Tech In the Hot Seat For Oct. 1st Obamacare Launch

bednarz writes "In four days, the health insurance marketplaces mandated by the Obama administration's Affordable Care Act are scheduled to open for business. Yet even before the sites launch, problems are emerging. Final security testing of the federal data hub isn't slated to happen until Sept. 30, one day before the rollout. Lawmakers have raised significant concerns about the ability of the system to protect personal health records and other private information. 'Lots and lots of late nights and weekends as people get ready for go-live,' says Patrick Howard, who leads Deloitte Consulting's public sector state health care practice."

Comments

Re:Is there really any point to this? (Yes)

[crow]

Yes, there is a point to this.

It may well be a long time before the Republicans have enough votes to get a repeal through the Senate. The way Demographics are headed, the Republican party of today will have to evolve significantly to stay relevant beyond this decade. And what Republicans fear about Obamacare more than anything else is that once it's implemented, people will decide that they like it, making it impossible for them to repeal it (much like Medicare and Social Security).

Re:Is there really any point to this?

[Cyberax]

Nope. In a few years you'll see Tea Party demonstrations with placards like "Don't let government get its hands into my Obamacare!".

Only if unsuccessful

[ranton]

The Republicans can only get rid of it if it is unsuccessful, which is why they tried so hard to get rid of it before it was enacted. Even so, repealing it would take a Republican president and simple majority in both the house and senate, which is much harder.

Luckily for the Republicans they will always be able to find some metrics that show that it was a failure. Health care premiums will continue to rise no matter what until we serious talk about rationing care, so any health care plan written by either party will always leave room for complaints.

Re:Only if unsuccessful

[AlphaWolf_HK]

The reason we pay so much for health care is because the recipient doesn't know and/or doesn't care how much it costs, namely because they don't pay for it. Likewise, they don't shop around. So even though it is all privatized, there isn't really much of a free market system.

Every doctor I've known (which admittedly isn't many) who has worked in a country with a nationalized health care system always talks about how it is problematic because as the end of the year approaches they have to stop caring for their patients because the money has run out. In addition to that, the pay is crap compared to here, which results in a brain drain (notice how when a foreign country needs the *best* care for a particular patient, they pay to have them shipped here for their operation. Always here. In the US resides the world's top centers for cancer, neurology, cardio, and numerous other medical disciplines, and this didn't happen by accident.)

Rationing is a horrible idea because it just reproduces that problem, in addition to putting you on long ass waiting lists for even basic operations, and making the medical field less attractive as a career choice. It's already bad enough that we have waiting lists for organ transplants (Which by the way this problem is very solvable - have a look at how Iran does transplants. With as much shit as that country gets wrong, they shockingly nailed that one better than anybody else.)

Anyways, find a way to get the patient to actually care about the cost of their medical services, and you'll see the prices go down. This socialized medicine shit is absolutely NOT without its set of problems, and price ceilings and rationing have always resulted in more problems than they solve, especially for products with inelastic demand (in the 70's we did both for gasoline, and the result was shitty. And that's just for gasoline - the notion that people want to try it with health care - basically playing with people's lives - is stupid.)

Re:Only if unsuccessful

[artor3]

Anyways, find a way to get the patient to actually care about the cost of their medical services, and you'll see the prices go down.

No, you won't. In fact, you'll see prices rise.

There are two cases in which someone would seek medical help -- life-threatening situations, and non-life-threatening.

In the vast majority of life threatening situations, people aren't going to care about the cost. You've heard about the stages of grief, right? Well bargaining's a big one. Most people will do ANYTHING to get just a few more years, or months, or days. They'll throw money away on homeopathic crap and colloidal silver and psychic voodoo. People don't generally go gently into that good night, and shifting more of the cost on to them won't change that.

But in non-life-threatening situations, people will look at the price tag, and decide that they don't need to see the doctor so bad after all. And so curable illnesses go untreated, and become far more dangerous. They might be contagious and spread their illness. They might lose a limb and end up unable to work and on the public dole. They might die. That might reduce costs in the short term, but in the long run the cost to society is far higher.

Re:Only if unsuccessful

[VortexCortex]

The reason we pay so much for health care [blah blah blah, untested opinions and unproven hypotheses]. ... - basically playing with people's lives is stupid.)

Bullshit.

Here, have another vantage point to consider, fool: Say you're an individual who has a serious medical problem..... "Nice life you have there, would be terrible if something happened to it. Better pay whatever the fuck we say, or you die." Given that folks who CAN pay WILL pay whatever it takes to not die, which direction do you expect such "free market" forces to direct the price regardless of cost to provide? Even if folks DO CARE how much living costs... So, I think there should probably be SOME kind of collaborative interest on the individuals' side because alone they have likely have little leverage when it comes to health care and that whole "divide and conquer" thing.

Personally, I'm not an absolutist. I'm a scientist. I think we should try a few systems out, maybe a few hybrid ones, in various smaller test areas. Gather some evidence as to what seems to work, and roll forward making examinations and modifications as we go along. However, governments and politicians and their moronic divisionist supporters are all NOT scientists and IRRESPONSIBLY roll out huge changes to entire countries without any fucking evidence at all.

So, when it comes to this sort of thing: Any change is at least an opportunity to SEE WHAT WORKS. Unlike you morons I don't have preconceived notions about what's best. I wait for time to tell. Sadly you all want to take the slowest and most dangerous route to country-wide or world-wide possible harm or success in every fucking debate.

TL;DR: Fuck all of you morons.

Re:Only if unsuccessful

[nbauman]

The reason we pay so much for health care is because the recipient doesn't know and/or doesn't care how much it costs, namely because they don't pay for it. Likewise, they don't shop around. So even though it is all privatized, there isn't really much of a free market system.

That's not true. There are countries with government-run insurance, like Canada and Germany, and government-run socialized medicine, like the UK, where patients don't know how much it costs, or care (except to the degree that a good citizen doesn't like to see tax money wasted), and they spend roughly half what we do.

Most of the difference is in the insurance system. For every $1 you pay in health insurance premiums, 15 cents of that right off the top goes to the insurance company (look up a health insurance company financial statement under "loss ratio"), and for every 85 cents that your doctor gets, another 15 cents goes for the administrative costs of dealing with the insurance companies. Another difference is in our use of expensive medicines (erythropoetin for kidney dialysis was Medicare's single most expensive drug, and the dialysis centers, which made a profit on it, were overusing it to the point that they were actually killing people with it), and high-tech equipment (such as CAT scans, which are so overused that they're causing a significant number of radiation-associated cancers). Specialists make around $300,000 a year. Malpractice is about 2% of the health care dollar, so there's no big savings there.

Patient choice has almost nothing to do with it. The doctor has to agree on a treatment (and the more expensive procedures they do, the more money they make). A doctor tells you, "You have to do this now or you can die." What choice do you have?

Here's an example of an unusually well-informed patient, a physician assistant himself, who got appendicitis, did his research, and wanted to be treated with antibiotics, rather than surgery (which can actually be safer):

http://www.kevinmd.com/blog/2013/09/77-percent-success-good-guy-insurance.html
A 77 percent success rate is good enough for a guy without insurance
Andrew T. Gray, PA-C
September 26, 2013

How many patients know enough to resist a doctor's sales pitch: "You have to do this immediately or you could die"?

Every doctor I've known (which admittedly isn't many) who has worked in a country with a nationalized health care system always talks about how it is problematic because as the end of the year approaches they have to stop caring for their patients because the money has run out. In addition to that, the pay is crap compared to here, which results in a brain drain (notice how when a foreign country needs the *best* care for a particular patient, they pay to have them shipped here for their operation. Always here. In the US resides the world's top centers for cancer, neurology, cardio, and numerous other medical disciplines, and this didn't happen by accident.)

Well, I've talked to a few doctors from the UK, Canada, Germany, Sweden, and a few other countries, and I've read the studies that compare their outcomes for standard indicators like infant mortality and life expectancy, and for common procedures like cancer and heart disease. Basically the outcomes in all the developed countries are about the same. I wouldn't disparage American medical research, but if you read the New England Journal of Medicine every week, as I do, you'll see that some of the most important studies are also done in Europe, Australia, and elsewhere, The American studies are often done to get an expensive new drug approved, but the foreign studies are often done to test whether a common treatment actually works (for example this week an Australian doctor wrote an article about whether IV fluids do more harm than good). We didn't discover the AIDS virus; Luc Montagnier of France did. We didn't discover s

Re: Is there really any point to this?

[DoofusOfDeath]

Not their fault. They had to pass the legislation before they could know what was in it.

Re:Is there really any point to this?

[MightyMartian]

Yes, the Provinces decide how, but the parameters are not all that wide, and because the system is in considerable aspects Federally proscribed, you don't see that much variance between Provinces. And, in fact, the Feds have on occasion flexed their muscle and have sent warning shots to provinces who have traveled too far off the line.

Here's the facts. I am a resident of British Columbia. I pay about $127 per month in Medical Services Premiums. For that I won't be given a bill at any hospital or any doctor if I have a medical issue. If I need a scan or some other diagnostic test, I will not be billed. Furthermore, if I end up needing healthcare in Prince Edward Island, I will still be protected.

Let's be real...

[GerryGilmore]

For all of those if us concerned about the privacy/sanctity of our medical information, it doesn't exist *now*. If you are treated under any private health insurance plan, all of the diagnoses and treatments are fed into a database (http://www.mib.com/facts_about_mib.html) that all the insurance companies share to protect themselves against people applying for insurance and "forgetting" about a pre-existing condition. Next time you have a few minutes, pull out the mice-type on your health insurance plan and read up on how they can collect and share that information.

Re:Is there really any point to this?

[RabidReindeer]

Here's the facts. I am a resident of British Columbia. I pay about $127 per month in Medical Services Premiums. For that I won't be given a bill at any hospital or any doctor if I have a medical issue. If I need a scan or some other diagnostic test, I will not be billed. Furthermore, if I end up needing healthcare in Prince Edward Island, I will still be protected.

Shoot, that sounds fantastic! Why can't we get something like that here in the U.S.?

Because we got FREEDOMS!!!!

Re:Is there really any point to this?

[MightyMartian]

And what, you don't think the US system has a ton of horror stories. My run-in with serious illness was my wife's thyroid cancer, and the only real delay was because the initial symptoms aped salivary gland blockage. Within days that that specialist figured out that it was a probable tumor (initially they thought a carotid body tumor), we were driving to Victoria to see an ENT (ear-nose-throat specialist) whose specialization was cancerous tumors. She had surgery a few weeks later, which identified it as a thyroid tumor, and the big delay for removing the thyroid gland (total thyroidectomy) was that she had to heal sufficiently from the initial surgery.

Yes, there are delays and rationing, but really that happens in any system. In the US, in many places, rationing is basically defined by the size of your wallet. In Canada and other countries with universal systems, it's defined by utilization.

The public health system saved my wife's life, and other than her need to take thyroid replacement hormone for the rest of her life, she has fully recovered. Furthermore, I was laid off right in the middle of this nightmare, and the end result was that there was no bankruptcy or loss of our house.

I'll take the odd delay in treatment over no service at all or going bankrupt to save my loved ones' lives. If you like the American system so damned much, I urge you to move there.

Re:Freeeeedumb!

[Penguinisto]

These "freedoms" and more are available... but they come at a price.

For instance? No problem...

The county where I live offers an anus-puckering discount on poor families wanting to buy a home (imagine this - being offered a decent home in a neighborhood full of $250k homes for a mere $27k at 0% interest. No, that's not a typo.) Only thing is, the county gets to stop by and make sure you're still poor during the 5-year 'mortgage' period, else the rates and total price rises accordingly. Oh, and CPS gets to check in on your kids any time they want, among other governmental visits that would otherwise demand a warrant.

Groceries? No problem, present an appropriate sob story and proof that you lack income, and most states will lavish you with an EBT card. 'course, unless you get creative about how you dodge it, there's an approved list of foods you can and cannot buy.

Car payments? Well, most metro areas do subsidize free mass transit if you make less than a certain income level... but really - it's mass transit. That means you're stuck with living within walking distance of it, and no further.

How does this relate to healthcare? Well, there are folks already demanding that people be forced to wear health activity monitors if they want that subsidized health-care... but you're forced to buy the subsidized plan if you cannot otherwise afford it on your own, so guess what happens if you have the misfortune to be impoverished? Yup - the government now owns your health.

Long story short, the "freedom"s are there, but the dependencies and (IMHO) conditions you subject yourself to in order to receive them are, well... about to become rather dehumanizing.

Re:Is there really any point to this?

[clarkkent09]

Of course it's not a party but that doesn't mean that it doesn't have a platform. This list is a good start seeing that most Tea Party groups endorse it and most Tea Party congressmen have signed up to it:

From http://contractfromamerica.org

1. Require each bill to identify the specific provision of the Constitution that gives Congress the power to do what the bill does. (82.03%)

2. Stop costly new regulations that would increase unemployment, raise consumer prices, and weaken the nationâ(TM)s global competitiveness with virtually no impact on global temperatures. (72.20%)

3. Begin the Constitutional amendment process to require a balanced budget with a two-thirds majority needed for any tax hike. (69.69%)

4. Adopt a simple and fair single-rate tax system by scrapping the internal revenue code and replacing it with one that is no longer than 4,543 wordsâ"the length of the original Constitution. (64.90%)

5. Create a Blue Ribbon taskforce that engages in a complete audit of federal agencies and programs, assessing their Constitutionality, and identifying duplication, waste, ineffectiveness, and agencies and programs better left for the states or local authorities, or ripe for wholesale reform or elimination due to our efforts to restore limited government consistent with the US Constitutionâ(TM)s meaning. (63.37%)

6. Impose a statutory cap limiting the annual growth in total federal spending to the sum of the inflation rate plus the percentage of population growth. (56.57%)

7. Defund, repeal and replace the recently passed government-run health care with a system that actually makes health care and insurance more affordable by enabling a competitive, open, and transparent free-market health care and health insurance system that isnâ(TM)t restricted by state boundaries. (56.39%)

8. Authorize the exploration of proven energy reserves to reduce our dependence on foreign energy sources from unstable countries and reduce regulatory barriers to all other forms of energy creation, lowering prices and creating competition and jobs. (55.51%)

9. Place a moratorium on all earmarks until the budget is balanced, and then require a 2/3 majority to pass any earmark. (55.47%)

10. Permanently repeal all tax hikes, including those to the income, capital gains, and death taxes, currently scheduled to begin in 2013. (53.38%)

Re:90 days waiting room, costs $1,000 - $1,300 /mo

[artor3]

It's a misleading number. It comes from this study by the Fraser Institute. Basically, they said "the government spends X% of it's income on health care, therefore we can take X% of each citizen's tax bill as the amount that they paid for health care". This is perfectly reasonable on its own, but the GP cherry-picked the number for a married couple with no kids because they have the highest tax bill. This makes Canadian health care costs seem higher than they truly are.

If you do an apples to apples comparison, the Canadians have a clear advantage.

Single adult: $3780 in Canada, $5884 in US
Family of four: $11320 in Canada, $16351 in US

Canadian numbers are from the Fraser Institute study, US numbers are from this study by KFF.

2700 pages of legislation

[Virtucon]

"You have to pass the bill to know what's in it." - Nancy Pelosi

And this representative from California was re-elected. Huh. Well as Ron White says "You can't fix stupid."

If you wanted to fix the US Healthcare system by making care affordable for all and allowing people with pre-existing conditions to get insured, then it wouldn't take 2700 pages of other crap that's in the legislative package. What we didn't get was:

1) No direct influence over rising expenditures for Medical Care. You have a system which doesn't abide by market forces and hospital administrators get paid millions of dollars in salaries and benefits. When you're seriously ill, you don't usually have the time to shop around so whatever they charge you (or your insurance) is what's charged. Sure, there's negotiations and maximums that insurance companies negotiate but that drives further business through insurance companies, forcing you to deal with them.
2) There was no discussion on tort reform so thousands of ambulance chasers can still sue the doctors and hospitals when your scars comes out a little bit strange. A big component to care is the necessary malpractice insurance which can cost upwards of $200,000 in some high cost states. Add that to office staff, paying the Nurse, the building costs and the medical coder to bill the insurance companies correctly and you can see easily why it costs a lot to see a doctor over a routine sniffle.
3) The Drug companies were let largely intact. There are a few costs they'll have to put up with but they're still expected to rake in Billions in profits under the ACA. Ask yourself why that pill you're taking is $5 and why, if it was allowed, you could get it for $.25. Sure the drug industry will claim that "these are inferior" but really it's a smokescreen.
4) The Single Payer system died. Nobody wanted to go against the big Insurance Firms and their lobbyists so we love big business in this country, so why not throw a few billion dollars their way. Well, they do now have to spend more on direct costs for Insurance which is good but allowing interstate competition and other market driven forces into the process would have been much better. That's what the exchanges are supposed to do but here we have the US Government trying to create markets rather than creating incentives with appropriate regulatory oversight for markets to flourish. Oh wait, considering the Financial Collapse, the Regulatory Process failed, so DC can't be trusted with that.

To be honest, you could have taken this 2700 pages, cut out the BS, the Pork like the "Exchanges" which Deloitte is now merrily feeding upon it seems and done away with it and had legislation that was no more than 10 pages long. Starting next year you'll hear more pigs in DC all lining up because the Feds have just blessed one industry with unlimited monopoly powers and you have to pay what they want to charge you. You have no choice, so invest in big Pharma, Hostpital chains and big medical concerns because they'll be raking it in even more.