<p>Notwithstanding the fact that employers who blame rising health care costs on Obamacare are lying, rising health care costs are a huge problem for employers, and for everybody else. Obamacare has some provisions to deal with costs-- maybe not enough, but some. </p>
<p>The main thing, I’d say, is the unpopular (but in my view, good) Independent Payment Advisory Board, tasked with finding worthless or near-worthless medical treatments (like, in a lot of cases, stents and back surgery, plus new expensive drugs that don’t work any better than old cheap drugs) and not paying for them. The IPAB might not work, but in my view there’s a lot of low-hanging fruit in the form of expensive medical treatments that don’t work or don’t work any better than the cheap treatments they replaced.</p>
<p>I sure wish we could also cut back on overtreatment at the end of life. This should be true low-hanging fruit, because why would we want to do expensive painful useless treatments on dying people?</p>
<p>“This should be true low-hanging fruit, because why would we want to do expensive painful useless treatments on dying people?”</p>
<p>I don’t think that dying people and their doctors think the treatments are worthless. They may work for some people to give them extra time. I bet when you or one of your loved ones is dying and there is a treatment that might work you’ll think twice about calling it useless. It’s easy to say “oh don’t spend money on the those people” until you are one of those people.</p>
<p>Yes but that may be why we need some panel to provide some guidelines. Otherwise we push medical costs beyond our national ability to cover them.</p>
<p>"The main thing, I’d say, is the unpopular (but in my view, good) Independent Payment Advisory Board, tasked with finding worthless or near-worthless medical treatments (like, in a lot of cases, stents and back surgery, plus new expensive drugs that don’t work any better than old cheap drugs) and not paying for them. "</p>
<p>This will pretty much kill ACA if there is any piece of ACA that gives such authority to anyone outside of doctors.</p>
<p>Stents and back surgery are routine. Anyone who hits 55 will probably have a high chance of a stent within 5-10 years. A colleague had couple of stents put in this month and was back to work next day, although from home. I have had several colleagues who have had back surgeries.</p>
<p>Quite obvious. On one side the lifetime caps are lifted which is being touted as a huge benefit but on the other side care is being denied because it might be expensive?</p>
<p>Texaspg, what you say may be true for a 55 or 65 year old. But what do you say to the physician who tried to talk my 91 year old mother with terminal cancer into having an incredibly expensive treatment that he said might prolong her life “as much as 6 months”. That would have been about $100,000 and days and days in a sterile hospital room. </p>
<p>My mother said he was crazy. She refused treatment and decided to spend her remaining life in her home, and lived 12 more months. </p>
<p>The question always comes down to where do you draw the line.</p>
<p>Post 1586 - that’s not really the comparison. Getting generics over brand names, or getting a colonoscopy beginning at age 30 vs age 50 is not what puts pressure on the life time caps.</p>
<p>Back in the stone ages when I was working for a large tech firm we would get a very glossy benefits folder each year. One of the included things was a detailed itemized list of everything the company was either required to pay or paying voluntarily behind my back on my behalf. This included the company cost of health insurance, medicare taxes, payroll taxes, FICA etc. and also the weighted facilities costs (yes, I was using electricity, space desk furniture etc.)</p>
<p>It was an eye opener to see that the actually cost to the company something was near double my pay rate (at that time - yes they offered some great benefits).</p>
<p>At one point we employed 2 people in a traditional W2 payroll manner. No we did not offer health insurance. Our weighted cost in CA at that time were about $1.60 for each $1.00 of employee pay (this was before the workmans comp reform).</p>
<p>I think each and every employee needs to know in detail how much they are really getting. An itemization of healthcare costs would - including the employers new costs related to compliance, legal and simply just understanding the nuances - would go a long way towards understanding.</p>
<p>LasMas…I was receiving small rebate checks from BS last the year before last. They would be calculated on a monthly basis. Then they changed my plan (no longer ACA compliant - so much for grandfathering) and raised my rates this year. It’s the same thing as getting the cash windfall from the IRS…it was originally yours, you just get a little back and it makes you feel like you won.</p>
<p>TatinG, there is a huge difference between guidelines and denial of reimbursement. The IPAB is designed to research recommendations and guidelines. It is still up to the physician to apply them. If the physician believes your specific case warrants more agressive screening or treatment it would be reimbursed. In other words, medical practice and protocols are developed in the aggregate, but are not dictated to any particular patient or doctor.</p>
<p>"who tried to talk my 91 year old mother with terminal cancer into having an incredibly expensive treatment "</p>
<p>Is this ACA though? We have been through this scenario before where Bay was explaining that her father in eighties chose to get expensive treatment as part of medicare. </p>
<p>"Post 1586 - that’s not really the comparison. Getting generics over brand names, or getting a colonoscopy beginning at age 30 vs age 50 is not what puts pressure on the life time caps. "</p>
<p>It was specific to CF’s post about stents and backsurgeries. I ignored the last piece about expensive drugs since I don’t know what these might be but I consider the surgeries quite common since I have had many friends in 40s and 50s who have had these types of surgeries. These are not questioned at all today.</p>
<p>Stents are indeed routine, but they shouldn’t be in non-acute cases, because we shouldn’t give patients a $10,000 operation with a 1 in a 1000 chance of death when it doesn’t do anything. Stents are worthless in non-acute cases, as studies keep proving:</p>
<p>When I was Googling for this, I found reference to an earlier study, maybe about five years earlier, that also demonstrated that stents in non-acute cases were worthless. And the article I read interviewed some cardiac surgeons, who said, this study is no good because it doesn’t include drug-coated stents. In other words, “yeah, the stents we’ve been telling you are effective all along don’t work at all, sorry about all those deaths in surgery for worthless treatments, but these new ones that we’re now telling you are effective really do work.” The new studies include drug-coated stents, which don’t work any better than the non-drug-coated versions. </p>
<p>Small daily doses of aspirin, however, are extremely effective.</p>
<p>“Is it ACA?” Not sure what this question means. It depends a lot on who your insurer is. </p>
<p>My mother was in Medicare. Medicare is run by the government. Have you ever heard of Medicare denying reimbursement to a patient? If she had elected the expensive treatment, Medicare would have covered it. </p>
<p>On the other hand, how many fundraisers do you see with families pleading for money to pay for some kind of medical treatment? Those are for people who either 1) never could get insurance, 2) used up their lifetime cap, or - most frequently, 3) had their treatment denied by their private insurer because they deemed it “experimental”. </p>
<p>What ACA will do is - hopefully since I don’t know what the question set looks like - make it clearer as to what is covered and not covered when you make a buying decision.</p>
<p>^^ I would be shocked if anything in heart treatment gets changed based on this study in the next 10 years.</p>
<p>There are unethical practices in medicine where some groups might be overprescribing stents. In a lot of cases, the patient choses the option and there are many out there who refuse a surgery until the blockages reach 80-90%. Most of us in 40s probably have 50-60% blockage already irrespective whether we take an aspirin. It just gets worse as we age unless one is blessed with superior genes and superb HDL levels of 100 or more (this might be dependent on race). For the rest, if the doctor says a stent is needed and patient agrees, the study won’t amount to anything.</p>
<p>“Medicare would have covered it”</p>
<p>Precisely. ACA would have no control over it.</p>
<p>Texaspg, the IPAB is tasked precisely with controlling Medicare costs. The IPAB recommendations for controlling the rise in Medicare costs (or, in the absence of the IPAB, the HHS secretary recommendations for cost control) become law and are implemented unless a supermajority of Congress votes against them.</p>
<p>If the IPAB says that a certain treatment is not warranted, it is very likely that it also won’t be reimbursed under the ACA. That was the fear when that government panel decided that mammograms were not necessary until after 40, or 50 and only every two years. The fear was that the insurance companies would no longer pay for such screenings using that panel’s recommendations as the reason. So the panel backed down as I recall. </p>
<p>It is not comfortiing to think that someday my healthcare options could be decided by a ‘supermajority of Congress’., in other words politics.</p>
<p>But before ACA, the insurance companies were quite happy to keep the overage and use it to pay exorbitant bonuses to CEOs, do fabulous remodels on corporate headquarters, etc. Thanks to ACA’s medical loss ratios, they are now required to give it back. That’s the difference.</p>
<p>For the life of me, I don’t understand why TatinG and texaspg are so interested in using my tax dollars and theirs to pay for procedures that don’t work and that make people die. I understand why a surgeon would convince himself that a useless stent actually is not a useless stent, but why should the rest of us support him and his high salary in doing expensive surgical procedures that don’t work, that are painful, and that have a measurable risk of immediate death for the patient?</p>
<p>The claim that surgeons tell patients that the stents are justified is… not even an argument. We all know that surgeons tell patients surgery is justified. Surgeons always want to operate. The question is, if we look at all the available evidence, are the surgeons correct in their claims? And in the case of stents, they are not correct. They may believe that stents for non-acute cases are warranted, but if they do, they are wrong in that belief, and we should stop paying for those surgeries and stop putting patients through unnecessary and dangerous procedures whose only benefit is buying yachts and college tuitions for doctors.</p>
<p>There are so many unnecessary stents done every year that you can google almost any state name with “unnecessary stents” and there are plenty of examples. Here is the biggest one that took place near me - </p>
<p>The hospital had to pay the feds $22m in a kickback settlement. The amount of money that must be wasted every year for these procedures is surely mind boggling.</p>