Wondering about your experiences with Obama care (ACA)

[seeahill]

You're right, Mr. Claw. I expected something of the sort. But if there had been universal praise from a tough audience, I might have figured ACA was pretty damn good for everyone.

[Testiclaw]

You're right, Mr. Claw. I expected something of the sort. But if there had been universal praise from a tough audience, I might have figured ACA was pretty damn good for everyone.

This is a very true point. I think a lot of the general consensus around the ACA is difficult to really get a idea of because, first, the mass-counter-propaganda that we saw (and see) against it, but, and I think this is more impacting: the general confusion over health coverage and insurance in the first place.

If the system was streamlined, or, universal coverage or a single-payer, Hell, even a Medcare/caid expansion to cover an entire population, it would be much easier for the average American family to sit down, see what they had, see what they now have, and compare.

With billions of different plans, employer-offered insurance, disability, subsidies, state-by-state portals, etc., it's almost impossible to really understand how one plan differs from another, especially if the medical system isn't regularly used by a family in the first place.

[bennyonesix]

http://www.forbes.com/sites/brucejapsen ... 6-percent/

This pegged the fuck out of my statistical and argumentation bullshit meter.

This commonwealth fund is as hack pro-Obamacare politically as any anti-Obamacare outfit. That article from FORBES(!) where they basically conclude they are worthless hacks is just one of many...

It ain't 86% of US citizens or residents or insured that is "satisfied"... It is 86% of those EITHER insured under the exchanges or through MEDICAID...

So at the least, this is selling a narrow finding as to one population as a finding as to all Americans etc...

I mean, shit, I ain't really looked at it that closely and the deception is already mounting.

I'm just gonna go ahead and call this a super narrow and expected and unsurprising finding dressed up as 12345678 times more significant than it is.

[Testiclaw]

It is 86% of those EITHER insured under the exchanges or through MEDICAID...

How many states offer expanded Medicaid?

How many states run their own exchanges, and how many default to a standard federal exchange?

This isn't exactly a tiny sliver of the American population. Show your work.

[bennyonesix]

Lulz you tell me stud.

You put it forward as proof of some point.

What % of US Citizens is that 86%?

[bennyonesix]

Remember, I am not smart and you frighten me with your brash and loud talk.

But could you please explain why they chose to limit the published results to that population?

Please don't be mean or I will just accept what you say as the truth to end the confrontation...

[Protobuilder]

But in December I cut my hand at work, needed an x Ray and stitches, and was told to return to the ER 10 days later to have the stitches removed.
When I went back, there were 6-8 other people waiting with me, and every single one appeared to be using the ER for primary care.

Not a new story at all and I'm sure anyone here who works in emergency services in the hood can support this never reported fact, regardless of the city. In fact, one of the best anecdotes I know is not one of my own from the Harlem NYPD days, but from a bud of mine in the Minneapolis FD/present day.....People actually time their 911 calls with the bus schedules. So, they get an ambulance ride to the ER for an 'asthma attack' or whatever, get meds and then get ca$h money for cab fare home since they are released when the buses aren't running. Rx's + Mo' money for 40s and blunts, yo.

IIRC, he said the cost of those rides to the taxpayer are in the vicinity of $1800/ride.

Oh, he's a hardcore union guy and lifelong Dem so it's not some angry right wing white guy blustering bullshit in case any of our bleeding heart types is wondering.

Definitely. They do not care one iota. Gotta headache? Call 911. Gotta fucking toothache? Call 911. Gotta upset tummy? Call 911. "You GOTTA take me. It's da law!". This subsequently leads to back ups and crowding at the ERs which lead to long wall times (as long as 8 hrs in my case) for us EMS folks since we cannot legally leave the patient there without signing care over to a nurse or higher. That leads to having ZERO ambulances in the entire bi-city area and 911 actually having to put calls on a hold list for the first available unit leaving the hospital, in the mean time they will send a fire truck or cop to "wait" with the patient to offer what level of care they can....thus leaving areas of the city with no EMS coverage, no fire coverage, and no police coverage. All of this because some back assward piece of shit is too lazy to go to the damn urgent care or Walmart for some headache pills. Our agency refuses to back us on this since they are deathly afraid of any litigation. This has lead to a huge rate of burnout among medics, which means many have quit...making the load even heavier for those of us who stay. On top of that the city says we make too much for what we do, gives a 1/2 a percent raise, while raising our premiums by over 5%.

I have made a person listen to the radio as a child was involved in a drowning literally a mile down the road and we were stuck with them for belly pain and they refused to let us leave. People fucking disgust me.

If EMTs refuse to leave somebody with a tummy ache because, you know, paperwork, and ignore a person drowning they may be able to save, fuck them. Same for police or firemen, an accountant in a meeting across the street or any person who likes to think of themselves as a human being.

Yeah, disgusting.

Easy to say, not easy to live in that moment. The list of viable 'what if's' for that EMT leaving or NOT leaving is a mile long....granted, we have to say it's possible that by abandoning orders, they can save that drowning victim's life. Unfortunately, the odds of strong disciplinary action against them for doing so would be strong to severe. They're not dealing with someone 'in custody' like a cop, but they are responsible for homie's care, well being, AND activity until an RN takes over. Lots can happen there.....even with a bullshit bellyache.

We were on the fire truck that day, so no ambulance. That being said, we cannot legally leave. And for the record, it's not my call seeing as I'm not in charge, that would be the officer on duty. The kid lived, but the wait time would've been much less if we had been able to leave Joqueshia the ghetto queen. We've had a similar incident occur in the past and the medic and the lieutenant lost their licenses and subsequently their jobs due to abandoning a patient.

It wasn't an attack on you but on a messed up system. If it isn't going to happen from above, I don't know how you guys on the ground can do it. I do know that the headline "EMT fired for leaving woman with stomachache to rescue drowning child" would get some attention. Of course, if the woman was black and the kid white, you could be a racist.

[baffled]

I hate it.

[Turdacious]

Asked my girl about the Pioneer program, and she basically said its way too early to call that successful. They went from 31 participants to 19 in the first year. In aggregate, they saved a very small amount of money, and there's no way of knowing yet if they did so without denying service to little old ladies.
Nevertheless, the secretary of HHS announced in January that the program is being expanded rapidly.

They are expanding the ACO program, but not the Pioneer ACO program. The Pioneer program required providers to share the risk--the participants were self selected and they still had a very high failure rate (12 of 31)).

The ACO program basically places no risk on the providers, and has been more successful. As with the Pioneer ACO program, the participants are self selected. Also, they tend to only serve healthier populations. In general, areas with high obesity and diabetes rates do not have ACOs, or the ACOs are set up to limit access to those populations.

[Turdacious]

It is 86% of those EITHER insured under the exchanges or through MEDICAID...

How many states offer expanded Medicaid?

How many states run their own exchanges, and how many default to a standard federal exchange?

This isn't exactly a tiny sliver of the American population. Show your work.

Irrelevant. For Obamacare to work, states have to spend the money to optimize their Medicaid programs. 90% of them haven't, and the five that have are all small (and either have healthier than average populations, or their poor populations tend to be Native Americans served by the extra shitty IHS). Provider networks haven't shifted much (if at all). Hospitals serving poorer populations are the ones most likely to be hurt by Obamacare Medicare regulations. The economies of scale for running an exchange discriminate against poorer states.

And don't worry-- I've shown my work. The ACA is shitty by both liberal and conservative standards.

[The Venerable Bogatir X]

The ACA is shitty by both liberal and conservative standards.

Indeed, even within the narrow confines of this thread, there are responding libs who are not at all too thrilled with ACA.

[The Ginger Beard Man]

Asked my girl about the Pioneer program, and she basically said its way too early to call that successful. They went from 31 participants to 19 in the first year. In aggregate, they saved a very small amount of money, and there's no way of knowing yet if they did so without denying service to little old ladies.
Nevertheless, the secretary of HHS announced in January that the program is being expanded rapidly.

They are expanding the ACO program, but not the Pioneer ACO program. The Pioneer program required providers to share the risk--the participants were self selected and they still had a very high failure rate (12 of 31)).

The ACO program basically places no risk on the providers, and has been more successful. As with the Pioneer ACO program, the participants are self selected. Also, they tend to only serve healthier populations. In general, areas with high obesity and diabetes rates do not have ACOs, or the ACOs are set up to limit access to those populations.

Heh. I asked her about this Saturday morning, and she went off on a long answer and I maybe didn't listen to everything.
As for the failure rate of the Pioneers, the 12 out of 31 dropped out of the program during the first year. (That's a story she broke about two months before the Times "broke" it.) The 19 remaining had a small savings in aggregate, with some saving money and others not. And one really fucked up. They were fined over a failure to report on the 32 safety measures.

[bennyonesix]

Turd, the poll Testiclaw cited used two specific populations: EITHER insured under the exchanges or through MEDICAID.

I am not familiar enough with the issue and demographics to understand why they limited it in this way. It could be perfectly reasonable, but like I said, my BS alarm is going off...

Can you explain what is going on there?

Any thoughts as that poll in general?

Clearly, the outfit is hackish in the extreme but hell they could still be onto something.

[TerryB]

re: "satisfaction"

Our wise legislators delayed several of the painful deadlines and what nots until after the 2016 election, and beyond, making "are you satisfied with Obamacare?" a nonsensical question no one can honestly answer.

[Turdacious]

Turd, the poll Testiclaw cited used two specific populations: EITHER insured under the exchanges or through MEDICAID.

I am not familiar enough with the issue and demographics to understand why they limited it in this way. It could be perfectly reasonable, but like I said, my BS alarm is going off...

Can you explain what is going on there?

Any thoughts as that poll in general?

Clearly, the outfit is hackish in the extreme but hell they could still be onto something.

People who gained coverage through the expansion of Medicaid are better off. Many (probably most) of the people who purchased and kept insurance through the exchanges are better off. Commonwealth selected a survey population that would definitely put the ACA in a good light.

Commonwealth is definitely pro ACA but they do solid research and present it very well. They also point out flaws in the ACA and it's implementation as well as anybody.

However, the sample size was small and the survey is not regularly conducted. The survey was also national and asked relatively broad questions. For those reasons, it doesn't tell us much. The differences between states, and the differences within states (ex. Baltimore City vs. the surrounding counties) are significant; so which people answered the survey is very important.

It also doesn't tell us much going forward-- insurers nationwide are asking for hefty rate increases despite having government funded loss protection. Nobody knows what will happen to the individual market when insurers raise rates significantly or if they take more measures to limit their exposure to sicker people. There's a lot of uncertainty going forward.

[Turdacious]

Asked my girl about the Pioneer program, and she basically said its way too early to call that successful. They went from 31 participants to 19 in the first year. In aggregate, they saved a very small amount of money, and there's no way of knowing yet if they did so without denying service to little old ladies.
Nevertheless, the secretary of HHS announced in January that the program is being expanded rapidly.

They are expanding the ACO program, but not the Pioneer ACO program. The Pioneer program required providers to share the risk--the participants were self selected and they still had a very high failure rate (12 of 31)).

The ACO program basically places no risk on the providers, and has been more successful. As with the Pioneer ACO program, the participants are self selected. Also, they tend to only serve healthier populations. In general, areas with high obesity and diabetes rates do not have ACOs, or the ACOs are set up to limit access to those populations.

Heh. I asked her about this Saturday morning, and she went off on a long answer and I maybe didn't listen to everything.
As for the failure rate of the Pioneers, the 12 out of 31 dropped out of the program during the first year. (That's a story she broke about two months before the Times "broke" it.) The 19 remaining had a small savings in aggregate, with some saving money and others not. And one really fucked up. They were fined over a failure to report on the 32 safety measures.

That's really interesting. I had no idea that the Pioneer program failed that badly.