OT: Ray, how's your Bitcoin investment going?

[1centaur]

Originally Posted by fuzzalow

@ 1centaur: As noted in my post #101, I was not taking a position that health care services should be provided on a non-profit basis. That will not be feasible within the culture and traditions of US society.

I do not understand where you are going with your post on for-profit versus non-profit and the consequence of spending limit caps on health care coverage. There is no controversy that there are finite resources available to anyone.

It is consistent that if health care were enabled to leverage government pricing power such as found with the Medicaid/Medicare programs, health care costs would be decreased considerably as compared to what an individual patient is forced to pay under their own coverage. Under this scenario the extent and duration of heath care might be extended for a given spending limit given the pricing structure advantages the patient rather than corporate margins.

Prescription drugs are expensive relative to other modern, industrialized nations because the US leaves prices to market competition among pharmaceutical companies. Allowing this however opens up all manner of manipulations.

I was responding directly to your words in 101 below my copied in quote, both as to what constitutes speculation or not and to the death panel reference, lest my words be viewed henceforth as simply in that vein.

Further to the quote from you above, but in the same vein as my last one, I want to reiterate what I and perhaps you view as a simple point but one that is clearly not viewed thus in mainstream discussions: the current system does both good and bad things for both outcomes and costs, as would single payer. The devil is not in corporate margins related to health care in the aggregate, though surely that is the case in some specific instances. The bads of margin can be calculated and observed quite easily; the bads of bureaucratic indifference, political trade offs, and systematic constipation are not so clearly visible and are harder to demagogue in a sound bite, but their implications for suboptimal health and unfair outcomes are no less real.

As simply a giant buyer, even if not the only buyer, the government could squeeze margin out of any business through threats implied and stated as well as purchasing power. With margins shattered, outcomes, products and services would change, not just cost less. Good and bad changes would occur. Probably, and this is speculation, the easy stuff would get cheaper and be more available and the harder stuff would go away or only be available to the rich, if the law allowed that outcome. As for pharmaceuticals, the makers logically base their pipeline development on what they can earn, and that earning stream is a mix of the regulated costs overseas and the much less regulated costs elsewhere. Thus US buyers subsidize foreign drug consumption. If there were coordinated efforts to minimize drug profits across all major buying nations, many drugs would not be developed, which might be good for societal health care costs (more people dying sooner is great for affordability). Win win, in a sense.

The fascinating thing about the health care payment structure debate is that even the best informed, best intentioned, most intellectually honest people would end up making both informed and uninformed decisions that would harm a lot of people. It is not a solvable problem, it is a barely manageable problem, which is why it is tempting to let the anonymous market make lots of hard decisions. If we were going with single payer, having an awesome executive run the program would be incredibly important. Somebody that awesome would be wise to do something else.

[54ny77]

Health care's insane. There is no answer. Just lesser of evils. People do what they can, as patients and service providers who try their best. Have lots of friends in the profession, and they're good people.

The sheer enormity of hospitals, especially in expensive locations, must be mind-boggling to run. Maybe they make money, maybe they don't. Dunno. What I do know is I had a friend who did their residency at St. Vincent's in Greenwich Village, a hospital in an immensely populated town (NYC) that is literally no longer there. How that can possibly happen is hard to grasp.

I remember a bunch of us rushing over there on 9/11 getting in line to donate blood. It's a memory that will last forever, that's for sure--particularly because we were told by nurses and staff that due to the situation, blood was not needed. Humbling.

My family doc thinks globally but acts locally: doesn't accept any insurance (he hasn't in the 25-30 years I've been going to him), but charges a fair price for majority of the services he provides. Funny enough, it's been only in the past decade or so that he even started accepting credit cards. Much of what he does is preventative care, or treatment as needed (flu stuff, broken bones, that sort of thing). Xrays are done with a machine likely as old as me. He uses the profit to provide for heavily discounted or free medical services for those in need.

[fuzzalow]

Originally Posted by djg

Fair enough, and I do apologize.

I appreciate your measured response and an apology is not needed as we both share and expect mutual respect participating on this forum.

If some of this strikes me very differently from the way it strikes others, then plainly it's the case that it strikes others differently from the way it strikes me. Sorry to insult good folks making a good faith effort at civil discussion.

I find myself in an odd position -- some things to which I think I devote serious attention -- say, at work -- are things of some general interest that I just should not address, at all, in a general discussion forum such as this. But many folks no doubt find themselves in similar positions.

Sorry again, I'll drop from the thread, but drop my objections at the same time.

No insult was given and none were taken. I would also ask that you not exit this thread, or any others like it in the future, and continue to add to the discussion. Especially if you have a real world perspective on a subject; that is highly valued insight that helps makes this forum a diverse and exceptional place. That nothing proprietary is divulged here is already understood as a given.

I'd like to believe we are all adults here and as such, are fully cognizant of the separation of our professional lives & identities from that of our personal lives & identities. What I must do as necessary to earn a living need not be absolutely lockstep and synchronized with what my personal mores and ethics might be.

For example, my work in capital markets does not create an unalloyed and unwavering faith in the sanctity and wisdom of the free markets as part and parcel with my own personal beliefs. Good grief, I know how the sausage is made, or at least a few varieties of all the different sausages that get sold. And anyone taking a a harsh view or voicing criticism of the sausage industry would never be taken as directed at me personally. This is the real world, there are skeletons everywhere.

Every adult in a professional career may find themselves placed in situation of moral ambiguity. It is not always cut and dried. It is also the price we pay as adults with careers and responsibilities.

[54ny77]

Mmmmm....sausage.....

[fuzzalow]

I'd agree that there will be collateral damage and errors along the way in trying solutions, having them fail, revising approaches and refining recursively this process again. But there is no thought that there will be an edict or even the goal to change all of health care to a singular monolithic approach anytime in your or my lifetime. But there should be an attempt at a model other than a pure pay-by-procedure based system which is largely in effect today.

Originally Posted by 1centaur

I was responding directly to your words in 101 below my copied in quote, both as to what constitutes speculation or not and to the death panel reference, lest my words be viewed henceforth as simply in that vein.

Further to the quote from you above, but in the same vein as my last one, I want to reiterate what I and perhaps you view as a simple point but one that is clearly not viewed thus in mainstream discussions: the current system does both good and bad things for both outcomes and costs, as would single payer. The devil is not in corporate margins related to health care in the aggregate, though surely that is the case in some specific instances. The bads of margin can be calculated and observed quite easily; the bads of bureaucratic indifference, political trade offs, and systematic constipation are not so clearly visible and are harder to demagogue in a sound bite, but their implications for suboptimal health and unfair outcomes are no less real.

I don't accept the view that personifies the control of health care to some governmental agency that brings harm by technocratic mandate on how to run a health care system. There are professionals working in the medical fields that equally want to see improvements to their ability to improve the success curve of their patient outcomes. And that medical and health services administrative talent & expertise will no doubt be incorporated and partnered with into crafting a solution. For example, the Mayo Clinic is often cited as an institution which produces a high standard for patient outcomes while simultaneously effectively controlling costs for the care provided. Might their approach be adapted into other venues and specialties. Try to replicate what works and revise or discard those that hinder, sub-perform or are excessively expensive.

Yes, there is risk to try something new. And a solution may well exhibit qualities of "bureaucratic indifference, political trade offs, and systematic constipation". That should not presume a a crushing weight of just those qualities to the exclusion of any positive result in care services - it makes it sound like doing this was just make a useless bureaucracy. There is no way the health care professionals would ever sign up for that - most actually want to do some good.

As simply a giant buyer, even if not the only buyer, the government could squeeze margin out of any business through threats implied and stated as well as purchasing power. With margins shattered, outcomes, products and services would change, not just cost less. Good and bad changes would occur. Probably, and this is speculation, the easy stuff would get cheaper and be more available and the harder stuff would go away or only be available to the rich, if the law allowed that outcome. As for pharmaceuticals, the makers logically base their pipeline development on what they can earn, and that earning stream is a mix of the regulated costs overseas and the much less regulated costs elsewhere. Thus US buyers subsidize foreign drug consumption. If there were coordinated efforts to minimize drug profits across all major buying nations, many drugs would not be developed, which might be good for societal health care costs (more people dying sooner is great for affordability). Win win, in a sense.

When the US pays 17% of GDP for health services and France expends 11% for a higher quality result, I don't accept the argument that a reduction in margin will be a crushing disincentive in services or products. The profit margin cannot be held at this level as it is an artificially expensive pricing construct based on lack of regulation and pricing manipulations.

Elisabeth Rosenthal for the NYTimes has covered medical costs extensively. There is nothing in commercial necessity that drives a 300% or greater margin for medical devices or prescrition drugs other than profit maximization.

The fascinating thing about the health care payment structure debate is that even the best informed, best intentioned, most intellectually honest people would end up making both informed and uninformed decisions that would harm a lot of people. It is not a solvable problem, it is a barely manageable problem, which is why it is tempting to let the anonymous market make lots of hard decisions. If we were going with single payer, having an awesome executive run the program would be incredibly important. Somebody that awesome would be wise to do something else.

All we can do is make our best effort. But what you have listed is a poor excuse to try.

I do not believe in a fate that will befall us no matter what we do. I do believe in a fate that will fall on us if we do nothing. - Ronald Reagan

[1centaur]

I do not for a moment suggest that nothing should be done just because there will be, not might be, significant negatives from the changes. I also do not doubt that doctors want to treat patients well and do not naturally become DMV workers when in giant bureaucracies (as hospitals often are). I HAVE seen the negatives of ALL the other less profit oriented systems over the years, and by this time find them unsurprising.

As a matter of interest, I have probably analyzed the financials from at least 150 minor players in US health care over the last decade, and the vast majority are not very profitable and a stunning number exist to save one side or another money through various means, partly existing as a derivative of the intersection of governmental rules and the never very free market. The clunkiness of Obamacare's early days partly reflects the same thing: government rules on what to pay for interacting with insurance companies actually trying to make money within those guidelines. When people say it was designed to fail, I think it's been failing in the same way for a long time.

As for giant profits, 300% is NOT sustainable in a competitive market and almost certainly NOT genuinely reflective of the calculus. Sort of like the oil business, the cost of failures is not counted by the accusers against the profits of success, and is 300% gross or net and how long does it last? To go to cycling references, Di2 is hugely profitable if you ignore the 17 years of research and development to bring it to market. One of the things non-investors don't get in their gut is that capitalism forces profits down to fairly predictable numbers. EBITDA margins are <10% for commodity products, 10-20% for products with some value added, 20-30% for some pretty exceptional products, and 30-60% for some niche monopoly products but more likely exceptional software, other than brief spurts of profit before others catch up (most health care is between 5% and 15%; anything above 10% and the government thinks you are a profiteer and skews regulations against you if the can). 300% is some other measurement (I am guessing gross margin on a single product with no thought to return on investment) that is designed to inflame rather than elucidate.

[fuzzalow]

This conversation has likely whittled down to include just you and me and a bunch of geeks and wonks into this kind of thing. As important as this topic is, I'd have hoped it would have a bigger crowd, but whaddaya gonna do?

So I'll comment here and we can agree to disagree while leaving our opposing arguments out here in the forum for posterity. LOL. You are welcome to the last word and thanks for a civil discourse, it was fun.

Originally Posted by 1centaur

I do not for a moment suggest that nothing should be done just because there will be, not might be, significant negatives from the changes. I also do not doubt that doctors want to treat patients well and do not naturally become DMV workers when in giant bureaucracies (as hospitals often are). I HAVE seen the negatives of ALL the other less profit oriented systems over the years, and by this time find them unsurprising.

To make an omelette you gonna have to break a few eggs.

All kidding aside, the particular circumstances have to be looked at to determine if there really was damage done or if people are grousing over having to make a change and what the effect of the change was.

For example, some of the well publicized "losers" in the Affordable Care Act (ACA) were confined to an estimated 3% who had a coverage change because their prior plan did not meet the minimum standard for coverage as far as a cap on out of pocket costs per year. Their old policies were cheaper because the coverage was lower quality than the new minimum required by ACA.

Chart: Winners and Losers from ObamaCare
TheNewYorker article that was the basis for the above chart

As a matter of interest, I have probably analyzed the financials from at least 150 minor players in US health care over the last decade, and the vast majority are not very profitable and a stunning number exist to save one side or another money through various means, partly existing as a derivative of the intersection of governmental rules and the never very free market. The clunkiness of Obamacare's early days partly reflects the same thing: government rules on what to pay for interacting with insurance companies actually trying to make money within those guidelines. When people say it was designed to fail, I think it's been failing in the same way for a long time.

I don't know the particulars of these institutions and why they skirt profitability. Then let the free market take its course. I don't take the view that these institutions are the drivers for overall health care as the priority is not to ensure their viability. Capitalism is adaptable and viable institutions will find ways for profit irrespective as to the changes to the healthcare landscape in which they operate.

The priority is the bring the overall cost curve down as it impacts the ability for any US citizen access to the health care system. As a secondary concern, the overall healthcare expenditures are a drawdown against GDP and need to be reduced as it is a detriment to US competitive capacity in the global economy (i.e. health care is not an exportable growth industry so for the US to burn about 17% of its GDP resources on healthcare means it can't deploy those resources for more profitable growth opportunities)

As for giant profits, 300% is NOT sustainable in a competitive market and almost certainly NOT genuinely reflective of the calculus. Sort of like the oil business, the cost of failures is not counted by the accusers against the profits of success, and is 300% gross or net and how long does it last? To go to cycling references, Di2 is hugely profitable if you ignore the 17 years of research and development to bring it to market. One of the things non-investors don't get in their gut is that capitalism forces profits down to fairly predictable numbers. EBITDA margins are <10% for commodity products, 10-20% for products with some value added, 20-30% for some pretty exceptional products, and 30-60% for some niche monopoly products but more likely exceptional software, other than brief spurts of profit before others catch up (most health care is between 5% and 15%; anything above 10% and the government thinks you are a profiteer and skews regulations against you if the can). 300% is some other measurement (I am guessing gross margin on a single product with no thought to return on investment) that is designed to inflame rather than elucidate.

HaHa, we start talking EBITDA and this conversation has even the geeks and wonks tuning out.

Again, I don't view the problem as one in support of corporate margins and what those interests would like to have. As a concerned American voter, I only care about how health care effects the citizenry and, in aggregate, the nation. And the number that is most relevant to a patient is not the margin percentage or the cost of manufacture of a medical device but what they have to pay for it. And the current markups are considerable, excessive to most any criteria except to those institutions that seek maximization of profit.

Hospitals and orthopedic clinics typically pay $4,500 to $7,500 for an artificial hip, according to MD Buyline and Orthopedic Network News, which track device pricing. But those numbers balloon with the cost of installation equipment and all the intermediaries’ fees, including an often hefty hospital markup.

That is why the hip implant for Joe Catugno, a patient at the Hospital for Joint Diseases in New York, accounted for nearly $37,000 of his approximately $100,000 hospital bill; Cigna, his insurer, paid close to $70,000 of the charges. At Mills-Peninsula Health Services in San Mateo, Calif., Susan Foley’s artificial knee, which costs about the same as a hip joint, was billed at $26,000 in a total hospital tally of $112,317. The components of Sonja Nelson’s hip at Sacred Heart Hospital in Pensacola, Fla., accounted for $30,581 of her $50,935 hospital bill. Insurers negotiate discounts on those charges, and patients have limited responsibility for the differences.

The basic design of artificial joints has not changed for decades. But increased volume — about one million knee and hip replacements are performed in the United States annually — and competition have not lowered prices, as would typically happen with products like clothes or cars. “There are a bunch of implants that are reasonably similar,” said James C. Robinson, a health economist at the University of California, Berkeley. “That should be great for the consumer, but it isn’t.”

Excerpt from NYTimes In Need of a New Hip, but Priced Out of the U.S.

I am in error about the margin regarding the markup on the hip joint referenced in the above article. It was not the rhetorical blurb of 300%, it was arithmetically 433%.

[Pete Mckeon]

Thanks


We are a huge country and with a diverse population. "One size does not fit all".

Over life i have learned to plan but execute in increments.


There are some very sharp people on the forum and we can learn from them, and maybe not agree but learn and grow/adapt. Very few things in life have only one solution for all and we can work together in life for common goals

[djg]

Originally Posted by fuzzalow

I'd agree that there will be collateral damage and errors along the way in trying solutions, having them fail, revising approaches and refining recursively this process again. But there is no thought that there will be an edict or even the goal to change all of health care to a singular monolithic approach anytime in your or my lifetime. But there should be an attempt at a model other than a pure pay-by-procedure based system which is largely in effect today.

I don't accept the view that personifies the control of health care to some governmental agency that brings harm by technocratic mandate on how to run a health care system. There are professionals working in the medical fields that equally want to see improvements to their ability to improve the success curve of their patient outcomes. And that medical and health services administrative talent & expertise will no doubt be incorporated and partnered with into crafting a solution. For example, the Mayo Clinic is often cited as an institution which produces a high standard for patient outcomes while simultaneously effectively controlling costs for the care provided. Might their approach be adapted into other venues and specialties. Try to replicate what works and revise or discard those that hinder, sub-perform or are excessively expensive.

Yes, there is risk to try something new. And a solution may well exhibit qualities of "bureaucratic indifference, political trade offs, and systematic constipation". That should not presume a a crushing weight of just those qualities to the exclusion of any positive result in care services - it makes it sound like doing this was just make a useless bureaucracy. There is no way the health care professionals would ever sign up for that - most actually want to do some good.



When the US pays 17% of GDP for health services and France expends 11% for a higher quality result, I don't accept the argument that a reduction in margin will be a crushing disincentive in services or products. The profit margin cannot be held at this level as it is an artificially expensive pricing construct based on lack of regulation and pricing manipulations.

Elisabeth Rosenthal for the NYTimes has covered medical costs extensively. There is nothing in commercial necessity that drives a 300% or greater margin for medical devices or prescrition drugs other than profit maximization.


All we can do is make our best effort. But what you have listed is a poor excuse to try.

Ok, you were kind enough in your response that I'll say something -- some very general things, anyway. First, yeah it's a swamp. Second, WRT pharma profits, it's true that they can be extremely high and, in some specialty drug cases, troubling indeed. But let's notice, first, the increasing (already majority) share of Rx sales moving to generics (the recent "patent cliff" is really a drop in a long-running trend). Some generics are still relatively pricey, but many are dirt cheap, average prices are even lower than in many countries that exert buying power -- say, Canada, at least via the provinces (well, we do it too, just not across the whole market). WRT branded drugs, read the economic literature on pharm. development and, in broad strokes, this is the ideal case -- truly, one of the only strong cases -- for strong, long-term patent protection. New drugs have a long and costly development pathway. For a NME, we're talking quite a few years and a billion dollars or more of development costs (from the lab through the Phase III clinical trials) where those large sunk costs are at risk, both in the sense that the trials may not pan out, post-approval issues might not be apparent, and in the sense that, for many products knowing the range of products that might compete more-or-less well as substitutes in the market can be pretty tricky over a big window.

Yes, businesses game the system, the various Hatch-Waxman provisions, etc., etc., and the details can get ugly in any given case. Without trying to argue that the present system is optimal -- not even as a joke on a board where most folks don't know my name -- I will suggest, first, that trying to design an optimal IP/competition balance is an intractable problem, second, that the promise of huge post-marketing profits is a key driver (necessary, I'd say) to new product development (independent of the handfuls of cool things we might get from this or that top-down long-term government project) and, third, that price discrimination can be rational for both sellers and buyers. What to do as a foreign policy matter about nations that free-ride on our expenditures is another question, and perhaps even thornier, but it doesn't alter the basic problem: how would you know, as a policy matter, what the next blockbuster drug should cost in its first year post-approval? Its third?

On the International thing, yeah, we pay tons for all sorts of things and some of those tons give very poor value for money. But most international comparisons are -- or really ought to be -- highly contentious. We've got some serious background health issues that contribute to relatively high chronic care and neonatal costs. We spend huge amounts of money on high-cost intervention late in life -- things rationed or accounted for very differently (perhaps very reasonably) in many other systems. Lop off trauma -- car accidents right up there, but also gun violence, etc. -- and you save a ton. The fact is, most people do fine with low-cost intervention most of their lives. Most Americans too. Nudge a few environmental factors and that's even more true. What should we spend on the rest of us, individually or collectively, and how should we spend it? I dunno. That's not to suggest that we have the best or third-best health care system, or even that the term "system" applies appropriately to health care, just to nod to some of the many wrinkles in the problem of international comparisons and the far more complex problem how you would "engineer" a tractable alternative, here, if you were to take a shot.

I'm not sure that bit coins or foundations of shiny rocks have anything much to do with this, but the thread had wandered, as threads do, and this seems responsive to something.

Not sure what I'm doing here -- a good follow-up question or rejoinder (and you or anybody else might have many) should ask for a 10 page paper or a stack of them, but there it is.

[malcolm]

Hey I'll leave some perspective on health care from someone who's practiced emergency medicine for 20 years.

First off it's difficult to compare systems from other countries and say one is better. Better has many different facets. Acute care medicine in the US is the best available, in my opinion. By acute care I mean if you have an injury or illness that is life threatening and demands immediate attention. We also do very well with catastrophic illness assuming you are insured and have had a modicum of prior treatment and were dx early. Few countries do as well as we do in these instances. A frequently cited statistic is infant mortality where we lag behind but if you look at the way the data is collected and what's excluded it can yield a different result.

Where we do poorly is preventative medicine. Medical practice in the US in my opinion for the most part quit being about health maintenance and disease prevention years ago and became focused on controlling symptoms and parameters of disease. Essentially selling drugs. Most diabetics would respond to exercise and weight loss, but for the most part we don't address that for many reasons. Just a quick look at the meds people are on will tell you something, almost every person I see is on an SSRI, something for attention/focus, reflux and the list goes on.

I've always been quite conservative, grew up in a single parent family, mom with two jobs. Paid my way through school. Had very little belief in free lunch. As I've gotten older I'm becoming convinced medicine will never be effective in a capitalistic system, nothing against capitalism, just don't think it works well in medicine especially independent primary care if for no other reason than it hinders the physician from telling the patient the whole truth because you have to preserve them as a customer. I've transitioned from the ER to an urgent care setting and I've seen the difference in me. In the ER, at least before the advent of patient satisfaction surveys and satisfaction tied to your income I did what I thought was right and necessary and really didn't give much consideration to what you wanted unless I thought you needed it. I now give way more steroid shots and antibiotics to people who really don't need them but are convinced they do. Many studies are done more based on patient desire than need. I think it also lends its self to loss of clinical practice of medicine. If you see a patient and treat them conservatively and they don't get better very likely they'll go somewhere else and if tests done then reveal they had X then they assume you were incompetent because you were conservative on the first visit. That in turn creates many unnecessary work ups, driving up costs.

We also as a group tend to have unrealistic expectations of medicine and insurance. If you talk to average joes they can't understand why everyone can't have this totally unrestricted insurance where they can go to the doctor anytime they want for any reason and not cost a dime. We want mack daddy coverage for everyone but nobody wants to pay. One thing some people don't realize is how much some of their fellow man go to the doctor. It's not unusual to look at the roles of a family practice clinic or walk in clinic and see people that go to the doctor for colds 6-8 times a year with only a 10-30 cost to themselves. This again drives up costs but the consumer has no real skin in the game. I don't think you have this kind of usage in most socialized systems.

I'm not sure what the answer is, but I do think it's broken. Sorry if this is rambling it was just off the top of my head. I've been amazed at how many really smart people have no idea about their own healthcare.

One last thought. I just read an article in the New York Times that bemoaned the income of physicians and gave numbers suggesting these increases in physician income. I'm not going to whine much because medicine afforded me a good living, but trust me I worked hard for, long hours, many holidays and weekends, missed recitals, birthdays, Christmases, etc. I don't personally know one physician that makes any more money now than they did 10 years ago unless their status has changed (become a partner). I spent my entire ED career with the same group in the same ER and my income change one time, when I became partner. I made the exact same amount of money the day I quit as the day I became partner. My wife is a radiologist and they are making about the same amount they did 10 years ago, some private practice guys actually make less due to restrictions on outpatient imaging centers.

Interesting discussion and I hope you younger guys live to see medicine be what it should be. I'm not sure government control is the answer and there will be painful fits and starts but something has to change.

One other thing I'll add is look at the cost of taking care of the elderly. It consumes most of our health care dollar. I'm not saying don't take care of the elderly but you need to do it with clinical decision making. Many of the preventative things we do don't necessarily add to life. Chasing PSAs on guys that are 80 and many other examples. Our end of life care is appalling we let our elderly die a cell at a time long after they've had a lucid thought and trust me that's way expensive. I suspect if you look at socialized systems these sort of things are not done.

[93legendti]

The Unaffordable Care Act's next gift to Americans:

http://www.politico.com/story/2013/1...ts-101212.html

And 89% of the uninsured aren't buying oliarcare.gov. Well, you can't buy on fubarcare.gov, because the payment mechanism hasn't been built yet!

The uninsured were the reason for this disaster, according to Oliar. The CBO projects UACA will never lower the amount of uninsured below 30 million. That and a promised premium reduction of $2,500. Instead, we have average hikes of $2,900. Politifact was right. Lie of the year.

[jblande]

Originally Posted by 93legendti

The Unaffordable Care Act's next gift to Americans:

http://www.politico.com/story/2013/1...ts-101212.html

And 89% of the uninsured aren't buying oliarcare.gov. Well, you can't buy on fubarcare.gov, because the payment mechanism hasn't been built yet!

The uninsured were the reason for this disaster, according to Oliar. The CBO projects UACA will never lower the amount of uninsured below 30 million. That and a promised premium reduction of $2,500. Instead, we have average hikes of $2,900. Politifact was right. Lie of the year.

how are you still allowed to post on this board?

[1centaur]

Before this gets shut down, in response to the hip implant cost discussion, if I followed that bouncing ball the margin was made in the hospital, not the device maker (or at least we don't see the margin at the implant maker, but can read their financial statements), but hospitals have 20% uninsured care losses and don't end up with high profit margins overall, which is a point that a reporter would choose not to report because the mark-up angle is sexier. One man's mark-up is another man's subsidy, for uninsured, Medicaid, etc. It's an ugly, twisted system that reflects non-market levers entwined with market levers encircled with fear, confusion and other emotions.

[buldogge]

Adam…Give it a rest…seriously.

Find a political board to troll, or a tea-party circle-jerk to join.

You can't even share your wacko crap without using kindergarten re-namings.

Go ride your bike, or play with your kids, or read a book…something.

Jeesh…
-Mark in St. Louis

Originally Posted by 93legendti

The Unaffordable Care Act's next gift to Americans:

http://www.politico.com/story/2013/1...ts-101212.html

And 89% of the uninsured aren't buying oliarcare.gov. Well, you can't buy on fubarcare.gov, because the payment mechanism hasn't been built yet!

The uninsured were the reason for this disaster, according to Oliar. The CBO projects UACA will never lower the amount of uninsured below 30 million. That and a promised premium reduction of $2,500. Instead, we have average hikes of $2,900. Politifact was right. Lie of the year.

[witcombusa]

Originally Posted by jblande

how are you still allowed to post on this board?

Nothing beats the intolerance of people who can only stand to hear their own views echoed back at them...

93ledgendti, your opinion is as good as any other forum members