# What is your ongoing opinion of the Affordable Care Act? (Title Edited) **URL:** \ **Category:** Politics & Elections\ **Created:** [January 17, 2013, 11:21pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561 "2013-01-17T23:21:39Z")\ **Posts on this page:** 20\ **Page:** 67
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [January 28, 2014, 4:56pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1322 "2014-01-28T16:56:55Z")
If they would rather die, they had better do it, and decrease the surplus population. ---
**Author:** ![lance\_strongarm](https://avatars.discourse-cdn.com/v4/letter/l/87869e/32.png) [@lance\_strongarm](https://boards.straightdope.com/u/lance_strongarm)\ **Post date:** [January 28, 2014, 4:59pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1323 "2014-01-28T16:59:20Z")
> [@Terr](#): > > Let’s take a “real life” case. [It takes 217 high-risk people taking annual CT to save one life from lung cancer.](http://www.thennt.com/nnt/ct-scans-to-screen-for-lung-cancer/) A CT scan at a cheap place is something like $500. Let’s say those high-risk people continue those CT scans for 20 years (reasonable, right?). The cost: $2M. That is WAY more than [treating lung cancer costs](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150743/) for one person, by order of magnitude at least. > > Is that “reality based”? The document I posted just above is a good response. ---
**Author:** ![TimeWinder](https://avatars.discourse-cdn.com/v4/letter/t/bcef8e/32.png) [@TimeWinder](https://boards.straightdope.com/u/TimeWinder)\ **Post date:** [January 28, 2014, 5:00pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1324 "2014-01-28T17:00:53Z")
> [@Terr](#): > > Let’s take a “real life” case. [It takes 217 high-risk people taking annual CT to save one life from lung cancer.](http://www.thennt.com/nnt/ct-scans-to-screen-for-lung-cancer/) A CT scan at a cheap place is something like $500. Let’s say those high-risk people continue those CT scans for 20 years (reasonable, right?). The cost: $2M. That is WAY more than [treating lung cancer costs](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150743/) for one person, by order of magnitude at least. > > Is that “reality based”? No, since they don’t give “annual CT scans” to most people – in fact frequent CT scans are a really, really bad idea for “most people.” For the high-risk population here, it may well be fine, since “treating lung cancer” is basically just palliative care until they die unless you catch it early…say by the annual CT scan. So sure: here’s a population that will cost more in health care than average. I don’t think there’s anyone claiming such populations don’t exist, but it’s obviously an outlier with regard to preventative care, which is more typically things like checkups and immunizations. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [January 28, 2014, 5:03pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1325 "2014-01-28T17:03:28Z")
> [@lance\_strongarm](#): > > The document I posted just above is a good response. Try it in your own words. You’re saying that spending $2M to save potentially $100K or so is good because why? ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [January 28, 2014, 5:07pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1326 "2014-01-28T17:07:29Z")
> [@TimeWinder](#): > > No, since they don’t give “annual CT scans” to most people – in fact frequent CT scans are a really, really bad idea for “most people.” For the high-risk population here, it may well be fine, since “treating lung cancer” is basically just palliative care until they die unless you catch it early…say by the annual CT scan. So sure: here’s a population that will cost more in health care than average. I don’t think there’s anyone claiming such populations don’t exist, but it’s obviously an outlier with regard to preventative care, which is more typically things like checkups and immunizations. First of all, there was an absolute statement I was responding to: “False. Screenings and early treatment are much, much cheaper than late treatment, and save the cost of more expensive treatments later.” It didn’t say “in some cases”. Or even “in most cases”. Second, immunizations - yes. Checkups - not really. [Annual physicals have been shown not to be cost-effective at all, for example](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038801/). ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [January 28, 2014, 5:23pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1327 "2014-01-28T17:23:29Z")
> [@TimeWinder](#): > > No, since they don’t give “annual CT scans” to most people – in fact frequent CT scans are a really, really bad idea for “most people.” Did you miss the words “high-risk people” in what I posted? > [@](#): > > For the high-risk population here, it may well be fine, since “treating lung cancer” is basically just palliative care until they die unless you catch it early…say by the annual CT scan. So sure: here’s a population that will cost more in health care than average. We’re not talking about that. We’re talking about people claiming that all preventive screenings save money. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [January 28, 2014, 5:24pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1328 "2014-01-28T17:24:12Z")
There are many studies on whether preventive care spends money, and just as many say it doesn’t as does. I guess it all depends on which preventive services. Contraception sure as hell doesn’t save money, because it tends to only change when women have kids, not if. So you pay for both the birth control and the birth. And BTW, that was another part of essential coverage: maternity services. Not everyone needs maternity services, yet now people have to pay for them whether they need them or not. For cancer patients who now lose access to their doctors, I’m sure they are grateful that now their pregnancy will be covered. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [January 28, 2014, 5:25pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1329 "2014-01-28T17:25:41Z")
> [@Terr](#): > > We’re talking about people claiming that all preventive screenings save money. While we’re at it, let’s also talk about the propensity of liberal Dopers to just say things without support. Lance cited a study, but the first poster who made that statement just took it as obvious. ---
**Author:** ![Buck\_Godot](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/buck_godot/32/6573_2.png) [@Buck\_Godot](https://boards.straightdope.com/u/Buck_Godot)\ **Post date:** [January 28, 2014, 5:31pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1330 "2014-01-28T17:31:48Z")
> [@adaher](#): > > [Page Not Found » Search » Washington Policy Center](http://www.washingtonpolicy.org/publications/legislative/being-medicaid-better-having-no-insurance-all) > > [http://www.americansurgical.info/abstracts/2010/18.cgi](http://www.americansurgical.info/abstracts/2010/18.cgi) > > The 2003 study showed that Medicaid patients were more likely to die in surgery than those with no insurance at all. > > The more recent Oregon study should be known to all of you, and it showed no improved health outcomes for Medicaid patients. Where to start. First I would note that the cite for the study is a meeting abstract not an actual peer reviewed article, which generally means that it is a bit preliminary and half baked. If at all possible I would never cite one in a paper I was writing. Usually if the results are any good, the presenters will later write it up into a full peer reviewed paper, so it is suspicious that they cited the abstract rather than the paper. The[nearest published study](http://www.journalacs.org/article/S1072-7515%2811%2900010-X/abstracthttp://) by these authors that I did track down restricted the study set to cardiac valve operations, probably indicating that mixing all of the available operations was seen as problematic, probably because the different surgeries had vastly different mortality rates and their prevalence may have differed among the insurance groups. In the revised study, the effect you mention (which was weak and probably not statistically significant to begin with) seems to have entirely reversed. Now when adjusted for covariates, the mortality odds ratio for Medicare vs insured is 1.36, while uninsured vs insured in 2.01\* which, based on the confidence intervals presented in the paper, is a highly statistically significant difference. Long story short, Adher, be wary of non scientific citations of scientific studies. Particularly from sources that bill themselves as “improving lives through market solutions” indicating they might just have the tiniest little bit of an agenda going. \*this is from the full text of the paper which may not be available to you. ---
**Author:** ![TimeWinder](https://avatars.discourse-cdn.com/v4/letter/t/bcef8e/32.png) [@TimeWinder](https://boards.straightdope.com/u/TimeWinder)\ **Post date:** [January 28, 2014, 5:42pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1331 "2014-01-28T17:42:35Z")
> [@Terr](#): > > Try it in your own words. You’re saying that spending $2M to save potentially $100K or so is good because why? > [@Terr](#): > > It didn’t say “in some cases”. Or even “in most cases”. > [@Terr](#): > > Did you miss the words “high-risk people” in what I posted? > We’re not talking about that. We’re talking about people claiming that all preventive screenings save money. I’m assuming you’re being deliberately obtuse in order to score some sort of “gotcha” points, but in case you really do need it spelled out in small words: Insurance is about averages. Not about individual people or populations. It’s risk averaging and cost averaging. The adults in the room are taking it for granted that that’s understood, and not adding every possible qualifier to their sentences, nor cherry-picking individual subsets. If you want to have an honest discussion about this…we can. But your posts read like a game of “Simon Says.” ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [January 28, 2014, 5:49pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1332 "2014-01-28T17:49:51Z")
> [@TimeWinder](#): > > I’m assuming you’re being deliberately obtuse in order to score some sort of “gotcha” points, but in case you really do need it spelled out in small words: Insurance is about averages. Not about individual people or populations. It’s risk averaging and cost averaging. Really. “Risk averaging” and “cost averaging” is not about populations? Do you ever read what you post? ---
**Author:** ![iiandyiiii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iiandyiiii/32/7924_2.png) [@iiandyiiii](https://boards.straightdope.com/u/iiandyiiii)\ **Post date:** [January 28, 2014, 5:57pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1333 "2014-01-28T17:57:09Z")
nm ---
**Author:** ![Buck\_Godot](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/buck_godot/32/6573_2.png) [@Buck\_Godot](https://boards.straightdope.com/u/Buck_Godot)\ **Post date:** [January 28, 2014, 6:02pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1334 "2014-01-28T18:02:12Z")
> [@Terr](#): > > Let’s take a “real life” case. [It takes 217 high-risk people taking annual CT to save one life from lung cancer.](http://www.thennt.com/nnt/ct-scans-to-screen-for-lung-cancer/) A CT scan at a cheap place is something like $500. Let’s say those high-risk people continue those CT scans for 20 years (reasonable, right?). The cost: $2M. That is WAY more than [treating lung cancer costs](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150743/) for one person, by order of magnitude at least. > > Is that “reality based”? FYI: If you actually read what you linked to you would realize that the 1/217 reduction in mortality was observed over a 6.5 year study, so we are talking at most 6.5 scans not 20. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [January 28, 2014, 6:04pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1335 "2014-01-28T18:04:30Z")
> [@Buck\_Godot](#): > > FYI: If you actually read what you linked to you would realize that the 1/217 reduction in mortality was observed over a 6.5 year study, so we are talking at most 6.5 scans not 20. Make it 6.5 years. It is still hugely not cost-effective. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [January 28, 2014, 6:05pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1336 "2014-01-28T18:05:30Z")
Interesting fact: The US government spends more on government-provided health care than most countries, despite the fact our system isn’t universal. That says that we can provide universal health care without increasing the health care budget. And we should expect that it won’t cost a penny more before agreeing to it. ---
**Author:** ![Gyrate](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gyrate/32/3588_2.png) [@Gyrate](https://boards.straightdope.com/u/Gyrate)\ **Post date:** [January 29, 2014, 10:30am UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1337 "2014-01-29T10:30:52Z")
> [@adaher](#): > > Interesting fact: The US government spends more on government-provided health care than most countries, despite the fact our system isn’t universal. > > That says that we can provide universal health care without increasing the health care budget. And we should expect that it won’t cost a penny more before agreeing to it. Only if you completely ignore transition costs. Nye Bevan famously quipped that in order to overcome resistance by the Conservatives and the medical establishment to the NHS he “stuffed their mouths with gold”, and that was in the late 1940s. These days there are a lot more mouths to stuff, and they’ve got bigger appetites. ---
**Author:** ![Buck\_Godot](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/buck_godot/32/6573_2.png) [@Buck\_Godot](https://boards.straightdope.com/u/Buck_Godot)\ **Post date:** [January 29, 2014, 7:32pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1338 "2014-01-29T19:32:46Z")
> [@Terr](#): > > Make it 6.5 years. It is still hugely not cost-effective. Using the revised numbers you get about 700k per life saved, possibly less because those in the control group whose cancer could have been detected near the end of the study might not die until after the end of the study. So from here I guess it depends on how much value you place on human life (wasn’t it your side that was complaining about death panels?). Jury awards of 1 million+ are not uncommon in wrongful death suits so this may be a bargain. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [January 29, 2014, 8:09pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1339 "2014-01-29T20:09:12Z")
> [@Buck\_Godot](#): > > Using the revised numbers you get about 700k per life saved, possibly less because those in the control group whose cancer could have been detected near the end of the study might not die until after the end of the study. So from here I guess it depends on how much value you place on human life (wasn’t it your side that was complaining about death panels?). Jury awards of 1 million+ are not uncommon in wrongful death suits so this may be a bargain. Once again, I was responding to: “Screenings and early treatment are much, much cheaper than late treatment, and save the cost of more expensive treatments later.” The “more expensive treatment later” for lung cancer is a lot less than $700K. QED. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [January 29, 2014, 8:54pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1340 "2014-01-29T20:54:12Z")
Now that Republicans have an alternative plan, I have a question for ACA supporters: Let’s say they win it all in 2016 and pass their plan in 2017. Would you consider that the utter defeat of ACA, or the entrenching of ACA’s most important aspects, and thus a victory? ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [January 29, 2014, 9:09pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1341 "2014-01-29T21:09:59Z")
> [@adaher](#): > > Now that Republicans have an alternative plan, I have a question for ACA supporters: > > Let’s say they win it all in 2016 and pass their plan in 2017. Would you consider that the utter defeat of ACA, or the entrenching of ACA’s most important aspects, and thus a victory? By using the same standards you judged Obamacare on; if one person loses their Obamacare policy, the Republican plan is an utter failure. [Previous page](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561.md?page=66) [Next page](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561.md?page=68)