# Obamacare will burn things to the ground **URL:** \ **Category:** Great Debates\ **Created:** [December 10, 2013, 7:30pm UTC](https://boards.straightdope.com/t/obamacare-will-burn-things-to-the-ground/676007 "2013-12-10T19:30:40Z")\ **Posts on this page:** 13\ **Page:** 3
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [December 16, 2013, 5:50pm UTC](https://boards.straightdope.com/t/obamacare-will-burn-things-to-the-ground/676007/41 "2013-12-16T17:50:50Z")
> [@bengangmo](#): > > When my clients are doing what I think are stupid ads, or poorly conceived websites, I still do my part to the very best of my ability and point out pitfalls, problems and roadblocks to them along the way rather than passive aggresively letting the project fail. … So, if I understand you correctly, when you see things going astray (stupid ads, poorly conceived websites) you point out the problems. Do you offer a solution (better ad, better designed website)? It seems to me that there are persons pointing out problems with the PPACA. There are defenders of the PPACA who are bristling at any criticism which does not offer an alternative solution to the liking of the defender. As it relates to this thread, the issue is PPACA treatment of certain fire departments in the United States. The PPACA critics have indeed offered a change, a relatively simply administrative tweak that does not require the action of Congress at all. The proposed change put forth by PPACA critics is that the IRS clarify that “on call” time in which a volunteer firefighter is carrying a pager (or otherwise making himself/herself available for call out) not count towards the 30 hours per week limit under PPACA for an employer providing mandatory health insurance. The request was made months ago. The IAFC is still awaiting a response. The delay is, IMHO, shameful as these VFDs need to have clarity in this matter in order to be able to continue providing a needed community service. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [December 16, 2013, 6:16pm UTC](https://boards.straightdope.com/t/obamacare-will-burn-things-to-the-ground/676007/42 "2013-12-16T18:16:02Z")
> [@BrokenBriton](#): > > I don’t understand all this shit. > > In the UK you just go to Emergency (A&E) yourself, or go to the doctor you’re registered with and they refer you to the local big hospital. I’ve never seen any paperwork apart from the date and time of an appointment. It really is that simple: become ill \> get treatment. > > How many GDP percentage points are taken up with all this bullshit insurance administration? [We spend more on administration than the entire combined budgets of the NHS and BUPA (and that includes BUPA’s foreign operations, because I couldn’t find UK-only numbers when I did the calculations) - or seven times (per capita) what the NHS and BUPA spend on administration](http://boards.straightdope.com/sdmb/showpost.php?p=14752338&postcount=13). ---
**Author:** ![steronz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/steronz/32/11765_2.png) [@steronz](https://boards.straightdope.com/u/steronz)\ **Post date:** [December 16, 2013, 6:25pm UTC](https://boards.straightdope.com/t/obamacare-will-burn-things-to-the-ground/676007/43 "2013-12-16T18:25:07Z")
> [@Iggy](#): > > The proposed change put forth by PPACA critics is that the IRS clarify that “on call” time in which a volunteer firefighter is carrying a pager (or otherwise making himself/herself available for call out) not count towards the 30 hours per week limit under PPACA for an employer providing mandatory health insurance. > > The request was made months ago. The IAFC is still awaiting a response. The delay is, IMHO, shameful as these VFDs need to have clarity in this matter in order to be able to continue providing a needed community service. Curiously, even though this was widely reported (and I said as much in post #4), the IAFC “PPACA Fact Sheet” I linked to upthread doesn’t seem to question the “on call hours” issue – the answer is that they don’t count. [Here’s a list of questions](http://www.iafc.org/files/1GR/gr_PPACAquestions.pdf) that they supposedly submitted to the IRS back in September. The actual questions, as you can see, are a lot more mundane. Some of them seem to be worded as a request for a simple-language clarification, as opposed to some rule-of-law that needs to be addressed. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [December 16, 2013, 11:24pm UTC](https://boards.straightdope.com/t/obamacare-will-burn-things-to-the-ground/676007/44 "2013-12-16T23:24:08Z")
> [@Mr.Duality](#): > > I would be very interested in knowing what medical administrative costs are in industrialized countries with single payer systems. [Here you go](http://www.pnhp.org/news/Admin%20Cost%20study.pdf) (for Canada) (pdf). Bottom line is that: > [@NEJM article linked to above](#): > > In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. ---
**Author:** ![PhillyGuy](https://avatars.discourse-cdn.com/v4/letter/p/ed655f/32.png) [@PhillyGuy](https://boards.straightdope.com/u/PhillyGuy)\ **Post date:** [December 17, 2013, 12:51am UTC](https://boards.straightdope.com/t/obamacare-will-burn-things-to-the-ground/676007/45 "2013-12-17T00:51:09Z")
> [@BrokenBriton](#): > > I presume you mean by “most Americans” the majority who do have healthcare insurance, not the very sizeable minority who don’t? A correct presumption. > [@](#): > > The anti-UHL lobby alwasy uses the NHS as it’s example exactly because it is absolutely the far, far end of the spectrum Correct again. They pick a system rather unlikely to be adopted in the US, and conflate it with universal coverage generally. > [@](#): > > You do however, always, have the option of private insurance. Not a good selling point 😉 > [@Mr.Duality](#): > > Administrative (paperwork) costs for US physicians is 25% to 30%. [cite](http://www.forbes.com/sites/realspin/2013/04/03/whos-to-blame-for-our-rising-healthcare-costs/) > > Medicare admin costs in the US are 2%. [cite](http://krugman.blogs.nytimes.com/2009/07/06/administrative-costs/?_r=0) I don’t totally buy this, and suspect a lot of the 25% to 30% is spent on medicare patients. However, there is a message here for conservatives. ACA is the regulated free market approach championed by moderate conservatives until bought into by moderate Democrats. A smart pro-free-market GOP would be trying to make ACA work better, and pointing out how Romneycare led the way. If ACA fails, repeal is less likely than fixing problem areas with greater centralization, as happened when Australia’s multi-payer Medibank was replaced by Medicare. If it happened in a center-right country with such a strong ethos of individualism as Australia, it can happen here. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [December 17, 2013, 1:20am UTC](https://boards.straightdope.com/t/obamacare-will-burn-things-to-the-ground/676007/46 "2013-12-17T01:20:29Z")
Is profit included as an administrative cost? How about salaries? I’m just guessing here, but I’m guessing that the CEO of United Health makes a pretty penny more than the Secretary of HHS. ---
**Author:** ![BrokenBriton](https://avatars.discourse-cdn.com/v4/letter/b/4bbf92/32.png) [@BrokenBriton](https://boards.straightdope.com/u/BrokenBriton)\ **Post date:** [December 17, 2013, 2:13pm UTC](https://boards.straightdope.com/t/obamacare-will-burn-things-to-the-ground/676007/47 "2013-12-17T14:13:17Z")
> [@Really\_Not\_All\_That\_Bright](#): > > [We spend more on administration than the entire combined budgets of the NHS and BUPA (and that includes BUPA’s foreign operations, because I couldn’t find UK-only numbers when I did the calculations) - or seven times (per capita) what the NHS and BUPA spend on administration](http://boards.straightdope.com/sdmb/showpost.php?p=14752338&postcount=13). What did amuse me was the Republican politicians who claimed adopting ‘socialized medicine’ will mean job losses. Which to anyone else means greater efficiency and lower costs 😃 It actually confirms the case. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [December 17, 2013, 2:17pm UTC](https://boards.straightdope.com/t/obamacare-will-burn-things-to-the-ground/676007/48 "2013-12-17T14:17:25Z")
Well, yes. They’re absolutely right. My wife, whose primary job is to make Employer X’s employee database work with Insurer Y’s coverage database, will be out of a job if we get socialized healthcare. And we’re fine with that. ---
**Author:** ![BrokenBriton](https://avatars.discourse-cdn.com/v4/letter/b/4bbf92/32.png) [@BrokenBriton](https://boards.straightdope.com/u/BrokenBriton)\ **Post date:** [December 17, 2013, 2:40pm UTC](https://boards.straightdope.com/t/obamacare-will-burn-things-to-the-ground/676007/49 "2013-12-17T14:40:26Z")
deleted, not helpful ---
**Author:** ![BrokenBriton](https://avatars.discourse-cdn.com/v4/letter/b/4bbf92/32.png) [@BrokenBriton](https://boards.straightdope.com/u/BrokenBriton)\ **Post date:** [December 17, 2013, 2:44pm UTC](https://boards.straightdope.com/t/obamacare-will-burn-things-to-the-ground/676007/50 "2013-12-17T14:44:55Z")
> [@elucidator](#): > > Is profit included as an administrative cost? How about salaries? I’m just guessing here, but I’m guessing that the CEO of United Health makes a pretty penny more than the Secretary of HHS. There is profit in most healthcare systems, and those are the systems with 5-6 GDP percentage points difference. The UK model, where the private secor is smaller, in now approx. 7-8 GDP points cheaper. Isn’t that pretty much the annual budget + 50% for the whole US military? ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [December 17, 2013, 4:24pm UTC](https://boards.straightdope.com/t/obamacare-will-burn-things-to-the-ground/676007/51 "2013-12-17T16:24:06Z")
So, maybe off the exact subject, but how are they going to compete? Actuarial tables are the same for everybody, the product is pretty much cut and dried. You take the risk, you take the benefits, you come up with a premium that satisfies the conditions of the calculation, add in your margin, and there you have it. Actuarial math is the same for all. So what is MegaHealth going to do to get you to pick their bronze plan if it is essentially identical to the plan offered by the next guy? Their gonna have to cut prices, aren’t they? They are going to have to find efficiencies to make that possible. If MegaHealth can offer the same plan for ten percent less that their competitors, well, its Adios, Mothefucker, no? Gosh, imagine that! The Invisible Finger of the Free Market (blessings and peace be upon it!) actually working for the well being of the people! Well, maybe. We’ll see… ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [January 13, 2014, 7:48pm UTC](https://boards.straightdope.com/t/obamacare-will-burn-things-to-the-ground/676007/52 "2014-01-13T19:48:07Z")
Update: [treasury to adopt final rule that exempts volunteer firefighters/EMS personnel](http://www.treasury.gov/connect/blog/Pages/Treasury-Ensures-Fair-Treatment-for-Volunteer-Firefighters-and-Emergency-Responders-under-the-Affordable-Care-Act-Under-ACA.aspx) from employer shared responsibility provisions of ACA. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [January 14, 2014, 2:11am UTC](https://boards.straightdope.com/t/obamacare-will-burn-things-to-the-ground/676007/53 "2014-01-14T02:11:39Z")
> [@Mr.Duality](#): > > Administrative (paperwork) costs for US physicians is 25% to 30%. [cite](http://www.forbes.com/sites/realspin/2013/04/03/whos-to-blame-for-our-rising-healthcare-costs/) > > Medicare admin costs in the US are 2%. [cite](http://krugman.blogs.nytimes.com/2009/07/06/administrative-costs/?_r=0) > > This is overwhelming proof that the US government _can_ do something right. > > I would be very interested in knowing what medical administrative costs are in industrialized countries with single payer systems. > > And what \*\*elucidator \*\*said. The figure of $360 billion in that first cite is consistent with numbers I’ve seen from other sources, for example I think it’s PNHP that quotes about $350 billion being wasted every year in the US on the administration of private insurance. Canada is a good comparison because the health care provider system is essentially private and free-market (though the vast majority of hospitals are not for profit) and health care costs are influenced by the market dynamics of US proximity – for example, if doctors received absurdly low rates of compensation they would all move to the US. Most numbers I’ve seen show per capita health care costs in Canada being about half of what they are in the US, and US costs being total outliers, right off the chart on comparisons with other industrialized nations. The cost savings are generally attributable to two important factors: (1) the ability of a single-payer system to control costs through upfront policy rather than claims adjudication, and (2) the streamlined administrative simplicity. It’s amazing how simple it is when you go to a doctor or a hospital because you’re sick, the health care provider treats you, and then sends an electronic invoice to the government plan and is then unconditionally paid in full by EFT. The physician is guaranteed full payment, and the patient never sees a single piece of paper related to billing, doesn’t pay a cent, and in general isn’t even aware of costs. Note that point (1) also has profoundly important clinical benefits – the doctor and patient alone make the medical decisions – there is no meddling insurance industry bureaucrat trying to micromanage every individual case – **a meddling interference that under private insurance the patient actually pays for**! [Previous page](https://boards.straightdope.com/t/obamacare-will-burn-things-to-the-ground/676007.md?page=2)