Debate Now An Unhappy Birthday for Obamacare?

[Greenbeard]

I am asking where the savings came from. That was the question I asked...pure and simple.

I know I don't always ask clearly.

So I'll keep trying.

Their cost sharing has dropped....does that mean things cost less or someone else is picking up the tab.

Don't try to read anything into it. It is just a question.

A critical thing to understand here (and in all things) is that health care in America doesn't cost $3 trillion because health care in America costs $3 trillion. It costs $3 trillion because those who fork over that money can be convinced or coerced to do so. "Cost" is used synonymously with "price" at times but price is just what people can be made willing to pay, and actual underlying cost tends to creep up as incentives for efficiency and wise use of resources disappear.

As for Medicare Part D, what HHS (and I guess by extension me) is talking about is a benefit change that saves millions of Americans on direct costs because it covers more of their prescription drug costs. Has the cost they used to pay but are now free of descended upon the taxpayer (as opposed to coming out of the puffed up "costs" that drug manufacturers pass on to payers)? Maybe, I don't really know--Medicare Part D isn't really my thing. But if it has the impact for the taxpayer has been minimal, since total per beneficiary Medicare spending is actually declining, which is not something that happens for Medicare. Even as the donut hole has been closing.

 

[LoneLaugher]

Greenberg, unlike me, is patient and may actually care what you do and don't appreciate. That dude is a straight-up authority on this shit. He's got the facts at his fingertips. He doesn't work his ass off trying to drag you into the weeds in hopes that you'll get bored to death.

I'm not a big believer that facts or arguments change minds, I enjoy this process more for me. Do you know the last time I've had occasion to look up how the HCAHPS scores of Albuquerque-area hospitals have done since the ACA passed? Never! But now I know they've gotten better. Not a thing I would otherwise know. Mostly it all just helps to clarify the thought processes, clear out the cobwebs. Also provides ample illustration of bad thinking and bad argumentation--an important thing for considering your own deficiencies.

Well I wish the healthcare professionals who are delivering the healthcare believed they were getting better. They don't believe that. And I doubt any government stats, given how those have been proved wrong again and again, will convinced them.

And you just know what they believe........because.

 

[Sun Devil 92]

I am asking where the savings came from. That was the question I asked...pure and simple.

I know I don't always ask clearly.

So I'll keep trying.

Their cost sharing has dropped....does that mean things cost less or someone else is picking up the tab.

Don't try to read anything into it. It is just a question.

A critical thing to understand here (and in all things) is that health care in America doesn't cost $3 trillion because health care in America costs $3 trillion. It costs $3 trillion because those who fork over that money can be convinced or coerced to do so. "Cost" is used synonymously with "price" at times but price is just what people can be made willing to pay, and actual underlying cost tends to creep up as incentives for efficiency and wise use of resources disappear.

As for Medicare Part D, what HHS (and I guess by extension me) is talking about is a benefit change that saves millions of Americans on direct costs because it covers more of their prescription drug costs. Has the cost they used to pay but are now free of descended upon the taxpayer (as opposed to coming out of the puffed up "costs" that drug manufacturers pass on to payers)? Maybe, I don't really know--Medicare Part D isn't really my thing. But if it has the impact for the taxpayer has been minimal, since total per beneficiary Medicare spending is actually declining, which is not something that happens for Medicare. Even as the donut hole has been closing.

You seem to want to couch things.

I am simply asking a question.

So, we really don't know if the savings are net to the system....or just costs being shifted.

I am not judging that...I just wanted to know what the situation really was.

In the end, we keep discussing the whole 16% (versus 8% in other places) argument. I agree. If you are paying twice as much (don't agree our outcomes are no better....I think it is more complex than that...but twice as much ?????) is stupid.

This was a metric.

For all those who argued for Obamacare..they implied (and in many cases said as much) that this would come down under the law.

That is measurable.

That is why I am asking.

It needs to come down.

 

[Greenbeard]

Well I wish the healthcare professionals who are delivering the healthcare believed they were getting better. They don't believe that. And I doubt any government stats, given how those have been proved wrong again and again, will convinced them.

This may shock you, but you're not the only one with connections in the health care industry. The change (and I acknowledge it's a huge change) is that health care providers are now being asked to show results for the exorbitant sums of money flowing into that sector.

That means more and more hospitals are at financial risk based on their performance, more docs are being scrutinized based on what they're doing and how their patients are doing. Is it shocking that some, particularly older docs, don't like that change? No! If I'd spent a whole career being paid without any heed to how well I'm performing, the (quality) results I'm actually producing, I wouldn't like that change either.

But this isn't your father's health system. it's not going to be an endless gravy train anymore, providers are not going to be unaccountable for the trillions of dollars flowing to them. There are going to be lower-cost alternatives to what's traditionally been available springing up (and indeed there already are). Patients are increasingly going to be acting like consumers, not wholly delegating decision-making to the assumed wisdom of a given doctor.

Younger docs tend to be more accepting of the new reality than older docs, but that's the way it is. You don't get all the money just for showing up anymore, you have to perform better. The models that show better quality results and save money are going to spread pretty quickly now. The old arrogance now must give way to evidence-informed change. Retirement isn't the worst thing in the world for those unable to adapt to the present--we don't need asses warming the seats, we need real doctors who are willing to practice as best we know how as of 2015 (not 1970) and who, come 2016, will practice as well we know how as of 2016.

 

[Sun Devil 92]

Greenberg, unlike me, is patient and may actually care what you do and don't appreciate. That dude is a straight-up authority on this shit. He's got the facts at his fingertips. He doesn't work his ass off trying to drag you into the weeds in hopes that you'll get bored to death.

I'm not a big believer that facts or arguments change minds, I enjoy this process more for me. Do you know the last time I've had occasion to look up how the HCAHPS scores of Albuquerque-area hospitals have done since the ACA passed? Never! But now I know they've gotten better. Not a thing I would otherwise know. Mostly it all just helps to clarify the thought processes, clear out the cobwebs. Also provides ample illustration of bad thinking and bad argumentation--an important thing for considering your own deficiencies.

Well I wish the healthcare professionals who are delivering the healthcare believed they were getting better. They don't believe that. And I doubt any government stats, given how those have been proved wrong again and again, will convinced them.

And you just know what they believe........because.

I think Fox has been pretty clear....because she asked them.

Who missed what ?

 

[Greenbeard]

In the end, we keep discussing the whole 16% (versus 8% in other places) argument. I agree. If you are paying twice as much (don't agree our outcomes are no better....I think it is more complex than that...but twice as much ?????) is stupid.

This was a metric.

For all those who argued for Obamacare..they implied (and in many cases said as much) that this would come down under the law.

That is measurable.

That is why I am asking.

It needs to come down.

I'm not saying a definitive answer is at hand here. What I am saying is that a path to an answer has been presented and that we've embarked on it.

There are two schools of thought on the cost problem here and both have significant merit. The first points to our fragmented, inefficient delivery system. The second to the insane prices our providers are able to charge for their services.

Both are a problem. The shift toward better health care delivery models and tying payment to the value (e.g., quality) of services provided gets primarily at the first. There's been huge movement on this front. On the second, the exchanges have made some progress but their market is small enough that it's primarily just been nibbling around the edges thus far (until insurers and employers adopt similar strategies for the rest of their markets). Greater cost-sharing, like higher deductibles, plays a similar role but that can only have so much impact.

In some respects these two threads, these two arguments, work against each other. Tackling one undoes the other. And I think figuring out how to reconcile them is by far the most important and interesting policy question in the entire world right now.

 

[Sun Devil 92]

Well I wish the healthcare professionals who are delivering the healthcare believed they were getting better. They don't believe that. And I doubt any government stats, given how those have been proved wrong again and again, will convinced them.

This may shock you, but you're not the only one with connections in the health care industry. The change (and I acknowledge it's a huge change) is that health care providers are now being asked to show results for the exorbitant sums of money flowing into that sector.

That means more and more hospitals are at financial risk based on their performance, more docs are being scrutinized based on what they're doing and how their patients are doing. Is it shocking that some, particularly older docs, don't like that change? No! If I'd spent a whole career being paid without any heed to how well I'm performing, the (quality) results I'm actually producing, I wouldn't like that change either.

But this isn't your father's health system. it's not going to be an endless gravy train anymore, providers are not going to be unaccountable for the trillions of dollars flowing to them. There are going to be lower-cost alternatives to what's traditionally been available springing up (and indeed there already are). Patients are increasingly going to be acting like consumers, not wholly delegating decision-making to the assumed wisdom of a given doctor.

Younger docs tend to be more accepting of the new reality than older docs, but that's the way it is. You don't get all the money just for showing up anymore, you have to perform better. The models that show better quality results and save money are going to spread pretty quickly now. The old arrogance now must give way to evidence-informed change. Retirement isn't the worst thing in the world for those unable to adapt to the present--we don't need asses warming the seats, we need real doctors who are willing to practice as best we know how as of 2015 (not 1970) and who, come 2016, will practice as well we know how as of 2016.

Some questions to you and others regarding these statements.

What does economics teach us about those who find a gravy train ? It teaches that, in a well greased economic market, that others will enter the system to take a part of the gravy train away.

The only way the existing competitors can protect the gravy train is to create barriers to entry.

How did doctors manage to do this ?

The other part of your addage is that you get what you pay for. In this case, you might see (and I fully expect it to happen) the system break into the two-tier system that many speak of when discussing other systems (Europe in particular).

I might add that my interest in this is related to my POV for a long time, that medicine had become a oligarchy (of sorts) with the AMA setting doctor quotas and things like that. It also seemed that doctors had to part of a "practice" in order to be successful. And as more regulations formed up, more and more small practices sold out to larger ones (with the same associated issues that come when a large company swallows a smaller one).

The same with insurance. I have never been able to get the financial information needed to understand just how insurance could be so limited. On a spreadsheet it would seem a pretty simple thing to do....and yet there are very few entrants into the market (offering insurance).

I challenge those who complain against Obamacare to show me where the right has done anything to uncork these markets to help bring costs down.

 

[Greenbeard]

Some questions to you and others regarding these statements.

What does economics teach us about those who find a gravy train ? It teaches that, in a well greased economic market, that others will enter the system to take a part of the gravy train away.

The only way the existing competitors can protect the gravy train is to create barriers to entry.

How did doctors manage to do this ?

The other part of your addage is that you get what you pay for. In this case, you might see (and I fully expect it to happen) the system break into the two-tier system that many speak of when discussing other systems (Europe in particular).

I might add that my interest in this is related to my POV for a long time, that medicine had become a oligarchy (of sorts) with the AMA setting doctor quotas and things like that. It also seemed that doctors had to part of a "practice" in order to be successful. And as more regulations formed up, more and more small practices sold out to larger ones (with the same associated issues that come when a large company swallows a smaller one).

The same with insurance. I have never been able to get the financial information needed to understand just how insurance could be so limited. On a spreadsheet it would seem a pretty simple thing to do....and yet there are very few entrants into the market (offering insurance).

I challenge those who complain against Obamacare to show me where the right has done anything to uncork these markets to help bring costs down.

You're on the right track with the reference to oligarchy. But there are larger systems than just physician practices--systems with hospitals, physician organizations, nursing homes, non-acute hospitals, you name it. They dominate markets and they elevate prices. They generally form (i.e, pass antitrust muster) on the argument that they can lower costs.

And i firmly believe that they can. The problem is that they don't have to.

That's the paradox I was getting at in my last post. That kind of integration of unconnected providers seems critical to lowering the actual cost of delivering care: it can improve the coordination between providers, reduce mishaps and errors in the handoff from one provider to the next, enhance information flow so providers don't need to unintentionally duplicate tests and work, etc. The problem is that when you're integrated (i.e., vertically integrated) enough that you can better manage the health of your enrollees and lower costs, you're also powerful enough in your market that you can negotiate higher prices from insurance companies.

Everything comes down to that negotiation between insurers and large provider systems. That's been shifting in recent years such that those systems don't just get money unconditionally, they're at risk for their performance and the health of the people they're responsible for. But is that enough? This is an early, ACA-esque experiment. As I said, I think addressing this question is the most important thing in the world right now. There are a number of experiments going on right now, which is good. So we should at least have some indication in the near future.

 

[Greenbeard]

I will share a positive example so we're not all dispirited.

An Obamacare Payment Reform Success Story

To understand how the health law is supposed to fix the mediocre, overpriced, absurd medical system, you could read wonky research papers on bundled payments and accountable care organizations.

Or you could look at what’s going on at Baptist Health System in San Antonio.

Under the potent lure of profit, doctors, nurses and managers at Baptist’s five hospitals have joined forces to cut costs for hip and knee replacements, getting patients on their feet sooner and saving taxpayers money.

The hospital group made a deal with Medicare, the huge government program for seniors, as part of an ambitious array of experiments authorized by the Affordable Care Act.

Medicare let Baptist take responsibility for the whole process of replacing knees and hips, from admission to surgery to rehab and anything else that happened within a month. (Traditionally the system, essentially tied with Methodist Health System as the region’s biggest, managed only what happened within its doors.)

Then Medicare lowered the average amount of what it pays for all that care by 3 percent, giving Baptist a lump sum for each patient getting the procedures. If the system and its orthopedic surgeons reduced costs below that price, they could keep the difference and divvy it up so long as quality didn’t suffer. If costs went up, Baptist was on the hook.

This is a purified form of the health law’s recipe to save health care: Get hospitals, doctors and other providers to work together. Cap their costs. Offer incentives to save and penalties for breaking the budget. Repeat.

A preliminary study of the tests at Baptist and elsewhere, overseen by the health law’s Center for Medicare & Medicaid Innovation, found substantial savings along with shorter patient stays in the hospital and lower use of expensive nursing facilities afterward.

 

[dblack]

I'm not saying a definitive answer is at hand here. What I am saying is that a path to an answer has been presented and that we've embarked on it.

There are two schools of thought on the cost problem here and both have significant merit. The first points to our fragmented, inefficient delivery system. The second to the insane prices our providers are able to charge for their services.

Both are a problem. The shift toward better health care delivery models and tying payment to the value (e.g., quality) of services provided gets primarily at the first. There's been huge movement on this front. On the second, the exchanges have made some progress but their market is small enough that it's primarily just been nibbling around the edges thus far (until insurers and employers adopt similar strategies for the rest of their markets). Greater cost-sharing, like higher deductibles, plays a similar role but that can only have so much impact.

In some respects these two threads, these two arguments, work against each other. Tackling one undoes the other. And I think figuring out how to reconcile them is by far the most important and interesting policy question in the entire world right now.

The problem with every "path" proposed by government is that it's always in the same direction, always toward more centralized, institutional control. And the irony is that that impulse is what's been poisoning the health care market all along. Well meaning reformers imagine that state control will give them the power to make things right, to make things better for society. But they aren't the only interests who want that kind of power, and they simply can't compete with legions of lawyers and corporate lobbyists who have much more to gain

 

[Sun Devil 92]

I will share a positive example so we're not all dispirited.

An Obamacare Payment Reform Success Story

To understand how the health law is supposed to fix the mediocre, overpriced, absurd medical system, you could read wonky research papers on bundled payments and accountable care organizations.

Or you could look at what’s going on at Baptist Health System in San Antonio.

Under the potent lure of profit, doctors, nurses and managers at Baptist’s five hospitals have joined forces to cut costs for hip and knee replacements, getting patients on their feet sooner and saving taxpayers money.

The hospital group made a deal with Medicare, the huge government program for seniors, as part of an ambitious array of experiments authorized by the Affordable Care Act.

Medicare let Baptist take responsibility for the whole process of replacing knees and hips, from admission to surgery to rehab and anything else that happened within a month. (Traditionally the system, essentially tied with Methodist Health System as the region’s biggest, managed only what happened within its doors.)

Then Medicare lowered the average amount of what it pays for all that care by 3 percent, giving Baptist a lump sum for each patient getting the procedures. If the system and its orthopedic surgeons reduced costs below that price, they could keep the difference and divvy it up so long as quality didn’t suffer. If costs went up, Baptist was on the hook.

This is a purified form of the health law’s recipe to save health care: Get hospitals, doctors and other providers to work together. Cap their costs. Offer incentives to save and penalties for breaking the budget. Repeat.

A preliminary study of the tests at Baptist and elsewhere, overseen by the health law’s Center for Medicare & Medicaid Innovation, found substantial savings along with shorter patient stays in the hospital and lower use of expensive nursing facilities afterward.

Nice, but now always the case.

Recall this one:

Mayo Clinic in Arizona to Stop Treating Some Medicare Patients - Bloomberg

I don't claim to know everything that went into it. But you can't praise the model for costs and then not take notice when they say whoever is setting prices is basically screwing them.

I don't know the Mayo or it's business model, but how can this happen:

The Mayo organization had 3,700 staff physicians and scientists and treated 526,000 patients in 2008. It lost $840 million last year on Medicare, the government’s health program for the disabled and those 65 and older, Mayo spokeswoman Lynn Closway said.

Now, the right held this way higher than they should have.

But it does show the fobiles of some of this. Your example about the hospital in San Antonio leaves several unanswered questions.

In general, though, this is what the right wants....free market health care. What you hope is that the Medicare costs savings are not being made up elsewhere. Additionally, if you are in Medicare, you better watch to make sure they are not taking short cuts.

While I understand the example.....it is not as un-dispiriting as you might think.

 

[Greenbeard]

The problem with every "path" proposed by government is that it's always in the same direction, always toward more centralized, institutional control. And the irony is that that impulse is what's been poisoning the health care market all along. Well meaning reformers imagine that state control will give them the power to make things right, to make things better for society. But they aren't the only interests who want that kind of power, and they simply can't compete with legions of lawyers and corporate lobbyists who have much more to gain

A hospital is an institution. Do you want a health care market without hospitals?

The real question is how you allow a hospital or hospital system to provide high-quality care without garnering enough unchecked market power to extract exorbitant prices for it. The answer isn't that we shouldn't have hospitals, only docs with black bags, because "institutional" control of health care is bad, it's that we need some way to harness what advanced health care institutions can offer while balancing it with the need to encourage efficiency and price competition.

There's virtually no way this question can avoid engaging the individual as a consumer, the government as a purchaser and regulator, and the institutional health care provider (along with the insurers that reimburse them) as a critical market participant.

 

[Greenbeard]

Nice, but now always the case.

Recall this one:

Mayo Clinic in Arizona to Stop Treating Some Medicare Patients - Bloomberg

I don't claim to know everything that went into it. But you can't praise the model for costs and then not take notice when they say whoever is setting prices is basically screwing them.

Let's be clear here. Mayo serves what, 1.3 million + patients a year? They stopped accepting Medicare for a few thousand patients in Arizona (I assume you're aware of this but Mayo is an institution primarily based in Minnesota).

All high-cost facilities say they lose money on Medicare patients, because they do. Facilities that are efficient and aren't rolling in dough from private payers willing to fork it over, on the other hand, tend to have positive margins on Medicare patients. Those that have money to waste tend to have negative margins on Medicare.

The question isn't do you do things well enough and efficiently enough to make Medicare profitable, it's can you? And institutions that have financial need to do so tend to. Which suggests that those who lose money on Medicare aren't being shortchanged, they've just had the luxury of adopting a cost structure expensive enough that Medicare has a negative margin. That's a choice, not a necessity.

In general, though, this is what the right wants....free market health care. What you hope is that the Medicare costs savings are not being made up elsewhere. Additionally, if you are in Medicare, you better watch to make sure they are not taking short cuts.

While I understand the example.....it is not as un-dispiriting as you might think.

Medicare isn't alone in this. Private payers are participating in payment reforms in a number of states. Medicare just happens to be the most important single payer out there. But this is part of why the shift to risk-based contracting (in private payer contracts) is important. This approach is spreading beyond Medicare. And that's changing the way health care providers do business, and providing some hope that the cost trajectory of the health system is, for the first time, beginning to shift favorably.

Anyway, the article isn't about prices, it's about actually lowering the cost of delivering care to Medicare patients.

 

[dblack]

The problem with every "path" proposed by government is that it's always in the same direction, always toward more centralized, institutional control. And the irony is that that impulse is what's been poisoning the health care market all along. Well meaning reformers imagine that state control will give them the power to make things right, to make things better for society. But they aren't the only interests who want that kind of power, and they simply can't compete with legions of lawyers and corporate lobbyists who have much more to gain

A hospital is an institution. Do you want a health care market without hospitals?

The real question is how you allow a hospital or hospital system to provide high-quality care without garnering enough unchecked market power to extract exorbitant prices for it. The answer isn't that we shouldn't have hospitals, only docs with black bags, because "institutional" control of health care is bad, it's that we need some way to harness what advanced health care institutions can offer while balancing it with the need to encourage efficiency and price competition.

You're steering around the coercive element of governmental institutions, and fixating on 'market power' as the culprit. But no amount of economic power can eclipse the coercive power of government. Which is why the insurance industry would rather get in bed with government than earn profits in a free market. The failure to recognize that is leading us in some really dangerous directions - the trend toward corporatism chief among them.

There's virtually no way this question can avoid engaging the individual as a consumer, the government as a purchaser and regulator, and the institutional health care provider (along with the insurers that reimburse them) as a critical market participant.

Of course there is. There's just virtually no one in government willing to limit the scope and reach of their own power.

 

[Greenbeard]

You're steering around the coercive element of governmental institutions, and fixating on 'market power' as the culprit. But no amount of economic power can eclipse the coercive power of government. Which is why the insurance industry would rather get in bed with government than earn profits in a free market. The failure to recognize that is leading us in some really dangerous directions - the trend toward corporatism chief among them.

The insurance industry's sin is not pushing back harder against price demands of providers. But health care providers are the ones who are actually demanding (and receiving) exorbitant prices.

A screed against "governmental institutions" or "the insurance industry" isn't going to change that fact. You pay a lot because providers demand (and receive) a lot for the services they bill.

 

[dblack]

You're steering around the coercive element of governmental institutions, and fixating on 'market power' as the culprit. But no amount of economic power can eclipse the coercive power of government. Which is why the insurance industry would rather get in bed with government than earn profits in a free market. The failure to recognize that is leading us in some really dangerous directions - the trend toward corporatism chief among them.

The insurance industry's sin is not pushing back harder against price demands of providers. But health care providers are the ones who are actually demanding (and receiving) exorbitant prices.

A screed against "governmental institutions" or "the insurance industry" isn't going to change that fact. You pay a lot because providers demand (and receive) a lot for the services they bill.

The fight against corporations and government teaming up to manipulate markets (the screed against "governmental institutions" or "the insurance industry") is the only thing that will fix this mess. "Hair of the dog that bit me" is sheer folly.

 

[Sun Devil 92]

Nice, but now always the case.

Recall this one:

Mayo Clinic in Arizona to Stop Treating Some Medicare Patients - Bloomberg

I don't claim to know everything that went into it. But you can't praise the model for costs and then not take notice when they say whoever is setting prices is basically screwing them.

Let's be clear here. Mayo serves what, 1.3 million + patients a year? They stopped accepting Medicare for a few thousand patients in Arizona (I assume you're aware of this but Mayo is an institution primarily based in Minnesota).

All high-cost facilities say they lose money on Medicare patients, because they do. Facilities that are efficient and aren't rolling in dough from private payers willing to fork it over, on the other hand, tend to have positive margins on Medicare patients. Those that have money to waste tend to have negative margins on Medicare.

The question isn't do you do things well enough and efficiently enough to make Medicare profitable, it's can you? And institutions that have financial need to do so tend to. Which suggests that those who lose money on Medicare aren't being shortchanged, they've just had the luxury of adopting a cost structure expensive enough that Medicare has a negative margin. That's a choice, not a necessity.

That's wonderful...if they need to. The problem is that if you have enough people competing for doctors such that medicare can't compete...then they don't get doctors or medicare has to pay more.

As I understand it, we are not swimming in doctors.

Doctors increasingly will not accept Medicaid or Medicare Twitchy

This was from late 2012. It was the most non-partisan article I could find. I did find something in Forbes that essentially quoted H&HS saying differently...but (as I've said) I really am going to believe those morons....???

Mayo was simply an example. An early one. If some institutions have to make Medicare work, then you have to ask what they cut out to get there.

Mind you, I am not saying it can't work.

While I don't like the concept of federal interferene in our health care system, I was all to well aware of many of it's issues. I've carped at many about how the system failed to take care of itself (not including the things you've pointed out).

I'll still go back to....are we going to reduce costs significantly below 16% or just shift things around.

Time will tell.

 

[Sun Devil 92]

This was telling.

Medicare treats physicians as criminals

 

[candycorn]

I believe I am telling the truth. Both my husband and I are paying higher deductibles and copays since the ACA went into affect and our premiums are higher. We have both lost our primary physicians because of the ACA and my husband lost his cancer doctor. My elderly aunt and uncle still have their primary care physician because she went into totally private practice, but she accepts no insurance of any kind so her patients pay for her services out of pocket.

Because we have so many personal contacts in various medical services we talk to a lot of professionals in those services and not one of them would say that the ACA didn't make changes that effectively changed the whole system and not one of them are liking it.

And if you read any source other than the pro-Obama propaganda network, there are one or two exceptions, but pretty much all agree that there is much more to dislike about Obamacare than there is to like.

Unless you are prepared to provide evidence of those claims, making them in this thread is against the rules.

Oh.....wait.......my bad. The thread rules state that no links or data are needed to support opinions. However...if you do use links and data...you need to provide a summary in your own words.

That's awesome!

Was there something here that justified our taking the time to read it. If so, I missed it.

Given all the time you are wasting in this thread......probably. You missed it? I'm shocked.

I do appreciate Greenbeards posts and have learned a great deal from them. It has pointed me to some topics I was not aware of. When you do something similar instead of wasting our time with your commentary, I'll be just as appreciative.

Greenberg, unlike me, is patient and may actually care what you do and don't appreciate. That dude is a straight-up authority on this shit. He's got the facts at his fingertips. He doesn't work his ass off trying to drag you into the weeds in hopes that you'll get bored to death.

I put this thread to bed on page one. As far as I am concerned...the rest is just idle chatter. Feel me?

Very well put. Nothing the OP is stating makes sense. You have more people with more insurance and her contention (that she admits she has no data to backup) is that clinics are closing.

 

[Foxfyre]

Unless you are prepared to provide evidence of those claims, making them in this thread is against the rules.

Oh.....wait.......my bad. The thread rules state that no links or data are needed to support opinions. However...if you do use links and data...you need to provide a summary in your own words.

That's awesome!

Was there something here that justified our taking the time to read it. If so, I missed it.

Given all the time you are wasting in this thread......probably. You missed it? I'm shocked.

I do appreciate Greenbeards posts and have learned a great deal from them. It has pointed me to some topics I was not aware of. When you do something similar instead of wasting our time with your commentary, I'll be just as appreciative.

Greenberg, unlike me, is patient and may actually care what you do and don't appreciate. That dude is a straight-up authority on this shit. He's got the facts at his fingertips. He doesn't work his ass off trying to drag you into the weeds in hopes that you'll get bored to death.

I put this thread to bed on page one. As far as I am concerned...the rest is just idle chatter. Feel me?

Very well put. Nothing the OP is stating makes sense. You have more people with more insurance and her contention (that she admits she has no data to backup) is that clinics are closing.

The thread topic is:

THE QUESTION TO BE ANSWERED:

Do you still support Obamacare in its entirety or are you ready to support those who want to repeal it in favor of a different and potentially better system? Why or why not? If you choose to repeal, what would a better system look like?

The information in the OP provides some background that prompted the thread topic.

The topic is just as stated and assumes no 'right or wrong' answer to the question posed.