Debate Now An Unhappy Birthday for Obamacare?

[Foxfyre]

I would further say that if somebody is objective and looks at the blatant misrepresentations of Obamacare that were employed by the President (and others) to sell it--see post #110--I think nobody can honestly say that the plan was not misrepresented from the get go. And I wonder how anybody who realizes how dishonestly the plan was sold to Congress and the American public can think that the government is being honest and truthful in reporting the results of it now.

Well considering it has a built in escape hatch not really. Come 2017 congress will be saved by waivers to appease the states and that will give them funding to rebuild their individual insurance structure.

How does this forgive the lies Foxfyre is calling out ?

I don't get the logic.

It's not. I was agreeing. But may have worded that badly. I also don't think the Repblicans really want to repeal and are just paying lip service to that . They... As well as the rest if congress know they have a trap door built in... If they can hold out until 2017.

IMO the motives of those in Washington DC are to promote their own power, prestige, influence, and personal wealth. What they do for their constituency is almost 100% a bribe of sorts to keep their constituency voting for them so they can continue to increase their personal power, pretige, influence, and wealth.

So here we have a monstrosity of a government program that was forced on us by a 100% partisan vote, a bill that nobody had read or even had time to read and figure out what was in it, and that has been changed so many times by Congressional action and/or executive fiat, that it is barely recognizable as the program that Congress passed.

What politician, no matter how righteous in his conviction that the bill never should have passed, has the smarts to know what the unintended negative consequences would be if Congress repealed the legislation now, five years after it has been implemented? So much of the health infrastructure has been so severely destroyed or altered, what would happen if the plug was pulled on Obamacare now?

I don't think the Republicans or anybody else is willing to stick their necks out to find out. So I guess the GOP is grateful for the Senate filibuster that prevents the House legislation from passing just as I suspect the Democrats were grateful for the GOP filibuster that prevented some of their worst stuff from being enacted into law. That way nobody gets blamed or accused and they go right on increasing their personal power, prestige, influence, and wealth with impunity.

(I'm guessing that a majority of Dermocrats in Washington are now wishing they didn't have that super majority that allowed them to pass Obamacare and that the GOP had been able to block it. They could have then accused the GOP of blocking healthcare reform and blamed them for every bad thing that happened to everybody and the GOP wouldn't have had a very unpopular Obamacare to use against the Democrats.)

 

[Sun Devil 92]

The health care system is about as far from "destroyed" as it can get. On most indicators, it's never done better than it's doing right now.

What indicators ?

 

[Greenbeard]

The health care system is about as far from "destroyed" as it can get. On most indicators, it's never done better than it's doing right now.

What indicators ?

How many times are you going to ask the same question and then never respond to the content of the response? I'll give you a synthesis one more time

Coverage and Access are Expanding

Coverage has hit a record high, uncompensated care costs (i.e., bad debt and charity care) for health care providers are falling. Indeed, people newly insured with coverage through the ACA's marketplaces are actually more satisfied with their coverage than people with traditional-employer-based insurance.

Market Dynamics are on the Rise and Business Models are Changing

Meanwhile, the insurance markets are actually working. Price volatility and turnover in the market leader in the marketplaces has been high as insurers aggressively compete for business--premiums have dropped in many rating areas due to an influx of new competitors. The results have been stunning: premiums that are up to 20% lower than the cost of coverage of comparable generosity in the less competitive employer-based market. The impact of this on the ACA's price tag has been discussed time and again: the law, like the premiums, is turning out to be way, way cheaper than expected.

At the same time, the market-based push for cost containment and individual choice has led to offer a variety of different networks at different prices points--the vilified narrower network options are generally cheaper despite being of comparable quality to broader networks and they're turning out to be extremely popular. Health savings accounts and high deductible plans, the heroes of the market-based consumer-directed care movement, are thriving under the ACA, a fact that's been somewhat surprising to their adherents on the right. Innovation is accelerating as market disruptors rush to introduce new low-cost, convenient options for care.

Insurers, now required to offer consistent prices to shoppers and to take all comers, are embracing the importance of helping their enrollees restore and maintain their health (as opposed to the old business model of screening out those who actually need health services), resulting in them offering a variety of health plans promoting wellness and care management supports. Indeed, one of the new features of healthcare.gov in 2015 was the ability to sort health plan offerings by the type of medical management programs they offer (e.g., heart disease, diabetes, high blood pressure, etc).

Health Care Delivery is Transforming

Under the ACA, health care providers are increasingly being paid for better care and patient-centeredness, not just more service volume. And this is helping them re-envision and re-interpret their role in patient health and how they serve their communities. Primary care docs are moving toward rapidly spreading new models of primary care built around the individual patient's needs--models that offer better access, greater patient input on decision-making, greater capacity for primary care practices, and so on.

Hospitals are embracing a population health management approach, which means that their responsibilities to patient health don't end at their four walls. They're building partnerships with community-based organizations, they're helping patients to better manage transitions back into the community to avoid preventable hospital readmissions, they're joining up with peer institutions to work on improving patient safety. Hospitals are increasingly agreeing to be held accountable for the cost and quality of the product they deliver, not to mention the health outcomes of the patients they serve. That's a pretty transformational change.

As I said before:

Are hospitals getting safer? Yes. ("U.S. hospitals make fewer serious errors; 50,000 lives saved")

Are hospitals improving on key quality measures? Yes. ("The Joint Commission: Hospitals make strides on core measures with more achieving 'top performer' status"; Hospital readmission rates heading in the right direction)

Are the docs and hospitals that teamed up to coordinated care under the ACA showing improvement on quality metrics? Yes. (ACOs continue to succeed in improving care, lowering cost growth)

And we know why. The accountable care organizations that are improving quality and starting to get a handle on cost growth are a creation of the ACA. Preventable hospital readmissions started falling after the ACA linked hospital payment to their prevention. Medical errors started falling (saving tens of thousands of lives) after the ACA brought hospitals together to implement new patient safety protocols and systems. The innovators and startups that are proliferating rapidly are explicitly forming in response to the new market opportunities created under the ACA.

And, if it actually needs to be pointed out, a delivery system that produces better results more efficiently will save money. And we know that spending and cost growth have slowed down substantially, health care prices in some areas are now falling, and health insurance premium growth in both the marketplaces and in the employer-based world has never been lower (as mentioned above, plenty of rating areas in the new marketplaces saw drops this year).

The health sector is seeing huge, unprecedented, transformational changes for the better.

 

[Foxfyre]

The health care system is about as far from "destroyed" as it can get. On most indicators, it's never done better than it's doing right now.

What indicators ?

How many times are you going to ask the same question and then never respond to the content of the response? I'll give you a synthesis one more time

Coverage and Access are Expanding

Coverage has hit a record high, uncompensated care costs (i.e., bad debt and charity care) for health care providers are falling. Indeed, people newly insured with coverage through the ACA's marketplaces are actually more satisfied with their coverage than people with traditional-employer-based insurance.

Market Dynamics are on the Rise and Business Models are Changing

Meanwhile, the insurance markets are actually working. Price volatility and turnover in the market leader in the marketplaces has been high as insurers aggressively compete for business--premiums have dropped in many rating areas due to an influx of new competitors. The results have been stunning: premiums that are up to 20% lower than the cost of coverage of comparable generosity in the less competitive employer-based market. The impact of this on the ACA's price tag has been discussed time and again: the law, like the premiums, is turning out to be way, way cheaper than expected.

At the same time, the market-based push for cost containment and individual choice has led to offer a variety of different networks at different prices points--the vilified narrower network options are generally cheaper despite being of comparable quality to broader networks and they're turning out to be extremely popular. Health savings accounts and high deductible plans, the heroes of the market-based consumer-directed care movement, are thriving under the ACA, a fact that's been somewhat surprising to their adherents on the right. Innovation is accelerating as market disruptors rush to introduce new low-cost, convenient options for care.

Insurers, now required to offer consistent prices to shoppers and to take all comers, are embracing the importance of helping their enrollees restore and maintain their health (as opposed to the old business model of screening out those who actually need health services), resulting in them offering a variety of health plans promoting wellness and care management supports. Indeed, one of the new features of healthcare.gov in 2015 was the ability to sort health plan offerings by the type of medical management programs they offer (e.g., heart disease, diabetes, high blood pressure, etc).

Health Care Delivery is Transforming

Under the ACA, health care providers are increasingly being paid for better care and patient-centeredness, not just more service volume. And this is helping them re-envision and re-interpret their role in patient health and how they serve their communities. Primary care docs are moving toward rapidly spreading new models of primary care built around the individual patient's needs--models that offer better access, greater patient input on decision-making, greater capacity for primary care practices, and so on.

Hospitals are embracing a population health management approach, which means that their responsibilities to patient health don't end at their four walls. They're building partnerships with community-based organizations, they're helping patients to better manage transitions back into the community to avoid preventable hospital readmissions, they're joining up with peer institutions to work on improving patient safety. Hospitals are increasingly agreeing to be held accountable for the cost and quality of the product they deliver, not to mention the health outcomes of the patients they serve. That's a pretty transformational change.

As I said before:

Are hospitals getting safer? Yes. ("U.S. hospitals make fewer serious errors; 50,000 lives saved")

Are hospitals improving on key quality measures? Yes. ("The Joint Commission: Hospitals make strides on core measures with more achieving 'top performer' status"; Hospital readmission rates heading in the right direction)

Are the docs and hospitals that teamed up to coordinated care under the ACA showing improvement on quality metrics? Yes. (ACOs continue to succeed in improving care, lowering cost growth)

And we know why. The accountable care organizations that are improving quality and starting to get a handle on cost growth are a creation of the ACA. Preventable hospital readmissions started falling after the ACA linked hospital payment to their prevention. Medical errors started falling (saving tens of thousands of lives) after the ACA brought hospitals together to implement new patient safety protocols and systems. The innovators and startups that are proliferating rapidly are explicitly forming in response to the new market opportunities created under the ACA.

And, if it actually needs to be pointed out, a delivery system that produces better results more efficiently will save money. And we know that spending and cost growth have slowed down substantially, health care prices in some areas are now falling, and health insurance premium growth in both the marketplaces and in the employer-based world has never been lower (as mentioned above, plenty of rating areas in the new marketplaces saw drops this year).

The health sector is seeing huge, unprecedented, transformational changes for the better.

That is a very nice promo piece for Obamacare. But I'm just not feeling it or seeing much positive results from Obamacare in reality. Nor are ANY of the professional healthcare people from doctors to nurses to physical therapists, etc. that I know. Sorry.

 

[Greenbeard]

That is a very nice promo piece for Obamacare. But I'm just not feeling it or seeing much positive results from Obamacare in reality. Nor are ANY of the professional healthcare people from doctors to nurses to physical therapists, etc. that I know. Sorry.

Okay. That doesn't really invite much response, does it? If you want to talk about what's happening in your neighborhood, I'll need more information on my end.

Which marketplace rating area are you in? We can look at how premiums have done in your area, how competition is shaping up, etc. We can also look at how many folks have gained coverage there under the ACA (perhaps even how much bad debt to local providers has declined, though I'd have to check and see if the available data is that granular).

What your preferred local hospital? We can look at how its quality performance is evolving, whether it's participating in accountable care arrangements, even if its medical workforce has abandoned it.

Then maybe there will actually be something to talk about. Beyond "nuh uh!"

 

[Foxfyre]

That is a very nice promo piece for Obamacare. But I'm just not feeling it or seeing much positive results from Obamacare in reality. Nor are ANY of the professional healthcare people from doctors to nurses to physical therapists, etc. that I know. Sorry.

Okay. That doesn't really invite much response, does it? If you want to talk about what's happening in your neighborhood, I'll need more information on my end.

Which marketplace rating area are you in? We can look at how premiums have done in your area, how competition is shaping up, etc. We can also look at how many folks have gained coverage there under the ACA (perhaps even how much bad debt to local providers has declined, though I'd have to check and see if the available data is that granular).

What your preferred local hospital? We can look at how its quality performance is evolving, whether it's participating in accountable care arrangements, even if its medical workforce has abandoned it.

Then maybe there will actually be something to talk about. Beyond "nuh uh!"

There are several local hospitals here, almost all controlled by the Presbyterian and Lovelace groups. And I am in the Pres hospital more than I care to be because of being the designated driver and caretaker for people who seem to wind up there a lot. This gives me opportunity to talk with a lot of healthcare professionals from the folks at the nurse's desk to the RNs to the physicians to the therapists to the lab workers, etc. And Hubby volunteers at Pres so he has even more access to the people who work there.

It doesn't take data or rocket science to notice that standards of cleanliness and a shiny sparkly environment has deteriorated in recent years. And the patients who say the wait times are much longer when they ask for this or that seems pretty credible to me. And I see no reason that any of these people have any reason to lie when they tell me that they are understaffed and aren't able to be as responsive as they once were. And I have witnessed myself emergency rooms with standing room only and the many hours that many of those visiting those facilities are having to wait.

And no amount of propaganda from a pro-Obamacare site will convince me that the local reality is anything other than what I describe.

 

[Greenbeard]

There are several local hospitals here, almost all controlled by the Presbyterian and Lovelace groups.

Great. Which hospitals are we talking about? Every hospital's patients are surveyed by an independent vendor about a number of patent experience metrics (including cleanliness) so we can actually see how those facilities are doing (in absolute terms and compared to peers), as perceived by patients. But you have to share the name of the hospitals so we can look. Then we'll have something solid to talk about.

 

[Foxfyre]

There are several local hospitals here, almost all controlled by the Presbyterian and Lovelace groups.

Great. Which hospitals are we talking about? Every hospital's patients are surveyed by an independent vendor about a number of patent experience metrics (including cleanliness) so we can actually see how those facilities are doing (in absolute terms and compared to peers), as perceived by patients. But you have to share the name of the hospitals so we can look. Then we'll have something solid to talk about.

Why not just review them all? There aren't that many in Albuquerque. And since many of the health professionals I have close contact work in more than one, I don't know that we ever ranked the hospitals as best to worst.

 

[Greenbeard]

Why not just review them all? There aren't that many in Albuquerque. And since many of the health professionals I have close contact work in more than one, I don't know that we ever ranked the hospitals as best to worst.

Fair enough, we can look at the "Patients who reported that their room and bathroom were 'Always" clean'" CAHPS metric for all five non-VA hospitals with an address in Albuquerque with metrics on Hospital Compare.

We'll look at their current scores (reporting period 7/1/2013 - 6/30/2014) and compare it to the scores for those same hospitals listed in 2010 (reflecting a pre-ACA 2009-10 reporting period baseline), as well as the NM and US averages for the current period.

Patients who reported that their room and bathroom were "Always" clean

Hospital	Current Score (as of 2015)	Score (as of 2010)	Current New Mexico Average	Current National Average
Lovelace Medical Center	66%	61%	71%	74%
Lovelace Women's Hospital	73%	64%	71%	74%
Lovelace Westside Hospital	70%	67%	71%	74%
UNM Hospital	66%	58%	71%	74%
Presybyterian	64%	63%	71%	74%

[TBODY] [/TBODY]

So the first thing I notice is that you're right: your local hospitals tend to score noticeably below the New Mexico state average on this measure, which in turn is below the national average.

That said, all of those hospitals have improved since the ACA passed (some substantially--Lovelace Women's and UNM in particular, though Lovelace Medical Center deserves honorable mention).

So according to representative samples of hundreds to thousands of patients who received care in each of these hospitals, they're getting better (though, again in fairness to you, they're still below where most hospitals in the U.S. are).

 

[Foxfyre]

Why not just review them all? There aren't that many in Albuquerque. And since many of the health professionals I have close contact work in more than one, I don't know that we ever ranked the hospitals as best to worst.

Fair enough, we can look at the "Patients who reported that their room and bathroom were 'Always" clean'" CAHPS metric for all five non-VA hospitals with an address in Albuquerque with metrics on Hospital Compare.

We'll look at their current scores (reporting period 7/1/2013 - 6/30/2014) and compare it to the scores for those same hospitals listed in 2010 (reflecting a pre-ACA 2009-10 reporting period baseline), as well as the NM and US averages for the current period.

Patients who reported that their room and bathroom were "Always" clean

Hospital	Current Score (as of 2015)	Score (as of 2010)	Current New Mexico Average	Current National Average
Lovelace Medical Center	66%	61%	71%	74%
Lovelace Women's Hospital	73%	64%	71%	74%
Lovelace Westside Hospital	70%	67%	71%	74%
UNM Hospital	66%	58%	71%	74%
Presybyterian	64%	63%	71%	74%

[TBODY] [/TBODY]

So the first thing I notice is that you're right: your local hospitals tend to score noticeably below the New Mexico state average on this measure, which in turn is below the national average.

That said, all of those hospitals have improved since the ACA passed (some substantially--Lovelace Women's and UNM in particular, though Lovelace Medical Center deserves honorable mention).

So according to representative samples of hundreds to thousands of patients who received care in each of these hospitals, they're getting better (though, again in fairness to you, they're still below where most hospitals in the U.S. are).

You rate hospitals on whether the patients think their room and bathroom are clean?

 

[Greenbeard]

You rate hospitals on whether the patients think their room and bathroom are clean?

I don't rate hospitals. Patients in the U.S., however, are surveyed on the cleanliness of the hospitals at which they receive care (among many other aspects of their care and the physical environment of the facility). They have been for a number of years.

And based on the responses from patients at your local hospitals, it's very clear that this statement is inaccurate for them:

It doesn't take data or rocket science to notice that standards of cleanliness and a shiny sparkly environment has deteriorated in recent years.

Keep trying.

 

[Foxfyre]

You rate hospitals on whether the patients think their room and bathroom are clean?

I don't rate hospitals. Patients in the U.S., however, are surveyed on the cleanliness of the hospitals at which they receive care (among many other aspects of their care and the physical environment of the facility). They have been for a number of years.

And based on the responses from patients at your local hospitals, it's very clear that this statement is inaccurate for them:

It doesn't take data or rocket science to notice that standards of cleanliness and a shiny sparkly environment has deteriorated in recent years.

Keep trying.

Until you have those same patients rate the public restrooms, dining room, hallways, waiting areas, etc. I'm sorry. That is where I have noticed the most problems. Just evaluating whether they found their own room satisfactory is too limited to made a judgment on beyond what they thought of their rooms. I don't recall anybody complaining about their room per-se--their roommates yes, but not their rooms.

 

[Greenbeard]

Until you have those same patients rate the public restrooms, dining room, hallways, waiting areas, etc. I'm sorry. That is where I have noticed the most problems. Just evaluating whether they found their own room satisfactory is too limited to made a judgment on beyond what they thought of their rooms. I don't recall anybody complaining about their room per-se--their roommates yes, but not their rooms.

You rate hospitals based on the dining room?

 

[Sun Devil 92]

Are hospitals getting safer? Yes. ("U.S. hospitals make fewer serious errors; 50,000 lives saved")

I'll take your responses one at a time as I have time.

This claim and the associated article don't make any sense.

This is from the article:

In 2010, the HHS inspector general estimated that poor care in hospitals contributed to the deaths of 180,000 patients covered by Medicare, which insures the disabled and those 65 or older, every year.

Really ? Someone wants us to believe that this many people died every year because of "poor care" in hospitals.

That pretty much pales against the Harvard BS study that said 47,000 people a year die because of a lack of health insurance (even though the left could never produce any of the names of the over 500,000 people who should have died since the study was published).

I have to say that if that many people were dying, there should have been a public outcry and someone should have gone to jail.

Bottom line is that I don't buy the claim to be that large.

This came from another article:

Hospitals prevented nearly 15,000 deaths and 560,000 injuries by reducing additional illnesses and infections acquired in the hospital, preliminary data from the Health and Human Services Department show.

Are Hospital Patients Healthier Under Obamacare - NationalJournal.com

If hospitals were really that unsafe (and it would be great to know just what so unsafe), I'd be astounded that someone like Barbara Boxer wasn't using it as a campaign issue.

This just does not pass the smell test.

And BTW: These four hospitals are now really safe:

Fourth Georgia hospital closes due to Obamacare cuts The Daily Caller

 

[Foxfyre]

Are hospitals getting safer? Yes. ("U.S. hospitals make fewer serious errors; 50,000 lives saved")

I'll take your responses one at a time as I have time.

This claim and the associated article don't make any sense.

This is from the article:

In 2010, the HHS inspector general estimated that poor care in hospitals contributed to the deaths of 180,000 patients covered by Medicare, which insures the disabled and those 65 or older, every year.

Really ? Someone wants us to believe that this many people died every year because of "poor care" in hospitals.

That pretty much pales against the Harvard BS study that said 47,000 people a year die because of a lack of health insurance (even though the left could never produce any of the names of the over 500,000 people who should have died since the study was published).

I have to say that if that many people were dying, there should have been a public outcry and someone should have gone to jail.

Bottom line is that I don't buy the claim to be that large.

This came from another article:

Hospitals prevented nearly 15,000 deaths and 560,000 injuries by reducing additional illnesses and infections acquired in the hospital, preliminary data from the Health and Human Services Department show.

Are Hospital Patients Healthier Under Obamacare - NationalJournal.com

If hospitals were really that unsafe (and it would be great to know just what so unsafe), I'd be astounded that someone like Barbara Boxer wasn't using it as a campaign issue.

This just does not pass the smell test.

And BTW: These four hospitals are now really safe:

Fourth Georgia hospital closes due to Obamacare cuts The Daily Caller

All of which goes to show the extreme mischaracterization and hyperbole that results from partisan eagerness to defend even the indefensible.

How many times have we seen it claimed that some in Congress cut or wanted to cut the budget for some presumable 'noble' purposes when in fact all that was proposed or implemented was a smaller increase than was initially requested. The actual budget or spending was not cut at all, but rather increased, just not as much as some wanted it to.

Likewise, I am seeing the same kind of argument applied to Obamacare. They see a factoid that enrollments are more than first thought or that costs for this or that are lower than they were projected to be as a triumph that Obamacare is working. They won't acknowledge that just because the increase in a cost was 25% instead of a projected 30% is not a huge endorsement. The fact that the worse case scenario didn't happen does mean that it wasn't bad.

 

[LoneLaugher]

The fact that the best case scenario didn't happen does not mean that it wasn't good.

 

[Foxfyre]

The fact that the best case scenario didn't happen does not mean that it wasn't good.

That is true. But when a majority of the population perceive it as bad, I don't think we can dismiss that perception just because it is politically incorrect to do so.

 

[LoneLaugher]

The fact that the best case scenario didn't happen does not mean that it wasn't good.

That is true. But when a majority of the population perceive it as bad, I don't think we can dismiss that perception just because it is politically incorrect to do so.

When that majority is misinformed...we most certainly can dismiss the perception.

 

[Foxfyre]

Lane Scott of the Independent Women's Forum found the words to describe Obamacare much better than I have been able to do:

. . .Obamacare is a despicable piece of legislation because it twists the noble desire to help those less fortunate into a duty to junk the entire United States health care system. It uses the common belief that we all should pitch in to help pay for the health expenses of a small percentage of the population as a disguise — a cover-up — for what it really is: a federal seizure of the administration and oversight of the entire health care and insurance system. . .
Why Americans will never love Obamacare The Daily Caller​

 

[Foxfyre]

The fact that the best case scenario didn't happen does not mean that it wasn't good.

That is true. But when a majority of the population perceive it as bad, I don't think we can dismiss that perception just because it is politically incorrect to do so.

When that majority is misinformed...we most certainly can dismiss the perception.

Nobody has shown me any credible evidence from non partisan sources that the majority are misinformed.