10 ms·

I wish I had a link for this, but I believe as Obamacare was being drafted / the economy was in dire straits in 2009, the Obama administration had to make a cho

I wish I had a link for this, but I believe as Obamacare was being drafted / the economy was in dire straits in 2009, the Obama administration had to make a choice about whether to radically streamline health care, but at the cost of killing employment in (at the time) the only growing sector of the United States. They chose to not streamline it, which is understandable, but obviously a price had to be paid at some point. Related story, went with my wife into a small but advanced local hospital where she has a surgical consult about her sinuses. This hospital was beautiful and fully loaded with all the latest technology, big screen TVs, tablets, etc. Nonetheless, in the waiting room there were 5 office admins each with dual monitors checking people in. It’s like they didn’t get any benefit at all from the technology......

ebikelaw 8y ago
This is the problem with common economic measures. We spend 18% of GDP on health care, but that's just overhead and we should be trying to drive it to zero.
- toomuchtodo 8y ago
  The people who are that overhead do not want it to be driven to zero.
  - bunderbunder 8y ago
    Not per se, but they do wish their own health care weren't so @#$#@% expensive, which amounts to roughly the same thing.
    - kgwgk 8y ago
      Not if the “waste” represents maybe 5% of their spending but accounts for 100% of their income.
  - LarryDarrell 8y ago
    When blue collar jobs get destroyed, all I hear about is the benefits of creative destruction and the people will benefit through lower prices. When white collar jobs are threatened, everyone loses their shit.
    - taeric 8y ago
      Oddly, I hear a ton about the loss of blue collar jobs. Your rhetoric makes it look like you likely just notice and are annoyed by the people pointing out some change as inevitable. Ultimately, this comes down to interests and money. Consider how much money is poured into saving a few well lobbied industries. Then look at how many more jobs are lost in the service/retail sector with relatively little press. I mean, sure, we all talked about Toys R Us going under. How many jobs did that represent? Why no considerations of a bailout? Sears, etc? Tons of discussion to prop up coal, of all industries. Retail? If there has been discussion, I've missed it. (So, definitely possible.)
      - pessimizer 8y ago
        > annoyed by the people pointing out some change as inevitable. I think that it's more white-collar people declaring axiomatically that all losses of blue-collar jobs are inevitable due to rising productivity (while productivity is falling), and simultaneously declaring that massive inefficiencies should be preserved to protect white-collar jobs. If we're willing to forgo efficiency, of course all blue collar jobs could be preserved. The inevitability come from the fact that white-collar people get to choose in which areas of industry we should be efficient, and in which areas reducing inefficiencies is pointless.
        bunderbunder 8y ago
        I see blue collar people suggesting the opposite - for example, supporting massive inefficiencies (like repealing NAFTA) in order to protect domestic blue collar jobs. Humans tending to empathize more readily with people like themselves is a regrettable, but not exactly exceptional or noteworthy, phenomenon.
  - gizmo686 8y ago
    What if we drive it to 0, and litterally hand those people the money they would otherwise be making.
  - drewg123 8y ago
    Can we re-train them to do something which is actually useful, and which benefits the rest of society? What if we spent 18% of GDP on a new space program, for example..
- AnimalMuppet 8y ago
  If you have a way of driving the cost to zero without driving the delivery of healthcare to zero, we'd all love to see the plan. Too much of it is overhead, but not all of it, nor even close to all.
iteriteratedone 8y ago
Gov should stay out of service sectors , we are mortal people die. Not everyone has the same health or will live the same length. Healthcare is not like road paving ... unless you can find a way to give everyone the same body and fine them for over eating
EliRivers 8y ago
Graeber in "Bullshit Jobs" quotes President Obama, but I can't find an independent source of the quote right now. To account for that persistence, Graeber quotes President Barack Obama on the topic of privatized health care. “Everybody who supports single-payer health care says, ‘Look at all this money we would be saving from insurance and paperwork,’ ” the former President noted. “That represents one million, two million, three million jobs.” https://www.newyorker.com/books/under-review/the-bullshit-job-boom https://www.newyorker.com/books/under-review/the-bullshit-jo...
- bunderbunder 8y ago
  A more optimistic formulation would be that that represents millions of people who could be doing something a bit more generally useful than mastering the intricacies of the layers and layers of bureaucracy built up around medical billing. And probably wouldn't mind having a slightly less mind-numbing job themselves. Too bad the US is also epically bad at supporting people in career transitions.
  - ethbro 8y ago
    The magnitude of the data systems migration is usually discounted as well. Insurance companies generally have atrocious IT (it's not their core competency) and consequently inflexible IT stacks. Elimination the layers and layers of bureaucracy also means change / rewritting all the places that's embedded in code. ... and the real kicker? Those changes have to happen on both sides of any party / counterparty transaction. While supporting a normal volume of work. Small example? ICD-10 code support https://www.cms.gov/Medicare/Coding/ICD10/index.html https://www.cms.gov/Medicare/Coding/ICD10/index.html
    - darawk 8y ago
      That's a capital cost though, not a marginal cost. Amortize it over the essentially infinite savings on a long enough time horizon and it's basically free.
      - 8y ago
btrettel 8y ago
How do you eliminate wasteful jobs without backlash? Stop hiring and let attrition take care of the problem? In 2009, they'd have to look to increase employment elsewhere.
- oh_sigh 8y ago
  That's still painful, because you have an entire pipeline of people feeding those useless jobs. Yes, the ones with the useless jobs get to stay, but the many people who were planning their lives around getting a useless job(with their useless skills) now need to find something to do. Let me be clear: I don't support keep useless jobs around simply because it would be painful to the employee to lose their job.
  - kimdotcom 8y ago
    Isn't another benefit that this will foster greater entreupenurship and thus create 'job creators'? Right now, if you are employed and have insurance, you are really just subsidizing these jobs - middle-class welfare.
- ethbro 8y ago
  Based on my experience (working around insurance IT during ACA implementation), the best solution is setting performance goals, then rebating some of the savings to the party for exceeding them. With the rebates tailing off after a number of years. This allows the party cutting costs the flexibility to reallocate now-redundant people directly to problem areas, without having to procure additional funding. The rebates cover the cost of retraining (maybe mandate this for for-profit parties).
  - throwaway080383 8y ago
    Why wouldn't the party simply fire the "redundancies" and pocket the money?
    - ethbro 8y ago
      Not-for-profit insurances entities (e.g. Blue Cross Blue Shield) legally can't pocket (in any beneficial way) the savings. Aside from that, there's a huge amount of undocumented knowledge in the field. Given its stability, people can still work 20-30 years for the same company. Given there are always areas who need more people, I can't believe you'd rather have someone who knows nothing than the person with 20-30 years of experience (salary aside, admittedly).
lostlogin 8y ago
Insurance companies have cleverly handed off administration of their crappy system to the facilities that do the work. Their systems often betray a lack of understanding of what is being done and it’s time consuming to work through. A quick search suggests that 15% of US healthcare costs are due to this - $350 billion. Pretty sure that this isn’t news to anyone. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283267/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283267/
- JacobDotVI 8y ago
  I hope this is part of how Amazon / JPM / Berkshire goes after health care, by becoming a TPA and reducing these admin costs through an API layer: https://blog.jacob.vi/amazon-as-a-tpa-or-how-amazon-solved-interoperability/ https://blog.jacob.vi/amazon-as-a-tpa-or-how-amazon-solved-i...
  - thatfrenchguy 8y ago
    Probably won't happen though.
- ergothus 8y ago
  This may be being handled off to us. I just got appts for both a nutritionists and a sleep specialist, and the clinics explicitly asked ME to find out if it is covered, mumbling something about the particular insurer (blue shield of AL) requiring it
  - jdavis703 8y ago
    This is why I'm really a big fan of HMOs (of which I'm a member). Wasteful spending hurts both the medical provider and the insurer because they're the same entity. I realize an HMO may not be for everyone, but whenever the idea of universal health care comes up Kaiser Permantee is a really good model to look at. I ran the numbers the last time a healthcare reform proposal came up in California, and it would have been cheaper for the state to just give a "Kaiser Permantee for all" scheme than to expand Medicaid/Medical for everyone.
dragonwriter 8y ago
> Obamacare was being drafted / the economy was in dire straits in 2009, the Obama administration had to make a choice about whether to radically streamline health care, but at the cost of killing employment in (at the time) the only growing sector of the United States. The basic outline of healthcare reform that all the leading candidates in the Democratic side had signed on to well before the first of the 2008 privates had gained broad consensus among party elites well before that. It was not a reaction to conditions in 2009, unless there was a whole lot of parallel construction to cover up the Democratic Party’s access to a reliable crystal ball (an idea that the 2016 election would cast serious doubt on even if it was otherwise plausible.)
bumblebritches5 8y ago
Because Obama totally cred about jobs with all of his other policies, right? that totally matches up with Obama as a President...
gerdesj 8y ago
"the economy was in dire straits in 2009" I'm a foreigner but to me Obamacare appears to be an effort to ensure that everyone in the US can have reasonably priced access to healthcare. That seems a laudable aim. In the UK we have the National Health Service which has a similar aim. The NHS was formed in 1948. The UK economy at the time could also be described as being in dire straits but perhaps with a little more emphasis.
- wu-ikkyu 8y ago
  Did you know Obamacare fined you $695 or 2.5% of your household's income (whichever is greater) if you went for more than 2 months without health insurance? That doesn't seem very laudable.
  - jonhendry18 8y ago
    You're exempt if the lowest-priced coverage available to you would cost more than 8.13% of your household income. You're exempt if you were uninsured for no more than two consecutive months during the year. You're exempt if you're a U.S. citizen living abroad. You're exempt if you're incarcerated. You're exempt if you can demonstrate that you experienced a hardship during the year. Etc
    - wu-ikkyu 8y ago
      I'm not exempt. What laudable goal could there be for such a fine?
      - jonhendry18 8y ago
        It's dealing with the free-rider problem. The system would work best with as many people participating as possible, and you don't want people waiting until they get sick to get insurance, since under the ACA they would receive coverage for conditions that arose prior to being insured.
        8y ago
duxup 8y ago
I think had they chosen a radical path... it wouldn't have gotten the votes.

ebikelaw 8y ago

This is the problem with common economic measures. We spend 18% of GDP on health care, but that's just overhead and we should be trying to drive it to zero.

toomuchtodo 8y ago
The people who are that overhead do not want it to be driven to zero.
- bunderbunder 8y ago
  Not per se, but they do wish their own health care weren't so @#$#@% expensive, which amounts to roughly the same thing.
  - kgwgk 8y ago
    Not if the “waste” represents maybe 5% of their spending but accounts for 100% of their income.
- LarryDarrell 8y ago
  When blue collar jobs get destroyed, all I hear about is the benefits of creative destruction and the people will benefit through lower prices. When white collar jobs are threatened, everyone loses their shit.
  - taeric 8y ago
    Oddly, I hear a ton about the loss of blue collar jobs. Your rhetoric makes it look like you likely just notice and are annoyed by the people pointing out some change as inevitable. Ultimately, this comes down to interests and money. Consider how much money is poured into saving a few well lobbied industries. Then look at how many more jobs are lost in the service/retail sector with relatively little press. I mean, sure, we all talked about Toys R Us going under. How many jobs did that represent? Why no considerations of a bailout? Sears, etc? Tons of discussion to prop up coal, of all industries. Retail? If there has been discussion, I've missed it. (So, definitely possible.)
    - pessimizer 8y ago
      > annoyed by the people pointing out some change as inevitable. I think that it's more white-collar people declaring axiomatically that all losses of blue-collar jobs are inevitable due to rising productivity (while productivity is falling), and simultaneously declaring that massive inefficiencies should be preserved to protect white-collar jobs. If we're willing to forgo efficiency, of course all blue collar jobs could be preserved. The inevitability come from the fact that white-collar people get to choose in which areas of industry we should be efficient, and in which areas reducing inefficiencies is pointless.
      - bunderbunder 8y ago
        I see blue collar people suggesting the opposite - for example, supporting massive inefficiencies (like repealing NAFTA) in order to protect domestic blue collar jobs. Humans tending to empathize more readily with people like themselves is a regrettable, but not exactly exceptional or noteworthy, phenomenon.
- gizmo686 8y ago
  What if we drive it to 0, and litterally hand those people the money they would otherwise be making.
- drewg123 8y ago
  Can we re-train them to do something which is actually useful, and which benefits the rest of society? What if we spent 18% of GDP on a new space program, for example..
AnimalMuppet 8y ago
If you have a way of driving the cost to zero without driving the delivery of healthcare to zero, we'd all love to see the plan. Too much of it is overhead, but not all of it, nor even close to all.

iteriteratedone 8y ago

Gov should stay out of service sectors , we are mortal people die. Not everyone has the same health or will live the same length. Healthcare is not like road paving ... unless you can find a way to give everyone the same body and fine them for over eating

EliRivers 8y ago

Graeber in "Bullshit Jobs" quotes President Obama, but I can't find an independent source of the quote right now. To account for that persistence, Graeber quotes President Barack Obama on the topic of privatized health care. “Everybody who supports single-payer health care says, ‘Look at all this money we would be saving from insurance and paperwork,’ ” the former President noted. “That represents one million, two million, three million jobs.” https://www.newyorker.com/books/under-review/the-bullshit-job-boom https://www.newyorker.com/books/under-review/the-bullshit-jo...

bunderbunder 8y ago
A more optimistic formulation would be that that represents millions of people who could be doing something a bit more generally useful than mastering the intricacies of the layers and layers of bureaucracy built up around medical billing. And probably wouldn't mind having a slightly less mind-numbing job themselves. Too bad the US is also epically bad at supporting people in career transitions.
- ethbro 8y ago
  The magnitude of the data systems migration is usually discounted as well. Insurance companies generally have atrocious IT (it's not their core competency) and consequently inflexible IT stacks. Elimination the layers and layers of bureaucracy also means change / rewritting all the places that's embedded in code. ... and the real kicker? Those changes have to happen on both sides of any party / counterparty transaction. While supporting a normal volume of work. Small example? ICD-10 code support https://www.cms.gov/Medicare/Coding/ICD10/index.html https://www.cms.gov/Medicare/Coding/ICD10/index.html
  - darawk 8y ago
    That's a capital cost though, not a marginal cost. Amortize it over the essentially infinite savings on a long enough time horizon and it's basically free.
    - 8y ago

btrettel 8y ago

How do you eliminate wasteful jobs without backlash? Stop hiring and let attrition take care of the problem? In 2009, they'd have to look to increase employment elsewhere.

oh_sigh 8y ago
That's still painful, because you have an entire pipeline of people feeding those useless jobs. Yes, the ones with the useless jobs get to stay, but the many people who were planning their lives around getting a useless job(with their useless skills) now need to find something to do. Let me be clear: I don't support keep useless jobs around simply because it would be painful to the employee to lose their job.
- kimdotcom 8y ago
  Isn't another benefit that this will foster greater entreupenurship and thus create 'job creators'? Right now, if you are employed and have insurance, you are really just subsidizing these jobs - middle-class welfare.
ethbro 8y ago
Based on my experience (working around insurance IT during ACA implementation), the best solution is setting performance goals, then rebating some of the savings to the party for exceeding them. With the rebates tailing off after a number of years. This allows the party cutting costs the flexibility to reallocate now-redundant people directly to problem areas, without having to procure additional funding. The rebates cover the cost of retraining (maybe mandate this for for-profit parties).
- throwaway080383 8y ago
  Why wouldn't the party simply fire the "redundancies" and pocket the money?
  - ethbro 8y ago
    Not-for-profit insurances entities (e.g. Blue Cross Blue Shield) legally can't pocket (in any beneficial way) the savings. Aside from that, there's a huge amount of undocumented knowledge in the field. Given its stability, people can still work 20-30 years for the same company. Given there are always areas who need more people, I can't believe you'd rather have someone who knows nothing than the person with 20-30 years of experience (salary aside, admittedly).

lostlogin 8y ago

Insurance companies have cleverly handed off administration of their crappy system to the facilities that do the work. Their systems often betray a lack of understanding of what is being done and it’s time consuming to work through. A quick search suggests that 15% of US healthcare costs are due to this - $350 billion. Pretty sure that this isn’t news to anyone. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283267/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283267/

JacobDotVI 8y ago
I hope this is part of how Amazon / JPM / Berkshire goes after health care, by becoming a TPA and reducing these admin costs through an API layer: https://blog.jacob.vi/amazon-as-a-tpa-or-how-amazon-solved-interoperability/ https://blog.jacob.vi/amazon-as-a-tpa-or-how-amazon-solved-i...
- thatfrenchguy 8y ago
  Probably won't happen though.
ergothus 8y ago
This may be being handled off to us. I just got appts for both a nutritionists and a sleep specialist, and the clinics explicitly asked ME to find out if it is covered, mumbling something about the particular insurer (blue shield of AL) requiring it
- jdavis703 8y ago
  This is why I'm really a big fan of HMOs (of which I'm a member). Wasteful spending hurts both the medical provider and the insurer because they're the same entity. I realize an HMO may not be for everyone, but whenever the idea of universal health care comes up Kaiser Permantee is a really good model to look at. I ran the numbers the last time a healthcare reform proposal came up in California, and it would have been cheaper for the state to just give a "Kaiser Permantee for all" scheme than to expand Medicaid/Medical for everyone.

dragonwriter 8y ago

> Obamacare was being drafted / the economy was in dire straits in 2009, the Obama administration had to make a choice about whether to radically streamline health care, but at the cost of killing employment in (at the time) the only growing sector of the United States. The basic outline of healthcare reform that all the leading candidates in the Democratic side had signed on to well before the first of the 2008 privates had gained broad consensus among party elites well before that. It was not a reaction to conditions in 2009, unless there was a whole lot of parallel construction to cover up the Democratic Party’s access to a reliable crystal ball (an idea that the 2016 election would cast serious doubt on even if it was otherwise plausible.)

bumblebritches5 8y ago

Because Obama totally cred about jobs with all of his other policies, right? that totally matches up with Obama as a President...

gerdesj 8y ago

"the economy was in dire straits in 2009" I'm a foreigner but to me Obamacare appears to be an effort to ensure that everyone in the US can have reasonably priced access to healthcare. That seems a laudable aim. In the UK we have the National Health Service which has a similar aim. The NHS was formed in 1948. The UK economy at the time could also be described as being in dire straits but perhaps with a little more emphasis.

wu-ikkyu 8y ago
Did you know Obamacare fined you $695 or 2.5% of your household's income (whichever is greater) if you went for more than 2 months without health insurance? That doesn't seem very laudable.
- jonhendry18 8y ago
  You're exempt if the lowest-priced coverage available to you would cost more than 8.13% of your household income. You're exempt if you were uninsured for no more than two consecutive months during the year. You're exempt if you're a U.S. citizen living abroad. You're exempt if you're incarcerated. You're exempt if you can demonstrate that you experienced a hardship during the year. Etc
  - wu-ikkyu 8y ago
    I'm not exempt. What laudable goal could there be for such a fine?
    - jonhendry18 8y ago
      It's dealing with the free-rider problem. The system would work best with as many people participating as possible, and you don't want people waiting until they get sick to get insurance, since under the ACA they would receive coverage for conditions that arose prior to being insured.
      - 8y ago

duxup 8y ago

I think had they chosen a radical path... it wouldn't have gotten the votes.