hard to have fair trade when the rest of the world is price fixing 10% of their economy.

[IntenselyOrange]

Originally Posted by DaytonIllini

Your knowledge of the pharm business far exceeds mine. The price controls in foreign countries essentially acts as a tariff on our businesses (through higher insurance rates for our employees). I see this as a major problem in the world's account balance. It's hard to have fair trade when the rest of the world is price fixing 10% of their economy.

But the sick irony is fantastic, isn't it?

You have many people who argue strongly that it's acceptable to take your money and give it to the poor. These same people are outraged that poorer nations get their drugs far cheaper than we do here in the rich United States.

[DaytonIllini]

Originally Posted by IntenselyOrange

But the sick irony is fantastic, isn't it?

You have many people who argue strongly that it's acceptable to take your money and give it to the poor. These same people are outraged that poorer nations get their drugs far cheaper than we do here in the rich United States.

I never thought of it that way.

[bdutts]

Originally Posted by bdutts

I'll be seeing my urologist on Wednesday (I have BHP and prostate cancer runs in my family). I'll ask him about that recommendation.

Saw my urologist yesterday. He said the way it was reported was misleading. For an otherwise healthy Caucasian, he would recommend getting a PSA test at the age of 50. Then he would review the result and determine how often it should be done in the future.

For those of us who have very close relatives with prostate cancer (brother, uncle or father), he recommends PSA screening every year starting at age 40. For me, my last PSA test was in 2010 and it was 2.30, which is borderline trouble for a guy my age (45). Since then, I had a procedure to shrink my prostate (I have BHP) and he wouldn't be surprised if my result is lower than 2.3. I will be getting a PSA test next week and my urologist recommends I get one every year, along with a DRE every year as well.

[Sure Shot]

Originally Posted by DaytonIllini

But we allow ourselves to be hoodwinked into thinking there is some grave flaw in our current system. There is not....

....Sure we have huge cost problems

Huge cost problems are a grave flaw. Increasing lack of access is another.

But I really liked something else you said in there, which was that the unhealthiness of the American people is a social problem, not a healthcare problem. That's absolutely true. HMO's aren't super-sizing people's fries at McDonalds.

Now, just because healthcare isn't the problem doesn't mean they aren't at least part of the solution, and I think they are. But we shouldn't buy into any notion that the health care system is going to solve all of our public health issues. Other issues, from education to farm subsidies to taxes to all sorts of things need to be marshaled in support of, most pressingly, reducing the waistline of America.

[DaytonIllini]

Originally Posted by bdutts

Saw my urologist yesterday. He said the way it was reported was misleading. For an otherwise healthy Caucasian, he would recommend getting a PSA test at the age of 50. Then he would review the result and determine how often it should be done in the future.

For those of us who have very close relatives with prostate cancer (brother, uncle or father), he recommends PSA screening every year starting at age 40. For me, my last PSA test was in 2010 and it was 2.30, which is borderline trouble for a guy my age (45). Since then, I had a procedure to shrink my prostate (I have BHP) and he wouldn't be surprised if my result is lower than 2.3. I will be getting a PSA test next week and my urologist recommends I get one every year, along with a DRE every year as well.

Sounds like sound advice.

Here is the principle investigator from the best study done to date on Prostate screening and it had some flaws but it's still the best and most mature study.

Dr. Schröder was the principal investigator of the European Randomized Study of Screening for Prostate Cancer (ERSPC), which found a mortality benefit from PSA screening — in contrast to the lack of effect found in the large American study published at the same time.

He takes issue with the way the USPSTF analyzed some of the data from that positive European study, and emphasizes that when the analysis is adjusted to follow men who actually underwent screening, it shows a large drop in prostate-cancer mortality — of 27% after 9 years of follow-up and of 56% after 14 years. Dr. Schröder also emphasizes a secondary end point of prostate cancer morbidity, and notes that a preliminary analysis suggests that screening reduces the relative risk for metastatic disease by 41%.

http://www.medscape.com/viewarticle/752482?src=nl_crb

[DaytonIllini]

Originally Posted by Sure Shot

Huge cost problems are a grave flaw. Increasing lack of access is another.

What I mean by those things is that, cost problems are a flaw in the insurance of healthcare, not in the delivery system. When you made healthcare free to everyone with insurance they do what always happens when demand is high and prices are infinitely low. They reach for more. Americans don't pay enough for healthcare so they abuse it and use it at the drop of a dime. Couple that with a ridicolous expectancy of care, a broken tort system, and a system of ridiculous privacy regulations and anti-trust regulations limiting the sharing of information (and thus redundant testing and prescribing on an epic scale) and you have a lot of costs.

I don't expect you all to understand this if you don't hang out with people with young kids but if you do, I guarantee you know some helicopter mother that is bringing their kids to the doctor everytime they get a sore throat, a sniffel or a bruise. Their kid is constantly on antibiotics and their facebook page is constantly updating the kid's 'strep' test results.

Ditto with the uninsured. Access problems are a myth for the most part as indigent systems in almost every part of the country are available. Sure you have to WAIT to see a specialist and you get the doctor you get and there is a good chance that you are not high on his priority list (since you are not paying him) but you still get care. In fact you get the care that you'd get if you lived in some 'utopia' like England. In Chicago and Dayton (there are no indigent to speak of in Rochester, MN), places I have worked extensively, a person with no insurance will get exactly the same care that someone with UHC will get. The primary difference is that you are going to see a less experienced doctor. Once a general surgeon has a full and busy practice he is not going to whittle on some guy with Medicaid. But the young new surgeon down the street will.

All that said, no matter how good I am if you are taking crack while pregnant, you are driving 90 mph w/o a seatbelt, or you take a series of .40 caliber slugs to the chest, or you SuperSize it every day, it is unlikely that the healthcare system can make you as healthy as a Japanese or Scandinavian where crime, violence, saturated fats and unsafe driving is far less common.

[DaytonIllini]

Poll: Most want Supreme Court to overturn individual health care mandate

I think you can argue the relative merits of those that want the whole law overturned and those that want none of it overturned. Overturning the mandate though is going to really create problems. The whole house of cards falls apart if I can wait to join the pool until I get sick.

[Sure Shot]

Originally Posted by DaytonIllini

I think you can argue the relative merits of those that want the whole law overturned and those that want none of it overturned. Overturning the mandate though is going to really create problems. The whole house of cards falls apart if I can wait to join the pool until I get sick.

No question about that. But why would they overturn the whole thing? I didn't even realize that was an option.

[DaytonIllini]

Originally Posted by Sure Shot

No question about that. But why would they overturn the whole thing? I didn't even realize that was an option.

From what I understand that is the most likely result. Perhaps a resident lawyer can explain it better but apparently there is often a clause added into a law saying that if any portion of this law is found to be unconstitutional the remainder will remain in force. Apparently the geniuses that wrote this 2000+ page monstrosity neglected something.

Also the Obama administration had argued, rightly in my opinion, that you cannot overturn the mandate because without it the whole thing is untenable. I don't know what to believe but I have read some opinion pieces by people that would not seem to have a desire to overturn the law who think that that is exactly what could happen.

[Sure Shot]

Oh my, there's no severability clause? Well that was a blunder.

[DaytonIllini]

Originally Posted by Sure Shot

Oh my, there's no severability clause? Well that was a blunder.

That is the clause I was looking for! Thanks. That's what I have read. Of course it might be hidden in the 2000 pages. I believe that was what Scalia was referring to when he said being forced to read the law was a violation of the 8th Amendment. There simply is no way for the court to determine whether the law can stand on its own because it is so intricate.

[DaytonIllini]

I don't know about the writing on this site but this MSNBC video in the site gives a pretty clear assessment of how severability was in the law and was removed (but nobody knows why - on accident or on purpose).

http://www.wrko.com/blog/todd/no-sev...socialist-plot

[DaytonIllini]

I might be reading more into this than I should

Ginsburg noted that one ACA-related question the court must decide is whether the whole law must fall if the individual mandate is unconstitutional — “or may the mandate be chopped, like a head of broccoli, from the rest of it?”

Read more: http://www.politico.com/news/stories...#ixzz1xvDhAjr6

but it sure sounds like at least some of ObamaCare is toast and it's just left to decide whether it's all gone or just some of it.

[illinirazorback]

Originally Posted by DaytonIllini

I might be reading more into this than I should



but it sure sounds like at least some of ObamaCare is toast and it's just left to decide whether it's all gone or just some of it.

No, even liberals are hinting about what they are going to do post-Obamacare. I'm not sure they care that much, as they will just turn it into an election issue about how Republicans and the Republican Supreme Court want to kill poor black people.

[illinibob]

Originally Posted by Lab Rat

You have to remember, what this "panel" decides doesn't apply to them. Their health care plan is paid in full by the taxpayers.

You really believe this is how the ACA works? Death panels? And theyre for you and me but not for Congress? And you work in health care? Terrifying.

How does a person with no insurance and limited resources get prostate screening now? You work in the industry so enlighten us.

[DaytonIllini]

Originally Posted by illinibob

You really believe this is how the ACA works? Death panels? And theyre for you and me but not for Congress? And you work in health care? Terrifying.

How does a person with no insurance and limited resources get prostate screening now? You work in the industry so enlighten us.

What is terrifying is your ignorance. Right before you is an example of a death panel. Sure it isn't a panel deciding whether YOU die, Obama decides that in his weekly meetings to decide who to assassinate without trial. It is a panel to decide whether people with prostate cancer are worth saving. Their answer was no. This group decides what insurance has to cover under ObamaCare.

The very fact that you call it the ACA shows your ridiculous lack of credibility.

[Sure Shot]

Originally Posted by DaytonIllini

The very fact that you call it the ACA shows your ridiculous lack of credibility.

[DaytonIllini]

Originally Posted by Sure Shot

ACA = Affordable Care Act

There is nothing Affordable about it. The only people that call it that are committed hardcore Democrats in their last gasp to defend a bloated, expensive bill. The good parts of which could have been reduced to the back of a napkin. Written in its entirety by Democrats. Voted for in its entirety by Democrats. God willing about to be stricken into the history books by 9 men and women in black robes.

It would be akin to calling the Afghan War, Operation Enduring Freedom. A ridiculous claim for a war where we murder people at will and send a general over once a month to apologize for slaughtering innocent civilians.

[Sure Shot]

Originally Posted by DaytonIllini

ACA = Affordable Care Act

There is nothing Affordable about it. The only people that call it that are committed hardcore Democrats in their last gasp to defend a bloated, expensive bill. The good parts of which could have been reduced to the back of a napkin. Written in its entirety by Democrats. Voted for in its entirety by Democrats. God willing about to be stricken into the history books by 9 men and women in black robes.

It would be akin to calling the Afghan War, Operation Enduring Freedom. A ridiculous claim for a war where we murder people at will and send a general over once a month to apologize for slaughtering innocent civilians.

Oh take a chill pill. It's the name of the law.

[DaytonIllini]

Originally Posted by Sure Shot

Oh take a chill pill. It's the name of the law.

Showing your bias further.

[DaytonIllini]

I wonder if there is pressure on Ginsburg and Breyer to retire right now. They are pretty old. If Obama could appoint young liberals to the bench before the election it would really help the party.

Otherwise Romney, if he wins, is likely to appoint replacements for Scalia, Kennedy, Breyer and Ginsburg. That would stack the court for the next decade or more. If Obama wins, he gets rid of the swing vote in Kennedy and probably the most conservative member in Scalia. Again the court would be decided for a decade or more.

This election is everything for cons and libs.

[Sure Shot]

Originally Posted by DaytonIllini

I wonder if there is pressure on Ginsburg and Breyer to retire right now. They are pretty old. If Obama could appoint young liberals to the bench before the election it would really help the party.

Otherwise Romney, if he wins, is likely to appoint replacements for Scalia, Kennedy, Breyer and Ginsburg. That would stack the court for the next decade or more. If Obama wins, he gets rid of the swing vote in Kennedy and probably the most conservative member in Scalia. Again the court would be decided for a decade or more.

This election is everything for cons and libs.

This is part of the reason I'd like to see some limitations on judicial tenure. When the latest polls out of Ohio and Florida pale in political significance to the results of an unelected old fart's prostate exam, something is broken.

How about 20 years active tenure, and then lifetime retired emeritus status to fill in for conflicted or otherwise absent judges, or to do whatever. This is essentially what already happens at the appellate level, thought the retirements are voluntary.

I'd also like to see the SCOTUS release unsigned, dissent-free opinions like many other countries do, but that can't be done by act of Congress.