# Oops. Looks like we were lied to about Obamacare after all. **URL:** \ **Category:** Great Debates\ **Created:** [October 29, 2013, 7:22am UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534 "2013-10-29T07:22:23Z")\ **Posts on this page:** 20\ **Page:** 25
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [November 2, 2013, 7:31pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/481 "2013-11-02T19:31:10Z")
> [@elucidator](#): > > … **Hentor** ’s site offers a good starting point. The thing about terrible coverage is you don’t know its terrible until you need it… My mistake, he didn’t. Here’s a good place to start. [http://talkingpointsmemo.com/dc/what-happens-to-people-whose-insurance-is-cancelled-because-of-obamacare](http://talkingpointsmemo.com/dc/what-happens-to-people-whose-insurance-is-cancelled-because-of-obamacare) (I do not include a liberal cootie warning for tighty rightys because TPM is pretty reliable, in all the years I’ve been checking on them, they’ve not burned me yet.) ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [November 2, 2013, 7:35pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/482 "2013-11-02T19:35:06Z")
> [@elucidator](#): > > Seriously? You don’t know about any of this, you come to argue about something which you have no information regarding? To oversimplify for the sake of brevity, hospital musts provide emergency care whether the patient can pay for it or not. They cover their losses by jacking up prices for people who _can_ pay. But you hadn’t heard about any of this? Wait just a cotton pickin’ minute there. We came into this thread argue about the OP, which was Obama’s statement about one aspect of the law. That doesn’t mean we’re all-knowing about the entire law. And you didn’t answer the question. At all. So I must conclude that you don’t know the answer, either. Unless you’d care to try again…? ---
**Author:** ![Twoflower](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/twoflower/32/22_2.png) [@Twoflower](https://boards.straightdope.com/u/Twoflower)\ **Post date:** [November 2, 2013, 7:42pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/483 "2013-11-02T19:42:02Z")
Of course we were lied to about Obamacare! Remember “Death Panels”? I don’t blame Mr. Obama one bit for making a slightly-too-rosy statement about keeping your insurance. The slightest qualification would have been pounced on and lie-fully amplified by the opposite side. Here’s a data point about bad insurance… My daughter is currently filing for bankruptcy because of a medical treatment that she was told was covered by her insurance. Only after the fact did she learn that she’d exceeded the annual maximum coverage, and they sent her a bill for $80,000. ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [November 2, 2013, 8:02pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/484 "2013-11-02T20:02:43Z")
The _tu quoque_ is strong in that one! OK, I spent a little time on The Google to find out about this aspirin issue. Every source I encountered said something [like this:](http://www.healthcarefinancenews.com/blog/why-aspirin-taken-hospital-can-cost-upwards-25) > [@](#): > > Many patients take their first look at a hospital bill, only to go into sticker shock. A single aspirin for $25? > > \ > > The culprit behind these high costs is our reimbursement structure. > > Public programs do not fully pay for the cost of care. The latest figures estimate that hospitals lose $35 billion a year on Medicare, Medicaid and other forms of government reimbursement. For specific procedures, the picture can be even bleaker. > > Take note, because this money isn’t lost – you pay the difference. Unable to absorb these losses, the bill gets passed to commercial insurers and employers that purchase health plans for their employees. Hence the itemized charges of $25 for an aspirin or $100 for diapers that are paid by insurers today, and by you and me tomorrow in the form of higher premiums and co-pays. And it’s only going to get worse as our population ages and more of us call Medicare our insurance provider. Well, it’s a good thing Obamacare doesn’t expand the ranks for medicare. Oops… Maybe I encountered only biased sources, and if so, I’m open to being corrected. ---
**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:** [November 2, 2013, 8:07pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/485 "2013-11-02T20:07:25Z")
That’s horribly misleading. No hospital loses money by participating in Medicare and Medicaid. They participate because they _make_ money by doing so. Hospitals are free to refuse Medicaid/Medicare patients, but in general the only ones that do are the Shriners Hospitals (funded by an endowment, don’t charge for care anyway) and the VA hospitals. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [November 2, 2013, 8:11pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/486 "2013-11-02T20:11:34Z")
> [@Really\_Not\_All\_That\_Bright](#): > > That’s horribly misleading. No hospital loses money by participating in Medicare and Medicaid. They participate because they _make_ money by doing so. Hospitals are free to refuse Medicaid/Medicare patients, but in general the only ones that do are the Shriners Hospitals (funded by an endowment, don’t charge for care anyway) and the VA hospitals. > **[Healthcare Financial Management Association](https://www.hfma.org/)** > > The Healthcare Financial Management Association (HFMA) equips its members to navigate a complex healthcare landscape. Healthcare finance professionals trust HFMA to provide the guidance and tools to help them lead their organizations, and the... The report concludes that the overall Medicare margin for hospitals declined from \*\*–4.5 percent \*\*in 2010 to **–5.8 percent** in 2011. Furthermore, MedPAC projects the overall Medicare margin in 2013 will be **–6 percent**. The report also notes that although Medicare payments are currently less than costs for the average hospital, it is possible for some hospitals to make money on Medicare: The median efficient hospital generated a positive 2 percent Medicare margin in 2011. I am not sure what an “efficient hospital” is vs. a non-efficient one, so I have no idea what that last paragraph means. But apparently, overall, hospitals lose quite significantly on Medicare patients. Ah there it is. 2/3 of the hospitals lose money on Medicare patients: [MedPAC: 64% of Hospitals Lose Money on Medicare Patients](http://www.forbes.com/sites/aroy/2011/09/21/medpac-64-of-hospitals-lose-money-on-medicare-patients/) And Medicaid reimbursement rates are lower than Medicare’s. ---
**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:** [November 2, 2013, 8:15pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/487 "2013-11-02T20:15:25Z")
And yet they participate. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [November 2, 2013, 8:16pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/488 "2013-11-02T20:16:51Z")
> [@Really\_Not\_All\_That\_Bright](#): > > And yet they participate. Yes. But your statement “No hospital loses money by participating in Medicare and Medicaid.” is demonstrably wrong. 64% of hospitals do lose money participating in Medicare and Medicaid. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [November 2, 2013, 8:27pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/489 "2013-11-02T20:27:18Z")
> [@Really\_Not\_All\_That\_Bright](#): > > And yet they participate. From that cite: > [@](#): > > …The report also notes that although Medicare payments are currently less than costs for the average hospital, it is possible for some hospitals to make money on Medicare: The median efficient hospital generated a positive 2 percent Medicare margin in 2011… ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [November 2, 2013, 8:28pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/490 "2013-11-02T20:28:09Z")
> [@Really\_Not\_All\_That\_Bright](#): > > And yet they participate. Well, yes they do. And the reason (I’m speculating here, so correct me if I’m wrong) is that they don’t want to be cut out of a huge segment of the market. So, in order to capture some of that market, they charge higher prices for non-medicare/medicaid patients. Now, whether they are actually “losing money” may or may not be true, depending on how you look at it. But it still seems to be the reason that they charge higher rates, when they can, for non-medicare/medicaid patients. So, the question is: how does Obamacare affect this phenomenon? Does it make it better, worse, or pretty much the same? ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [November 2, 2013, 8:28pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/491 "2013-11-02T20:28:54Z")
> [@John\_Mace](#): > > …Well, it’s a good thing Obamacare doesn’t expand the ranks for medicare. Oops… Have you a better idea? A pity you didn’t come up with it sooner, but better late than never… ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [November 2, 2013, 8:31pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/492 "2013-11-02T20:31:53Z")
> [@elucidator](#): > > Have you a better idea? A pity you didn’t come up with it sooner, but better late than never… Ah, the old “Oops, maybe I was wrong, so let’s change the subject before too many people notice” trick. Got nothing better than that? ---
**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:** [November 2, 2013, 8:32pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/493 "2013-11-02T20:32:18Z")
John: it makes it better and worse. There will be far fewer write-offs for ER visits by the uninsured, but there will also be some reimbursement rate cuts for CMS patients. > [@](#): > > Yes. But your statement “No hospital loses money by participating in Medicare and Medicaid.” is demonstrably wrong. 64% of hospitals do lose money participating in Medicare and Medicaid. No, you are missing the point: hospitals which _actually_ lost money accepting Medicaid/Medicare patients would stop doing so. They’re not stupid. The reason they appear to lose money on Medicare patients is that the Feds are the largest single payer, so they can account things like capital improvement as Medicare costs and _appear_ to lose money (to help lobbyists get their reimbursement rates jacked up.) ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [November 2, 2013, 8:33pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/494 "2013-11-02T20:33:55Z")
> [@John\_Mace](#): > > Wait just a cotton pickin’ minute there. We came into this thread argue about the OP, which was Obama’s statement about one aspect of the law. That doesn’t mean we’re all-knowing about the entire law… What part of > [@](#): > > …To oversimplify for the sake of brevity… did you not understand? > [@](#): > > …And you didn’t answer the question. At all. So I must conclude that you don’t know the answer, either. Unless you’d care to try again…? Conclude whatever you like, **John.** No worries. ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [November 2, 2013, 8:34pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/495 "2013-11-02T20:34:43Z")
> [@Really\_Not\_All\_That\_Bright](#): > > No, you are missing the point: hospitals which _actually_ lost money accepting Medicaid/Medicare patients would stop doing so. They’re not stupid. The reason they appear to lose money on Medicare patients is that the Feds are the largest single payer, so they can account things like capital improvement as Medicare costs and _appear_ to lose money (to help lobbyists get their reimbursement rates jacked up.) I said it doesn’t matter whether they are losing money or not, only if they are charging the rest of us more in order to make up for medicare/medicaid and whether or not that will change under Obamacare. That is what the question was. Will Obamacare mean the end of the $25 aspirin? Yes or no? ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [November 2, 2013, 8:38pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/496 "2013-11-02T20:38:25Z")
> [@Really\_Not\_All\_That\_Bright](#): > > No, you are missing the point: hospitals which _actually_ lost money accepting Medicaid/Medicare patients would stop doing so. The report from MedPAC, a federal agency, says 64% of hospitals lose money on Medicare patients (and they definitely lose money on Medicaid patients, since Medicaid reimbursement rates are lower than Medicare’s). Is that federal agency lying? As for stopping - not necessarily. Hospitals need volume to maintain themselves. They get that volume from Medicare patients, and cover their losses on those patients by jacking up prices for non-Medicare ones. ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [November 2, 2013, 8:44pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/497 "2013-11-02T20:44:51Z")
> [@elucidator](#): > > What part of > did you not understand? But your “oversimplification” seems to be, well, wrong. > [@](#): > > Conclude whatever you like, **John.** No worries. Forget all the reasons for now. Just answer this simple question: Does Obamacare make the $25/aspirin more or less prevalent, or does it stay about the same. Because, if it doesn’t make it less prevalent, I’m curious as to why you brought that up in defense of that law. Honestly, I don’t know the answer, but I’m not finding anything that tells me it’s going to be less prevalent. ---
**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:** [November 2, 2013, 8:45pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/498 "2013-11-02T20:45:42Z")
> [@](#): > > The report from MedPAC, a federal agency, says 64% of hospitals lose money on Medicare patients (and they definitely lose money on Medicaid patients, since Medicaid reimbursement rates are lower than Medicare’s). Is that federal agency lying? > > As for stopping - not necessarily. Hospitals need volume to maintain themselves. They get that volume from Medicare patients, and cover their losses on those patients by jacking up prices for non-Medicare ones. Exactly: that volume is what keeps them solvent. MedPAC isn’t lying, it is taking the hospitals’ own cost figures at face value. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [November 2, 2013, 8:51pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/499 "2013-11-02T20:51:15Z")
> [@Really\_Not\_All\_That\_Bright](#): > > Exactly: that volume is what keeps them solvent. No, volume is what is needed for prestige and preventing downsizing of the hospital. What keeps them solvent is jacking up prices for non-Medicare/Medicaid patients in order to cover losses on Medicare/Medicaid ones. ---
**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:** [November 2, 2013, 8:59pm UTC](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534/500 "2013-11-02T20:59:05Z")
Prestige? Pull the other one. If they were making a loss on Medicare patients, they’d stop taking them and the savings would allow them to cut private rates. Then they’d get all the private payer patients from other hospitals and not have to downsize. However, that doesn’t happen. So, either: (1) hospital administrators don’t understand business; (2) insurers don’t care what they are being charged; or, (3) they aren’t actually taking a loss. [Previous page](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534.md?page=24) [Next page](https://boards.straightdope.com/t/oops-looks-like-we-were-lied-to-about-obamacare-after-all/672534.md?page=26)