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Consulting and the Affordable Care Act
11

Consulting and the Affordable Care Act

Consulting and the Affordable Care Act

(OP)
I'm curious as to the thoughts of the Eng-Tips community as to whether we will see the Affordable Care Act have a significant impact on the Engineering Consulting industry.

For a moment, lets put aside the turmoil associated with Obamacare, and operate under the assumption that the ACA won't be repealed any time soon.

The single greatest factor in me not venturing into the world of private consulting has been healthcare. As someone with a number of preexisting medical conditions and a history of cancer, any sort of private health insurance is either a pipe dream, or tremendously cost prohibitive. As much as I hate to entertain the though, Obamacare does provide at least some inkling of a possibility that I could leave the big Fortune 100 EPC's and venture off on my own, with premiums and care much worse than my corporate policy, but not unbearable.

If the ACA manages to stick around, do the folks here anticipate any sort of significant influx of private consultants? Any other anticipated consequences or thoughts on the matter?

RE: Consulting and the Affordable Care Act

Quote (Mr168)


As much as I hate to entertain the though, Obamacare does provide at least some inkling of a possibility that I could leave the big Fortune 100 EPC's and venture off on my own, with premiums and care much worse than my corporate policy, but not unbearable.

Until you've actually gone on-line (or spoken to an insurance agent participating in the ACA program) and looked at what might be available in your state and for your family's situation, I think that you should NOT assume that you will not be able to get something close to or better than your current group coverage or that the cost will be out-of-line with what you'd have expected to have paid if you did NOT have any sort of "preexisting medical conditions and a history of cancer". This is really the benchmark by which you should be basing your decision, NOT what it's costing you today for your employer-subsidized insurance coverage. After all, you seem to be suggesting that if it were NOT for your current medical issues holding you back, that you would have already left the "big Fortune 100 EPC" and would have struck out on your own.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Consulting and the Affordable Care Act

(OP)
John - These are all hypothetical. I have no inherent desire to leave my present job, simply pondering what doors could be conceivably opened to those who either a) always feared losing the safety net of employer-subsidized coverage, or b) have been denied based on preexisting conditions. I fall into both categories (I took a look into category b some years ago when I was considering relocating, was refused coverage by more than one provider), and had never given it any thought otherwise. The topic had surfaced when some fellow engineers were informed of a branch closing, and were discussing venturing out on their own.

I should note that my reference to being "worse than my corporate policy" is based on having lucked into a very nice PPO setup which far exceeded those of my previous employers. I'd be stunned if I could find deductibles and overall costs as low as my current setup with comparable coverage.

RE: Consulting and the Affordable Care Act

My response was based on your statement that "The single greatest factor in me not venturing into the world of private consulting has been healthcare." To me that sounded a bit more than your questions being purely "hypothetical" winky smile

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Consulting and the Affordable Care Act

(OP)
Sorry, poor wording on my part. I worded it as past/present tense, when I really meant to imply future!

RE: Consulting and the Affordable Care Act

You will get lots of opinions, but until you actually investigate, you won't know. I understand your reluctance to give up your safety net before you know what will replace it. From what I read, and this is only from afar, this situation looks like it will take a while to shake down.

RE: Consulting and the Affordable Care Act

I think that if the insurance companies and brokers and those who hate Obama don't kill off the ACA that it will allow a lot of people to quit hanging onto jobs for the sake of having insurance. I hope the ACA gets a chance.

RE: Consulting and the Affordable Care Act

Most of us are part of professional groups that offer group plans, so why do we have to look very far for health care?

RE: Consulting and the Affordable Care Act

Cranky108-both my husband and I belong to pro groups which offer health care plans, but due to pre-existing conditions, he was rejected from both organizations. It wasn't that coverage was expensive, they just would not insure him.
To date, employer insurance has been our only option-I am looking forward to seeing how the new program will shake out, because COBRA is running out for us.

RE: Consulting and the Affordable Care Act

I will say that I always assumed I would start my own consulting business. When my child was diagnosed with serious medical issues I assumed that I would never work on my own. In fact, the need for medical insurance was the reason that I changed jobs from a two man office (what would happen to my insurance if my boss died?) to a much larger office. I needed health insurance.

I have no regrets in changing jobs and I don't have much of a desire to start out on my own, but I do wonder if my decisions would have been the same if I had another option for insurance for my family.

RE: Consulting and the Affordable Care Act

Unrelated but I felt I needed to share.

Buddy of mine was at a Christmas party this year with some high paid hospital admin types. They were talking about how the uninsured are going to be the latest big gold mine. The hospital can find someone who's uninsured who needs a procedure, and then offer to pay the guy's first six months of health insurance (since he can't be denied for preexisting conditions) and then the patient can drop coverage.

Patient never pays a dime. Hospital pays six months of insurance, and gets paid the full value of the procedure in return. And nobody can stop it because of the new law.

Next few years could be interesting.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Consulting and the Affordable Care Act

beej67, you mean there are unintended consequences to something that had to be passed before it was understood? How dare you make those assertions! :)

PE, SE
Eastern United States

"If a builder builds a house for someone, and does not construct it properly, and the house which he built falls in and kills its owner, then that builder shall be put to death!"
~Code of Hammurabi

RE: Consulting and the Affordable Care Act

The voters get the kind of goverment they deserve. And the laws they deserve.

RE: Consulting and the Affordable Care Act

2
I believe we're at a point where the average voter cannot possibly hope to understand our system of government to any level necessary to affect a proper change. Too many loophole safeguards have been put in place over the years, and the same confusion reigns that allow new loopholes to be implemented if old ones are closed.

Essentially, I think we've hit critical mass for a system that cannot be fixed by the average Joe. It can only be done by a group of altruistic politicians or a civil uprising.

Dan - Owner
http://www.Hi-TecDesigns.com

RE: Consulting and the Affordable Care Act

It is time to defenestrate the non-altruistic politicians in the US, or to choose the other alternative. Problem is getting a consensus on the definition of altruistic.

RE: Consulting and the Affordable Care Act

2
So, this is supposedly worse than waiting for these uninsured to get critically ill, thereby justifying going to the ER, and making all the taxpayers pay anyway, but even more? Or worse, allowing people to die for the lack of insurance in the riches country in the world? People are gaming whatever system exists. The existing system was not sustainable.

Rather than spending brainpower gaming the system or criticizing the system, put all the brainpower into making it work correctly, cost-effectively, and efficiently.

TTFN
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RE: Consulting and the Affordable Care Act

Where is the money in making the system work correctly? Heretics go to Siberia.

RE: Consulting and the Affordable Care Act

Taxpayers didn't pay for people to go to the ER. Nobody paid. It just went on the government's tab, which never gets paid. The new system is not different in that respect.

RE: Consulting and the Affordable Care Act

Stalin and Lennin already tried that. It didn't work.

RE: Consulting and the Affordable Care Act

Quote (IRstuff)

We need to shoot all the CEOs and continue to do so until things start working the way they're supposed to
I agree, IRstuff, but you left out shooting all the lawyers too.

Anyone supporting the current system of enriching them what has and letting them what don't just perish should read The Puritan Gift

I wish somebody would show some care for the have-nots like me.

Best to you,

Goober Dave

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RE: Consulting and the Affordable Care Act

That's only because they stopped shooting when it came to the party itself. winky smile
1986... that was a Republican admin, wasn't it? ...interesting that in a country where "a stitch in time," etc., we were willing to have people wait until their illnesses got to the most expensive point before treating them. This is, of course, contrary to every economic concept in every production environment. But, I soapbox, so fie on that.

TTFN
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RE: Consulting and the Affordable Care Act

What's wrong with a dual system?
1. You pay for the care you can afford (or have the insurance for).
2. You get for free, treated by doctors that can't be procuscuted for malpractice. Who can't keep a private practice, or who just don't care. You can wait in long lines for what passes for treatment.

You choose.

RE: Consulting and the Affordable Care Act

"You choose."

Not really a choice when you're poor. Moreover, unless it's a medical emergency, there's actually no treatment at all for the poor. So they wait until it becomes an emergency, and what could have dealt with a few bucks worth of drugs now costs $10k/night in the intensive care. And, they still don't have to pay for it, but I do. The other side of the coin is those that have insurance also have no incentive to manage costs, and demand the latest and "greatest" drugs/therapies/instruments, even though there's no proof that the "new" stuff is any better than the "old" stuff, and the only thing that gets "better" are the suppliers' bottom lines.

The only reason some drugs exist is to maintain the patent rights. When minoxidil first came out, the maker insisted that quantity and concentration were irrelevant. The instant the patent ran out, a new, patented, more concentrated version hit the market.

If I have to pay the bills, I rather it have at least the semblance of efficacy and common sense. Treat things before they get out of hand, promote healthy living/foods, don't use new drugs and therapies unless there's some objective, and non-miniscule, improvement in outcome, etc.

TTFN
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RE: Consulting and the Affordable Care Act

In the states, something around 60% of bankruptcies are medically related. I would take substandard care by state paid doctors and longer waits any day over the possibility of being completely cleaned out.

RE: Consulting and the Affordable Care Act

So are you suggesting that poor people never use the "free clinics"? So who uses them?

As far as managing costs, when was the last time you saw a hospitel menu that actually listed the costs? Most people don't bother managing costs, because there is no way to know the cost ahead of time. Just like there is no way to know the death rates of hospitals. Maybe to fix this there needs to be a rating system like restrants have.

In the states it is much cheeper to take a flight to South America and have it preformed there than to have it done in the states. So why does insurance not pay for overseas medicel?
Because most insurance is regulated by the goverment, that's why. The goverment created this problem.

The whole shop around thing dosen't work if you don't know the costs. Besides, percription drugs are cheeper than over the counter, if you have a percription drug plan.

RE: Consulting and the Affordable Care Act

Just how many "free" clinics are there, really? My impression is that they are far and few between, as demonstrated by the annual free-for-all trying to get a slot in the annual Los Angeles free clinic at the Staples CEnter. Waits are long, and not manageable for people that are hourly and unable to take time off work.


re:costs Of course they don't tell you the true cost. The multipayer insurance system means that you can arbitrarily charge whatever the particular insurance company is willing to pay. Given that many of the engineers complain about the concept of bidding, since that tends to lower the profit line, that forcing the same on doctors would be suggested.

TTFN
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RE: Consulting and the Affordable Care Act

So you are saying "free clinics" do work, if you have the time to spend. And apperently with the number of people with medical weed cards, the cost of doctor visits isen't that expencive.

There was a time when my doctor would not give Flu shots. She would send us to the Health Department for that. Now I work for a company that offers them to employees and family.
And some companies have health fairs that do blood pressure, weight, and blood testing. Sure saves on Dr office visits.

We also have discounts for these small care centers, which take care of things like ear infections, which costs much less than the ER.

RE: Consulting and the Affordable Care Act

There's the hidden cost of losing up to a day's pay, because they have to travel and they have to wait, taking money away from food and shelter. I can certainly understand why someone who gets $7.25/hr might hesitate to essentially blow an entire day's pay as a co-pay to see a "free" doctor. Likewise, I would certainly balk at having to pay a day's wages as a co-pay to see my doctor.

TTFN
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RE: Consulting and the Affordable Care Act

Maybe a days pay is the difference between poor, and being a free loader. Poor people can afford to spend a days pay waiting in line.

Just look at the hoops one has to jump through to get into a charter school, versis a normal school. Don't have that with privite schools.

Everything has a cost, and nothing is for free. Someone pays, and if the resources are in short supply you have to pay with your time. It's a sign of how short the supply is, and goverment will never be able to buy all the supply of medical that people demand. There must be a regulating mechanic somewhere. With Free market it is cost. With Socialism it is time.



RE: Consulting and the Affordable Care Act

I was just in the office of my first job asking what they thought would happen when ACA goes into affect in 2015 for businesses. The office manager didn't have any good things to say about it. I was asking because my company is small and I have my own private health insurance. Grand fathered in but some type of luck. We are looking to maybe expand but everyone tells me just do contract work, don't actually hire anyone. There is something very wrong when a small up and coming company like mine is being told do not hire people. My take is that I would have to pay 3 times as much for the most similar PPO plan and have less benefits.

I don't think the ACA should be the thing to determine if you want to start a business or not. Its just something that you have to be aware of.

B+W Engineering and Design
Los Angeles Civil Engineer and Structural Engineer
http://bwengr.com

RE: Consulting and the Affordable Care Act

And this is exactly the same argument that was made when Social Security and unemployment insurance was first introduced.

Anyone or any business that thinks that they are not already paying the costs of people without insurance should be asking themselves who pays for the $600 ER visits for a sore throat or the person who misses four days of work for something that if they had been able to go to a doctor before it debilitated them they might have been able to have stayed on the job with a minimal lost of productivity? Or the other side of that coin, a person who DOES come to work but who's so ill that they give something to their fellow employees that ends up costing a lot more than just one employee missing work, all because they could not afford to see a doctor on their own? Society as a whole is already bearing the costs of medical care, just not always in a direct or visible manner, but it's all comes out of someone's pocket. It would be different if the US was currently paying significantly less per person for medical care than in those countries which already has some sort of universal health care, be it outright socialized medicine, which the ACA it a LONG ways from, or something closer where citizens are required to purchase insurance coverage, often thru some national plan not all that different than Medicare and where the poor are covered by either a public medical service or by subsidized coverage like Medicaid. But that is NOT the case. While the US has the highest per capita health care costs in the developed world, we are not necessarily getting the best overall medical care or getting the best medical results.

http://www.pbs.org/newshour/rundown/2012/10/health...

http://www.huffingtonpost.com/2013/10/03/health-ca...#

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Consulting and the Affordable Care Act

As a Canadian looking into hanging my own shingle, worrying about healthcare has never crossed my mind. I cant imagine having to worry about healthcare as a burden in regards to starting my own business.

As a driven, hard working guy, I've often idealized the American system. My perspective has been that, due to lower taxes, an entrepreneur could make much more money. I had never thought about the realities of healthcare, and the lack of a public system, which serves as a major barrier to entrepreneurship in the US.

Gives an interesting perspective. Though once a business is established and making real money, business may pay more tax in Canada than the US, there is easier access to the market for individuals looking to open shop in the frozen north.

RE: Consulting and the Affordable Care Act

I would like to take this time to remind everyone that the NSA's affiliates reads discussion forums.

http://www.nrc.nl/nieuws/2013/11/30/dutch-intellig...

And that they compile a threat matrix score for everyone.

http://www.dailykos.com/story/2013/06/06/1214209/-...

"Throw the bums out of Washington" is a very valid and worthwhile opinion, until the bums decide they want to fight back, and they've been practicing murdering insurgent goat farmers with flying death robots for over a decade. In today's age, you have to watch what you post.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Consulting and the Affordable Care Act

And yet after warning us, you still saw fit to write something like "...and they've been practicing murdering insurgent goat farmers with flying death robots for over a decade." which contains at least a few words that I'm sure would 'ring some bells' along the Washington Parkway winky smile

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Consulting and the Affordable Care Act

Quote (KENAT)

beej67, I fear your tin foil hat may be on a little tight.
It's squeezing the logical thought right out of him...

Dan - Owner
http://www.Hi-TecDesigns.com

RE: Consulting and the Affordable Care Act

You know if we all followed logical thought, we might all come to about the same conclusions. And worse, there would not be most of the crap that are in the stores today.

You know there is a type of freedom in being stupid. "50 thousand a year will buy a lot of beer".

After all isen't the Affordable care act about spreading and reducing the cost of being stupid?

RE: Consulting and the Affordable Care Act

Just like any other actuarial-based underwriting scheme.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Consulting and the Affordable Care Act

What bothers me the most is having to pay for things I doubt I will ever need. Honestly if my risk is 0%, how do I have an insurable risk?

RE: Consulting and the Affordable Care Act

So you've figured out how to avoid falling down a stairs or getting food posioning, eh? Can you let the rest of us in on your secret?

How is this any different than buying car insurance? Even if you're a good driver who never breaks any traffic laws, how do you account for the unavoidable accidents, like blowing a tire at 60 mph or having a tree fall on your car while parked in your driveway?

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Consulting and the Affordable Care Act

Did I say I don't need any insurance? I said "having to pay for things I doubt I will ever need". Yes I have fire insurance, but I don't have flood insurance, or volcano insurance, etc.

What I intended to say is my risk of some things is very low, and I don't think I should be forced to purchance insurance for those.

Besides if I am paying for someone elses contreciptives, should I also not expect to recieve free sex?

RE: Consulting and the Affordable Care Act

I pay for free contractives now in my taxes for the poor people, and that dosen't seem to reduce anything. So now I pay again for the freeloaders, and I doubt that will reduce anything.
So it seems I pay and pay for nothing. Why should I keep paying.

Sort of goes back to my thoughts on the homeless. If you want to reduce the number of wild cats, stop feeding them.

RE: Consulting and the Affordable Care Act

Well if you've got coverage for pharmaceuticals, then some women out there is paying for your Viagra.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Consulting and the Affordable Care Act

Viagra! Without free sex who needs it.

RE: Consulting and the Affordable Care Act

Quote:

"flying death robots"

beej67, I fear your tin foil hat may be on a little tight.

You do realize they have those now, right?

Here's what they look like:



See those things on the wing mounts? That's the "deathy" part.

Back on topic, I don't see how Ocare is going to affect the consulting industry any differently than it would affect any other industry. In fact, I think the ACA might make it easier to be a small company or a sole proprietor. I also think we're going to see some very interesting ways emerge for self-employed people to hide earnings under the 4*(poverty) cap and sneak some government assistance out of the deal.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Consulting and the Affordable Care Act

By that ridiculously ignorant & hyperbolic phrasing we've had 'flying death robots' since at least WWII - so I'm well aware of them thanks.

To see such phrasing such as that on a site like this is disappointing to say the least.

Posting guidelines FAQ731-376: Eng-Tips.com Forum Policies http://eng-tips.com/market.cfm? (probably not aimed specifically at you)
What is Engineering anyway: FAQ1088-1484: In layman terms, what is "engineering"?

RE: Consulting and the Affordable Care Act

Don't see what's so ridiculous or ignorant about it, considering that's exactly what it is, and at a completely different and very important level than WWII. Regardless, my only point was that people should take care what they post in public forums nowadays, given the news. I presume you pay attention to the news.

Again, back on topic, I don't see the ACA affecting our industry any differently than it affects others. In fact, probably less than industries like retail who are having to try and dump full time workers without looking like they're dumping full time workers. The real effect of the ACA will be seen in three or four years as everyone starts to learn how to game the system, and the cost-benefit model unravels.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Consulting and the Affordable Care Act

Quote (beej67)


The real effect of the ACA will be seen in three or four years as everyone starts to learn how to game the system, and the cost-benefit model unravels.

Or perhaps when it becomes as ubiquitous as Social Security, and where, like Social Security and Medicare today, both the people and businesses come to accept the idea that our society could not long survive without it. I mean, it's not like America is the first nation attempting to provide some sort of 'universal health care' solution for their citizens or that the rest of the world is waiting around to see how this radical experiment in 'socialism' pans out before they try something on their own. After all, where is the outrage and condemnation coming from other parts of world over THEIR ruinous health care delivery systems if something like the ACA is, by definition, structurally doomed to inevitable failure?

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Consulting and the Affordable Care Act

Quote:

I mean, it's not like America is the first nation attempting to provide some sort of 'universal health care' solution for their citizens or that the rest of the world is waiting around to see how this radical experiment in 'socialism' pans out before they try something on their own.

Nobody else in the world has anything like the ACA. No other country's experiences with socialized healthcare are remotely applicable to the ACA. Australia, for example, just gave everybody their equivalent of Medicare and allows folks to supplement it at their leisure. That's how it's usually done around the world. The ACA doesn't do that - it holds a gun to everyone's head and forces them to buy health insurance from a for-profit company, and then you have a once-per-year window where if you can prove you're poor enough, you can use a highly disfunctional website to get the government to pay some of that cost for you with tax dollars.

No other country in the world does it that way. Somewhere along the line, the problem of rising healthcare costs was transformed by political rhetoric into a problem of lack of universal coverage, and the solution they came up with was simply to force everyone to buy the expensive, broken product. The reason they landed on this solution, is the solution was brewed up by the lobbyists of the people selling that same expensive, broken product. Free market (cash) medicine would be better. Socialist medicine would be better. Our system pre-ACA was the worst of both worlds, and it got yet worse with the ACA because participation was coerced by force.

It's all going to blow up in ten years anyway, but our business won't be affected any more or less by it than any other business. In fact, I'd speculate the only major effect it's going to have on engineering consulting will be felt in the overall economic ramifications of how it blows up, not in the details of how it "works" for now.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Consulting and the Affordable Care Act

I think it was intended to blow up, as a transisition to something the people don't want.

Back to the main point: What consultant would work without insurance? What employer would not offer health insurance?
The answer is that no large employer would not offer health insurance, nor would very many engineers want to work for a firm that dosen't offer it.

The only changes I see is what is covered, and what isen't.

What has changed is the cost to self insure, because you now have to pay a tax to do that.

If you don't like the system, get behind another because this was never intended to last very long, and dosen't even cover every body.

RE: Consulting and the Affordable Care Act

For the record, my personal preference would be Medicare 'Part E' ('E' for 'Everyone').

You have to remember that what we now have was the ONLY thing that could get through congress. And to be honest, the basis for the ACA, what you describe as "holding a gun to everyone's head and forcing them to buy health insurance from a for-profit company", was originally the plan that was first put-forward by the Heritage Foundation back in the early 90's to counter so-called 'Hillarycare' which was being proposed by Bill Clinton during his campaign for President. Later on it was adopted as the foundation for what was later referred to as 'Romneycare' in Massachusetts, which eventually become the model for the ACA. So the next time some conservative politician stands up and condemns 'Obamacare' as being 'socialized medicine' rammed-down the throats of Americans by the 'liberals', don't forget that the major provisions of the LAW (as upheld by a conservative Supreme Court) was the brainchild of an old style Conservative 'think tank' and which was embraced by a broad spectrum of main-stream Republicans not that long ago.

Trust me, if the Progressives in the country could have gotten their way, we would have had a true Universal Health Care system based on either Medicare or modeled on a system like Canada, Australia or Germany.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Consulting and the Affordable Care Act

Quote:

You have to remember that what we now have was the ONLY thing that could get through congress.

That right there should sound the alarm bells.

Quote:

what you describe as "holding a gun to everyone's head and forcing them to buy health insurance from a for-profit company", was originally the plan that was first put-forward by the Heritage Foundation back in the early 90's

And the blues hated it back then, but they love it now. And the reds loved it back then but hate it now. Right?

That should sound even more alarm bells.

Here's a quick lesson: Nothing will ever get through congress that takes money away from the people who've bought congress. In this case, someone decided to try and take money away from the health care industry, and instead what we get is a law that forces everyone to give more money to the health care industry, and borrows/prints/taxes additional money to give to the health care industry for everyone who can't afford to be forced to give more money to the healthcare industry. And participation is mandatory. That's the ACA. Socialism would be better. Cash medicine would be better. The ACA synthesizes the worst features of both, for profit.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Consulting and the Affordable Care Act

Quote (beej67)


Socialism would be better.

I couldn't agree more!!!!!

A true 'single-payer' system would have gone a LONG way toward curing a LOT of the structural and cost problems with the heath care delivery system that we have in America today.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Consulting and the Affordable Care Act

It would indeed. And it would have made other problems worse.

A cash medicine system, more like we used to have back when things were actually affordable, would solve another bunch of problems with our current system almost instantly because people would start to become good stewards of their money again. But it would make the 'coverage problem' worse.

The ACA is the worst of all worlds. There is no incentive in the system to keep our own costs down. Providers can lobby on one side to have their procedures covered and on the other to convince the public to use these unnecessary procedures. The overruns are paid for by printing money. And the capstone is it all flows through a website that doesn't work.

And it was passed because people felt like they "had to at least pass something."

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Consulting and the Affordable Care Act

Quote (beej67)


And it was passed because people felt like they "had to at least pass something."

Or accept the idea that the richest nation on Earth would be willing to continue to allow tens of millions of it citizens to go without proper health care leaving even middle-class working families only one catastrophic health event away from total bankruptcy.

If you have another plan that would have even an outside chance of working AND WHICH COULD GET THROUGH CONGRESS, please be my guest...

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Consulting and the Affordable Care Act

Actually it's not the plan that I object to, it's the details in the plan. For example the fact that it specifies what type of contract I must have with my insurance company. Also the changing date requirments, which looks like congress is doing a bad job of managing. Then there is no rime or reason behind the exemptions, except political.

The other issue is that, requiring people to buy it, will in itself make the price go up, not down. The opt-out is the single most valuable way to bring down the cost of medical insurance, and the whole medical cost struture. After all doctors should not be perscribing the latest drugs to people who can't afford them. Last years drugs (not out of date) should still work even though the patent has run out.

The shortage of doctors should not be a bearing on all of us, it should be a bearing on people who don't visit them.

And why is the US health insurance only good in the US? After all health care is less expencive in other countries. US insurance companies should be encuraging people to go on health holidays.
I know for a fact that having a dentest that dosen't speak english is better, because it cuts the chit-chat while his hands in your mouth.

RE: Consulting and the Affordable Care Act

Quote:

If you have another plan that would have even an outside chance of working AND WHICH COULD GET THROUGH CONGRESS, please be my guest...

I reiterate:

Quote:

Here's a quick lesson: Nothing will ever get through congress that takes money away from the people who've bought congress.

You cannot expect the very people who profit from something's brokenness to willingly fix it.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Consulting and the Affordable Care Act

There are so many problems with your response I don't know here to start.

As for the so-called "type of contract" I assume you're talking about the extents of coverage and such. That was part of the problem with the current health insurance system, too many people were being sold plans which were nothing more than legal scams. Everything was fine as long as you never actually had to be treated for something serious because if you were your policy was automatically cancelled no matter how many years you had been paying premiums without any big claims. That's NOT a 'health insurance' policy, it's a 'you better not get sick' policy.

As for the so-called 'opt-out' idea, this would cause several problems. First is that people would continue to not be treated for preventable conditions leading to poor outcomes and impacts on society in general including more people walking around with communicable diseases and/or missing work thus increasing the cost to businesses for time lost and productivity impacts. And then there would still be the costs imposed on the system by people going to the ER for non-emergency care or would you suggest that we make it illegal for hospitals to treat uninsured individuals? And then there's the problem that someone might just wait until they become truly ill, like with cancer or after being involved in an accident, and they suddenly decide that YES they really do need to buy insurance. That will not work if preexisting conditions no longer prevents people from getting insurance or would you be willing to allow insurance companies to deny insurance to anyone they chose, because if so, we'd be right back to where we were. In fact, this was the rational for the recommendations made by the Heritage Foundation, you know, that 'ultra liberal' think tank, that there be be NO opt-out and that insurance coverage had to be mandatory, what they themselves called the 'Individual Mandate', or this would not work since insurance companies would go bankrupt if people could simply go ON and OFF coverage anytime they wanted to. And this is what conservatives and Republicans in general liked about this propsal (at the time), this idea of 'individual responsiblity', which is always a big deal with the Right, except of course when it's being promoted by someone they consider as being an 'illegitmate' president.

As for proscribing generic drugs versus patented ones, have you looked as what's happening in the pharmaceutical industry lately with the abuse of the patent system? There's been cases where formulas were changed by adding some totally inert ingredient which technically changes the 'formula' and thus means that s new patent can be applied for another 21 years. Or the big companies buying up the little guys making the generics and simply shutting them down or reducing the production to a level where only the patented ones are readily available. Also convincing doctors, with kickbacks and other 'considerations', to only prescribe the patented drugs.

A good example is Nexium, a drug that has been on the market for years but it has remained very expense and without any apparent generic subsitute. My wife is on Nexium and even with our very good insurance plan, the cost is running close to $100/month and it's the only thing that works as she has tried all of the so-called 'alternatives'.

And as for this idea that insurance companies should simply tell people to go overseas the get treatment where, as you put it, "health care is less expencive". Well since the United States is the ONLY industrialized country in the world that has NOT had some sort of 'national health care' system or mandatory coverage (remember, only in America is it legal for insurance companies to make a profit selling basic health care insurance) of course it would be cheaper to go to Germany or Switzerland for medical care. But how long do you think that would last if suddenly every plane to Europe was filled with Americans looking for a discount on their medical care?

I'm sorry, but someone's got to do a better job than that if you're going to suggest that the current plan will never work.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Consulting and the Affordable Care Act

How can you say that some of these plans were nothing but schams? Every one of them was approved by the insurance commission of some state. Are you saying that the goverments could be corrupt, and if so what makes the existing regulation any better? Believe me that corruption will follow, and we will be in the same mess. So if you did not read the fine print of the policy, you might have a problem, still.

Actually many younger people are choosing the opt-out feature of Obamacare, because it is cheeper than the insurance. So the opt-out group still exists. We haven't fixed that.

And the abuse of the patent system is allowed by both the patent office, and the FDA. Such a shame we have this goverment corruption that created this mess.

And the presedent seems to be powerless to correct any of it. What a spineless golfer we have.

The people get the goverment they deserve.





RE: Consulting and the Affordable Care Act

And Congress and the 'loyal opposition' bares no responsibility whatsoever, EH?

The Republican controlled House has just voted for the 50th time to repeal the ACA in totality. Does this sound like a group that could have done better? I think Alan Grayson got it right when he said:

http://www.youtube.com/watch?v=-usmvYOPfco#t=10

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Consulting and the Affordable Care Act

Where is Alan Grayson when you need him?

RE: Consulting and the Affordable Care Act

I am always curious about the US system, as there are forces at work within Canada which would want to see such a system here. Fortunately opinion polls have consistently shown that attacking the Canadian system would be abject political suicide for any political party.

Only a socialist-style "President for Life" could undo the Canadian system. Anything else would be reversed. For argument's sake, let's say that a government gets in WITHOUT admitting their intension to take apart the Canadian model. The model is, firstly, divided into thirteen parts (each Province and Territory has their own Health Care system)... So you would have to win a goodly number of separate elections, or potentially just attack federal transfer payments. So let's go the more realistic route: Separate transfer payments.

Here we go:

- Election.
- Process starts to convince Canadians that our Universal Healthcare is unaffordable and must go. Eventually a "functional minority" of 35% are convinced.
- Laws passed. Let's get really crazy: Not only is US-style private corporate insurance now mandatory, it is illegal to campaign against this or undo.
- People start dying aka the US uninsured model.
- Canadians demand better. The Loyal Opposition of the day campaingns to "Undo the wrongs of the current administration". No one is confused as to what they mean.
- New government elected. Unfortunately there are laws on the books making it "impossible" to reinstate universal health care. Fortunately this is a Constitutional Monarchy and not a <insert "Banana" as needed> Republic and parliament is supreme.
- Universal Health Care is back and a monument is built to those who died under US style Medi-don't-care.

While I am being perposely inflammatory and hyperbolic, I am not kidding about Canadians and our single-user-pays Universal HealthCare system. It is far less expensive on our Economy than most other options, and EVERYONE gets first-world health care. At that it is criplingly expensive; I'm not going to cheat and look it up but I believe it is now over 30% of our economy... And nearly universally supported. Everyone loves to hate it, but like a cruel and sick mistress who presses ALL of your buttons, we keep coming back for more and will do nearly anthing to keep her.

RE: Consulting and the Affordable Care Act

CELinOttawa,

I can't ever see us getting rid of healthcare. As its provincially administered, I'm not sure the federal gov could dismantle it. Even if there was a federal government elected on dismantling healthcare, it would probably lead to successful separatism, and not only in Quebec. That being said, our modern day Conservatives, considered by many to be outright extremists, are mostly left of the US democrats.

RE: Consulting and the Affordable Care Act

NorthCivil: Agreed on each point!

RE: Consulting and the Affordable Care Act

This was featured on our national radio... At least the testimony of the Canadian expert. It was very interesting, as a US Republican Senator tried to twist her submission's facts and had is proverbial handed to him:

http://www.popularresistance.org/testimony-by-expe...

RE: Consulting and the Affordable Care Act

Buddy of mine had his family on a very high deductible plan with a large Health Savings Account. He earmarked his own money to pay for his family's own health care. He had a vested interest in keeping his own costs down, since he was effectively paying for all routine care, and only relying on insurance in true emergencies. His style of plan is the kind of plan that actually reduces the overall cost burden to everyone, because of his own personal incentive to keep his own costs down.

His plan was made illegal by ACA. Obama called his plan a 'sham.' He liked his plan, and his plan wasn't a burden on anyone else, but he can't keep it.

Now he's on a plan like everyone else, where the deductable is lower, his monthly costs are higher, and he's doing everything he can to wring every cent out of it to justify the higher monthly costs just like everyone else is, pushing his costs onto everyone else. And this is somehow supposed to make health care more affordable.

Right.

Our system was dumb before, and all the ACA did was enshrine the dumbness of it and made it mandatory.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Consulting and the Affordable Care Act

There never was any savings in the ACA. It was always about control. Another tax for you while making someone else rich.

There is a slight glimmer of hope in this. The AMA, and most doctors have a vested interest in you being sick. And it is to a point where you are being recommended things and procedures you don't need. The slight hope is to pull the reigns on this greed.

RE: Consulting and the Affordable Care Act

That's interesting beej67, because my company just introduced a new medical plan option exactly as you describe -- high deductable, (very) low premiums, and health savings account participation. And the benefits lawyers say it fully compliant with the ACA. I'm not aware that the President opined on it personally, though.

Or you can stick with the old (also compliant) plan.

RE: Consulting and the Affordable Care Act

Your HSA participation is subject to a new, lower cap than permitted before, and the items covered by your plan, Mr. Erickson, are broader than some prior plans were allowed to be.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East - http://www.campbellcivil.com

RE: Consulting and the Affordable Care Act

There actually is a limit to high deductibles that wasn't there before.

I think the authors of ACA had this in mind:

1) Family A has a very good income, and therefore had a medical plan pre-ACA with a low deductible and high premiums.

2) Family B is the opposite - low income, high deductible, low premium.

Now, if B has a major health calamity, and racks up a $500,000 bill at the hospital, do you think of B will pay that full deductible? Chances are, not, and B will default on payment to the hospital.

Now, since ACA is purely a result of hospital owners being in bed with Nancy Pelosi, and of course Mr. B. O. has convinced the public that ACA is something good for all of us, it was written to force B into a plan where the hospital would be able to take more of B's money...it is that simple.

RE: Consulting and the Affordable Care Act

But if family 'B' had had insurance prior to the ACA, I'll bet it also had a high deductible with a low premium. And if they didn't have insurance at all. which was likely for many in their situation, how is it that things are not going to be better now? After all, if they weren't going to pay their full deductible under the ACA why would they have done so in the past prior to the ACA? And if they had no insurance at all, well, we know what would have happened then, everyone would have paid with higher insurance rates to cover the uninsured and those $500,000 unpaid hospital bills.

And don't be so sure of family 'A' having had a high premium, low deductible policy. Just because they can afford the higher premiums does not mean that they would automatically pay them just to get a lower deductible. There's a lot of people out there who are very willing to take that risk and from the wealthy people whom I personally know, many of them are serial 'risk-takers' even to the point of making it one of their claims for being successful.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Consulting and the Affordable Care Act

I still predict health insurance will go the way of flood insurance. It will be required, expencive, goverment controled, and won't cover the internals of the insured site.

I just think some people forget where insurance started. It was gambling. You are betting you will get very sick, and the insurance company is betting you won't. And it is usually rigged in the houses favor.
Strange how gambling addicts don't buy loads of insurance. Must be the instant gratification.

The only insurance that keeps going up in cost is what is almost required. We don't see the cost rising so much for self-insured companies. But the goverment has a fix for that.
Also hole-in-one insurance for golf games isen't rising that fast.

RE: Consulting and the Affordable Care Act

JohnR,

I was offering that opinion as my version for the real reason behind ACA, not the reasons expressed to the public.

RE: Consulting and the Affordable Care Act

And only time will tell as to what the reality turns out to be.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

RE: Consulting and the Affordable Care Act

I think it is sort of OK however. There was a "barbaric" aspect to our pre-ACA system, compared to Canada.

Too many people with no insurance, doomed to do die slow painful deaths, not mercy euthanasia allowed.

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