<p>Deleted. I forgot we weren’t allowed to talk about other countries’ health care systems. </p>
<p>Increased taxes do not necesssarily decrease economic output. Same with insurance premiums. It shifts economic output. May even increase economic output.</p>
<p>I thought I would just repeat what you wrote.</p>
<p>What do we mean, btw, by healthy? People who use less than the average dollar amount in med services (I think it may be $8900?). Or some very low amount or zip? Curious.</p>
<p>I thought I would throw this in since I live here…</p>
<p><a href=“Affordable Care Act Creates Almost 100K Jobs, Boosts Economic Activity in California by $4.4 Billion : Bay Area Council”>http://www.bayareacouncil.org/community_engagement/affordable-care-act-creates-almost-100k-jobs-boosts-economic-activity-in-california-by-4-4-billion/</a></p>
<p>LF: Is that $8900 per year? That’s a lot of medical services, IMO. But averaged over a lifetime, maybe not so much. </p>
<p><a href=“The Lifetime Distribution of Health Care Costs - PMC”>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028/</a></p>
<p>This large study found that the average person used $316,579 in health services over a lifetime in 2000 dollars. That included dentistry, vision care, nursing home, hospitalization and doctor’s services. Women used more than men in part due to their longer life spans. Costs rose exponentially as people age. </p>
<p><a href=“Costliest 1 Percent Of Patients Account For 21 Percent Of U.S. Health Spending | KFF Health News”>http://www.kaiserhealthnews.org/stories/2013/october/08/one-percent-of-costliest-patients.aspx</a></p>
<p>These patients are among the 1 percent whose ranks no one wants to join: the costly cohort battling multiple chronic illnesses who consumed 21 percent of the nearly $1.3 trillion Americans spent on health care in 2010, at a cost of nearly $88,000 per person. Five percent of patients accounted for 50 percent of all health-care expenditures. By contrast, the bottom 50 percent of patients accounted for just 2.8 percent of spending that year, according to a recent report by the federal Agency for Healthcare Research and Quality.</p>
<p>Sometimes known as super-utilizers, high-frequency patients or frequent fliers, these patients typically suffer from heart failure, diabetes and kidney disease, along with a significant psychiatric problem. Some are Medicare patients unable to afford the many drugs needed to manage their chronic health problems. Others are younger “dual eligibles” who qualify for Medicare and Medicaid, and who often bounce from emergency room to emergency room, struggling with substance abuse, homelessness and related medical conditions. Still others have private health insurance.</p>
<p>TatinG, I like that article. Your daughter is entering a very good field.</p>
<p>Tatin, my number was from this: </p>
<p>Health care spending in the United States grew 3.7 percent in 2012, to $2.8 trillion, or $8,915 per person. 2012 marked the fourth consecutive year of slow growth in health care spending. The share of the economy devoted to health spending decreased from 17.3 percent in 2011 to 17.2 percent in 2012, as the Gross Domestic Product increased nearly one percentage point faster than health care spending at 4.6 percent. (Source: Centers for Medicare and Medicaid Services, National Health Expenditures 2012 Highlights.)</p>
<p>From TatinG’s link… There is a lot there… I am just going to highlight this …</p>
<p>"Nearly all wind up in emergency rooms because they have enormous difficulty navigating the increasingly fragmented, complicated and inflexible health-care system. Because of lack of alternatives or force of habit, they use hospitals, often several in the same city, for care that could be provided far more cheaply and effectively in outpatient settings. Many suffer from the phenomenon known as “extreme uncoordinated care.”</p>
<p>I think this is where, comparatively speaking, Kaiser does a good job. ( I dont work for Kaiser. :)). )</p>
<p>This looks another way. It needs to be read mostly as a whole, to see what picture it conveys. And I think it makes it fair to put into the conversation, the word “crisis,” which will mean different things to groups of us. I hope no one focuses too much on any once piece without the context. But that’s up to each of you.<br>
<a href=“http://www.acainternational.org/products-health-care-collection-statistics-5434.aspx”>http://www.acainternational.org/products-health-care-collection-statistics-5434.aspx</a><br>
…</p>
<p>Good link, Tatin. Fascinating and gives us all some perspective that, for me, goes beyond whether we like ACA or not. </p>
<p>Well… LF… You know I love that link. :)</p>
<p>Yes. It adds another dimension to the discussion here. It seems that if these ‘frequent fliers’ could be managed better, (that other 1%) who drive up health care costs, that costs for everyone could go down.</p>
<p>Yes. I agree with you TatinG.</p>
<p>For sure, TatinG. It’s worth pointing out, though, that managing the “frequent fliers” better wouldn’t drive down our insurance premiums much. Most “frequent fliers” are either on Medicare or Medicaid (or both).</p>
<p>And the sad fact is, managing their care better, which we should do on the grounds that they deserve better care, might not drive Medicare/Medicaid costs down as much as we hope. Going to emergency rooms and hospitals for care is expensive, but the kind of high-touch monitoring that such patients need is also expensive.</p>
<p>A lot of the parents here end up managing their own elderly, sick parents’ care. It’s complex, even for us, and we are highly educated and want to do the best for our sick, confused parents. If our parents had no children, either they wouldn’t be able to manage the complex health system and they would flounder, or someone would have to be paid to help them manage it. That doesn’t come cheap.</p>
<p>Some of us have adult children with mental illness or mental disorders. As well as we can, we manage their physical and mental health care. Again, we are highly educated and love our children, and we still find their problems complex and time-consuming. If we weren’t around, either they would flounder or someone would have to be paid to help them manage. It’s not cheap.</p>
<p>I read that the ACA cut spending for Medicare home health care, the lack of which may increase hospital visits and consequent costs. </p>
<p>But if the hospitals incur expenses for the frequent fliers and are not adequately reimbursed by Medicare or Medicaid, then they raise the costs for everyone else. </p>
<p>TatinG, do you have a link for the issues for the ACA and home health care? I read that one issue is that companies who do home health care are companies with low-wage employees, and they are hit by the employer mandate. Is there another issue as well?</p>
<p>CF - Awhile back there was an article blaming Medicare Advantage cuts for home health care lay-offs. I don’t have the link.</p>
<p>I think this one is complicated- something is happening. Whether it has the impact the home healthcare industry says it will, is tbd. Most articles are from that industry and don’t explore. I haven’t found what will pass my own sniff test. Party line on both sides. One says states will manage more. All of us would say, “Oh, yeah?”</p>
<p>AARP: (but not in the recent period)
“The Affordable Care Act (ACA) in fact prohibits cuts to guaranteed Medicare benefits…savings will come from reining in unreasonable payments to providers, taxing high-premium plans (beginning in the year 2018), cracking down on fraud and waste, and encouraging patient-centered, coordinated care,” blah, blah, from Commonwealth Fund.</p>
<p>"The ACA does not eliminate Medicare Advantage plans, which are privately administered plans that provide benefits to about a quarter of Americans with Medicare. These plans were created to bring market efficiencies to Medicare, but they actually cost taxpayers 14 percent more per enrollee than the traditional Medicare program does. The ACA aims to bring costs back into line.</p>
<p>“The plans are still required to provide at least the same benefits as those available through traditional Medicare plans,” …Commonwealth Fund. “And for the first time, the law ensures that plans that perform better will be paid better, so the care they provide should improve.”</p>
<p>If someone finds something clearer and more recent, post it. </p>
<p>Texaspg - you wrote: </p>
<p>
</p>
<p>Anyone who earns under 40K is subsidy-eligible. You said something about immigrants, but most legal immigrants are eligible for subsidies. (The only example that I could find that are not eligible are the Dream Act / DACA group – who really aren’t quite “legal” – they are more in a limbo status – but I think by definition they all are going to be young, currently no more than age 32 - DACA relief was limited to individuals under age 31 as of June 2012 - so on the lower end of the spectrum for insurance premiums).</p>
<p>So why do you think that some of your employees can’t get subsidies? </p>
<p>Has your cost to provide group based insurance substantially increased with the ACA essential benefits requirement? Or are you just trying to save some money for your organization, by letting the federal government take over the role you have been filling in the past?</p>