
United States Health Care Reform: Progress to Date and Next Steps - fabuzaid
http://jama.jamanetwork.com/article.aspx?articleid=2533698
======
boneheadmed
The worst piece of legislation ever to be passed in the United States of
America. I am a physician. My personal health insurance rate for a family of 5
increased immediately by 66% (since I have an individual policy). I have
resorted to using the Medishare healthcare cost sharing plan as traditional
insurance became unaffordable.

I have seen many patients lose their doctors because the doctors were not
contracted with Covered California. The reason the doctors do not contract
with Covered California is because at face value the plan appears to be just
like the usual say PPO plan. But in fact it pays about 33% less than medicare
(in other words, no different than Medi-Cal.

These are only some of the financial problems created by Obamacare. The
problem with the government effectively taking over Health IT by way of
forcing Electronic Health Records to abide by bureaucrats definitions for
"meaningful use" is a completely different disaster that has resulted in
marked decreases in productivity and worse care for patients.

Giant Hospital systems are taking over individual and group practices and
turning them into corporate mills with little to no autonomy for physicians
and terrible care for patients. All the while greedily taking in government
and private dollars.

This is crony capitalism at its very worst.

~~~
zrail
ACA is the best legislation in my lifetime. It has allowed me the luxury of
being able to purchase individual insurance as a cancer survivor, allowing me
to spend more time with my young family instead of being chained to a 8-5
corporate job.

See, I can anecdote too.

~~~
Alupis
> It has allowed me the luxury of being able to purchase individual insurance

You could do that before ACA.

> instead of being chained to a 8-5 corporate job

What does this lifestyle choice have to do with ACA? ACA doesn't somehow give
you free time or extra money. Unless you are getting your insurance for free
(which was possible before ACA, mind you). ACA often does not offer the
cheapest plans either...

~~~
dragonwriter
> You could do that before ACA.

The GP said he was a cancer survivor. I've talked with several people with
serious past or pre-existing conditions, including past occurrences of cancer,
who could not find anyone willing to sell them an individual health insurance
plan at any price prior to the ACA -- the only way they could get insurance
was to be in a job where a group plan was offered.

> What does this lifestyle choice have to do with ACA?

It creates health insurance exchanges on which people can by individual
insurance without being denied for pre-existing conditions, meaning they don't
need to be in a job offering a group plan in order to get insurance.

> ACA often does not offer the cheapest plans either...

ACA has made it possible for people to buy individual plans who were not able
to buy them, at any price, before (the rules that do that, such as the rule
against pre-existing condition exclusions, are the _reason_ for the cost
increases for individual insurance for people who were insurable prior to the
ACA.)

~~~
Alupis
> It creates health insurance exchanges on which people can by individual
> insurance without being denied for pre-existing conditions

One could (and can) do this without the exchanges.

Yes, before ACA some pre-existing conditions would deny access to some
policies from some insurers. This was to prevent a career smoker at age 75
from signing up for a new very large policy, and immediately get the benefits
they haven't paid for.

We didn't need all of the baggage that came with ACA to accomplish this.

> meaning they don't need to be in a job offering a group plan in order to get
> insurance

> ACA has made it possible for people to buy individual plans who were not
> able to buy them

Before ACA, you did not need to belong to a group plan to get insurance. And
to that endeavor, private individual insurance policies are about the same
price now as they were then...

~~~~

Meanwhile... ACA didn't touch pharmaceutical companies - the true reason
healthcare is so expensive ($700 salt water IV's anyone?).

~~~
twotwotwo
> private individual insurance policies are about the same price

Not for `zrail: pre-ACA, insurers charged high-risk buyers like him/her much
higher-than-average premiums based on their medical history. Now that's not
allowed.

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loarake
He published a single author paper even though he acknowledges in the end "I
thank Matthew Fiedler, PhD, and Jeanne Lambrew, PhD, who assisted with
planning, writing, and data analysis". In my field, those people probably
would have deserved a place on the authors list ;)

~~~
rubidium
My exact thought. They did all the work. He took all the credit.

Then again, they're politicians and not academics so not as big a deal.

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aub3bhat
Figure 6. Medicare 30-Day, All-Condition Hospital Readmission Rate, is plotted
with Y-Axis not starting from zero, which makes it look like there was a
dramatic decrease.

Having studied readmission rates, I was amazed, only to be disappointed as I
looked at the Y-axis.

~~~
jlmorton
It will be nice to confirm this over the next several years, but as of now,
and despite the misleading graph, it still looks to be a pretty amazing
achievement.

~~~
aub3bhat
No doubt about that.

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matznerd
This is awesome. I love the listing under Author Affiliations: "1-President of
the United States, Washington, DC "

~~~
danso
Unbelievable that they publish a non-Doctor with so many potential conflicts
of interest that he has to turn in a separate PDF
[http://jama.jamanetwork.com/article.aspx?articleid=2533698#A...](http://jama.jamanetwork.com/article.aspx?articleid=2533698#ArticleInformation)

~~~
organsnyder
Where are the conflicts of interest that would affect this article? The linked
form is his standard form as a government official, and lists various
holdings. Actually, looking through it, his seems much more mundane than I
expected—a 403(b) from when he was a professor, 529 accounts for his kids...
The most interesting thing I saw was book royalties.

~~~
danso
I was just being facetious. Usually financial disclosures are a couple of
lines. President Obama, being the president and having to fill those forms out
every year, just sent them his most recent filing (past years are linked from
this blog post [https://www.whitehouse.gov/blog/2016/05/16/president-and-
vic...](https://www.whitehouse.gov/blog/2016/05/16/president-and-vice-
presidents-2015-financial-disclosure-forms))

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bsbechtel
FWIW, considering half the Democratic Party wanted to nominate a candidate who
wanted to reform healthcare AGAIN (expansion of medicare for all), that should
be an indicator of the quality of this piece of legislation.

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brooklyndavs
It will be very interesting to see how the below does in November in Colorado.
If this passes and is successful it could act as a catalyst for other states
to try the same. Like many progressive issues before it (Same-sex marriage,
weed legalization etc) single payer universal healthcare in the US might go
through the states first. The insurance, pharmaceutical, and hospital
industries know this and are working hard to see it defeated.

[http://www.coloradocare.org/](http://www.coloradocare.org/)

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steveplace
In the findings, the author states:

>These and related reforms have contributed to a sustained period of slow
growth in per-enrollee health care spending

Has the rate of change in insurance premiums or healthcare spending actually
slowed? I don't see it in any of the data presented.

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vsr_pg
Pretty funny to see his author byline and affiliation

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bmmayer1
Wonder what Obama's Erdos number is now.

~~~
jhugg
Would help to have a co-author, no?

~~~
dexterdog
I would assume Obama was at most a co-co-author of this.

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SilasX
Sorry if OT but ... Anyone get a snicker out of putting JD by his name?

"Barack Obama ... don't know the cat. Oh, he has a law degree? Hm, okay, I
guess his opinion might matter then."

It would be like seeing "Guido van Rossum, Dropbox Employee".

~~~
thucydides
This appears to be JAMA's in-house style.

See
[http://jama.jamanetwork.com/article.aspx?articleid=2533068](http://jama.jamanetwork.com/article.aspx?articleid=2533068),
[http://jama.jamanetwork.com/article.aspx?articleid=2533066](http://jama.jamanetwork.com/article.aspx?articleid=2533066),
etc.

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chimpchange
The hubris of this clowncar Presidency is just unbelievable.

