Meanwhile, at the Capital...

aircooled wrote: How would them being in the ACA make any difference anyway? They, like the majority of the US, get their healthcare from their employer. Does this mean to credit them the employee cost and make them buy it on their own? I don't understand how this is supposed to be bad for them. Or even different. I guess the other side of that question is what effect does this exemption have? Exempt from what? They don't use the exchange anyway.

Despite following the developments closely, I really don’t know. I’m not even confident in the basic, quantifiable stuff…20,000 pages of legislation have effectively produced an Enigma machine that even a crack team of code breakers couldn’t untangle.

One of the few things I do know about is the 2.3% medical device tax as I’ve spent nearly a decade working in the industry. The President has repeatedly said “hey, it’s only 2.3% and besides, they’ll make it up in volume”.

First, the 2.3% is on gross sales not net profits. Given that medical device companies typically have 8% to 10% profit margins, this represents a 23% to 29% tax on top of the corporate taxes they’re already paying.

Second, how many people in America are left to die in the streets each year for lack of a pacemaker. Almost none so the argument that “they’ll make it up in volume” is just ridiculous.

Third, if there was any validity to the medical device tax, the same would have been imposed on the pharmaceutical industry but that didn’t happen. If fact, given how much larger pharma is than devices, we would have generated the same revenue if a survivable 0.5% tax was imposed on both industries but nope.

So, I don’t know about the other stuff but the one area I do understand well is just dirty, greasy, politics at their worst.

In reply to RX Reven':

Are tongue depressors, cotton swaps and rubber gloves considered "medical devices"?

Asked half-jokingly...

yamaha wrote: In reply to Flight Service: Actually they sent a clean budget to the senate with one added stipulation. Removing the lawmakers exemption from the ACA(why are they exempt anyways) and even that was turned down.

How are they exempt? I keep hearing this BS and it simply isn't true. If you, your neighbor, the guy down the street, Congress, has insurance that meets the minimum requirements (which believe me Congress' plan qualify) They have nothing more to do. The ACA literately does not effect them.

Why is this so hard for so many people to understand? If you have insurance go on about your day. Which is what makes all of this so funny. 99% of the people screaming about the ACA aren't even effected by it.

They just want to hate the guy in the White House.

RX Reven' wrote: ...Third, if there was any validity to the medical device tax, the same would have been imposed on the pharmaceutical industry but that didn’t happen....

Government.... uhm, I mean lobbyist, you get what you pay for.

Flight Service wrote: ...The ACA literately does not effect them....

This is what I am thinking also.

Flight Service wrote: ... 99% of the people screaming about the ACA aren't even effected by it....

Well... the increase in insurance costs will affect a lot of people.

aircooled wrote: Well... the increase in insurance costs will affect a lot of people.

So will the decrease

In reply to aircooled:

And I'm one of them getting effected in a negative way......at least I still have a job though. A few of my friends have already had theirs "eliminated due to projected shortfalls in the medical field".

I can give a berkeley less what shiny happy person is in whatever elected office. Seriously.

Friend of mine just got hired for a robotics contract at NIST. Contract suspended.

In reply to Datsun1500:

For what part, the insurance regulation? Doesn't need money for regulation.

For Medicaid, Medicare expansion, now that is a different story. The idea is that because the Federal government will stop giving tax breaks for all the uninsured people who don't pay their bills. That is one spot (and medical bills default for non payment is huge) of money. The other is overall medical costs across the board go down because now it is negotiated rate. When my wife had her hysterectomy the bill was $70K, but negotiated rate got it down to $12k.

There are many positions where this saves money. Don't be fooled by the "where is the money coming" from rehtoric. The system goes to a cost + system. to be an insurance company across the board. They are taking profit margins out.

I have not heard a single medical professional that has said they would be seeing a shortfall. Just the opposite.

The people who oppose the ACA have done a great job of selling the Socialist Obamacare. The Dems have done a very poor job of disrupting the mis-information out there.

10% on medical devices? Never. Try 1000%

http://boombustblog.com/reggie-in-the-news/item/9134-what-a-i-doing-with-glass?-hint-healthcare-companies-enjoy-margins-many-multiples-of-that-of-cocaine-dealers

It's kind of a cruddy article and dosent take into account r&d and regulatory costs. But I think we can agree that 8-10% ain't happening in the medical field.

aircooled wrote:

Flight Service wrote: ...The ACA literately does not effect them....

This is what I am thinking also.

Flight Service wrote: ... 99% of the people screaming about the ACA aren't even effected by it....

Well... the increase in insurance costs will affect a lot of people.

Our deductable 3 years ago was $500 for the family, now it is $5000 per year EACH, we are affected.

Flight Service wrote: For Medicaid, Medicare expansion, now that is a different story. The idea is that because the Federal government will stop giving tax breaks for all the uninsured people who don't pay their bills.

How does this jive with low-income uninsured receiving tax credits to assist payment for newly acquired insurance?

Uninsured who don't pay bills (before the ACA) receive tax breaks for non-payment? Wow!

The ACA's intent is to reduce profit? Where's the incentive to even offer insurance if that's the case? Or, is that the plan; to drive private entities out of the market, leaving government as the only source?

The ACA is over three years old. There has been plenty enough time to have fully explained it and eliminate mis-information. Maybe it could have happened if those who passed it had first bothered to have read and analyzed it. Maybe it's because regulations are still being written while it's being implemented? Maybe it's because no one knows what the hell is going on?

It would have been cheaper and more efficient to simply issue payment vouchers to the uninsured and tell them "Here's your money. Now, go buy health insurance from (insert company names here). We'll do this again next year. Have a happy life!".

aussiesmg wrote: Our deductable 3 years ago was $500 for the family, now it is $5000 per year EACH, we are affected.

My defuctible was 7k and my premiums are near $400/month. Now they are $200/month with a $2k deductible.

aussiesmg wrote:

aircooled wrote:

Flight Service wrote: ...The ACA literately does not effect them....

This is what I am thinking also.

Flight Service wrote: ... 99% of the people screaming about the ACA aren't even effected by it....

Well... the increase in insurance costs will affect a lot of people.

Our deductable 3 years ago was $500 for the family, now it is $5000 per year EACH, we are affected.

You obviously have no idea what you are talking about you Jeebus loving backwater hick and the republicans have brainwashed you! $5k is chump change, you are obviously rolling in mad skrilla and can afford that (heavy sarcasm).

Your guys' system is broken, and always will be because the underlying goal of your healthcare system is to make some CEO rich.

HiTempguy wrote: Your guys' system is broken, and always will be because the underlying goal of your healthcare system is to make some CEO rich.

Yup. Regulation needs to happen. Nothing wrong with profit , but the uninsured need to be covered as they are needlessly driving up costs for the rest of us.

Fueled by Caffeine wrote: 10% on medical devices? Never. Try 1000% http://boombustblog.com/reggie-in-the-news/item/9134-what-a-i-doing-with-glass?-hint-healthcare-companies-enjoy-margins-many-multiples-of-that-of-cocaine-dealers It's kind of a cruddy article and dosent take into account r&d and regulatory costs. But I think we can agree that 8-10% ain't happening in the medical field.

Why stop at 1,000%, I’m sure we can find a blog that has it at a kazillion%.

Bottom line…the fact that we weren’t able to buy off Obama like the pharmaceutical industry did is in itself a proof that our margins aren’t excessive.

I’m giving it to you straight, 8% to 10% is an honest number.

Fueled by Caffeine wrote: ....It's kind of a cruddy article and dosent take into account r&d and regulatory costs. But I think we can agree that 8-10% ain't happening in the medical field.

Aww, come on now. This is like saying cars or planes are overpriced because the cost of the steel, aluminum etc. is only 1% of what they sell them for.

I can assure you, as can another here (see post above), pharma and medical devices companies have been cutting everything they can find to keep their companies profitable. Are they still making money? Certainly, that is why they are still in business, but the regulatory and research cost (and risks) there are HUGE.

HiTempguy wrote: Your guys' system is broken, and always will be because the underlying goal of your healthcare system is to make some CEO rich.

Fueled by Caffeine wrote: 10% on medical devices? Never. Try 1000% It's kind of a cruddy article and dosent take into account r&d and regulatory costs. But I think we can agree that 8-10% ain't happening in the medical field.

I'd bet that it is. For every drug on the market, there are probably 50 that have had just as much rd that will never make a penny, because they will never see the market. Not to mention the ones that they've developed that the FDA is holding back.

GSK and Novo Nordisk report net profits in the 20-25% range. Hardly single digits. I'll bet individual products are in the triple digit margin range.

I don't get a few complaints about the ACA.

First, insurance rate increases due to the new law. Weren't rates rising obscenely prior to the ACA being passed? How can we say rising costs are due to the ACA when the majority of the law has not even been implemented?

Second, complexity. That's a pretty bogus argument. As a healthcare worker, I can tell you that healthcare billing is and has been very complicated for a long time.

Single-payer system would be much simpler, and if we run it anything like every other country in the world, lots cheaper. Is that what ACA detractors are calling for?

bastomatic wrote: Single-payer system would be much simpler, and if we run it anything like every other country in the world, lots cheaper. Is that what ACA detractors are calling for?

Nope, not by a longshot. The naysayers generally want to keep the existing system of "if you can't pay, well tough nuts... except for old people, cause we really need those votes... or if you show up at the ER, because even we can't look that barbaric to our constituents". If the motivation for their objections were really to make comprehensive care available to people in the most efficient and equitable manner, they would be, but it isn't, so they aren't.

oldsaw wrote:

Flight Service wrote: For Medicaid, Medicare expansion, now that is a different story. The idea is that because the Federal government will stop giving tax breaks for all the uninsured people who don't pay their bills.

How does this jive with low-income uninsured receiving tax credits to assist payment for newly acquired insurance? Uninsured who don't pay bills (before the ACA) receive tax breaks for non-payment? Wow! The ACA's intent is to reduce profit? Where's the incentive to even offer insurance if that's the case? Or, is that the plan; to drive private entities out of the market, leaving government as the only source? The ACA is over three years old. There has been plenty enough time to have fully explained it and eliminate mis-information. Maybe it could have happened if those who passed it had first bothered to have read and analyzed it. Maybe it's because regulations are still being written while it's being implemented? Maybe it's because no one knows what the hell is going on? It would have been cheaper and more efficient to simply issue payment vouchers to the uninsured and tell them "Here's your money. Now, go buy health insurance from (insert company names here). We'll do this again next year. Have a happy life!".

The unpaid bills are given as tax write off to the hospitals and medical facilities, not the people

As I said in an earlier post, they have done and incredibly poor job of selling it and getting rid of the mis-information. They aren't crossing Ts and dotting Is. But then again they are politicians...

Also as I said before, the ACA isn't the answer or the end all be all, but the old system was killing us. You can not have that many mark ups on something and it stay affordable and not bloated. I count 3 levels of mark up, I suspect there is more. And they aren't looking at 10% either. Now profit isn't a dirty word, but too much crushes the customer base. And what is worse, the extra levels don't add value. Ask any business owner here, if you can't get a volume discount by going through a distributor it is always better to buy direct. If there is no value ad, service, cost savings, extra, always buy direct. Since with insurance you can't buy direct in most cases (direct to Dr., hospital, meds, etc) or straight insurance (looked at single person plans recently?) Direct isn't an option so the exchanges and regulations get the volume discounts.

Even if this one fails it shows they can make changes and gives them something new to build on.

Flight Service wrote: The unpaid bills are given as tax write off to the hospitals and medical facilities, not the people

OK; that still means previously uninsured are on the hook for high-deductibles which will then be funded by the govt. The plan only works if it appeals to younger, healthy people and they forego the penalty. The penalty is very low and the "easy button". If those who cannot afford it are also subsidized, we have an even deeper spending deficit when ordinary folks are real, real tired of watching govt doing things they (themselves) cannot rationally do.

Flight Service wrote: As I said in an earlier post, they have done and incredibly poor job of selling it and getting rid of the mis-information. They aren't crossing Ts and dotting Is. But then again they are politicians...

Being politicians is but one excuse; there are many others that go far beyond crossing T's and dotting I's.

Flight Service wrote: Also as I said before, the ACA isn't the answer or the end all be all, but the old system was killing us. You can not have that many mark ups on something and it stay affordable and not bloated. I count 3 levels of mark up, I suspect there is more. And they aren't looking at 10% either. Now profit isn't a dirty word, but too much crushes the customer base. And what is worse, the extra levels don't add value. Ask any business owner here, if you can't get a volume discount by going through a distributor it is always better to buy direct. If there is no value ad, service, cost savings, extra, always buy direct. Since with insurance you can't buy direct in most cases (direct to Dr., hospital, meds, etc) or straight insurance (looked at single person plans recently?) Direct isn't an option so the exchanges and regulations get the volume discounts.

You're right in that the old system was terribly flawed. I also agree with the basics of your economic analysis. But, I not remotely convinced that trading multiple layers of profit for multiple layers of bureaucracy is an attractive or affordable alternative.

Flight Service wrote: Even if this one fails it shows they can make changes and gives them something new to build on.

Something about that thought process makes me wonder about the next occurrence of a 1906 magnitude earthquake in modern day San Francisco.

Flight Service wrote: ...The unpaid bills are given as tax write off to the hospitals and medical facilities, not the people...

Soooo, this makes it free? This is kind of like saying "its not hurting anyone, the insurance company pays"

So the hospitals are paying less tax because of all these expenses. Taxes are collected for a purpose. If the hospitals don't pay their "share" someone else has to make that up, and obviously "the people" will pay more taxes in some way (or pay more to someone else who does) to cover it.