Your example doesn't work, the question is the mark up from the factory to the new car dealership. You aren't buying a used pill, that wouldn't taste very good.

the premise is the same...if you are fine with marking a pill up from pennies or sub penny to $26 you must be fine with marking every other thing up the same percentage...If the supermarket buys their meat at $.89 per pound you're fine with them selling it to the consumer at $26 a pound? THAT is my argument...It's absurd to mark up anything that much

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the premise is the same...if you are fine with marking a pill up from pennies or sub penny to $26 you must be fine with marking every other thing up the same percentage...If the supermarket buys their meat at $.89 per pound you're fine with them selling it to the consumer at $26 a pound? THAT is my argument...It's absurd to mark up anything that much

I understand your argument, it just doesn't make sense. You're advocating for price controls and we know those don't work. Acceptance of the mark up is dependant on the value of the product. This basic economics, not peculiar to healthcare as I've already demonstrated.

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

I understand your argument, it just doesn't make sense. You're advocating for price controls and we know those don't work. Acceptance of the mark up is dependant on the value of the product. This basic economics, not peculiar to healthcare as I've already demonstrated.

You're  not grasping the fact that it's unethical and just flat out WRONG to artificially inflate the value of a pill from pennies or sub pennies  and sell them to the consumer for thousands of percent profit...You can't justify that kind of a markup, it's IMPOSSIBLE...What I'm beginning to think is that you are claiming that by having such a pill available for whatever purpose it serves makes it THAT valuable which is pure horse [BLEEP]. There is no way to justify that sort of markup and make any validity to the argument...I'm advocating anti GREED measures and anti GOUGE measures because that's all that percentage of markup really is...They could sell for a handsome profit at $2-$5 but instead their fat fingers price them at $26...GREED and value are not the same thing

---

You're  not grasping the fact that it's unethical and just flat out WRONG to artificially inflate the value of a pill from pennies or sub pennies  and sell them to the consumer for thousands of percent profit...You can't justify that kind of a markup, it's IMPOSSIBLE...What I'm beginning to think is that you are claiming that by having such a pill available for whatever purpose it serves makes it THAT valuable which is pure horse [BAD WORD REMOVED]. There is no way to justify that sort of markup and make any validity to the argument...I'm advocating anti GREED measures and anti GOUGE measures because that's all that percentage of markup really is...They could sell for a handsome profit at $2-$5 but instead their fat fingers price them at $26...GREED and value are not the same thing

I'm sorry, this is all your opinion. Nothing you've said makes you right, and many hospital's margins are so thin that to do business your way would cause them to close. The best way to fix it is to advocate for free market solutions.

---

“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

If you can accept that kind of markup for health care products, you should be fine for the same markups at grocery stores and other consumer staples, I for one believe it's price gouging and should be  illegal

---

I'm sorry, this is all your opinion. Nothing you've said makes you right, and many hospital's margins are so thin that to do business your way would cause them to close. The best way to fix it is to advocate for free market solutions.

there is no way to have free market hospitals..I do know that most hospitals do operate on a very thin margin, but I still believe that marking pills up that much is nothing more than a "because I can" analogy and motivated by pure greed

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If you can accept that kind of markup for health care products, you should be fine for the same markups at grocery stores and other consumer staples, I for one believe it's price gouging and should be illegal

What you're advocating even if you don't realize it is government control of price points. Think about the dangerous precedent that would set......

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What you're advocating even if you don't realize it is government control of price points. Think about the dangerous precedent that would set......

 

We've already done price controls in this country, they don't work.

---

“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

If you can accept that kind of markup for health care products, you should be fine for the same markups at grocery stores and other consumer staples, I for one believe it's price gouging and should be  illegal

 

I'm for a market that regulates the prices, not one where someone, somewhere in some bureaucracy tells everyone what amount is an "acceptable" mark up or level of profit. 

---

“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

The ACA is garbage legislation and the 20% premium spikes coming for 2015 show why, nothing they did will bend the cost curve down. The ACA has one intention, make our system so bad that Universal coverage looks attractive by comparison. Free market advocates know that we are going the wrong way and it's only going to get worse as our government takes over more and more of the industry.

 

 

You still didn't address my main point: that the US does not have the best health care system in the world.  I think your "sabotage" theory is way off base, and is dead wrong.  The ACA is an attempt to regulate an industry with runaway costs that every single American relies on for their lives.

 

Perhaps there is more sensible legislation, but at least the ACA is an attempt to address a very real problem:  the elimination of the American middle class due to catastrophic health care costs.  As for "free market", what could be more "free market" than listing all possible choices and letting the public decide - like the ACA is doing with their exchanges.

 

The government hasn't taken over the industry any more than the NHTSA has taken over the auto industry.  They've set reasonable standards and regulations - like eliminating the $5000 deductible garbage plans you so eloquently decried a few pages back.

 

If rising health care costs didn't threaten to ruin our country, this legislation would be unnecessary.  But they are, and it finally reached a point where our politicians couldn't just sweep them under the rug anymore.  One party is still trying, which is a shame, because the ACA is their idea - Massachussett's system writ large.  So tweak it, because the public knows that if it's repealed, it will not be replaced with a better idea.

---

there is no way to have free market hospitals..I do know that most hospitals do operate on a very thin margin, but I still believe that marking pills up that much is nothing more than a "because I can" analogy and motivated by pure greed

 

First, yes, it's entirely possible to have free market hospitals, just not in our current regulatory environment.

 

Second, if you understand the thin margin then how can you claim they're gouging you? If revenue minus expenses isn't a positive number then they don't stay in business. Not to mention that 60% of American community hospitals are non-profit anyhow, so no share holders are making money on those greedy transactions (only 15% are for profit). BTW, that 60% of the industry has a profit margin of 2.2% for 2013 (margin for all hospitals was 3.1%). If the margin is 2.2% and they are "gouging" you then what do you call the retail clothing industry that has a margin of 48%? A 3% margin isn't indicative of "greed" by any measure. 

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

First, yes, it's entirely possible to have free market hospitals, just not in our current regulatory environment.

 

Second, if you understand the thin margin then how can you claim they're gouging you? If revenue minus expenses isn't a positive number then they don't stay in business. Not to mention that 60% of American community hospitals are non-profit anyhow, so no share holders are making money on those greedy transactions (only 15% are for profit). BTW, that 60% of the industry has a profit margin of 2.2% for 2013 (margin for all hospitals was 3.1%). If the margin is 2.2% and they are "gouging" you then what do you call the retail clothing industry that has a margin of 48%? A 3% margin isn't indicative of "greed" by any measure. 

It's simple...when you buy a pill for pennies or sub pennies just because you can, it's and sell it for $26 it's gouging,,,,simply operating on a slim margin doesn't make gouging ethical or not happening...gouging does not mean that the company is making a huge profit overall, it means "to overchargewindle" (gouge). The company can even operate in the red and be guilty of price gouging...

 

Not for profit agencies make money...The NFL is a not for profit entity but look how much money it generates, so not for profit means nothing....

 

The bottom line is anything that is bought at a level such as pennies or sub pennies and sold for $26 for one, and a 30 day supply is less than $12, is pushing the boundaries of ethics and guilty of fleecing the consumer...

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I can't understand how you can justify the charge of $26 for delivery of a pill that cost pennies or a fraction of a penny...The percentage of profit on that is outrageous...It doesn't matter if the insurance company pays that amount or not, the consumer without coverage will be billed that cost...

 

The pill in the hospital is accompanied by a medical analysis of just how safe that pill is to the patient. You're not paying $26 for an aspirin, you're paying $.01 for the aspirin and $25.99 for the doctor to look at your chart and say it's OK for you to have an asprin.


 

Or you can have a friend or relative smuggle it in if you don't think the medical approval is necessary.

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"Why should I give information to you when all you want to do is find something wrong with it?"

It's simple...when you buy a pill for pennies or sub pennies just because you can, it's and sell it for $26 it's gouging,,,,simply operating on a slim margin doesn't make gouging ethical or not happening...gouging does not mean that the company is making a huge profit overall, it means "to overchargewindle" (gouge). The company can even operate in the red and be guilty of price gouging...

 

Not for profit agencies make money...The NFL is a not for profit entity but look how much money it generates, so not for profit means nothing....

 

The bottom line is anything that is bought at a level such as pennies or sub pennies and sold for $26 for one, and a 30 day supply is less than $12, is pushing the boundaries of ethics and guilty of fleecing the consumer...

 

You really don't understand the NFL, not for profit thing, do you? 

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The sun's not yellow, it's chicken.

You still didn't address my main point: that the US does not have the best health care system in the world. 

 

When you speak of "best" there are parts of the system that are clearly the best in the world while others need improvement. Total cost is definitely an issue, as much of the discussion in this thread shows. I don't disagree at all, American healthcare financing is too complex and has too many players. When it comes to actual care though, we break it down into two distinct categories: Acute and Preventative. Studies from every political perspective agree that, if you suffer an acute episode, the best place in the world for access, diagnostics, and treatment of your condition is the USA. Preventative care is an entirely different animal though, and the US lags significantly behind other countries. Several reasons for that  include the size and mix of our population, the land mass of our country, the baseline health of our population, cost for services and relative lack education of the population about prevention in health.


 

The last one is something that physicians can impact the most and the most quickly. Last year the ACA mandated that preventive services be free of out of pocket costs for patients and included in all new insurance plans. Do you know how much our compliance rate for simple annual physicals improved? 6%. Basically 37 out of every 100 patients thought a physical was important enough to make time for EVEN when it was "free." In the land of the Hoveround where Type 2 Diabetes in king we can't get folks to take an hour out of the day once a year to check on their health. We're currently building a program to encourage our patients to use those benefits, but it's going to be a long process to change the mindset of the population, and we certainly have huge incentive to do so. That compliance rate for preventive services is measured and evaluated by the federal government to determine whether or not our reimbursement should be reduced in aggregate. That's right, physician's pay is reduced based on whether or not the patient panel will come in for their preventive services. The incentives are there, now we have to change their behavior. Hopefully we'll see that change in the near future and the US will close that quality gap in the preventives, because cost isn't an issue there anymore.


 

 

I think your "sabotage" theory is way off base, and is dead wrong.  The ACA is an attempt to regulate an industry with runaway costs that every single American relies on for their lives.

 

Perhaps there is more sensible legislation, but at least the ACA is an attempt to address a very real problem:  the elimination of the American middle class due to catastrophic health care costs.  As for "free market", what could be more "free market" than listing all possible choices and letting the public decide - like the ACA is doing with their exchanges.

 

The government hasn't taken over the industry any more than the NHTSA has taken over the auto industry.  They've set reasonable standards and regulations - like eliminating the $5000 deductible garbage plans you so eloquently decried a few pages back. 

 

Actually, the cheapest plans offered under the ACA (bronze plans) average about $300 per month and have a $5,000 deductible. I guess they didn't eliminate those plans after all! And don't forget that those premiums will average 20% more for 2015, what a great deal! Source: http://www.healthpocket.com/individual-h...Fd7KjTF-So


 

As for whether or not the government is taking over healthcare, here's what the ACA looks like from a functional perspective. Way too many government segments, way too much complexity to pay for a service, and it can (and will!) only get worse from here.


 



 

If rising health care costs didn't threaten to ruin our country, this legislation would be unnecessary.  But they are, and it finally reached a point where our politicians couldn't just sweep them under the rug anymore.  One party is still trying, which is a shame, because the ACA is their idea - Massachussett's system writ large.  So tweak it, because the public knows that if it's repealed, it will not be replaced with a better idea.

 

After the first year full year these are some of the results:


1. People who liked their insurance plans lost them because the law said the insurance company  could no longer offer it.


2. People who liked their doctor had to switch to someone else because of their new insurance plan, or it will cost them more OOP to keep him.


3. Many, many, many people will pay in excess of 15% more for their premiums in 2015


4. Many of these patients were pushed to Medicaid instead of a commercial plan. Medicaid care is of significantly lower quality which puts these patients at risk.s 


5. The young and healthy, who are needed to keep the actuary table balanced, are choosing to pay the tax fine rather than pay for insurance. And according to the site at the link,  the CBO recently came out and said that 90% of the 30 million Americans who didn't buy it won't have to pay the penalty in 2016, so that, coupled with the removal of pre-existing condition rules, means that this particular cohort can wait to see if they get sick to buy a policy. All those premium dollars needed to keep the ACA afloat aren't going to come in. Lots of info here: http://obamacarefacts.com/obamacare-individual-mandate/


6. The implementation of healthcare.gov was a fiasco that cost us over 2 billion dollars. A web portal cost 2 BILLION dollars and it didn't work. That's certainly not bending the cost curve in any meaningful way.


 

The ACA is legislation that took us the wrong way. It gives the government more say, more power, more control; all things that make the industry worse off, not better.

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

You really don't understand the NFL, not for profit thing, do you? 

 

That's the problem with this issue, it's not simple and it's very hard to understand it all, but very easy to latch onto one single circumstance and use that to decry the whole thing. 

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

Actually, hospital payments rates are contracted for the majority of their patients. Medicare, Medicaid and Tricare are government programs, so you don't get to negotiate a rate, you simply take what they offer or don't participate. Commercial payers like Blue Cross, Aetna and United Healthcare negotiate individual contracts with physicians and facilities that pay on some percentage of the Medicare rate (good rates are 110 - 120% of Medicare, bad ones can be 80% or lower). Once the service is rendered the insurance company has the leverage because they can (and do) simply deny the claim and not pay it short of a judge forcing them to. They also deny claims for illegitimate reasons or say the service is the patient's responsibility and force the physician to rebill the claim costing labor time and a delay in cash flow or force the patient to spend time on the phone demanding they pay the claim. You've not seen corporate greed until you've seen how an insurance company works to hold on to their dollars!

 

Truth.

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Quoting the reply to my post, with the comical tea party Sam Brownback "Obacare complexity chart", is fruitless.  I understand opposition to the ACA on philosophical grounds, and that no matter what the success or failure, views against it will not change because to do so would undermine the foundation on which one has built his/her life.  What's genuinely perplexing is the admission that what we had prior to the ACA was unacceptable, but a return to that system is somehow a better idea.

 

Anyway, in response to some of the more misleading points:

 

1. People who liked their insurance plans lost them because the law said the insurance company  could no longer offer it.
Because the law set standards that made $10,000 deductibles and other garbage illegal.  Just like we have usery laws for unreasonable interest, but I suppose those laws are unfair to the "free market" principles too.

 

2. People who liked their doctor had to switch to someone else because of their new insurance plan, or it will cost them more OOP to keep him.
Free market advocates are the first to state that if you want to eat at Ruth's Chris instead of McDonalds, don't complain about the price.  By the way, this is no different than the system before the ACA.  If you liked your doctor and he was in your system, great.  If out of network, you paid more.

 

3. Many, many, many people will pay in excess of 15% more for their premiums in 2015 
And many, many, won't.  Some will pay even more than 15%, some will pay less.  My own premiums went up 200% from 1998 to 2004 prior to the ACA, which made me drop my policy and take my chances with the uninsured masses.  Perhaps the ACA didn't help this problem, but it sure didn't cause it.

 

4. Many of these patients were pushed to Medicaid instead of a commercial plan. Medicaid care is of significantly lower quality which puts these patients at risk.s 
Medicare is of significantly lower quality?  News to me.  And my mom.  She didn't have to change a single doctor.

 

5. The young and healthy, who are needed to keep the actuary table balanced, are choosing to pay the tax fine rather than pay for insurance. And according to the site at the link,  the CBO recently came out and said that 90% of the 30 million Americans who didn't buy it won't have to pay the penalty in 2016, so that, coupled with the removal of pre-existing condition rules, means that this particular cohort can wait to see if they get sick to buy a policy. All those premium dollars needed to keep the ACA afloat aren't going to come in.
  Some young folks are choosing to pay the fines, others are living their lives ignorant of the fact that they have to get health insurance or pay fines.  They're young people after all.  And if they are paying fines, at least that's better than them paying nothing, getting appendicitis, and then ditching the bill - allowing you and me to pay for it with our own higher premiums.  And the money's not going to come in??? It hasn't even been mandated a year yet - so that's just speculation, largely influenced by your core philosophy.

 

6. The implementation of healthcare.gov was a fiasco that cost us over 2 billion dollars. A web portal cost 2 BILLION dollars and it didn't work. That's certainly not bending the cost curve in any meaningful way.
The healthcare.gov website was indeed an incredibly embarrassing and expensive fiasco.  Web designers in just about every small city in the country could've done a better job.  The designers should have known there would be far more interest in the portal than they figured.  Bad math, for sure, but I hear it's up and running well now.

 

The ACA is legislation that took us the wrong way. It gives the government more say, more power, more control; all things that make the industry worse off, not better
When an industry can't do an acceptable job of regulating itself, the government steps in with regulation.  Sucks for profits, but if you can't mine coal without killing workers, produce chemicals without poisoning groundwater, or racially integrate a public university, the government steps in.  A dozen eggs are 3 times more to buy now as when I was a teenager.  Gasoline is four times as much. An appendectomy is ten times as much, or more.

 

By the way, this ties into the Social Security thread in that this is what we'll be buying with that money that most of you don't think we'll be getting back.  Healthcare and health insurance.  Yay?

---

Quoting the reply to my post, with the comical tea party Sam Brownback "Obacare complexity chart", is fruitless.  I understand opposition to the ACA on philosophical grounds, and that no matter what the success or failure, views against it will not change because to do so would undermine the foundation on which one has built his/her life.  What's genuinely perplexing is the admission that what we had prior to the ACA was unacceptable, but a return to that system is somehow a better idea.

 

Call it what you will, the ACA is worse than that old system and time will continue to bear this out. 


 

Anyway, in response to some of the more misleading points: (you mispelled F-A-C-T-U-A-L)


 

1. People who liked their insurance plans lost them because the law said the insurance company  could no longer offer it.
Because the law set standards that made $10,000 deductibles and other garbage illegal.  Just like we have usery laws for unreasonable interest, but I suppose those laws are unfair to the "free market" principles too. 

 

A $10,000 deductible is not unreasonable. If I want catastrophic coverage instead of a payment system for regular routine maintenance I shouldn't have the government telling me I can't do it that way. Exactly the same as car insurance for a wreck but not for an oil change.


 

2. People who liked their doctor had to switch to someone else because of their new insurance plan, or it will cost them more OOP to keep him.
Free market advocates are the first to state that if you want to eat at Ruth's Chris instead of McDonalds, don't complain about the price.  By the way, this is no different than the system before the ACA.  If you liked your doctor and he was in your system, great.  If out of network, you paid more.

 

Being forced into another network because of some bureaucratic decision instead of my own choosing to do so is the issue. Don't forget, I advocate a robust individual market so that even my employer wouldn't have a say in my decisions.


 

3. Many, many, many people will pay in excess of 15% more for their premiums in 2015 
And many, many, won't.  Some will pay even more than 15%, some will pay less.  My own premiums went up 200% from 1998 to 2004 prior to the ACA, which made me drop my policy and take my chances with the uninsured masses.  Perhaps the ACA didn't help this problem, but it sure didn't cause it.

 

It was supposed to fix it but its failed because it can't work. I'm sure you'll agree with me that a less restrictive market place would exert downward pressure on prices much more than a government demand that all citizens purchase the product.

 

4. Many of these patients were pushed to Medicaid instead of a commercial plan. Medicaid care is of significantly lower quality which puts these patients at risk.s 
Medicare is of significantly lower quality?  News to me.  And my mom.  She didn't have to change a single doctor.

 

Perhaps you should get your glasses checked and read what I wrote again.


 

5. The young and healthy, who are needed to keep the actuary table balanced, are choosing to pay the tax fine rather than pay for insurance. And according to the site at the link,  the CBO recently came out and said that 90% of the 30 million Americans who didn't buy it won't have to pay the penalty in 2016, so that, coupled with the removal of pre-existing condition rules, means that this particular cohort can wait to see if they get sick to buy a policy. All those premium dollars needed to keep the ACA afloat aren't going to come in.
  Some young folks are choosing to pay the fines, others are living their lives ignorant of the fact that they have to get health insurance or pay fines.  They're young people after all.  And if they are paying fines, at least that's better than them paying nothing, getting appendicitis, and then ditching the bill - allowing you and me to pay for it with our own higher premiums.  And the money's not going to come in??? It hasn't even been mandated a year yet - so that's just speculation, largely influenced by your core philosophy.

 

When premiums are >$5,000 per year and the penalty is <$1,000 then the simple fact is that they aren't and won't do it.


 

6. The implementation of healthcare.gov was a fiasco that cost us over 2 billion dollars. A web portal cost 2 BILLION dollars and it didn't work. That's certainly not bending the cost curve in any meaningful way.
The healthcare.gov website was indeed an incredibly embarrassing and expensive fiasco.  Web designers in just about every small city in the country could've done a better job.  The designers should have known there would be far more interest in the portal than they figured.  Bad math, for sure, but I hear it's up and running well now.

 

We'll see how it goes this year, I , of course, have my doubts. This least competent administration shouldn't give anyone confidence that they can pull it off.


 

The ACA is legislation that took us the wrong way. It gives the government more say, more power, more control; all things that make the industry worse off, not better
When an industry can't do an acceptable job of regulating itself, the government steps in with regulation.  Sucks for profits, but if you can't mine coal without killing workers, produce chemicals without poisoning groundwater, or racially integrate a public university, the government steps in.  A dozen eggs are 3 times more to buy now as when I was a teenager.  Gasoline is four times as much. An appendectomy is ten times as much, or more.

 

Because the industry hasn't been regulated for the last century? The government did so well with it already we should give them more power, never mind that the local, state and federal governments have had their disruptive paws all over the it and total screwed it up. That's the mindset that Conservatives and Libertarians just can't accept. And I had my appendix out in 1985, my God do I wish they had laproscopic surgery back then, I wouldn't have this 6 inch scar in my gut. But hey,it's clearly not worth paying for all these swell advances we've given the world. 


 

 

By the way, this ties into the Social Security thread in that this is what we'll be buying with that money that most of you don't think we'll be getting back.  Healthcare and health insurance.  Yay? 

 

You'll have your Medicare, you just might not have any doctors that will see you. Or you'll have some "C" student leftover who's willing to work for the scraps the government will pay him to treat you since all the good doctors left the business. The SGR is going to pass eventually, and when they put it into practice you'll see the mass exodus of the professionals from the industry.

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

 

<blockquote class="ipsBlockquote" data-author="anonymous2112" data-cid="354356" data-time="1415051744">
<div>
 

4. Many of these patients were pushed to Medicaid instead of a commercial plan. Medicaid care is of significantly lower quality which puts these patients at risk.s 
Medicare is of significantly lower quality?  News to me.  And my mom.  She didn't have to change a single doctor.

 

Perhaps you should get your glasses checked and read what I wrote again.


 

 

</div>
</blockquote>
 

I accept your objections to the ACA, and disagree with most of them.  They are very well stated, however, and consistent with your conservative philosophies.

 

I do have a decent pair of reading glasses, got them out, and read this again.  You made 2 statements here:

 

1) That these patients were pushed to a Medicaid instead of a commercial plan.  I'll take that at face value.

2) Medicaid care is of significantly lower quality.  When my mother reached retirement age, she qualified for Medicare, including part D.  She is satisfied with both.  She did not have to change providers.

 

What am I missing?

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