Obamacare

It Sure Looks Like This Obamacare Program Has Led to More People Dying

Under the health law, Medicare started penalizing hospitals for too many readmissions. Now mortality rates are up.

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Richard B. Levine/Newscom

To determine whether a government program is successful, it's often necessary to look not only at how well it does what it's supposed to do, but what it's doing that it isn't supposed to. For example, killing people.

Take the hospital readmissions program built into Obamacare. The program derived from a simple observation that hospitals were treating lots of people who would then return for more treatment within the month. Unnecessary readmissions cost Medicare an estimated $17.5 billion a year. If hospitals were treating people effectively, the thinking went, those people shouldn't need to return so soon.

So the health law instituted a Medicare payment penalty for hospitals with too many readmissions for pneumonia, heart failure, and heart attack. Since 2012, Medicare has assessed about $2 billion in penalties on hospitals with too-high readmissions rates.

Hospital groups have argued that these payments are punitive and unfair, particularly to so-called safety net hospitals that serve the poorest, sickest patients. These patients tend to have higher readmissions rates, and the hospitals that treat them were more likely to be hit with payment reductions. (Earlier this year, the Trump administration changed the penalty structure for safety net hospitals.)

But the program has often been labeled a success because it accomplished its primary goal. Readmissions dropped between 2.3 and 3.6 percentage points for the conditions targeted. Readmissions associated with other maladies dropped by 1.4 percent. The authors of one 2016 study suggested that the lower readmission rates "point to how Medicare can improve the care that patients receive through innovative payment models." It offered proof, and hope, that with the right incentives, Medicare could save money and provide better care.

A new study appears to dash that hope, at least as far as readmissions are concerned.

The study, published in the Journal of the American Medical Association (JAMA) and conducted by by researchers associated with Beth Israel Deaconess Medical and Harvard Medical School, looked at hospitalizations between 2005 and 2015. It found that "30-day post-discharge mortality"—the number of people who died within a month of leaving the hospital—increased for heart failure patients after the readmissions penalty program was implemented.

Although heart failure mortality was already on the rise, the rate of increase became more rapid after Medicare started penalizing readmissions. In addition, mortality rates amongst pneumonia patients, which had been stable, increased.

Fewer people were being readmitted to hospitals, but more people were dying.

This is not the first study to conclude that the program increased mortality. A separate JAMA study last year looked at about 115,000 Medicare patients and also found that although readmissions for heart failure were down, mortality had increased, with about 5,400 more people dying annually.

It is possible that this effect is merely a correlation rather than a direct causation; there may be other factors at play, and the new study does not definitively conclude that the payment program is causing the deaths, although the authors worry that it is a possibility.

The point of the program is to change the practices of medical providers; it seems likely, if not quite certain, that the documented change in results, in terms of both readmissions and mortality, was linked to the change in payment structure. The new study notes that "the increase in mortality for heart failure and pneumonia were driven mainly by patients who were not readmitted within 30 days of discharge." It is reasonable to assume that this program is causing more people with the targeted medical conditions to die.

The program, then, was a success by one measure—but not the most important one.

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  1. The death panel decisions are coming from…. inside the house!

  2. Unintended consequences you say? No, can’t be.

    1. We shouldn’t judge these laws based on actual observations. We should judge them based on the intended consequences of the legislators and campaign rhetoric generation.

      1. Yes it is moral to have good intentions and immoral to point out the negative consequences of the arbitrary uninformed decisions caused by them.

        1. If you point out the unintended consequences of good intentions then you oppose those good intentions. Which means you have bad intentions and are a bad person.

      2. I really don’t see how you can pass a law that makes it harder for sick people to be admitted to the hospital and claim you intended anything except harm.

        1. The point was to encourage hospitals to provide better care for patients on first admission, reducing the need for re-admissions. we have known about this problem for decades: it’s called “quicker and sicker”, referring to discharging patients quicker while they are sicker than they would have been many years ago. And that is driven by the economics of care: the outrageous cost of keeping a patient in-house for one day makes it attractive to discharge that patient as soon as possible, nearly guaranteeing a high rate of re-admission.

          Dave Taylor, MD, PhD

    2. Maybe these are the intended consequences. Dead people are cheaper.

      1. Social Darwinism. Who is it that end up dying?

        Having dealt with the so called homeless for many years (aka hobos, bums and winos in my younger days), I find myself fantasizing about eugenics more than I thought I ever might be capable of.

        What a freaking waste of money!

      2. Would a death panel by any other name smell as sweet?

    3. This is definitely not unintendend. The entire point of the misanthropic left, of which democrats are a part, is population control and they want to decide who lives and who dies.

  3. Obama did far worse for the country than Trump ever did! Trump has to clean up Obama’s mess!

    https://aladyofreason.wordpress.com/

    1. …and Bush’s mess
      …and Bill CLinton’s mess
      …and HW Bush’s mess
      …and Reagan’s mess
      …and Carter’s mess
      ….

      1. And Nixon’s, and Johnson’s,… but nobody’s mess was greater than James Buchanan’s. And I submit that Grover Cleveland’s mess is now completely cleaned up, at least from his first time in office, and if you only count actions taken in office, Martin Van Buren, our Dark Founder, is the only president to leave no mess worth cleaning up.

        1. What about WH Harrison? One of the least destructive ever.

          1. Harrison’s mess was the entire Tyler administration

        2. And now we will spend a decade or two fixing Trumps reign of total incompetence.

      2. How do you not include FDR in Presidential messes. That one man screwed the country to it’s core.

        1. So few recognize this. Look at the “New Deal” history they teach in public schools. FDR “saved the world”. Just ask the few, remaining survivors.

          AFAIK, it set the entire tone of government as the ultimate arbitrator and provider of everything for everyone.

          1. There is a monument in Washington to this man who locked up 70,000 people based on their race.

            And people are worried about Civil War statues!

            1. Well, at least FDR’s people didn’t yank the babies out of the arms of the mommas among these 70,000 unjustly punished people, and then ship them hundreds of miles apart, and lose track of which babies belonged to whom…

              Speaking of presidential messes, how about that mess on Monica Lewinski’s blue dress? HOW could we forget THAT one?

              1. SQRLSY One|12.28.18 @ 11:28AM|#
                “Well, at least FDR’s people didn’t yank the babies out of the arms of the mommas among these 70,000 unjustly punished people, and then ship them hundreds of miles apart, and lose track of which babies belonged to whom…”

                Naah, he just let ’em die an early death from malnutrition as he was ‘making the economy fair’.

                1. Yes indeed, FDR was an asshole, I do agree. Food utterly wasted (milk dumped on the ground, beef cattle shot and buried on the spot) at his command, to “help” farmers and prices, while people went hungry. You are correct!

                  I’m not trying to excuse any of the old historical assholes when I compare them to modern assholes… Am just saying they are all assholes, but their assholishness is bigger here for this one, smaller there, and vice versa for the other, other asshole…

                  North Korea has more “lung flute” freedom than we do in the USA right now, speaking of USA assholes at the FDA! But don’t get me started…

                  1. “Lung flute”, as opposed to the routes you play without your lungs?

  4. Whenever there is a cut to a government program, the bolshies on my fb timeline scream “Murderers!” I reply with articles like this saying, “Medicare KILLS!” It’s a similar situation with addiction ‘treatment’. Many are pushing for public funding for in-patient drug treatment. But it is really deadly – huge death rates immediately upon discharge. Far better not to treat it at all. (Because it’s not really a disease!) #thankureason

  5. But muh preexisting conditions!

  6. “Fewer people were being readmitted to hospitals, but more people were dying.”

    Fox Butterfield would call this ironic.

    1. Fox Butterfield is the irony.

  7. How else did you expect them to bend the cost curve?

  8. learned just yesterday what CDU means at a hospital … Clinical Decision Unit … death panel room … is thing now.

  9. Can we file this under “DUH!”? You disincentive readmissions and the number of readmissions goes down but not necessarily because care was improved. More likely because the assessment team factored the penalty into their decision about whether or not to readmit. Borderline cases that might have been readmitted weren’t and some of them died that wouldn’t have otherwise. Unintended consequences might be unintended but they’re not unpredictable.

    1. Also our tort system means that’s society’s most disadvantaged, are a lot less dangerous to a hospital after they are dead.

  10. The goal of this penalty is to save Medicare money, not to save lives. It’s doing the right kind of rationing, according to libertarians (spend less government money on healthcare). Luckily for poor patients the policy has been reevaluated.

    1. “It’s doing the right kind of rationing, according to libertarians (spend less government money on healthcare).”

      Which is why libertarians cheered the Obamacare law?

      1. Tony, the only reason you’re criticizing this provision of the law is that you’re mad that we had a black President who fixed health care.

        /sarc

      2. No, they mostly twitched in place with no argument for how to make healthcare better, added a large dollop of pure partisan hackery, and then tacitly endorsed a pure pay-if-you-can program (if you’re poor, too bad), and are now apparently bitching about people dying from lack of adequate healthcare.

        1. How to improve healthcare: fix the marketplace!

          These ideas were floated but spines are required to implement them:

          Transfer the HC tax deduction from companies to individuals
          Make it harder to sue Drs
          Encourage clinic environments (de-fang the AMA; more nurse practitioners)
          Encourage price comparisons (high deductible insurance)
          Encourage cross-state HC insurance (the only Obamacare provision worth a damn)

          1. Those are all good ideas.

          2. Make it harder to sue Drs

            Why? A doctor fucks you up, you deserve to sue them.

            1. A reasonable model here is no-fault auto insurance. If a doc causes a malpractice claim that is approved in arbitration, his malpractice insurance premiums go up. Screw up badly enough and his MI rating craters, no insurance company will issue insurance, and the doc loses his license. No-fault auto insurance greatly reduced the number of lawsuits and speeded the resolution process.

              This type of insurance already exists (see link), but IIRC most states don’t yet have explicit legislation requiring E&O for licensing.

              https://preview.tinyurl.com/z2oqbhj

          3. Encourage price comparisons (high deductible insurance)

            Obamacare already raised deductibles (and premiums) through the roof.

        2. Bull. There were plenty of options for how to fix the marketplace for healthcare, but you don’t want a fix you want control.

          1. The ACA was the marketplace-oriented option as dreamed up by market-friendly think tanks on the Republican side of politics. You know this. It was portrayed as a socialist takeover once a Democrat decided to affix his name to it, but that’s just because Republicans are terrible who have no interest in helping any humans with anything, unless they’re billionaires.

            1. marketplace-oriented

              Yeah, there was a byzantine tome of rules for the marketplace to follow or else, so it was marketplace oriented.

            2. “The ACA was the marketplace-oriented option as dreamed up by market-friendly think tanks on the Republican side of politics.”

              You
              Are
              Full
              of
              SHIT!
              “The ACA v. the Heritage Plan: A Comparison in Chart Form”
              […]
              “What is striking, though, in both that thread and the follow-up, is how committed anti-ACA lefties are to the ridiculous argument that the ACA is a “Republican Plan” developed by the Heritage Foundation even after presented details that make the comparison unsustainable. Perhaps it would help to present the comparison in graph form. Here, first, is an exhaustive list of the similarities between the plans:
              (they both require carrying insurance)”
              http://www.lawyersgunsmoneyblog.com
              /2013/12/the-aca-v-the-heritage-plan
              -a-comparison-in-chart-form

        3. “they mostly twitched in place with no argument for how to make healthcare better”

          Heh. My favorite is when dipshits like you pretend to know what healthcare I need, so pretend it’s a good idea to use the violent power of the police state to force me to pay for and use the healthcare you think I need, while violently denying me the healthcare I want. To myopic dipshits like Tony, it’s healthcare liberty isn’t good for anyone.

        4. The real scandal is how unremarkable we find our centuries old pay-if-you-can food program.

          1. Government subsidizes food production and access out the ass you moron.

            1. And buries huge amounts of welfare for the rich in the program, paid for by taxes on the middle-class and by artificially raising food prices.

    2. If the goal is to save money, then cut 100% of Medicare.

      Problem solved.

      1. That’s the kind of big thinking we need in these parts.

        Tell me, is your problem with Medicare that you think the families of old people need to learn how to budget better, or do you just think that the poor elderly can better serve society in the form of food cubes?

        1. Tell me, is your problem with Medicare that you think the families of old people need to learn how to budget better, or do you just think that the poor elderly can better serve society in the form of food cubes?

          Old people not receiving heroic medical care in the last two years of their life would certainly cut down on the overall cost of healthcare.

        2. “you think the families of old people need to learn how to budget better”

          Yes. It is evil for today’s old people to use the violent power of the police state to rob the people who will be old tomorrow, thus ensuring tomorrow’s old people will be less able to financially handle their medical needs.

        3. Soylent green is Tony!!!!!

      2. I read an article some time ago, it said that approximately 70% of Medicare expenses are incurred in the final 12 months of Medicare patients’ lives. Seems to me that we are not getting a good return on investment if the best we can do is extend someone’s life for less than a year. I actually personally observed this in my family: my godfather was in a coma, and one doctor (of the many on the treatment team) gave my godmother some hope saying that there was “a chance” he would come out of it. Nearly a year later, he never came out of the coma, and eventually expired of “natural causes”. Total bill was roughly $3 million, if I remember correctly.

        1. I read an article some time ago, it said that approximately 70% of Medicare expenses are incurred in the final 12 months of Medicare patients’ lives

          A society that’s steeped in its own hedonism is going to take every measure it can to extend a person’s life far beyond the lengths that the person’s quality of life is actually decent. People who think they have nothing to look forward to beyond their time on earth will be desperate to make sure they stay kicking as long as possible, even if they end up continually shitting themselves and can’t remember who their own children are.

        2. For some reason, America shifted to having people die in hospitals instead of at home like most people did 60+ years ago.

          Doctors would check on patients and come when the patient died.

          Much cheaper to have people die in their homes.

          1. The idea that old people need to die in hospitals is ridiculous.

          2. This may interest you.

            https://tinyurl.com/y7pbna4r

            The trend is that fewer people are dying in hospitals. You are right most people would prefer to die at home.

            I want to go like King David. In my old age, nice comfortable bed, with my loved ones in attendance and the lovely Abishag the Shunnamite curled beside me to keep me warm.

              1. And people think the Bible is boring.

          3. My uncle did home hospice earlier this year. He was just shy of his 90th birthday and his oma restricts cancer, while under control, had already spread to his brain. Fortunately, he went relatively fast (about 12 really sick days) and didn’t suffer much, as he was mostly out of it.

    3. The goal of Obamacare was to achieve an arbitrary idea of “universal healthcare coverage”, not save lives.

      1. And the goal of the anti-Obamacare movement was to make fart noises in the direction of President Blackerson.

        1. Obama lied, thousands died.

          He said Obamacare would work. But it was too expensive, so corners needed to be cut to make the Affordable Care Act Affordable. Those corners were people. Bet meh. In 50 years, everyone will know who Obama was and those dead people will be long forgotten.

          1. corners needed to be cut to make the Affordable Care Act Affordable

            And it still never happened.

        2. Fuck you Tony. Obama shit on everyone who actually pays their own way for their health insurance. People like you should have their organs harvested to pay the rest of us back.

          I favor skipping the anesthesia in your case. For the yucks.

      2. Correct. Solve the symptom (insurance), not the cause (cost)

      3. No, the goal was to serve as a money siphon from the middle class to Obama’s welfare class supporters, with the blessing of the hyper-wealthy left-wing media/entertainment class who didn’t have to worry about affording high-cost healthcare plans.

    4. Libertarians understand that one size fits all programs are doomed to failure from the start.

  11. But they got to keep their doctor, right? right?

    1. Man, you people really liked your doctors.

      1. I do. And if you had any chronic health issues to deal with, you might find value in maintaining a long-running relationship with the same doctor as well.

        1. And if I had the money to afford it out of pocket, that wouldn’t be an issue. The subject here is what government pays for. Do you want them to cut costs or not?

          1. Actually, the subject as stated by Benitacova was whether or not people got to keep their doctors.

            1. Anyone can keep a doctor they can pay for. Is the big bitch about government not giving you people enough goodies, or do you just like to zing Obama out of substance-free purely partisan hackery?

              1. It wasn’t about the government giving anyone goodies. Most people affected by Obamacare weren’t on the slightest bit of government assistance, yet their insurance plans were canceled because they didn’t fit the new expansive coverage requirements. These people weren’t begging government to give them anything. They just wanted to keep their old policies.

              2. Tony|12.27.18 @ 2:53PM|#
                “Anyone can keep a doctor they can pay for.”

                Push them goal-posts, shitbag.

          2. And if I had the money to afford it out of pocket, that wouldn’t be an issue

            Used to be that way before progressives started demanding “free healthcare”. You could afford to pay for most procedures out of pocket before Medicare and Medicaid were implemented.

          3. But Tony, you can AFFORD to pay it out of pocket. It’s a matter of priorities.

            And, if we had our priorities straight, health care as we like to call it, would probably be a lot cheaper overall because people would have had to make the hard choices instead of spending other people’s money for whatever care they desired.

            Life is priceless. Right? Well, not according to an insurance actuarial I know. He can name a minimum price for anyone’s life.

            We’ve trained people to believe that 1) health care is free and, 2) that life is priceless and has no economic limits.

      2. Tony, a good internist is worth their weight in gold if you have any health issues. Once again, something else where the government had no business involving itself.

      3. Tony|12.27.18 @ 1:44PM|#
        “Man, you people really liked your doctors.”

        Man, scumbag, you really liked that lying pile of shit.

      4. I like how people like you think it’s weird people should have the liberty to spend their own money on the services from the doctor of their own choosing on the services of their own choosing. You make clear your hatred and contempt for liberty and those who value it. You think others are you personal serfs and economic units upon which to experiment, with no human dignity to decide anything for themselves, particularly healthcare.

  12. The 30-day standard, like so many quantitative standard-of-care controls imposed on hospitals and healthcare providers, is arbitrary and capricious. It was festered forth from a federal committee’s brain droppings. It is as fanciful as unicorn poop, and just means about as much.

    If you have heart failure, or bone cancer, bowel cancer, brain tumor, or are recovering from major surgery, you are very unwell. You might need to come back for a night or three of professional care.

    If a patient is stubborn, mean, or just plain ignorant, or old and alonethey might not follow instructions at home, and develop a woumd infection. Or fall and rebreak the hip. Or say fuck it, and eat the steak and eggs, ESRD be goddamned.

    But no, we’re all the same. 30 days. Or else.

    1. The other portion to this is hospitals discharging patients way too soon, and double billing when they get readmitted. Not to mention the practice of Medicaid dumping.

      And regardless, the onus is on the hospital to readmit if warranted, which it appears hospitals have been negligent in.

      Fully expect even more penalties to follow.

      1. why should hospitals be required to take on fines? You’re demanding they both must act in one way and must be penalized for doing what you’re demanding. Expect more hospital closures you ignoramus.

        1. Then tell me good sir how do you hold hospitals accepting government money to account? I mean feel free to point out how to best solve this. I mean medicare fraud is only 10% of the total outlay. How do you address it without penalties?

          “Expect more hospital closures you ignoramus.”

          So what? Should the government then accept fraud as a consequence of keeping hospitals open?

  13. A predictable consequence is never unintended.

  14. Well, isn’t that what government healthcare is for?
    To cull the excess population?
    Otherwise these people would get competent care in the private sector and live longer.
    Where’s the humanity in that?

  15. Healthcare should be free and equal for all.

    Health is as important a part of a society’s infrastructure as it’s clean water, roads and human rights and they all require taxes to maintain and enforce.

    If people are unhealthy, we will end up caring for them and their families, inadequately. This doesn’t end with their death, because their children never received proper healthcare either. It is a perpetual situation for all but the most exceptional of people.

    Do you think the military should receive free healthcare or save their money for other things? I suspect fewer would choose to play with guns in the first place and the rest would be far less effective, sick injured and in pain.

    1. “Healthcare should be free and equal for all.”

      But Obamacare solved that problem, didn’t it?

      1. Do you think Obamacare made healthcare free and equal for all?

        1. I dunno. Let’s ask Congress!

        2. My coverage costs nearly tripled, and o have no major health issues. My diabetic cousin who is a highly paid lawyer, saw her costs plummet. So now I get to pay for her insulin, even though she could afford to pay for it herself. And apparently we’re paying for any trannys who cross the border to get free tranny meds.

          Once again, I suggest organ harvesting all the organs of progtards like Tony. Use the proceeds to pay the difference for all this bullshit.

    2. Suppose society accepts your premise- how do you pay for it?

      How do you implement it in a way that doesn’t cause market distortions? Can you guarantee the results will unconditionally better than what a market would provide, or is “free health care” a giant step backwards in health promotion?

      Soundbites of single-payer or medicare for all won’t cut it. Show your work on how to improve the existing system.

      1. “show your work” is a bridge too far for Rob.

        1. Easy, stop providing any free healthcare to the military and have them pay for everything like everyone else does.

          Follow the money and watch America’s military devolve.

          Put your “security” where your mouth is.

          And explain how clean water isn’t exactly like free healthcare.

          1. “stop providing any free healthcare to the military”

            Yeah, I suppose putting 24 hour clinics on subs on 6 month deployments does make more sense. Not to mention you want soldiers to be thinking about ER costs when they are on the front lines.

            Makes perfect sense.

            “how clean water isn’t exactly like free healthcare”

            Area I live in has numerous farms. As of consequence, nitrates tend to get into the water supply from the run off.

            Now federal drinking water standard for nitrate is 10 mg/L, but the water supply here regularly exceeds that depending on when tested (still in compliance with federal standards). As there is absolutely NO MONEY to build another water treatment plant, you can either pay $100 to get an osmosis filter or scuttle the entire town.

            Which do think is more effective?

            1. Sounds like a shithole.

              1. Admittedly there isn’t an app to remove feces from off the streets, but the farmer’s market is grand, the people are nice enough, and there are enough local oddities to keep one interested.

                Compromises where ever you live.

                1. Yep,

                  Compromise means to accept standards that are lower than is desirable:

          2. You’re desperately flailing here.

            1. Why is it a good idea for free military healthcare but not everyone else?

              1. Why do you desperately shift the burden of proof? Oh yeah, because you can’t show your own.

              2. Well, there is a trade off. I am guessing that military pay would increase substantially.

                1. Yes, and servicemen would own nicer homes, better food, new trucks and they would limp into battle sick, injured and in pain.

                  The American dream.

                  1. So, you’re not actually going to show your work, then? Quelle surprise.

          3. I pay a quarterly bill for my water usage. It’s way higher for people with leaky toilets and swimming pools.

            If I had a well. I’d be on my own

            1. Yes, you’re clean water is regulated and maintained by your government paid for by your taxes.

              You pay more by volume.

              True that you would pay less should you have a well. You do pay through your taxes for government inspections still.

              1. Yes, you’re clean water is regulated and maintained by your government paid for by your taxes.

                It’s a usage bill, not a tax.

                1. “Most Americans are served by publicly owned water and sewer utilities. ”

                  https://en.m.wikipedia.org/wiki/Drinking_water_ supply_and_sanitation_in_the_United_States

                  That means paid by taxes and also by volume.

          4. “And explain how clean water isn’t exactly like free healthcare.”

            I pay for water, and pay more for higher usage.

            Free healthcare has no cost to me (by definition) so there is no incentive to use the system prudently. Completely different.

            1. Doctors can’t fix what isn’t broken. Prudence is irrelevant.

              The financial incentive and human weakness is what corrupts health care, like everything else.

              1. Show your work, dumbshit.

        2. Show your work- Taiwan’ healthcare system.

          1. “However, many healthcare providers took advantage of the system by offering unnecessary services to a larger number of patients and then billing the government.”

            “Dr. Michael Chen, vice president and CFO of Taiwan’s National Health Insurance Bureau explained that one of the models investigated was the United States and that fundamentally, NHI “is modeled after Medicare [in the USA]. And there are so many similarities ? other than that our program covers all of the population, and Medicare covers only the elderly.”

            “Taiwan has suffered many misfortunes. From 1996 to 2008, the average annual growth rate of expenditures was 5.33%, which outstripped the growth rate of revenue at 4.43%.[22] The revenue base is capped so it does not keep pace with the increase in national income. Premiums are regulated by politicians,[23] and they are afraid to raise premiums because of voters.”

            “There is a low doctor-to-population ratio resulting in too many patients depending on too few doctors. There is also a shortage of nurses.”

            Pass.

            1. OK how about Israel. Ranks higher than the US in quality and efficiency. Highly regulated and paid for by employment tax and general taxes with government paying about 60%, below average for developed countries. 100% of the population covered. There are four official HMOs you can choose from.

              1. There is probably something to be said about at least a different type of regulation instead of letting insurance and trade groups (or the government for that matter) dictate the terms of healthcare. I don’t know if that means “highly regulated” or just a different focus to regulations to strike a better balance.

                I do know that most ideas to improve healthcare are just adding market distortions to address market distortions. It just creates a different set of problems, and never addresses the root cause in the first place.

                So how about removing complexity from the current equation instead of adding to it? Fundamentally markets work. It may be all that is needed is a cost effective floor and removing incentives for insurance than a complete restructuring. Work with markets instead of against them.

              2. “with government paying about 60%” That is truly funny! Where does the Israeli gov’t get that money? It has to come from somewhere, does it not? If it’s not coming from taxes, is it quite possibly coming from US aid? i would TOTALLY be in favor of single payer health care, if we could get another country to pay for 60% of it.

                1. Cmon, who would be that stupid?

      2. What pay for it? Didn’t you read where he said “free”?

        1. Free, but not cheap.

    3. Enjoying winter break? Man, going back to school in a week is gonna suck!

    4. Not so. Put a price on it and let the losers die by the side of the road.

      Problem solved.

      1. Are you talking about the military?

        1. The military should not have anything paid for with funds extracted by threats of violence. Ideally, nothing should. At that point, if the military as an organization decided to centrally fund the health care of its members, then let them.

          1. Paid for by your taxes. Free healthcare.

            1. Rob, you have convinced me that you are a total idiot. Military health care is not free, and i’m astonished that everyone here will even debate that phony premise with you. Military health care is part of the compensation package to its employees. State employee health insurance is not free, it is part of the compensation package to its employees. My Medicare is not free (far from it), i paid into it all my life. The truth is that the only people who get free health care in this country are newly arrived illegal aliens, who have not paid a fucking cent into the system. If they go to the ER, they will be treated free of charge (it’s the law that they cannot be turned away). And if you do not believe that’s true, then you are, like i said, an idiot.

              1. Palatki|12.28.18 @ 3:37PM|#
                “Rob, you have convinced me that you are a total idiot.”
                This has been obvious for some time:
                Misek = fucking idiot.

              2. Their entire compensation package is taxpayer funded.

                Road repai isn’t free, your taxes fund it.

                So I guess when your taxes fund everyone’s total healthcare, it won’t be free either. You will be paying for them, and they will be paying for you.

                I called it free. My bad. Taxpayer funded.

                That’s the way it is, for good reason.

                1. You still can’t show your work.

  16. And of course, the discharge is based on the medicare one size fits all limit on how long you can stay in the hospital for diagnosis ‘X’. So the hospital is penalized if they keep the sick patient ‘too long’, and penalized if the sick patient they discharged too soon medically, but on schedule according to medicare, comes back in less than 30 days.
    How many people who show up after 28 or 29 days do you think are shuffled off to the ER for 48 hours of observation before they are re-admitted?

  17. It’s a feature, not a bug.

  18. Joe’s Morgue. You stab ’em, we slab ’em.
    Now serving Obamacare and Medicare fallout.

  19. Well you saved $2500. Whaddayawant for crying out loud?

  20. This is exactly the efficiency socialists talk about with government healthcare: paying less money for more or less the same outcomes.

    A few old farts dying of heart disease around the time people are expected to doesn’t change national life expencancy any noticeable bit. Therefore, this is more efficient.

    What? You didn’t think government healthcare meant guaranteed health service, right?

    1. paying less money for more or less the same outcomes.

      It would be nice if it weren’t actually paying more for worse outcomes.

      1. Outcomes are largely the product of public health and not health care.

  21. The consequences of government programs cannot be determined because human action is too complex to determine cause and effect. That leaves us with politicians and “experts” telling us what the consequences have been. Getting involved in the debate over causes and effects is a game for suckers, and assumes such things can be determined – and that results can be improved by tweaking policies.

  22. All I know is that my health insurance premium doubled with ACA and I have never even used my insurance.

    1. Mine too

    2. “Fact check: Trump misleads with latest Obamacare claim”, NBC News, 12/17/2018

      Who are you gonna believe: what you you know from experience or the fact-checkers at NBC news?

      In my case, I’m age 63 and wife 61. AGI is about $75,000. Without ObamaCare subsidy, the cheapest policy on Healthcare.gov runs about $20,000/year for the two of us; deductible is almost $14,000. Don’t tell me that a $14,000 deductible is affordably after I’m already out of pocket for $20K.

      Seriously, ObamaCare is pissing on my leg and NBC [fake] news tells me its raining.

      The only beneficiaries of ObamaCare are people who receive “free” or “nearly free” “insurance”. The former are at or below poverty line and get Medicaid in the states that signed up with the program. The latter are between 100% and 250% of poverty line who get heavily subsidized insurance from the so-called “Marketplace” that includes “cost sharing reductions” that reduce deductibles.

      Otherwise, it’s a massive rip-off. And, yeah, in my case ObamaCare runs about 2.5 times what I paid in 2014 and has even worse coverage.

      1. Great comment. The obvious thing to do is extend the subsidies and when healthier people enter the Exchanges it pretty much pays off itself.

        That said the true beneficiaries of Obamacare are the providers and their BMW dealers and the Kushner family, the actual people on Obamacare don’t really get any new benefits other than they can eat more because their dialysis is now free!

        1. You can’t beat the truth from people battling government BS on the front lines. I imagine your example has been played out in millions of cases.

      2. Blame ACA failure on republican tinkering and some key democrats who are really GOP asswipes. The law would have worked had the stupids in charge would not keep trying to destroy it and then tell us it dont work.. You got to be stupid to believe anything the GOP/freedumb caucus has to say.

      3. Blame ACA failure on republican tinkering and some key democrats who are really GOP asswipes. The law would have worked had the stupids in charge would not keep trying to destroy it and then tell us it dont work.. You got to be stupid to believe anything the GOP/freedumb caucus has to say.

      4. Blame ACA failure on republican tinkering and some key democrats who are really GOP asswipes. The law would have worked had the stupids in charge would not keep trying to destroy it and then tell us it dont work.. You got to be stupid to believe anything the GOP/freedumb caucus has to say.

  23. If you like your undertaker you can keep him.

  24. The only reason, and the only reason period that Obama care does not work is because of the GOP/Trump regime of stupidity and downright ignorance has defunded and neutered all the rules that made Obamacare work. You can’t destroy a program from within and then take the high ground and claim it is broken and does not work. This is not the work of genius or brilliance this is the cult of stupid coupled with basic ignorance and rhetorical bullshit as the basis of fact. You cant hide stupid with republican controlled government you cant fix stupid either. Anything republican controlled is doomed for failure. If brains was dynamite republicans and Trump would not have enough to blow their nose. Same goes for their ignorant racist bigoted evangelical zealot base. Stupid is their master and their master is trump.

  25. “If hospitals were treating people effectively, the thinking went, those people shouldn’t need to return so soon.”

    Sure. This must be an example of science-based, facts matter thinking that progressives pride themselves on.

    Everybody knows that people with serious chronic health conditions can be cured in one hospital visit! What’s wrong with those doctors anyway? Can’t they cure congestive heart failure with a single dose of medical marijuana?

  26. “The program, then, was a success by one measure?but not the most important one.”

    Seriously? You think “30-day post-discharge mortality” is the most important metric to the creeps who wrote ObamaCare?

    You’d do well to read Dr. Ezekiel Emanuel’s “”Principles For Allocation of Scarce Medical Interventions.”

    Sarah Palin isn’t quite as dumb as you might have been led to believe. Sure, she may be dumb, but she was smart enough to foresee the consequences of expanding state control of health care.

    1. Is there a bigger dumbass in America than Zeke Emanuel?? Nobody takes him seriously in 2018.

    2. Sarah Palin isn’t quite as dumb as you might have been led to believe. hahahaha saying this does not make you look very smart either and makes you comment a stupid attempt to say health care for all is bad….. No health care for all is bad you dumbshit Your just just one of them libertarian/GOP idiots who swallow all the bullshit the current administration feeds ya. Your an expert on your own rhetorical fantasies.

  27. No!!
    A centralized program for medical care causes deaths?!
    Paging NHS! NHS, your cousin is on the white courtesy tlephone!

  28. I am shocked that Big Pharma hasn’t lobbied to have this law changed. After all, sick people and more of them make for heftier drug profits.

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  30. True life stories have a way of bringing front and center the flaws in Obamacare. Today many people have coverage with a deductible so high that they are afraid to use it which is akin to having no coverage at all and this poses a massive problem. This is about someone very close to me and I know it is true because I drove them to the hospital.

    After sitting in my vehicle for about 30 minutes waiting for the pain to subside she finally conceded to the idea it was not a silly quest and succumbed to the heavy pressure upon her chest. After about an hour and several tests they found nothing and advised her to be admitted for more tests but feeling rather silly and much better she declined because spending two thousand dollars to be told nothing is enough.

    The next night it happened again and this time a heart attack was confirmed. It was only during surgery they discovered she was lucky the bomb within her chest had not exploded and if it had she most likely would have died. Before entering surgery they did not know just how dire her condition was. It seems that luck is indeed a big factor in healthcare just as it is in Russian-roulette. More on this subject in the article below.

    https://brucewilds.blogspot.obamacare-can-killhtml

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