(06-23-2015 08:31 PM)dawgitall Wrote:  

(06-23-2015 12:24 PM)Hambone10 Wrote:  

(06-23-2015 11:36 AM)dawgitall Wrote:  There you go again, twisting everything I post.

Nope. Didn't twist a thing.

Quote:My post was simple. The difficultly in getting seen in a timely manner wasn't observed yesterday. That is a good thing, regardless of a person's opinions on the ACA.

It's good that the ACA hasn't made things worse FOR YOU? Well yes, it's good FOR YOU... but that doesn't make it universally good.

What I mean by that is that you probably would have said exactly the same thing about your experience with healthcare 5 years ago. I know I would have as would tens of millions of others.. yet Obama and Bush and Clinton and the AMA and everyone else keeps talking about the shortage. I didn't see it PERSONALLY in 2007 and neither did you I suspect.

You spend a lot of time talking about the 'good' of the ACA without talking about anything having to do with the ACA. As an example, the 'sign-ups' you like to tout are merely people complying with the law, and not some example of some sort of improvement in healthcare. Your 'unchanged' experience is no different from the currently unchanged experience of ERs where people are still going for primary care, which is what the ACA was supposed to fix.

Your experience isn't worse, but it was supposed to be better... not just for you, but for everyone. If it isn't better, why are we all paying more? (and yes, everyone is in one way or another paying more... it is a bit of semantics, but true) When a physician's reimbursement for his services goes down, you pay for his loss.

has (have) moved on.

Five years ago there were about 16.5 fewer people with insurance. The repeated argument by many here and elsewhere has been that with all these new people getting coverage there will be long delays to be seen by doctors. It is great that you aren't one of those that is claiming that Ham!

So my simple point was that despite the addition of 16.5 million adults to the rolls of the insured, the health care providers seem to be adjusting fairly well. That seems like a positive to me.

The absence of a potential negative does not equal a positive. In this case it simply shows that the bottleneck has yet to become congested in your area. To use your singular personal experience as any sort of measure for the entire system is flawed logic.

(06-23-2015 09:17 PM)200yrs2late Wrote:  

(06-23-2015 08:31 PM)dawgitall Wrote:  

(06-23-2015 12:24 PM)Hambone10 Wrote:  

(06-23-2015 11:36 AM)dawgitall Wrote:  There you go again, twisting everything I post.

Nope. Didn't twist a thing.

Quote:My post was simple. The difficultly in getting seen in a timely manner wasn't observed yesterday. That is a good thing, regardless of a person's opinions on the ACA.

It's good that the ACA hasn't made things worse FOR YOU? Well yes, it's good FOR YOU... but that doesn't make it universally good.

What I mean by that is that you probably would have said exactly the same thing about your experience with healthcare 5 years ago. I know I would have as would tens of millions of others.. yet Obama and Bush and Clinton and the AMA and everyone else keeps talking about the shortage. I didn't see it PERSONALLY in 2007 and neither did you I suspect.

You spend a lot of time talking about the 'good' of the ACA without talking about anything having to do with the ACA. As an example, the 'sign-ups' you like to tout are merely people complying with the law, and not some example of some sort of improvement in healthcare. Your 'unchanged' experience is no different from the currently unchanged experience of ERs where people are still going for primary care, which is what the ACA was supposed to fix.

Your experience isn't worse, but it was supposed to be better... not just for you, but for everyone. If it isn't better, why are we all paying more? (and yes, everyone is in one way or another paying more... it is a bit of semantics, but true) When a physician's reimbursement for his services goes down, you pay for his loss.

has (have) moved on.

Five years ago there were about 16.5 fewer people with insurance. The repeated argument by many here and elsewhere has been that with all these new people getting coverage there will be long delays to be seen by doctors. It is great that you aren't one of those that is claiming that Ham!

So my simple point was that despite the addition of 16.5 million adults to the rolls of the insured, the health care providers seem to be adjusting fairly well. That seems like a positive to me.

The absence of a potential negative does not equal a positive. In this case it simply shows that the bottleneck has yet to become congested in your area. To use your singular personal experience as any sort of measure for the entire system is flawed logic.

It is an observation, but there are any number of reports and surveys that indicate that the influx of newly insured are being served without significant problems. You can check the PCP shortage thread for some of those links.

This in no way is meant to imply that the PCP shortage isn't an ongoing issue that needs addressing. It also in no way is meant to disregard the problem of people continuing to show up at ERs when they need to be establishing relationships with a PCP.

(06-23-2015 08:31 PM)dawgitall Wrote:  Five years ago there were about 16.5 fewer people with insurance. The repeated argument by many here and elsewhere has been that with all these new people getting coverage there will be long delays to be seen by doctors. It is great that you aren't one of those that is claiming that Ham!

The repeated claim was also that having insurance would reduce the people using the ER for primary care.

This too hasn't happened.

The long delays already existed.

But if you look at the actual numbers... http://www.washingtonpost.com/blogs/wonk...18-5-days/

and yes, that is a KFF article...

You'll see that lots of what i've said all along is consistent with their findings.

As plan deductibles and copays have gone up, patient volumes have declined.... that means that for the portion of the 16.5mm people who go to the doctor because they now have insurance are merely replacing those of the (Pulling a number from thin air) 100mm previously insured who are now paying higher copays or deductibles so they don't go as often. So you dont 'go there', I didn't say 100mm people are paying more... I honestly don't know what that number is... I said that some portion of the previously insured is... and they are responding by consuming less healthcare... that isn't MY opinion, that is KFF's and MGMA's.

It is different people seeing the doctor, not more people. If you still consider that a positive... then there isn't much to say about it.



I DO note this... according to the plan, only 45% of physicians take Medicaid, down from 55% in 2009. If you don't attribute that to the ACA, then I don't know what you DO attribute it to. I also note that Boston accepts 73% of Medicaid patients, but they also have a VERY long (though improving) wait time, while Dallas has only a 23% acceptance rate of Medicaid and the wait time is the shortest in the country.

To argue that more people on 'acceptable' insurance isn't otherwise correlated to longer wait times is to argue against the facts on the ground. No, it isn't a 1:1 relationship and there are lots of moving parts... but to argue that there is no relationship at all is just not intelligent.

I also note that the decrease from 20.9 days in 2004 to 20.4 days in 2009 to 18.5 days in 2013 is (according to the researchers) practices employing more mid-levels, IT and the increase in urgent care centers. Only IT is an area fundamentally impacted by the ACA. The other two were already happening before the ACA was even mentioned.

Quote:So my simple point was that despite the addition of 16.5 million adults to the rolls of the insured, the health care providers seem to be adjusting fairly well. That seems like a positive to me.

Well, if you consider people who previously got care, now not getting care because of increases in their copays and deductibles and hospitals doing things like closing and consolidating services (one of my hospitals no longer performs surgery and another one no longer delivers babies) a positive. Then I guess there is no reason to continue the discussion.

For all the positives you want to mention, there are negatives which you ignore... and more importantly, you ignore the 'why's'. As I've repeatedly said... not all of the ACA is bad... Uncapping policies is very cheap, doesn't impact many people but it IS a good thing (because in part it is so cheap). The focus on improved IT is also a good thing... and spending more money on healthcare in general is a good thing.

Most of the rest of it is merely robbing Peter to pay Paul.

That's not me saying that, It's KFF, MGMA and other large, non-partisan consulting firms

The song remains the same.

(06-24-2015 10:13 AM)Hambone10 Wrote:  

(06-23-2015 08:31 PM)dawgitall Wrote:  Five years ago there were about 16.5 fewer people with insurance. The repeated argument by many here and elsewhere has been that with all these new people getting coverage there will be long delays to be seen by doctors. It is great that you aren't one of those that is claiming that Ham!

The repeated claim was also that having insurance would reduce the people using the ER for primary care.

This too hasn't happened.

The long delays already existed.

But if you look at the actual numbers... http://www.washingtonpost.com/blogs/wonk...18-5-days/

and yes, that is a KFF article...

You'll see that lots of what i've said all along is consistent with their findings.

As plan deductibles and copays have gone up, patient volumes have declined.... that means that for the portion of the 16.5mm people who go to the doctor because they now have insurance are merely replacing those of the (Pulling a number from thin air) 100mm previously insured who are now paying higher copays or deductibles so they don't go as often. So you dont 'go there', I didn't say 100mm people are paying more... I honestly don't know what that number is... I said that some portion of the previously insured is... and they are responding by consuming less healthcare... that isn't MY opinion, that is KFF's and MGMA's.

It is different people seeing the doctor, not more people. If you still consider that a positive... then there isn't much to say about it.



I DO note this... according to the plan, only 45% of physicians take Medicaid, down from 55% in 2009. If you don't attribute that to the ACA, then I don't know what you DO attribute it to. I also note that Boston accepts 73% of Medicaid patients, but they also have a VERY long (though improving) wait time, while Dallas has only a 23% acceptance rate of Medicaid and the wait time is the shortest in the country.

To argue that more people on 'acceptable' insurance isn't otherwise correlated to longer wait times is to argue against the facts on the ground. No, it isn't a 1:1 relationship and there are lots of moving parts... but to argue that there is no relationship at all is just not intelligent.

I also note that the decrease from 20.9 days in 2004 to 20.4 days in 2009 to 18.5 days in 2013 is (according to the researchers) practices employing more mid-levels, IT and the increase in urgent care centers. Only IT is an area fundamentally impacted by the ACA. The other two were already happening before the ACA was even mentioned.

Quote:So my simple point was that despite the addition of 16.5 million adults to the rolls of the insured, the health care providers seem to be adjusting fairly well. That seems like a positive to me.

Well, if you consider people who previously got care, now not getting care because of increases in their copays and deductibles and hospitals doing things like closing and consolidating services (one of my hospitals no longer performs surgery and another one no longer delivers babies) a positive. Then I guess there is no reason to continue the discussion.

For all the positives you want to mention, there are negatives which you ignore... and more importantly, you ignore the 'why's'. As I've repeatedly said... not all of the ACA is bad... Uncapping policies is very cheap, doesn't impact many people but it IS a good thing (because in part it is so cheap). The focus on improved IT is also a good thing... and spending more money on healthcare in general is a good thing.

Most of the rest of it is merely robbing Peter to pay Paul.

That's not me saying that, It's KFF, MGMA and other large, non-partisan consulting firms

The song remains the same.

You certainly overstated your case here. KFF found some people, less than 20% of those with high OOP policies, in some way didn't address a med concern at one time or another last year. That number is dwarfed by the number of newly insured. KFF also found that most people are somewhat or very satisfied with their coverage and able to be seen in a timely manner.

I've never been a big Led Z fan, CSN&Y was always more my cup of tea, but LZ has kind of grown on me in my old age.

(06-24-2015 01:51 PM)dawgitall Wrote:  

(06-24-2015 10:13 AM)Hambone10 Wrote:  

(06-23-2015 08:31 PM)dawgitall Wrote:  Five years ago there were about 16.5 fewer people with insurance. The repeated argument by many here and elsewhere has been that with all these new people getting coverage there will be long delays to be seen by doctors. It is great that you aren't one of those that is claiming that Ham!

The repeated claim was also that having insurance would reduce the people using the ER for primary care.

This too hasn't happened.

The long delays already existed.

But if you look at the actual numbers... http://www.washingtonpost.com/blogs/wonk...18-5-days/

and yes, that is a KFF article...

You'll see that lots of what i've said all along is consistent with their findings.

As plan deductibles and copays have gone up, patient volumes have declined.... that means that for the portion of the 16.5mm people who go to the doctor because they now have insurance are merely replacing those of the (Pulling a number from thin air) 100mm previously insured who are now paying higher copays or deductibles so they don't go as often. So you dont 'go there', I didn't say 100mm people are paying more... I honestly don't know what that number is... I said that some portion of the previously insured is... and they are responding by consuming less healthcare... that isn't MY opinion, that is KFF's and MGMA's.

It is different people seeing the doctor, not more people. If you still consider that a positive... then there isn't much to say about it.



I DO note this... according to the plan, only 45% of physicians take Medicaid, down from 55% in 2009. If you don't attribute that to the ACA, then I don't know what you DO attribute it to. I also note that Boston accepts 73% of Medicaid patients, but they also have a VERY long (though improving) wait time, while Dallas has only a 23% acceptance rate of Medicaid and the wait time is the shortest in the country.

To argue that more people on 'acceptable' insurance isn't otherwise correlated to longer wait times is to argue against the facts on the ground. No, it isn't a 1:1 relationship and there are lots of moving parts... but to argue that there is no relationship at all is just not intelligent.

I also note that the decrease from 20.9 days in 2004 to 20.4 days in 2009 to 18.5 days in 2013 is (according to the researchers) practices employing more mid-levels, IT and the increase in urgent care centers. Only IT is an area fundamentally impacted by the ACA. The other two were already happening before the ACA was even mentioned.

Quote:So my simple point was that despite the addition of 16.5 million adults to the rolls of the insured, the health care providers seem to be adjusting fairly well. That seems like a positive to me.

Well, if you consider people who previously got care, now not getting care because of increases in their copays and deductibles and hospitals doing things like closing and consolidating services (one of my hospitals no longer performs surgery and another one no longer delivers babies) a positive. Then I guess there is no reason to continue the discussion.

For all the positives you want to mention, there are negatives which you ignore... and more importantly, you ignore the 'why's'. As I've repeatedly said... not all of the ACA is bad... Uncapping policies is very cheap, doesn't impact many people but it IS a good thing (because in part it is so cheap). The focus on improved IT is also a good thing... and spending more money on healthcare in general is a good thing.

Most of the rest of it is merely robbing Peter to pay Paul.

That's not me saying that, It's KFF, MGMA and other large, non-partisan consulting firms

The song remains the same.

You certainly overstated your case here. KFF found some people, less than 20% of those with high OOP policies, in some way didn't address a med concern at one time or another last year. That number is dwarfed by the number of newly insured. KFF also found that most people are somewhat or very satisfied with their coverage and able to be seen in a timely manner.

I've never been a big Led Z fan, CSN&Y was always more my cup of tea, but LZ has kind of grown on me in my old age.

You want to show the math on that, Einstein?

(06-24-2015 02:03 PM)UofMstateU Wrote:  

(06-24-2015 01:51 PM)dawgitall Wrote:  You certainly overstated your case here. KFF found some people, less than 20% of those with high OOP policies, in some way didn't address a med concern at one time or another last year. That number is dwarfed by the number of newly insured. KFF also found that most people are somewhat or very satisfied with their coverage and able to be seen in a timely manner.

I've never been a big Led Z fan, CSN&Y was always more my cup of tea, but LZ has kind of grown on me in my old age.

You want to show the math on that, Einstein?

It's actually far worse than that... 'I' didn't state a case at all, dawg... so I certainly didn't OVER state it.

From the article:

Quote: says Singleton. “If no one will take your insurance, you're going to end up in the same place, and that’s probably the ER.” And with more patients covered both by Medicaid and private insurance, he says, wait times are likely to get worse.

Singleton is Senior VP of Merritt Hawkins, The health care and physician search consulting firm that conducted the survey. What does HE know about the issue?

Quote:But Ken Hertz of the MGMA Health Care Consulting Group, which consults with physician practices, says wait times don't always increase in proportion to patient volume. As plan deductibles and co-pays have gone up in recent years, patient volume in outpatient settings have actually declined, he says.

Hertz actually takes some issue with Singleton's conclusion... but not in a way that exonerates the ACA... He essentially says that you may not see as direct a link as Singleton describes because of these other issues. What does HE know about the issue?

and so there is no confusion:

Quote:This article was produced by Kaiser Health News with support from The SCAN Foundation.

What do THEY know about the issue? Obviously they chose to produce this article because the people who conducted the research are not credible in their fields.

But THESE people don't know what they're talking about and are overstating the case.

Let's listen to Dawg and politicians instead.

Utah and Alaska are added to the number of states expanding Medicaid. I believe that would leave 19 states that have not done so.