The Tulsa Forum by TulsaNow

http://www.theatlantic.com/business/archive/2012/06/the-health-care-decision-explained-in-1-paragraph-on-scotusblog/259097/
The Health Care Decision, Explained in 1 Paragraph on SCOTUSblog
By Derek Thompson

Jun 28 2012, 10:37 AM ET33


In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding.

http://www.politico.com/blogs/on-congress/2012/06/rand-paul-obamacare-is-still-unconstitutional-127574.html

Last time I checked, opthamologist <> Supreme Court Justice.

Why Women Stand To Gain the Most From the Health Care Decision

http://www.slate.com/blogs/xx_factor/2012/06/28/supreme_court_and_health_care_why_the_decision_is_good_news_for_women_.html (http://www.slate.com/blogs/xx_factor/2012/06/28/supreme_court_and_health_care_why_the_decision_is_good_news_for_women_.html)

QuoteThe Supreme Court's decision is in. With the Affordable Care Act mostly intact, tens of millions of uninsured Americans will gain coverage. Senior citizens will get billions of dollars of prescription drug benefits. Everyone with insurance will get preventive services at no cost. Roughly 60,000 people now covered by the new Pre-existing Condition Insurance Plan will still have that coverage, even though they are actually sick and thus might actually use it. We all still have the guarantee that our policies won't be canceled when we get sick. And our adult children can stay on our health plans until they're 26.

The bullet we just collectively dodged would have caused pain throughout the country, with women taking the hardest hit. That's because women stand to gain the most from the health law. We are already getting improved benefits under the Affordable Care Act—things like mammograms, pap smears, and immunizations for our kids, which insurers have been required to cover without a co-pay since last year. And in just over a month, on Aug. 1, women will have the same unfettered access to diabetes screenings (men too, but women are more negatively impacted by the disease), annual well-woman visits, HPV testing, domestic violence screenings, breast-feeding support, and, after much wrangling, contraception.

Even more is on the horizon, of course. Though the decision left new room for states to wiggle out of expanding their Medicaid programs in 2014, millions of uninsured women will still likely gain coverage this way, when states are made to include everyone with incomes below 133 percent of the federal poverty level. Also, by then, insurers will be forbidden from charging women more, an abhorrent practice known (though apparently not widely known) as gender rating.

Women have been getting a harsh deal on health care for years. We pay more than men on average for our policies. It's been de rigueur—and perfectly legal—to deny us coverage in the private insurance market because we have had breast cancer or a c-section or been sexually assaulted. (Men are denied coverage because of pre-existing conditions, too, of course, but women, being more likely to have chronic diseases, are more likely to face this problem.) Even pregnancy has been grounds for insurance companies to refuse policies on the grounds that it's a pre-existing condition. 

All this made women more likely to be uninsured—as one in five women under 65 were in 2010. And even when we did have coverage, we often weren't able to get our insurers to pay for birth control and other basic prevention (even while they were doling out Viagra, no questions asked).

Many mothers stayed in full-time jobs they didn't otherwise want because they provided them, and their kids, with health care. Shameful bogus "maternity insurers" sprung up to exploit the very real desperation of pregnant women who couldn't find care in the individual market. And because many health plans lacked abortion coverage, some women even resorted to do-it-yourself abortions.

And then came the Affordable Care Act. Years after other rich nations figured out how to provide all their citizens with decent health care, we were finally heading there ourselves. Had the court decided to reverse that progress, women might have remained stoic. Given our years spent taking the greed and unfairness of the insurance industry on the chin (and uterus), you might think we'd just soldier on with our benefits returned to their former pathetic level.

But I don't think so. While this decision is a victory for the Obama administration, it should also come as a relief to the very Republicans who mounted the challenge—and surely would have been the objects of wrath had they stripped these basic, humane gains from the millions of women and other Americans who are already benefiting from them.

While I disagree with the concept of Obamacare (and since I am insured and have health care already built in the family), I cannot argue too terribly right now with the "tax" rationale of the mandate. I personally do not know how it will look if the IRS begins chasing around lower or middle class "tax cheats" who do not want insurance and refuse (or cannot afford) to pay the tax. My thought is that it is not the "rich" or even the "middle" who have an issue with paying for or having health care, only the government intrusion part bothers them.

QuoteAlso, by then, insurers will be forbidden from charging women more, an abhorrent practice known (though apparently not widely known) as gender rating.

Women have been getting a harsh deal on health care for years. We pay more than men on average for our policies. It's been de rigueur—and perfectly legal—to deny us coverage in the private insurance market because we have had breast cancer or a c-section or been sexually assaulted. (Men are denied coverage because of pre-existing conditions, too, of course, but women, being more likely to have chronic diseases, are more likely to face this problem.) Even pregnancy has been grounds for insurance companies to refuse policies on the grounds that it's a pre-existing condition. 

Uh, this is the way all insurance works.  The largest risks and highest exposures for loss always have a higher premium!

It's going to be a few years before we can truly see either the benefit or complete folly the ACA is on medical costs.  Honestly, I don't see how costs come down when you bring 10+ more million people into the care pool.

Quote from: Conan71 on June 28, 2012, 03:33:30 PM
Uh, this is the way all insurance works.  The largest risks and highest exposures for loss always have a higher premium!

It's going to be a few years before we can truly see either the benefit or complete folly the ACA is on medical costs.  Honestly, I don't see how costs come down when you bring 10+ more million people into the care pool.

They'll have insurance now?

Quote from: guido911 on June 28, 2012, 03:03:38 PM
While I disagree with the concept of Obamacare (and since I am insured and have health care already built in the family), I cannot argue too terribly right now with the "tax" rationale of the mandate. I personally do not know how it will look if the IRS begins chasing around lower or middle class "tax cheats" who do not want insurance and refuse (or cannot afford) to pay the tax. My thought is that it is not the "rich" or even the "middle" who have an issue with paying for or having health care, only the government intrusion part bothers them.

Why don't they want health insurance? Will they have a private health savings account? If so they are in the system! Or do they just want to go to the Hospital and pay per use, or not pay at all? In that case you and I have traditionally paid for them with higher insurance premiums.

Quote from: Conan71 on June 28, 2012, 03:33:30 PM
Uh, this is the way all insurance works.  The largest risks and highest exposures for loss always have a higher premium!

It's going to be a few years before we can truly see either the benefit or complete folly the ACA is on medical costs.  Honestly, I don't see how costs come down when you bring 10+ more million people into the care pool.

hopefully 80% or better of these additional people are healthy so they are just paying and only using their new insurance for preventive medicine.

Quote from: carltonplace on June 28, 2012, 03:39:18 PM
Why don't they want health insurance? Will they have a private health savings account? If so they are in the system! Or do they just want to go to the Hospital and pay per use, or not pay at all? In that case you and I have traditionally paid for them with higher insurance premiums.

And hospital costs.  CT scan at St John's was $1,000 more my cost than a private stand alone in South Tulsa.  Per the admin I spoke with, "to cover the costs the hospital has to absorb from helping the uninsured."

Quote from: Conan71 on June 28, 2012, 03:33:30 PM
Uh, this is the way all insurance works.  The largest risks and highest exposures for loss always have a higher premium!

That is not how insurance works. Depending the amount of risk the insured wishes to self insure for, the premium can be lowered substantially despite the risk and exposure. I know you know this so why did you say "always?"   ???

Quote from: Townsend on June 28, 2012, 03:43:41 PM
And hospital costs.  CT scan at St John's was $1,000 more my cost than a private stand alone in South Tulsa.  Per the admin I spoke with, "to cover the costs the hospital has to absorb from helping the uninsured."

You can negotiate with them by saying "I'm not paying that amount....I will pay you what they charge in South Tulsa and no more." ( we refer to this as Christianing them down on price ;) :D)

Quote from: Teatownclown on June 28, 2012, 03:44:46 PM
That is not how insurance works. Depending the amount of risk the insured wishes to self insure for, the premium can be lowered substantially despite the risk and exposure. I know you know this so why did you say "always?"   ???

I'm not comparing how much someone cares to self-insure on the cost difference between two separate risks, simply the level of risk.

Given the same deductible from one policy to another, if the risk of exposure is greater to the insurer, the premium will be higher at given deductible levels whether the deductible is $500 or $1500 for the person, building, or ?? which represents a higher risk to the insurer.

Quote from: Conan71 on June 28, 2012, 03:50:24 PM
I'm not comparing how much someone cares to self-insure on the cost difference between two separate risks, simply the level of risk.

Given the same deductible from one policy to another, if the risk of exposure is greater to the insurer, the premium will be higher at given deductible levels whether the deductible is $500 or $1500 for the person, building, or ?? which represents a higher risk to the insurer.

So, you take self insuring and premium balancing out of the discussion to get to an identical deductible? I see why I have to argue with you so often..... ::)

What the Obamacare Ruling Means for Consumers

http://www.usnews.com/news/articles/2012/06/28/what-the-obamacare-ruling-means-for-consumers (http://www.usnews.com/news/articles/2012/06/28/what-the-obamacare-ruling-means-for-consumers)

QuoteThe Supreme Court's ruling on the Affordable Care Act—also known as Obamacare—is being hailed as a victory for President Barack Obama and healthcare reform, but what does it mean for consumers' pocketbooks?

Here's a breakdown of how the Affordable Care Act affects you:

The uninsured. For the millions of uninsured Americans, the Supreme Court's ruling to uphold the individual mandate—the part of the Affordable Care Act that requires most Americans to have health insurance—means they'll have to get health insurance by 2014, or pay a penalty of $95 a year or 1 percent of their income, whichever is greater.

Insurance companies will be required to sell policies to everyone regardless of current or past health issues. As a result, over the next two decades, tens of millions more Americans will get health coverage under the new systems.


"The law certainly facilitates greater access to health insurance for millions of consumers," says David Balto, a Washington, D.C.-based attorney.

Americans looking for health insurance will also be able to better shop around for coverage the fits their needs using "health insurance exchanges" that function a lot like online travel agencies such as Expedia.

That is if the law survives past the November election. According to some experts, the Supreme Court's decision will give Republicans and other opponents fresh fodder to campaign on in the months leading up to the election.

The insured. For the other 256 million Americans who already have health insurance through their employers or another source, the impact isn't as dramatic. Parents will still get to keep kids on their insurance plans up to age 26 and many insurers will continue to offer preventative services, such as immunizations, without a co-pay.

While most insurance companies instituted the major provisions of the health care law, there could be changes coming down the pipeline as insurers tweak plans to comply with new regulations, such as covering preventative services without a co-pay. The new regulations almost certainly mean rising premiums, which have already edged up according to experts. That doesn't even take into consideration the overall rising costs of healthcare, which insurers pass on to customers.

"Insurance companies are still free to add to the premium for the additional benefits that they're required to offer," says Caryl Carpenter, professor of health care management at Widener University. "People with insurance can also expect an increase not because of the Affordable Care Act, but just because health care costs are still going up."


Seniors on the other hand could see a little break in their premiums as the Affordable Care Act puts some restrictions on how much insurers can vary costs by age.

Those eligible for Medicare. Seniors who fell in the "doughnut hole"—the gap in Medicare's prescription drug coverage—will continue to get discounts on their medications.

Those eligible for Medicaid. According to the Court's ruling, expansion of state Medicaid programs is no longer mandatory. So while a greater number of less fortunate Americans would have had access to care under the ACA's Medicaid expansion, that probably won't happen now. Given how fragile many state budgets are, states have not been eager to expand Medicaid because it takes necessary spending away from other things, Carpenter says.

"It's no longer mandatory that [states] expand [Medicaid], and if a voluntary option continues to exist, it may not be exercised," she says. "The consumer who would've gotten coverage [under Medicaid] probably lost out in this decision."

Quote from: carltonplace on June 28, 2012, 03:39:18 PM
Why don't they want health insurance? Will they have a private health savings account? If so they are in the system! Or do they just want to go to the Hospital and pay per use, or not pay at all? In that case you and I have traditionally paid for them with higher insurance premiums.

Some people, especially the young, consider themselves "healthy" and figure the cost of insurance is unnecessary. Kinda of a gamble. Then there is EMTALA. Also, there are wealthy people who don't need it or pay out of pocket.

In a way I want to see how this plays out. Stop the litigation, interference, and give this a chance.

Quote from: Teatownclown on June 28, 2012, 03:53:08 PM
So, you take self insuring and premium balancing out of the discussion to get to an identical deductible? I see why I have to argue with you so often..... ::)

No, I'm making a simple point that higher risk always equates to higher premiums. Don't make it so difficult on yourself.

Deductibles are simply a way to mitigate how much you end up paying in premiums.

Quote from: guido911 on June 28, 2012, 04:05:00 PM
Some people, especially the young, consider themselves "healthy" and figure the cost of insurance is unnecessary. Kinda of a gamble. Then there is EMTALA. Also, there are wealthy people who don't need it or pay out of pocket.

In a way I want to see how this plays out. Stop the litigation, interference, and give this a chance.

Insurance is a financial tool only. It does nothing to actually provide health care. That is what doctors and hospitals do. It only has to do with paying for said care. Young people take the risk just like some people take the risk of not buying life insurance, or auto insurance (beyond the minimum), or trip insurance. It is always a risk, but a financial one all the same.

I don't really see how ACA can reduce costs for insurance. Making everyone buy will likely add many health payers which logically should lower the premiums for everyone, however, it will be countered somewhat by the fact that now no one can be denied insurance regardless of preexisting conditions. Honestly I don't understand why insurers are that worried about the later, the risk has been reduced, they already know the client will be chronically ill or whatever. Charge them out the nose and move on. Just like someone who wrecks cars a bunch. Do they ever stop them from buying insurance...not that I've heard. It just starts getting pretty expensive.

Disclaimer: Since I don't work in insurance, and personally can't stand dealing with it :) , I could be totally off base on all of this.

Where do I get a application for CEO of the red tape division in the United States Government healthcare plan?

Quote from: DolfanBob on June 28, 2012, 05:07:56 PM
Where do I get a application for CEO of the red tape division in the United States Government healthcare plan?

Bundle $250K for Obama '12 and you won't even have to fill out the application.

Quote from: erfalf on June 28, 2012, 04:22:40 PM
Insurance is a financial tool only. It does nothing to actually provide health care....

Bingo!  A while back I was talking to someone from overseas and they mentioned that. "How is health insurance,,, health care?"  It's like we buy car insurance, but don't have a maintenance plan.  We don't change the oil etc, (don't eat right and exercise) then the engine drops out.   If you have regular maintenance/preventative care/inspections and "healthcare" you can reduce costs.   

Quote from: TheArtist on June 28, 2012, 05:36:20 PM
Bingo!  A while back I was talking to someone from overseas and they mentioned that.

Three days ago I was talking to someone from overseas and it shocked them that, for example, Medicare can't negotiate on drug prices. For around $50, I could have had someone come to the place where I was staying to draw blood and whatever else was needed, get the results of the tests online by the next day, then take the printout to an English speaking doctor and get a full physical. None of it subsidized by the government. That's private system cost. Further, if I needed a CT for whatever reason, or say a colonoscopy, that would be another $50. And if I needed the drugs delivered, that would cost me a whopping two bucks, plus the drugs themselves cost less than a tenth what they do here. Even on a typical $1000-$1500 a month (equivalent) local salary, none of that is unaffordable.

In said country, the only point in health insurance if you have even a modest income is to cover the catastrophic care. If a person is destitute, the government pays for it all at no cost to the end user, which helps keep disease from spreading unnecessarily.

The cost of insurance here is outrageous, but it's not only because of for-profit insurers driving up costs through arcane rules and refusal to standardize, it's also due to the outrageous cost of drugs, procedures, and everything else. Given that the same companies can sell the same stuff (MRI machines, drugs, whatever) to people in other countries for so much less, isn't it a bit odd that they charge us so much?

Anyway, I think the HCR law will probably help slow the increase in costs in some areas, but overall it doesn't go far enough in breaking the rent-seeking behavior endemic in the medical profession.

Quote from: nathanm on June 28, 2012, 05:49:35 PM
Three days ago I was talking to someone from overseas and it shocked them that, for example, Medicare can't negotiate on drug prices. For around $50, I could have had someone come to the place where I was staying to draw blood and whatever else was needed, get the results of the tests online by the next day, then take the printout to an English speaking doctor and get a full physical. None of it subsidized by the government. That's private system cost. Further, if I needed a CT for whatever reason, or say a colonoscopy, that would be another $50. And if I needed the drugs delivered, that would cost me a whopping two bucks, plus the drugs themselves cost less than a tenth what they do here. Even on a typical $1000-$1500 a month (equivalent) local salary, none of that is unaffordable.

In said country, the only point in health insurance if you have even a modest income is to cover the catastrophic care. If a person is destitute, the government pays for it all at no cost to the end user, which helps keep disease from spreading unnecessarily.

The cost of insurance here is outrageous, but it's not only because of for-profit insurers driving up costs through arcane rules and refusal to standardize, it's also due to the outrageous cost of drugs, procedures, and everything else. Given that the same companies can sell the same stuff (MRI machines, drugs, whatever) to people in other countries for so much less, isn't it a bit odd that they charge us so much?

Anyway, I think the HCR law will probably help slow the increase in costs in some areas, but overall it doesn't go far enough in breaking the rent-seeking behavior endemic in the medical profession.

It would appear consumers in the United States are paying a disproportionate share (if not all of) of the development and marketing costs of meds while other countries enjoy incredibly cheap prices.  Unless the meds they are getting are coming from substandard plants where the regulatory costs are nil, I really can't think of any other reason why our costs should be so much higher.  Actual drug manufacturing must not be a terribly high-cost endeavor when you consider how much cheaper generic meds are than when it was proprietary to the original manufacturer.

I've never really thought too much about it before but something Mrs. C alluded to is insurance really should be for the major catastrophes, not a payment service for nickel and dime crap like check ups or seeing the doc when you have a sniffle.  The HMO or PPO negotiates a lower rate from my PCP, I still pay a $30 co-pay, the insurance company probably pays $40 so the doc gets $70 for a 5-10 minute visit & eval.  I'd love to know how much of what my employer pays (I admit I'm fortunate to have 100% paid health insurance and 70% covered for my wife) is allotted for major medical and how much is maintenance or "well coverage".  If more than $200 per year in premiums for me are for PCP visits, it would be better off to pay $100 out of pocket for each visit considering I usually only go once per year.  Or perhaps the doctor would simply take $70 cash from me instead of marking up the rate to everyone to account for the lower rates the HMO's & PPO's negotiate for their members.  To me they are more like a buyers discount club than an insurance plan.

(https://sphotos.xx.fbcdn.net/hphotos-ash4/428565_436856033012331_1040265204_n.jpg)

:-*

Quote from: Conan71 on June 28, 2012, 07:36:56 PM
It would appear consumers in the United States are paying a disproportionate share (if not all of) of the development and marketing costs of meds while other countries enjoy incredibly cheap prices.  Unless the meds they are getting are coming from substandard plants where the regulatory costs are nil, I really can't think of any other reason why our costs should be so much higher.  Actual drug manufacturing must not be a terribly high-cost endeavor when you consider how much cheaper generic meds are than when it was proprietary to the original manufacturer.

Is it really necessary to "market" medications beyond submitting articles to medical journals? Also, what makes you think that they're not merely engaging in price discrimination, much as airlines often charge more if you buy your ticket with less advance notice or don't want to stay over a weekend or whatever? Is there any real evidence that, given the same pricing, there would not be enough money for R&D? Which, come to think of it, is a cost largely borne by the government anyway?

I don't think it's unreasonable to believe that price gouging isn't a large part of why medical costs are so high here. Not the only issue, after all, there's the refusal of the insurance industry to consider efficiency an important goal (why, when you can just pass through the cost?), the general decline in public health in the US among the greatest portion of the people, increasing longevity among those with means, and a raft of unnecessary procedures done either to pad a doctor's bottom line (if you own an MRI machine, it seems like a great idea to give all your patients MRIs, I'm sure) or as a means to stave off nuisance malpractice suits.

None of that really addresses the basic disparity in cost per procedure between us and all other countries, advanced or not, hence my thinking basic price gouging may well be a significant factor.

It 's all Bush's fault. He appointed Roberts to the supremes.

Quote from: nathanm on June 28, 2012, 07:51:34 PM
None of that really addresses the basic disparity in cost per procedure between us and all other countries, advanced or not, hence my thinking basic price gouging may well be a significant factor.

If "you" know that "you" will have to negotiate a final price, you start high to get what "you" want/need when done negotiating.

Quote from: Conan71 on June 28, 2012, 07:36:56 PM
It would appear consumers in the United States are paying a disproportionate share (if not all of) of the development and marketing costs of meds while other countries enjoy incredibly cheap prices.  Unless the meds they are getting are coming from substandard plants where the regulatory costs are nil, I really can't think of any other reason why our costs should be so much higher.  Actual drug manufacturing must not be a terribly high-cost endeavor when you consider how much cheaper generic meds are than when it was proprietary to the original manufacturer.

My generic blood pressure medicine costs $10 for 90 days supply at WalMart.  It has a minor side effect of giving a tickle in the throat which can make someone cough.  Another medicine, still patent protected, without the tickle in the throat, is $87 per month.

Quote
I've never really thought too much about it before but something Mrs. C alluded to is insurance really should be for the major catastrophes, not a payment service for nickel and dime crap like check ups or seeing the doc when you have a sniffle.  The HMO or PPO negotiates a lower rate from my PCP, I still pay a $30 co-pay, the insurance company probably pays $40 so the doc gets $70 for a 5-10 minute visit & eval.  I'd love to know how much of what my employer pays (I admit I'm fortunate to have 100% paid health insurance and 70% covered for my wife) is allotted for major medical and how much is maintenance or "well coverage".  If more than $200 per year in premiums for me are for PCP visits, it would be better off to pay $100 out of pocket for each visit considering I usually only go once per year.  Or perhaps the doctor would simply take $70 cash from me instead of marking up the rate to everyone to account for the lower rates the HMO's & PPO's negotiate for their members.  To me they are more like a buyers discount club than an insurance plan.

Health Insurance vs. Health Care is the difference.  My father generally had insurance to cover the big stuff and planned to pay for routine issues out of his pocket.  That was when it was possible to go to the Doctor's office without taking out a 2nd mortgage on the house.  Artist made a comparison to car insurance.   BMW offers "free" maintenance for 3 years or 36,000 miles (or similar) when you buy a new car.  You can be sure the price of that maintenance is included in the price of the car.  There are also limits.  I don't believe you can get your oil and filter changed earlier or more often than the oil change monitor in the car allows.  I don't know the fine print though.  My BMW is getting pretty old now (1995 Model).   Pre-existing conditions is like (trying) buying collision insurance after you've had a wreck to fix that wreck as well as any in the future.  Good Luck on that one with your car.  If we are going to have a Health Care system, then requiring companies to accept pre-existing conditions makes sense.

I get detailed billing info for my medical costs from the insurance company.  It's amazing how much the prices are negotiated down.

One of the insurance options where I work is a large deductible policy.  My employer provides a "bucket of money" to take care of normal expenses.  Depending on how healthy you are, it may cover your expenses.  After that, it's 100% out of my pocket until the deductible is met.  Then there is a split between me and the insurance up to the annual maximum out of pocket level.  Then the insurance covers all the cost.  When I go to the doctor, there is no co-pay.  The negotiated price comes 100% out of the "bucket of money" or my pocket until the deductible is met.   My employer also offers a more standard insurance policy with co-pays etc but the employee's share of the premium is higher.   Which policy is better for someone will depend on their own conditions.

I thought this photo summed it up nicely regarding yesterday:

(https://p.twimg.com/AwfzK2WCQAIIsI9.jpg)

I'm not a big fan of Pelosi either, but that sourpuss Boner sure lived up to his moniker here.

And here comes the attack ads:


As I said, let's see how this plays out. But still:

(http://thegatewaypundit.com/wp-content/uploads/2012/06/mandate-tax.jpg)

How much more clear can he make it?
Has he come out to say they used the wrong word yet?
It was supposed to be a different three letter word.

Quote from: Conan71 on June 28, 2012, 03:33:30 PM


It's going to be a few years before we can truly see either the benefit or complete folly the ACA is on medical costs.  Honestly, I don't see how costs come down when you bring 10+ more million people into the care pool.

You just mentioned the fallacy - how costs could come down adding 10 million to the care pool... They are already IN the care pool.  Hospitals are required to treat, so, instead of going to a doctor in what most of us would consider the 'normal' way - make an appointment for yearly checkup - they go to the ER.  Your costs today, including the insured part includes 30% or so extra to cover those expenses.  If those 10 million get into the pool, costs may still actually go up, but it won't be because of that 30% contribution today.  (It will be price gouging, fixing, and collusion....)

We have a classic example of how this SHOULD work (but, granted, may not) in EMSA.  What does it cost to take an ambulance ride?  And what does it cost to take an ambulance ride if you subscribe to the Totalcare plan for EMSA rides?  EXACTLY the same principle.  (And anyone who lives in the coverage area and does not subscribe is an idiot.)  Now, will reality be hijacked?  We will just have to wait and see.

Quote from: guido911 on June 29, 2012, 08:34:06 AM
And here comes the attack ads:


As I said, let's see how this plays out. But still:

(http://thegatewaypundit.com/wp-content/uploads/2012/06/mandate-tax.jpg)

More accurately would be the condition that if you don't want to buy health insurance, fine, you get no access to the health care system that has been so heavily built by the other taxpayers - and YES, even the private hospitals who get either tax exemptions or medicare/medicaid payments (even the Catholics!).  Contact your local witch-doctor, or voodoo practitioner.

Quote from: heironymouspasparagus on June 29, 2012, 09:49:01 AM

More accurately would be the condition that if you don't want to buy health insurance, fine, you get no access to the health care system that has been so heavily built by the other taxpayers - and YES, even the private hospitals who get either tax exemptions or medicare/medicaid payments (even the Catholics!).  Contact your local witch-doctor, or voodoo practitioner.

Wow. "If you don't pay for something, you don't get use it." Now you are talking my language.

And as for what's "more" accurate about that funny ad, you missed.

Since the Obamacare thread is lengthy, I thought I would put this story in this thread. I do not know much about the source, but the story is supported.

http://www.businessinsider.com/what-obamas-affordable-care-act-will-cost-consumers-2012-6#ixzz1zC54X0Sw

More like "I wish to push the cost of the gum I'll buy later on everyone else." "OK, the tax on that will be 15 cents." The penalty is laughably low, and even more so on the employer's side, at least compared to the cost of buying even high deductible insurance.

FWIW, I'm seriously considering getting all my health care on a nice island in the Caribbean. It's far cheaper. Lucky me that I can afford the plane ticket.

Quote from: guido911 on June 28, 2012, 04:05:00 PM
Some people, especially the young, consider themselves "healthy" and figure the cost of insurance is unnecessary. Kinda of a gamble. Then there is EMTALA. Also, there are wealthy people who don't need it or pay out of pocket.

In a way I want to see how this plays out. Stop the litigation, interference, and give this a chance.

I didn't have health insurance when I was young, but not because I didn't want it. My employer did not offer it and COBRA plans were $900 per month. I opted to take my chances though I still ended up in the ER with monthly bills after one accident or another. I think the young do want a health insurance plan that still allows them to eat and pay their rent. I will capitulate on the wealthy that can pay for a liver translplant out of pocket.

If I understand this correctly, if you are a single adult and you don't have health insurance, your mandate fine penalty tax is $95.00 or 1% of your salary for the year. If you salary is $25,000/year your additional tax is $250.00. They will probably just tell you "Sign over a weeks paycheck, and we'll call it even." No one is going to be paying the base tax, it's all going to be the 1% of your salary.

Quote from: dbacks fan on June 29, 2012, 01:57:09 PM
If I understand this correctly, if you are a single adult and you don't have health insurance, your mandate fine penalty tax is $95.00 or 1% of your salary for the year. If you salary is $25,000/year your additional tax is $250.00. They will probably just tell you "Sign over a weeks paycheck, and we'll call it even." No one is going to be paying the base tax, it's all going to be the 1% of your salary.

Consumer penalties: Part of the controversy surrounding health care reform was that the law would mandate coverage for all Americans on pain of penalties. Those penalties will be tiered and rise over a three-year period that kicks off in 2014, according to the National Association of Consumer Protection:

2014: Families––$285 or 1 percent of total household income, whichever is lesser. Individual adults––$95.
2015: Families––$975 or 2 percent of income, whichever is lesser. Individual adults––$325.
2016: Families––$2,085 or 2.5 percent of income, whichever is lesser. Individual adults––$695.

If you're not covered by your employer, you'll have to pick from a list of government-mandated health insurance packages (they'll be called "exchanges", with options for individuals and businesses provided at the state level). Some exceptions do apply, including low-income families who can prove financial hardship.


http://www.businessinsider.com/what-obamas-affordable-care-act-will-cost-consumers-2012-6#ixzz1zD6LWVNA

Quote from: CharlieSheen on June 29, 2012, 01:59:37 PM
If you're not covered by your employer, you'll have to pick from a list of government-mandated health insurance packages (they'll be called "exchanges", with options for individuals and businesses provided at the state level). Some exceptions do apply, including low-income families who can prove financial hardship.

That is the center of this whole effort. There will be some new health insurance plans that everybody who currently doesn't have any insurance will have. If your employer offers you insurance, you won't be affected. When all the uninsured are insured, the people will start taking better care of themselves by not waiting till they need an emergency room. Prescription prices and new lower costs health care will benefit all of us.

I am tired of paying high medical bills that include me paying for the uninsured. I would think that fiscal conservatives would embrace any plan that would lower the costs for most Americans.

Quote from: guido911 on June 29, 2012, 08:34:06 AM
(http://thegatewaypundit.com/wp-content/uploads/2012/06/mandate-tax.jpg)

No thanks, I don't want to have kids.  Ok, the tax on that will be $5 a year
No thanks, I don't want to have a mortgage.  Ok, the tax on that will be $10 a year
No thanks, I don't want to eat corn.  Ok, the tax on that is $4 a year

Just as a slight aside.  You may have noticed the Sullivan ads from the Opthamologists and wondering what that was about.   In a nutshell the Opthamologists want to make it more expensive and difficult for many people to get help with their eyes.  Optometrists, I happen to live with one, In Oklahoma are highly trained and prescribe some medications for eye conditions and even perform some minor surgeries "like removing a metal filing from your eye from a work accident", they do all kinds of tests for things like Diabeties, etc.  Essentially, for many many cases its more convenient, and less costly, to go to your local optometrist for routine eye exams/check-ups and problems than to go to a hospital and see an opthamologist.  They are also many times easier to find since there are so many optometrist offices and cab act as a "first responder" to any eye trouble/accident or conditon.  The bill Sullivan wants to pass would make it illegal for an optometrist to call themselves a eye doctor, and I also think the bill would not allow them to bill for medicade which would in many cases, especially rural ones, pretty much take away much of an optometrists livelihood.

BUT the Opthamologists, make a lot of money, and saw a way to get more of the pie, so they donate to Sullivan to have him screw the Optometrists along with you the general public and indeed the insurance companies.   Was one reason we were volunteering for the Bridenstine campaingn, doing the phone banks, house meet and greet meetings, etc.

Back to the healthcare debate.....    What I have learned from living with someone in the medical field is that there is a lot of crappy politics out there that also drive up our medical costs and actually make preventative care more costly and difficult!  It's frustrating and sad really.

Charlie? Surely you see the difference. Are you just trying to be funny?

We all don't have to pay for your failure to produce children if you don't have any children, we don't have to pay for your housing if you don't secure a mortgage and we don't have to pay extra if you don't eat corn. (Though you really should eat your corn.)

But if you fail to secure insurance and fall catastrophically ill, the rest of us do have to pay for your folly. If you fail to buy insurance and smoke cigarettes, eat so much you're morbidly fat and have early onset diabetes, the rest of us have to pay more for our insurance to cover your excesses. The alternative would be for the rest of us to practice tough love by refusing you medical care when you try to go to the emergency room without insurance, but we're not that kind of society. We suck it up, pay the extra and know its the right thing to do.

Its like being invited to a pot luck dinner and bringing nothing but a good appetite, then suing the others for making you sick.

Quote from: TheArtist on June 29, 2012, 03:43:20 PM
Just as a slight aside.  You may have noticed the Sullivan ads from the Opthamologists and wondering what that was about.   In a nutshell the Opthamologists want to make it more expensive and difficult for many people to get help with their eyes.  Optometrists, I happen to live with one, In Oklahoma are highly trained and prescribe some medications for eye conditions and even perform some minor surgeries "like removing a metal filing from your eye from a work accident", they do all kinds of tests for things like Diabeties, etc.  Essentially, for many many cases its more convenient, and less costly, to go to your local optometrist for routine eye exams/check-ups and problems than to go to a hospital and see an opthamologist.  They are also many times easier to find since there are so many optometrist offices and cab act as a "first responder" to any eye trouble/accident or conditon.  The bill Sullivan wants to pass would make it illegal for an optometrist to call themselves a eye doctor, and I also think the bill would not allow them to bill for medicade which would in many cases, especially rural ones, pretty much take away much of an optometrists livelihood.

BUT the Opthamologists, make a lot of money, and saw a way to get more of the pie, so they donate to Sullivan to have him screw the Optometrists along with you the general public and indeed the insurance companies.   Was one reason we were volunteering for the Bridenstine campaingn, doing the phone banks, house meet and greet meetings, etc.

Back to the healthcare debate.....    What I have learned from living with someone in the medical field is that there is a lot of crappy politics out there that also drive up our medical costs and actually make preventative care more costly and difficult!  It's frustrating and sad really.

Yeah, I was aware of that little subplot. I have gone to both Opthamalogists and Optometrists for different reasons. What you say is true about everyday eye emergencies and measuring for glasses. But Opthamologists are eye doctors and have more training and more certifications to hang that shingle out.  It seems they would want to elevate and protect their industry. If there is little to be gained by getting the MD designation I'm sure fewer would go to the trouble to get it. Eventually everyone would just go for Physicians Assistant.

An EMSA paramedic can give you a life saving procedure that involves cutting your body, but if you have the time wouldn't you rather have a doctor do it?

Quote from: CharlieSheen on June 29, 2012, 03:35:31 PM
No thanks, I don't want to have kids.  Ok, the tax on that will be $5 a year
No thanks, I don't want to have a mortgage.  Ok, the tax on that will be $10 a year
No thanks, I don't want to eat corn.  Ok, the tax on that is $4 a year

The difference is that you don't have to have or won't absolutely need any of those things.  Most, by far, WILL absolutely HAVE to have and need medical care and if lots of people don't have insurance and help pay in, they are trying to gamble that they can put the higher risk of paying, on those who are already paying. 

Quote from: TheArtist on June 29, 2012, 03:43:20 PM
Just as a slight aside.  You may have noticed the Sullivan ads from the Opthamologists and wondering what that was about.   In a nutshell the Opthamologists want to make it more expensive and difficult for many people to get help with their eyes.  Optometrists, I happen to live with one, In Oklahoma are highly trained and prescribe some medications for eye conditions and even perform some minor surgeries "like removing a metal filing from your eye from a work accident", they do all kinds of tests for things like Diabeties, etc.  Essentially, for many many cases its more convenient, and less costly, to go to your local optometrist for routine eye exams/check-ups and problems than to go to a hospital and see an opthamologist.  They are also many times easier to find since there are so many optometrist offices and cab act as a "first responder" to any eye trouble/accident or conditon.  The bill Sullivan wants to pass would make it illegal for an optometrist to call themselves a eye doctor, and I also think the bill would not allow them to bill for medicade which would in many cases, especially rural ones, pretty much take away much of an optometrists livelihood.

BUT the Opthamologists, make a lot of money, and saw a way to get more of the pie, so they donate to Sullivan to have him screw the Optometrists along with you the general public and indeed the insurance companies.   Was one reason we were volunteering for the Bridenstine campaingn, doing the phone banks, house meet and greet meetings, etc.

Back to the healthcare debate.....    What I have learned from living with someone in the medical field is that there is a lot of crappy politics out there that also drive up our medical costs and actually make preventative care more costly and difficult!  It's frustrating and sad really.

If you recall I was questioning this very issue about optometrists and also chiropractors favoring one candidate over the other during the primary. I figured this was part of the problem optometrists would have, whether they are entitled to be called a "doctor" and all. I saw similar territory disputes between orthopedists and podiatrists in Arkansas--although in my opinion podiatry can be a more invasive medical/surgical profession than optometry.

We don't consider Dentists Doctor in Thailand! "Hangover 2"

Quote from: AquaMan on June 29, 2012, 04:03:59 PM
Yeah, I was aware of that little subplot. I have gone to both Opthamalogists and Optometrists for different reasons. What you say is true about everyday eye emergencies and measuring for glasses. But Opthamologists are eye doctors and have more training and more certifications to hang that shingle out.  It seems they would want to elevate and protect their industry. If there is little to be gained by getting the MD designation I'm sure fewer would go to the trouble to get it. Eventually everyone would just go for Physicians Assistant.

An EMSA paramedic can give you a life saving procedure that involves cutting your body, but if you have the time wouldn't you rather have a doctor do it?

You don't need to elevate yourself by tearing someone else down who has very good training to do what they do.  I bet you would be very suprised at the qualifications and training that optometrists in Oklahoma get and they do a LOT more and help and see a LOT more medical conditions very adeptly than you might think.  They can DO THEIR JOB! They know MORE than your general practitioner or regular doctor does about eye problems or medical conditions that relate to the eye and often catch things that they miss.  Yet the general practitioner isn't being forbidden from treating minor eye related problems or forbidden from billing medicare in relation to those conditions.  Optometrists won't even get the training anymore for those things if they don't need them.  Heard the story the other day of someone who had just gone to the "doctor" and then the optometrist caught a condition the person had that basically if left untreated, that person could have died within the hour.  Without the training to do what they do, that might not have been caught.  Also, you may not know it but because of Okhlahomas laws which allow for higher training of Optometrists than you find in other states, we have some of the top Optometry schools in the entire WORLD here.

Why go to your general practitioner to have a hangnail "surgery", when you can go to a surgeon who has studied more?  How about if some politician wrote a law that forbade your general practitioner from removing a hangnail, though he is perfectly, even overly qualified and capable, to do so, BUT he is not "as qualified" as the "real" surgeon?  

Quote from: TheArtist on June 29, 2012, 04:14:47 PM
The difference is that you don't have to have or won't absolutely need any of those things.  Most, by far, WILL absolutely HAVE to have and need medical care and if lots of people don't have insurance and help pay in, they are trying to gamble that they can put the higher risk of paying, on those who are already paying. 

Aquaman, the artist, those are all things those people are currently paying higher taxes for not doing.  Every person who doesn't have kids is paying more in taxes than they would have if the child tax credit didn't exist.  Anyone who doesn't like corn is paying higher taxes than they would if there weren't any corn subsidies.  Anybody who doesn't have a mortgage is helping pay higher taxes to give those that do a tax break.  We already pay higher taxes because of things we don't do.

Quote from: TheArtist on June 29, 2012, 04:24:54 PM
You don't need to elevate yourself by tearing someone else down who has very good training to do what they do.  I bet you would be very suprised at the qualifications and training that optometrists in Oklahoma get and they do a LOT more and help and see a LOT more medical conditions very adeptly than you might think.  They can DO THEIR JOB! They know more than your general practitioner or regular doctor does about eye problems or medical conditions that relate to the eye and often catch things that they miss.  

Why go to your general practitioner to have a hangnail "surgery", when you can go to a surgeon who has studied more?  How about if some politician wrote a law that forbade your general practitioner from removing a hangnail, though he is perfectly, even overly qualified and capable, to do so, BUT he is not "as qualified" as the "real" surgeon?  

Is an Optometrist a Doctor? An MD? Is the term Doctor generic? How many years do each matriculate? Do Opteometrists intern or have residency requirements?

This friction between Optometrists and Opthamologists, between Chiro's, MD's and Osteopaths has been going on since I was a child (who was delivered by an Osteopath btw). There is no need to take it personal. This a professional squabble over money, prestige, insurance and power. Sullivan misjudged and got caught in the crossfire.

Quote from: CharlieSheen on June 29, 2012, 04:33:30 PM
Aquaman, the artist, those are all things those people are currently paying higher taxes for not doing.  Every person who doesn't have kids is paying more in taxes than they would have if the child tax credit didn't exist.  Anyone who doesn't like corn is paying higher taxes than they would if there weren't any corn subsidies.  Anybody who doesn't have a mortgage is helping pay higher taxes to give those that do a tax break.  We already pay higher taxes because of things we don't do.

So no new news here then lol.

Quote from: CharlieSheen on June 29, 2012, 04:33:30 PM
Aquaman, the artist, those are all things those people are currently paying higher taxes for not doing.  Every person who doesn't have kids is paying more in taxes than they would have if the child tax credit didn't exist.  Anyone who doesn't like corn is paying higher taxes than they would if there weren't any corn subsidies.  Anybody who doesn't have a mortgage is helping pay higher taxes to give those that do a tax break.  We already pay higher taxes because of things we don't do.

I think that's pretty weak. Those general statements are not universally true anyway. The market interferes. These are real costs of health care that are inflated because some people are not insured yet we must still provide them services. Perhaps you would prefer that we go the tough love route? People dumped off on the curb in front of hospitals to die because they refused to let government interfere with their private choices?

Quote from: AquaMan on June 29, 2012, 04:38:21 PM
Is an Optometrist a Doctor? An MD? Is the term Doctor generic? How many years do each matriculate? Do Opteometrists intern or have residency requirements?

This friction between Optometrists and Opthamologists, between Chiro's, MD's and Osteopaths has been going on since I was a child (who was delivered by an Osteopath btw). There is no need to take it personal. This a professional squabble over money, prestige, insurance and power. Sullivan misjudged and got caught in the crossfire.

I will have Chris answer those questions for you.  I do know that Optometrists intern, have state and national board exams, etc.
 Sullivan would have taken money out of our household.  He would have hurt us financially if he could have.  How could I not take that personally?  He made it personal and we fought back.  

Quote from: AquaMan on June 29, 2012, 04:51:12 PM
I think that's pretty weak. Those general statements are not universally true anyway. The market interferes. These are real costs of health care that are inflated because some people are not insured yet we must still provide them services. Perhaps you would prefer that we go the tough love route? People dumped off on the curb in front of hospitals to die because they refused to let government interfere with their private choices?

I am trying to show that taxing us for not buying something isn't new.  They just take it from a different pocket.

Quote from: CharlieSheen on June 29, 2012, 05:06:18 PM
I am trying to show that taxing us for not buying something isn't new.  They just take it from a different pocket.

Charlie, you automatically win every thread and argument because of your avatar.

Quote from: guido911 on June 29, 2012, 05:30:02 PM
Charlie, you automatically win every thread and argument because of your avatar.

Ok clue me in on that avatar. Am I missing something?

Quote from: AquaMan on June 29, 2012, 04:38:21 PM
Is an Optometrist a Doctor? An MD? Is the term Doctor generic? How many years do each matriculate? Do Opteometrists intern or have residency requirements?

This friction between Optometrists and Opthamologists, between Chiro's, MD's and Osteopaths has been going on since I was a child (who was delivered by an Osteopath btw). There is no need to take it personal. This a professional squabble over money, prestige, insurance and power. Sullivan misjudged and got caught in the crossfire.

Via Chris....  Basically, optometrists are primary eye care doctors. They are trained and licensed to test vision, prescribe eye glasses/contact lenses, manage eye diseases like diabetes and glaucoma, and much more. Ophthalmologists are primarily surgeons. Optometrists are doctors who have graduated from a four year undergraduate program, and then a four year graduate program entirely in eye care. Residency and fellowship programs are optional for optometrists who want to specialize in certain areas of eye care. Ophthalmologists have attended medical school, where they get at most two to three weeks of exposure to eye care. They then go into a three year residency focused on eye surgery. Optometrists and opthalmologists are trained differently and are intended to serve different purposes.

Via moi... its interesting to note that Opthamologists often intern under Optometrists.  Also, in rural areas, there may not be an Opthamologist within 300 miles, but there are Optometrists.  Denying people the care that Optometrists can offer will only serve to make healthcare more difficlult and expensive (why are "conservatives" pushing for this?).   Also, why would an Opthamologist want to "lower" themselves to doing relatively minor things like plucking a stray eyelash "which is considered surgery by insurance companies"?  

Optometry practice defined by Oklahoma statute:

QuoteA. The practice of optometry is defined to be the science and art of examining the human eye and measurement of the powers of vision by the employment of any means, including the use or furnishing of any self-testing device, the use of any computerized or automatic refracting device, the use of pharmaceutical agents, the diagnosis of conditions of the human eye, and the correcting and relief of ocular abnormalities by means including but not limited to prescribing and adaptation of lenses, contact lenses, spectacles, eyeglasses, prisms and the employment of vision therapy or orthoptics for the aid thereof, low vision rehabilitation, laser surgery procedures, excluding retina, laser in-situ keratomileusis (LASIK), and cosmetic lid surgery. The practice of optometry is further defined to be nonlaser surgery procedures as authorized by the Oklahoma Board of Examiners in Optometry, pursuant to rules promulgated under the Administrative Procedures Act.

B. The practice of optometry shall also include the prescribing of dangerous drugs and controlled dangerous substances for all schedules specified in the Uniform Controlled Dangerous Substances Act except Schedules I and II for the purpose of diagnosis and treatment of ocular abnormalities. The practice of optometry shall not include the dispensing of drugs but may include the dispensing of professional samples to patients.

C. Optometrists shall be certified by the Board of Examiners in Optometry prior to administering drugs, prescribing drugs, or performing laser or nonlaser surgery procedures.

D. Nothing in this title shall be construed as allowing any agency, board, or other entity of this state other than the Board of Examiners in Optometry to determine what constitutes the practice of optometry.

http://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=439178

Interestingly, this is the definition of the practice of allopathic medicine:

QuoteA. Every person shall be regarded as practicing allopathic medicine within the meaning and provisions of this act, who shall append to his or her name the letters "M.D.", "Physician" or any other title, letters or designation which represent that such person is a physician, or who shall for a fee or any form of compensation diagnose and/or treat disease, injury or deformity of persons in this state by any allopathic legend drugs, surgery, manual, or mechanical treatment unless otherwise authorized by law.

[Emphasis added].
http://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=95745

My only "dispute", if you want to call it that, is an optometrist (or chiropractor) calling themselves "doctor" can be misleading to the everyday consumer/patient. These professionals are trained no question, but in my opinion are not a professional equal to an MD, DO, Dentist (except in Thailand). To flip Artist's point, an optometrist who would attempt to draw that comparison would be, in his words, elevating themselves by tearing down the skills of the others.

Quote from: CharlieSheen on June 29, 2012, 03:35:31 PM
No thanks, I don't want to have kids.  Ok, the tax on that will be $5 a year

The tax on that is $3000-$5000 a year for most people.

Quote
No thanks, I don't want to have a mortgage.  Ok, the tax on that will be $10 a year

The tax on that would be around $2,000 for me next year.

Quote
No thanks, I don't want to eat corn.  Ok, the tax on that is $4 a year

There is no special tax favor foregone by not eating corn..as far as I am aware. (Although it is highly unlikely that there is a living person in the US who consumes absolutely no corn or products made from corn in any given year)

Quote from: nathanm on June 29, 2012, 06:20:15 PM
The tax on that is $3000-$5000 a year for most people.

The tax on that would be around $2,000 for me next year.

There is no special tax favor foregone by not eating corn..as far as I am aware. (Although it is highly unlikely that there is a living person in the US who consumes absolutely no corn or products made from corn in any given year)

Corn get a huge government subsidy.  For each corn product you ingest (or put in your car) your benefit increases.

Quote from: Red Arrow on June 28, 2012, 08:19:18 PM
If "you" know that "you" will have to negotiate a final price, you start high to get what "you" want/need when done negotiating.

That's got nothing to do with it. I'm not comparing rack rate that nobody who has insurance pays, but the actual price paid by the insurer to the doctor, hospital, and the rest, on average (http://voices.washingtonpost.com/ezra-klein/IFHP%20Comparative%20Price%20Report%20with%20AHA%20data%20addition.pdf).

We pay more for basically everything. Hospital stays are the worst, which is why we send people home sooner than almost any other developed country (and many developing nations). This pushes the cost of nursing onto family members, who may well not be able to afford the loss of income from taking leave from work to nurse their sick relative. Few insurance plans pay (much) for home health aides these days.

It might be tolerable if we got measurably better outcomes for our extra healthcare dollars, but we don't. We pay more and get nothing.

Quote from: guido911 on June 29, 2012, 05:51:16 PM
Optometry practice defined by Oklahoma statute:

http://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=439178

Interestingly, this is the definition of the practice of allopathic medicine:
[Emphasis added].
http://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=95745

My only "dispute", if you want to call it that, is an optometrist (or chiropractor) calling themselves "doctor" can be misleading to the everyday consumer/patient. These professionals are trained no question, but in my opinion are not a professional equal to an MD, DO, Dentist (except in Thailand). To flip Artist's point, an optometrist who would attempt to draw that comparison would be, in his words, elevating themselves by tearing down the skills of the others.

Basically, if an optometrist is not allowed to be called a physician, they can't bill medicare and medicaid or any other health insurance for any of their services, forcing patients to go to an opthamologist for something like say, glaucoma management and treatment (where they would mostly then work with a technician who is not required to have ANY formal training, not the surgeon).  They won't likely do the little "eye puff" thing anymore, or look for other signs of illnesses and refer the person to a specialist like an Opthamologist, because they cant bill insurance for doing those tests.  

There are real world consequences for not allowing them to be called doctors or physicians beyond what you might think.

Say you had a condition that caused you to have dry eyes or eye allergies that was not treatable by over the counter medications, or over the counter medications werent working for you and you needed a prescription medication for it.  The optometrist diagnoses the condition,(btw, optometrists have more training than Dentists) but since he is no longer allowed to be called a doctor (physician) he or she can't prescribe the medication.  So what your saying is that if some rural person has a dry eye condition that needs presciption medication for that, they have to drive perhaps hundreds of miles to see a SURGEON who (probably interned under an optometrist to learn about eyes) and who apparently has nothing better to do with his "high surgical" skills than pluck eyelashes and prescribe dry eye medication?  

I can't believe this thread turned into a conversation about eye surgery.

I didn't see that coming.

Quote from: TheArtist on June 29, 2012, 06:47:52 PMThe optometrist diagnoses the condition,(btw, optometrists have more training than Dentists) but since he is no longer allowed to be called a doctor (physician) he or she can't prescribe the medication.   

Wow, you sure about that?

Optometrist:

QuoteEducation

Optometrists need a Doctor of Optometry (O.D.) degree. In 2011, there were 20 accredited Doctor of Optometry programs in the United States, one of which was in Puerto Rico. Applicants to O.D. programs must have completed at least 3 years of postsecondary education, including coursework in biology, chemistry, physics, English, and mathematics. In practice, most students get a bachelor's degree before enrolling in a Doctor of Optometry program. Applicants must also take the Optometry Admission Test (OAT) to apply to O.D. programs.

Doctor of Optometry programs take 4 years to complete. They combine classroom learning and supervised clinical experience. Coursework includes anatomy, physiology, biochemistry, optics and visual science, and the diagnosis and treatment of diseases and disorders of the visual system. After finishing the O.D., some optometrists do a 1-year residency program to get advanced clinical training in a specialty. Specialty areas for residency programs include family practice, primary eye care, pediatric or geriatric optometry, vision therapy and rehabilitation, cornea and contact lenses, refractive and ocular surgery, low vision rehabilitation, ocular disease, and community health optometry.

http://www.bls.gov/ooh/Healthcare/Optometrists.htm#tab-4

Dentistry

Quotee U.S. Bureau of Labor Statistics reports that more than 85% of dental students obtain a bachelor's degree prior to entering dental school (www.bls.gov). While no specific undergraduate degree is required, students commonly take science courses in biology, anatomy, chemistry and microbiology.
Dental School

Aspiring dentists enroll in a dental school accredited by the American Dental Association. Dental colleges offer either a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD). Prospective students must submit Dental Admission Test (DAT) scores with their application.

DDS degree programs cover four years of in-class, pre-clinical and clinical instruction. The first two years are devoted to lab and class instruction. Courses may include oral pathology, dental diagnosis and dental treatment techniques. In the last two years, students typically complete a dental rotation externship, which is usually conducted in dental clinics and allow students to treat patients under supervision.

In addition to general dentistry, dental schools typically offer specialized areas of study, such as oral and maxillofacial surgery, orthodontics or pediatric dentistry.These postgraduate programs generally take an additional 2-6 years to complete, depending on the chose specialty, and may include a residency.

http://education-portal.com/dentist_education_requirements.html

I do know dentists can write hardcore pain meds and administer anesthesia. Not sure if optometrists can. As for me, I have always gone to the ophthalmologist for eye issues, mainly because I am too lazy to schedule my own appointments and I follow instructions from SWMBO.

Quote from: RecycleMichael on June 29, 2012, 06:56:07 PM
I can't believe this thread turned into a conversation about eye surgery.

I didn't see that coming.

Quote from: CharlieSheen on June 29, 2012, 05:06:18 PM
I am trying to show that taxing us for not buying something isn't new.  They just take it from a different pocket.

I see what you're saying. The tax code is often used to encourage or discourage behaviors that are deemed to benefit the country or private interests.

Quote from: AquaMan on June 29, 2012, 07:11:05 PM
I see what you're saying. The tax code is often used to encourage or discourage behaviors that are deemed to benefit the country or private interests.

They could have increased taxes by $2,100 per family and then given a deduction up to $2,100 per family and nobody would have blinked.  But just have a tax of up to $2,100 based on not doing something and everybody flips because it has never been done before.  since they didn't raise and then give a credit to offset the raised taxes.  Anyway, if this bill doesn't work as indented I hope they repeal it.  If it does work (as intended) then I'm for it.  There are unforeseen consequences to almost all bills passed.

Are these taxes annual or monthly?

I recall when tax rates were over %50 but you could deduct interest paid on investments against income from those investments which served to encourage development in all types of business.

The GOP is the definition of "give em enough rope and they will hang themselves. Newt did it in the 90's, Bush in the 2000's.

I see the militia guy behind "fast and furious" is calling for armed revolution over health care.  Stay away from federal buildings.

Quote from: RecycleMichael on June 30, 2012, 02:53:37 PM
Why would you say something like that? I get it. You are a dick.

Admin: do something about RM's slander. Wait....never mind. That's like asking the GOP to police their own.

You DO NOT get it....

Quote from: nathanm on June 29, 2012, 06:39:12 PM
That's got nothing to do with it. I'm not comparing rack rate that nobody who has insurance pays, but the actual price paid by the insurer to the doctor, hospital, and the rest, on average (http://voices.washingtonpost.com/ezra-klein/IFHP%20Comparative%20Price%20Report%20with%20AHA%20data%20addition.pdf).
We pay more for basically everything. Hospital stays are the worst, which is why we send people home sooner than almost any other developed country (and many developing nations). This pushes the cost of nursing onto family members, who may well not be able to afford the loss of income from taking leave from work to nurse their sick relative. Few insurance plans pay (much) for home health aides these days.
It might be tolerable if we got measurably better outcomes for our extra healthcare dollars, but we don't. We pay more and get nothing.

The "list" (rack?) price is relevant to the thread.  High prices which can be negotiated down by insurance companies make it nearly impossible for the non-insured to pay for health care.  Therefore, you have to have health care insurance.  Nice racket for the insurance companies.  Get the medical community to jack up prices to the point where insurance is necessary for all but the wealthiest among us.  

More specifically to your point though is what expenses are we imposing on the medical community that other countries in that report do not.  The perennial favorite is malpractice insurance.  Staffing requirements now are much more than when I was a kid.  Back then, our family doctor had his office in part of his home.  He had one nurse on staff and I believe his wife was the accountant.  When I go to the doctor now at St. John Medical Center, there are at least 3 office personnel, a physician's assistant, and a couple of nurses.  There are several patient areas.  I am getting good care but I don't know that it's any better than when I was a kid.   Do our high costs help subsidize the rest of the world?  Does the price of a MRI Scanner in the US keep the price of the same machine lower in another country?  Is the wealthy USA is paying a higher tax price so the middle class countries rest of the world don't have to?  It's only fair that the (formerly?) wealthiest nation in the world should pay its fair share.

Quote from: Teatownclown on June 30, 2012, 03:55:59 PM
Admin: do something about RM's slander. Wait....never mind. That's like asking the GOP to police their own.

You DO NOT get it....

What do they call somebody who runs from the violence they bestow on others (in this case erasing their hateful posts)?

Chicken smile!

I was wrong to use such language and deleted my slander.

This forum should not be besmirched by my contempt for you. I do think it is irresponsible for you to say such ridiculous and clearly stupid things. I have no clue as to what happened in your life to make you think and write such things, but trying to make people afraid to go to federal buildings because you think there will be a bombing is really low. I believe such an attack would make you happy.

If that makes you feel that I am a chicken smile, fine. But remember, I post my thoughts here with people having clear knowledge of who I am. You hide behind a fake name with no reponsibility. Look in the mirror, chicken smile.

Quote from: Teatownclown on June 30, 2012, 05:05:53 PM
What do they call somebody who runs from the violence they bestow on others (in this case erasing their hateful posts)?

Chicken smile!

Funny, that's what I call little punk wastes of sperm who send these sorts of things via pm (NSFW):

http://www.philzone.org/discus/messages/36579/759342.jpg

Quote from: Red Arrow on June 30, 2012, 05:01:41 PM
The "list" (rack?) price is relevant to the thread.  High prices which can be negotiated down by insurance companies make it nearly impossible for the non-insured to pay for health care.  Therefore, you have to have health care insurance.  Nice racket for the insurance companies.  Get the medical community to jack up prices to the point where insurance is necessary for all but the wealthiest among us.  

If this is true, why is it that doctors who don't accept insurance also charge exorbitant (by global standards) amounts? Because they can, I guess.

Quote
More specifically to your point though is what expenses are we imposing on the medical community that other countries in that report do not.  The perennial favorite is malpractice insurance.  Staffing requirements now are much more than when I was a kid.  Back then, our family doctor had his office in part of his home.  He had one nurse on staff and I believe his wife was the accountant.  When I go to the doctor now at St. John Medical Center, there are at least 3 office personnel, a physician's assistant, and a couple of nurses.  

Based on the days back when I had some doctors as clients, I'd say a large part of the issue is that they have to employ half as many billing specialists as medical personnel. I once did some work for an eye clinic with 3 doctors and around 10 medical staff, plus a couple of receptionists, and an accountant. And another 5 people to deal with making the insurance companies pay up. It's definitely a good racket for the insurers. Med mal has less to do with it than you'd think. The cost simply pales in comparison, IME. Maybe guido can ask his wife how the numbers work out for her. They may be different in different practice areas. My dentist manages to get by with himself, a dental assistant, a hygenist, and his wife. I gather dental insurance isn't as bad as some others at frivolously denying claims and withholding payments for inordinately long periods of time.

Quote
There are several patient areas.  I am getting good care but I don't know that it's any better than when I was a kid.   Do our high costs help subsidize the rest of the world?  Does the price of a MRI Scanner in the US keep the price of the same machine lower in another country?  Is the wealthy USA is paying a higher tax price so the middle class countries rest of the world don't have to?  It's only fair that the (formerly?) wealthiest nation in the world should pay its fair share.

I seriously doubt GE is selling MRI machines to other countries at below cost.

Quote from: heironymouspasparagus on June 29, 2012, 09:41:25 AM
You just mentioned the fallacy - how costs could come down adding 10 million to the care pool... They are already IN the care pool.  Hospitals are required to treat, so, instead of going to a doctor in what most of us would consider the 'normal' way - make an appointment for yearly checkup - they go to the ER.  Your costs today, including the insured part includes 30% or so extra to cover those expenses.  If those 10 million get into the pool, costs may still actually go up, but it won't be because of that 30% contribution today.  (It will be price gouging, fixing, and collusion....)

We have a classic example of how this SHOULD work (but, granted, may not) in EMSA.  What does it cost to take an ambulance ride?  And what does it cost to take an ambulance ride if you subscribe to the Totalcare plan for EMSA rides?  EXACTLY the same principle.  (And anyone who lives in the coverage area and does not subscribe is an idiot.)  Now, will reality be hijacked?  We will just have to wait and see.

Not everyone realizes they can simply show up at Tulsa Regional with a raging case of the herps at 2am.  There are millions who don't go because they think they are on the hook for hundreds, if not thousands in medical bills awaiting them if they do. 

Let 10 million people think Obama is personally going to pay the tab for having someone else to put a Band Aid on that boo boo on their elbow and you will see how fast the outlays add up.  If you think people who were irresponsible about their health before this pile passed will use insurance judiciously, there's a spillway up on highway 88 I'd love to sell you.

Quote from: RecycleMichael on June 30, 2012, 05:48:37 PM
I was wrong to use such language and deleted my slander.

This forum should not be besmirched by my contempt for you. I do think it is irresponsible for you to say such ridiculous and clearly stupid things. I have no clue as to what happened in your life to make you think and write such things, but trying to make people afraid to go to federal buildings because you think there will be a bombing is really low. I believe such an attack would make you happy.

If that makes you feel that I am a chicken smile, fine. But remember, I post my thoughts here with people having clear knowledge of who I am. You hide behind a fake name with no reponsibility. Look in the mirror, chicken smile.

Bull....the federal building comment was a sarcastic commentary in retaliation for all the years of righties laying blame for such threats at the feet of liberals. You MP are the type of chicken smile that allows righties to run all over the progressives in this country. You are a loserman who fails to see how satire works. It was pure and simple gonzo journalism.  :o You are basically the type who fakes critical thinking with cuteness. I guess you can't always have it your way. Do you control this forum? You evidently think you do.... :-*

Quote from: Teatownclown on July 01, 2012, 01:34:01 AM
You are basically the type who fakes critical thinking with cuteness.

Do you really think I am cute?

OMG.

Quote from: RecycleMichael on July 01, 2012, 08:33:27 AM
Do you really think I am cute?

OMG.

RM & Teatown sittin in a tree. . .

Quote from: Gaspar on July 01, 2012, 08:44:37 AM
RM & Teatown sittin in a tree. . .

It better be a damn big tree.

http://tulsa.craigslist.org/apa/3075995382.html

Quote from: Teatownclown on July 01, 2012, 01:34:01 AM
Bull....the federal building comment was a sarcastic commentary in retaliation for all the years of righties laying blame for such threats at the feet of liberals. You MP are the type of chicken smile that allows righties to run all over the progressives in this country. You are a loserman who fails to see how satire works. It was pure and simple gonzo journalism.  :o You are basically the type who fakes critical thinking with cuteness. I guess you can't always have it your way. Do you control this forum? You evidently think you do.... :-*

Remind us how many different monikers you've used due to being banned?

Quote from: nathanm on June 30, 2012, 11:47:08 PM
I seriously doubt GE is selling MRI machines to other countries at below cost.

I didn't say or try to imply they were.

Quote from: Teatownclown on July 01, 2012, 01:34:01 AM
Bull....the federal building comment was a sarcastic commentary in retaliation for all the years of righties laying blame for such threats at the feet of liberals. You MP are the type of chicken smile that allows righties to run all over the progressives in this country. You are a loserman who fails to see how satire works. It was pure and simple gonzo journalism.  :o You are basically the type who fakes critical thinking with cuteness. I guess you can't always have it your way. Do you control this forum? You evidently think you do.... :-*

Gosh, I step out for a couple of hours and look what happens!

Mark Twain wrote, "A lie can travel halfway around the world while the truth is putting on its shoes."  That's clearly evident in today's rapid-fire news cycles where getting the scoop rates higher than getting it right.  Those of us on either side of the aisle can engage in finger-pointing, calling the other side a bunch of feckless liars, but is it really true that our opponents are willfully lying, or is it that our world views are so fundamentally different that we end up talking past each other?  It's like using the same words, but those words have different meanings.

I work with dyed-in-the-wool conservatives.  That's merely a fact of life here in Oklahoma.  Some are capable of honest discussions on politics, religion, and assorted controversies, but others cannot get past the talking points they heard on talk radio that morning.  They're angry and fearful around a host of subjects, a trait they share with some on the left.  We're not an "organized political party" after all, if Will Rogers is to be believed.

It's a truism, however, that frightened people are easily mislead.  When faced with a threat, the American people have always supported our political leaders.  That could be attributed to patriotism if we're high-minded about it, but I think there's a substantial amount of gut-wrenching fear on the personal level.  What I find objectionable is any attempt to augment that fear as a tool for a political agenda.

"We are not descended from fearful men." Edward R. Murrow said that at the height of the Cold War and our descent into McCarthyism.  It's a good idea to keep in mind that those who promote fear do so with an objective in mind.

Quote from: Red Arrow on July 01, 2012, 09:56:16 AM
I didn't say or try to imply they were.

Sorry, I thought the "do our high costs subsidize the rest of the world" question implied otherwise. It does definitely subsidize someone, but it's probably mainly executives of medical device manufacturers. (and possibly shareholders, if they're one of the few [large] companies with functional corporate governance)

Quote from: nathanm on July 01, 2012, 02:22:03 PM
Sorry, I thought the "do our high costs subsidize the rest of the world" question implied otherwise. It does definitely subsidize someone, but it's probably mainly executives of medical device manufacturers. (and possibly shareholders, if they're one of the few [large] companies with functional corporate governance)

Please note that "I didn't say or try to imply they were." applies only to the "I seriously doubt GE is selling MRI machines to other countries at below cost." part of your post.  I didn't quote the rest of your post.

Subsidize?  I guess we could play semantics.  I was noting that as an overall wealthy nation we are paying our fair share.  We can (or at least used to be able to) afford the higher costs so that the poorer nations don't have to pay a disproportionate amount of their GDP/GDI/wealth.....  for medical care.

I hate to get into a word parsing game, but I'm not sure how other countries could be receiving benefit in the form of more reasonable prices from our excess spending unless goods are being sold to them below cost. If they're paying the full cost of their MRI machines, we're not subsidizing them. (beyond the implicit subsidy inherent in conducting basic research that is openly published, anyway, but that's almost exclusively government and charitable spending, not private spending)

The fact that we pay more than others does not suggest that it is our fair share or that equitable distribution of costs is even a consideration in the prices we pay. Perhaps your suggestion is true, but nothing you've written supports that contention. Even other equivalently wealthy nations pay far less than we do.

I suspect the WHO and others do occasionally buy expensive medical equipment for poorer countries, but I don't see how that should keep the prices people pay for unrelated services low. Across the board we pay more. It doesn't matter if it's a hip replacement, setting a broken bone, a simple strep test, or anything else. We (or our insurance companies) pay more. Obviously, the most expensive procedures here are the ones that have the most eye popping price differential, but it's there in every procedure I've seen numbers for.

If it were just that we used more care or that we used more advanced machinery the whole thing wouldn't be so infuriating.

Quote from: nathanm on July 01, 2012, 06:33:59 PM
I hate to get into a word parsing game, but I'm not sure how other countries could be receiving benefit in the form of more reasonable prices from our excess spending unless goods are being sold to them below cost. If they're paying the full cost of their MRI machines, we're not subsidizing them.

Price on ability to pay does not require a selling at a loss to the less fortunate.  Think about it.  I'm sure you can figure it out.

Quote from: Red Arrow on July 01, 2012, 07:42:19 PM
Price on ability to pay does not require a selling at a loss to the less fortunate.  Think about it.  I'm sure you can figure it out.

I wouldn't disagree but for the extremely large price disparity.

Quote from: nathanm on July 01, 2012, 09:24:55 PM
I wouldn't disagree but for the extremely large price disparity.

I think we can agree on the largeness of the disparity.

Apparently, Roberts switched sides sometime after oral arguments.

http://www.cbsnews.com/2102-3460_162-57464549.html

(print link, so it will pop up a print dialog)

(http://25.media.tumblr.com/tumblr_m6chknRWC61ry69bho1_500.jpg)

I guess a lot of people are mispelling "ACT" on their tweets.