Overshadowed by the federal government shutdown (for which they are likely to be somewhat grateful), the PPACA’s health insurance exchange web site went alive today, marking a major milestone in the program’s slow emergence from its cocoon.
Here’s my prediction: there is no level of problems with the web sites or with the exchanges themselves which will be deemed a failure. Just showing up will be enough to declare victory.
Computer glitches will eventually get worked out. The big question will be the aggregate effects. There are a lot of duelling opinions an models. One side says that only a small minority will see more expensive options due to the ACA – the other side says that only a small minority will see benefits. I have no idea what the truth is, but am pretty skeptical of both these narratives.
I have no idea what the truth is, but am pretty skeptical of both these narratives.
Nobody does, Andy. I’m fiscally conservative. So this whole PPACA bites, as far as I’m concerned. And, I can’t see a positive outcome for such a contorted, flawed, highly regulated, misunderstood plan.
However, those who focus primarily on accessibility for the uninsured, as being a pinnacle of success, all glitches, objections, premium hikes for others, cost curve directional changes, will go by the wayside, be downplayed, and derided if objected to or criticized by others.
Has steve ordered unnecessary procedures yet to make up his revenue shortfall? That’s what he said he would do.
“Has steve ordered unnecessary procedures yet to make up his revenue shortfall? That’s what he said he would do.”
Golly, do you have proof of that? Someone might say it’s libel, you know.
Yeah Drew, I don’t think steve ever said he would do that, he said he knew doctors that would.
sam, can you libel a “steve” or a “sam,” and for that matter how can one’s reputation be harmed by a “red barchetta”? Is it a car, or a Rush song that is making the accusation?
sam
I called out steve on that, and he did the moon walk. But I suspect Dave has an archive function, and that is EXACTLY what he said. If you are enterprising, do the work.
I have what my partners call a “photographic ear,” vs memory. That is, I can recount discussions from 10 years ago and recite word for word the discussions on deal selection, hiring decisions etc etc. I can describe the hand gestures, facial expressions and what people were wearing on that day. Its a gift, in this little noggin of mine. My partners hate it beyond belief. Truth is a bitch. Revisionist history don’t-no-work at our firm. Heh.
I bet steve hates it too. (and Michael)
PD
Yes he did.
And by the way, moving away from the actual facts……..even if steve was saying “others would do it,” it was a debate in the context of how Obamacare would affect doctors. (that memory thingy) So ObamaCare turns doctors into used car salesmen? WTF??
Trees grow to the sky. Yes sirree!!
Yes, I made the mistake of saying we, meaning doctors as a whole, would, or at least could, order more stuff. I said that in the context of the expected response to a cut in fees, not really what is happening with the ACA. When people talk about cutting physician salaries I always make the point that how you accomplish that matters a lot, and if your primary goal is really cutting medical spending it is utilization you should be going after. Actual physician salaries make up about 7% of our medical spending but the amount of spending docs control is much higher. If you cut utilization you reduce salaries AND decrease overall spending.
Steve
Smooth, steve.
And by the way, I’m not an advocate of cutting physician comp. I don’t think that’s the issue. Its usage, born of essentially no cost incidence to the buyer.
I’ve had some real health issues. Orthopedic, ulnar nerve entrapment, atrial fib and so on. I’d pay whatever for good care.
But we bloat the system for trips to the doc for sniffles.
Also, and you always make the point, steve, which I believe is basically correct, that certain high cost procedures dominate. But that doesn’t absolve everyday expenditures.
My father told me a good 30 years ago that the reimbursement scheme was out of whack. Surgeons, who basically perform technique based procedures, get paid like kings. (I remember watching a YouTube video of my ulnar nerve repo surgery and thinking “OK, I get it, got to be good with the anatomy once you are in there, can’t screw up in dealing with a nerve, got to make sure you go down the arcade of struthers with room, but is this really rocket science??” ) The rest get paid disproportionately lower. I wonder what your take on that is.
I think that specialists in general are paid too much now. Surgeons have seen, in general, their salaries come back a bit (especially CT surgeons) , but some specialties remain out of whack IMO. In general, those in procedural specialties take more call, require more training and work a bit longer, but not enough to merit such large discrepancies. We should be more in line with the rest of the world.
Steve
Now all this is all fine and well. But here’s what I’m really thinking about tonight.
So your current driver has a Diamana “white board” 72 shaft. Low, boring trajectory. But suppose you are looking to spring, with wet fairways? Diamana Kai-li, at 70 grams to flight it up a bit? Or the new “B” version, with the exact same bend profile but at 60 grams? Does D2 vs D4 swingweight matter? I think it does. So maybe you can’t just re-shaft, but you have to buy a lighter head and go “B.” You could go Aldila Phenom, or RIP alpha 60, but I just never felt that smooth, smooth feel of Diamana’s rayon.
These are the things that keep people up at night.
Drew,
You completely lost me!
In the meantime, Steve, specialists do cost more. But, isn’t it the primary care physicians who are in short demand, or even dropping out of the medical care equation?
Why don’t you just go with two or three drivers? You can afford it.