Hate to break it to ya, but YOU are the goverment. I am the goverment. We're ALL the goverment.

The ruling on ACA is a beginning.

but we can take back our representative goverment from the Rich, Powerful and Greedy who for the last 30 years have been stealing our power, treasure and future for themselves.

5. Upticks in horizontal integration. Some hospitals won't be able to integrate care and service lines alone and will need to partner with other systems, which is already happening. Community hospital systems may not have the necessary assets to achieve clinical integration.

"When they do the math, they will find it's more attractive to part of a larger system that has the necessary resources," Dr. Saxena says.

It may be very difficult for smaller hospitals to implement data analytics, acquire and partner with more physicians, as well as redesign care delivery models alone.

"All these things are very expensive and pretty difficult for standalone community hospitals to be able to pull off," Dr. Saxena notes.

With 32 million newly insured Americans entering the healthcare system, addressing the nation’s physician shortage — projected to climb to more than 90,000 by 2020 — is now more critical than ever. Medical schools have done their part, increasing enrollments during the last six years in response to these shortage projections. But the overall supply of U.S. physicians cannot expand unless Congress increases the number of federally funded residency training positions, a number that has been frozen since 1997.

We urge Congress to move quickly to provide more federal support for additional doctor training to ensure that Americans have access to care — not just an insurance card.

Hate to break it to ya, but YOU are the goverment. I am the goverment. We're ALL the goverment.

Every point I made you disagreed with you response back that I am parroting.. I am offended and there is nothing that you have brought to the table other than idiocy.

People need to recognize that all government is not evil, maybe highly inefficient, but not evil. That some services, needed by the majority of us, would be good.

That's because every talking point they post are parroted talking points of Maddow/Maher.

P.S.: My health insurance premium just now went up by another $121 per month, out of my pocket. Thanks.

Your post is extremely naive and takes a whole bite of the talking points of the faux news POV. Sorry but either fix

P.S.: My health insurance premium just now went up by another $121 per month, out of my pocket. Thanks.

The result of the "haves" trying to shaft the "have nots". Guess you'll just have to live with it until the PPACA totally kicks in. Then there will be no way the "haves" can continue to shut out the "have nots".

your premium went up because of a practice known as "hedging" which is common in business. In other words, the "haves" anticipate droughts in their solvency and raise prices accordingly

In Germany, the "provincial government" had more than enough doctors for us to choose from ... and took a census every few years just to make sure the population was taken care of. I lived in a very provincial place ... surrounded (back then) 3/4 by the East German border ... but never had a problem finding a physician to help my growing family.

I lived in Florida ... worked as a nurse there and am quite aware of the Canadian Snowbirds who have "elective" surgery in Florida.

Again, it's a good business down there because a lot of the Canadians' elective surgery is in fact cosmetic surgery ... often cosmetic surgery that they don't necessarily want their friends to know about ... face lifts, nose jobs, breast augmentations, liposuctions ... even bariatric surgery that doctors up in Canada don't consider absolutely necessary, but American doctors appear to be able to do ... especially if the customer is paying cash....
I can well imagine that the "elective (cosmetic) surgery" in Canada would be put on the back burner

Well here are the facts about German Health Care...

Orderly in a hospital...EH?

Glad to see that there is somebody here who knows what he is talking about! I was thinking the same thing but you capsulized it better then I could have.

The negotiation that takes place between care providers (such as the above-mentioned hospital group) and insurance providers equates to a discussion of the prices consumers will pay. When insurance companies see their prices driven up by powerful, monopolistic health groups, these price hikes are passed onto consumers in the form of higher premiums.

The danger here is that the PPACA is set to ignite these tendencies among hospitals nationwide. Because the Act imposes burdensome regulations that increase administrative expenditures and threaten noncompliance costs, individual doctors and small practices are coerced into mergers.
•According to one analysis, the number of hospital mergers and acquisitions has increased by more than 50 percent since the law's passage.
•The last big wave of consolidations, in the 1990s, caused market prices nationwide to climb by at least 5 percent, and as much as 40 percent in some markets.

Source: Margot Sanger-Katz, "The New Goliaths," National Journal, February 16, 2012.

Investment bankers who work on mergers and acquisitions in the healthcare services industry privately concede that there is a lot of activity among health plans looking to acquire physician networks. So far, the large health plans have not been able to buy as many assets as the hospitals. For their part, the doctors seem to prefer to sell their practices to hospitals rather than the health plans.

“As the reform law is implemented, health plans will continue to focus on promoting affordability and peace of mind for their beneficiaries. The law expands coverage to millions of Americans, a goal health plans have long supported, but major provisions, such as the premium tax, will have the unintended consequences of raising costs and disrupting coverage unless they are addressed.

“Health plans will continue to work with policymakers on both sides of the aisle to make coverage more affordable, give families and employers peace of mind, and promote choice and competition. Health plans also will continue to lead efforts to reform the payment and delivery system to promote prevention and wellness, help patients and physicians manage chronic disease, and reward quality care.”

Blue Cross and Blue Shield Association President and Chief Executive Officer Scott Serota also emphasized the tax, saying in a statement that the nation's 39 Blue Cross and Blue Shield plans, which cover about 100 million people, “will continue to implement the law while working with policy makers to fix provisions that will increase costs, such as the health insurance tax that will add hundreds of dollars to families' premiums each year.”

1. Starting in 2014, the hiring of a company's 50th worker will cost an extra $40,000 per year. PPACA raises employment costs by requiring employers to offer qualifying insurance coverage or else pay a penalty. Because this requirement will apply only to firms with more than 49 full-time employees, it will discourage the hiring of full-time workers. Firms with more than 49 workers will have to pay $2,000 a year for each employee without qualifying coverage (the first 30 workers are exempt).

Clueless

Sure it is ... not even a link where you might have picked up your information ... out of your head?

Just keep those cosmetic surgeries coming our way ... maybe your cousin is one of the so-called doctors performing them so he can bolster his income from Canada. Does he file with the IRS on his income here in the US?

Prove it wrong!

Hardly.

We will clean up the mess lord knows you orderly's clean up enough messes at work.

The Commerce Department said Friday that consumer spending was unchanged in May. Income growth edged up 0.2%, but that was mostly because of gains from investments. Wages, the largest component of income, were essentially flat.

Well here are the facts about German Health Care...
In Germany, health insurees are covered either by statutory health insurance (SHI) or private health insurance (PHI). Due to a 20%–35% higher reimbursement of physicians for patients with PHI, it is often claimed that patients with SHI are faced with longer waiting times when it comes to obtaining outpatient appointments.
Germany shows clear differences in access to care, with SHI patients waiting 3.08 times longer for an appointment than PHI patients. Wide-spread anecdotal reports of shorter waiting times for PHI patients were empirically supported. Discrepancies in access to care not only depend on accessibility to comprehensive health insurance cover, but also on the level of reimbursement for the physician.

Conclusion: Even with comprehensive health insurance coverage for almost 100% of the population, Germany
shows clear differences in access to care, with SHI patients waiting 3.08 times longer for an appointment than PHI
patients. Wide-spread anecdotal reports of shorter waiting times for PHI patients were empirically supported.
Discrepancies in access to care not only depend on accessibility to comprehensive health insurance cover, but
also on the level of reimbursement for the physician. Higher reimbursements for the provider when it comes to
comparable health problems and diagnostic treatments could lead to improved access to care. We conclude that
incentives for adjusting access to care according to the necessity of treatment should be implemented.

I can compound on this point a tad further: your premium went up because of a practice known as "hedging"

its a win win for them

In theory (based on how insurance systems work), once the PPACA takes effect, premiums will go down significantly across the board.

why not take the "free market" approach and shop for a better price?

Personally, I do shop around for health care.
Now I will have to figure in the price of taxes or a penalty in my search

IMO it's not really a "win win" so much as a "win/guarantee not to lose so we can still continue operating as a business because these are the cash reserves we need to keep paying claims."

A theory which basically proves the people that put this forward don't really know how insurance or health care systems, or general consumer behavior work, or it wasn't about that at all.

Premiums will go down because they are redefining what a premium is.
If I don't have to buy insurance, only pay a tax, then that tax is my new premium.
Your tax bill is your new "premium," helping my insurance/health care premiums go down.
So thanks.

Personally, I do shop around for health care.
Now I will have to figure in the price of taxes or a penalty in my search.
I have always paid cash for health care, and gotten it pretty reasonable.
But now the government is mandating I pay them more of my cash.
So I have less to pay my doctor.

I have always paid cash for health care, and gotten it pretty reasonable.

Personally, I do shop around for health care.
Now I will have to figure in the price of taxes or a penalty in my search.

But now the government is mandating I pay them more of my cash.

Health-care provision at center of Supreme Court debate was a Republican idea
By N.C. Aizenman, Published: March 26

As the Supreme Court moves Tuesday to the heart of the challenge to President Obama’s signature health-care law, there is a curious twist: The case largely rests on the constitutionality of a provision that originated deep in Republican circles.

The individual insurance mandate, which requires virtually all Americans to obtain health coverage or pay a fine, was the brainchild of conservative economists and embraced by some of the nation’s most prominent Republicans for nearly two decades. Yet today many of those champions — including presidential hopefuls Mitt Romney and Newt Gingrich — are among the mandate’s most vocal critics.

Meanwhile, even as Democratic stalwarts warmed to the idea in recent years, one of the last holdouts was the man whose political fate is now most closely intertwined with the mandate: President Obama.

“The ironies to this story are endless and everywhere,” said John McDonough, a professor at the Harvard University School of Public Health who, as a Senate Democratic staffer, played a key role in drafting the law.

The tale begins in the late 1980s, when conservative economists such as Mark Pauly, a professor at the University of Pennsylvania’s Wharton School of business, were searching for ways to counter liberal calls for government-sponsored universal health coverage.

“We wanted to find an alternative that was more consistent with market-oriented economic ideas and would involve less government intervention,” Pauly said.

His solution: a system of tax credits to ensure that all Americans could purchase at least bare-bones “catastrophic” coverage.

Pauly then proposed a mandate requiring everyone to obtain this minimum coverage, thus guarding against free-riders: people who refuse to buy insurance and then, in a crisis, receive care whose costs are absorbed by hospitals, the government and other consumers.

Heath policy analysts at the conservative Heritage Foundation, led by Stuart Butler, picked up the idea and began developing it for lawmakers in Congress.

By 1993, when President Bill Clinton was readying his major health-care overhaul bill, the Heritage approach — subsidizing and facilitating the purchase of private health plans, while using the individual mandate to maximize participation — had gelled as the natural Republican alternative.

Then-Sen. John H. Chafee (R-R.I.) formally proposed it in a bill that attracted 20 Republican co-sponsors; the bill foundered once Clinton’s effort unraveled. But the idea of the mandate gained currency in the ensuing years as Democrats chastened by the failure of the Clinton plan began considering new solutions more likely to attract bipartisan support.

The Massachusetts plan

That process came to a head in 2004 when Mitt Romney, then governor of Massachusetts, turned to then-Sen. Edward M. Kennedy (D-Mass.) for help adopting a health-care overhaul for the state that was largely based on providing residents with government subsidies to buy private insurance.

The plan, signed into law in 2006, regulated insurance companies to a degree beyond anything Pauly had envisioned: For instance, they were barred from excluding or charging higher premiums to people with preexisting health conditions.
But this only heightened the conviction of the health-care plan’s Republican backers that an individual mandate was needed. Without it, they argued, people could wait until they were sick to buy insurance, forcing insurers to pull out of the market or cover the extra cost by massively increasing rates.

McDonough said it is hard to overstate the significance of Kennedy agreeing to take on the free-market ideas advanced by Romney.

“The alliance between Romney and Kennedy was of fundamental importance in terms of creating a level of confidence going into [the] 2008 [presidential elections] that this could actually be the bipartisan path to achieve universal health care in the United States,” he said.

The no-mandate candidate

Indeed, during the 2008 Democratic primary race, candidates Hillary Rodham Clinton, John Edwards and Obama all proposed health-care overhaul plans that shared some features of the Massachusetts system.

But while Clinton and Edwards included an individual mandate, Obama did not (although he did propose requiring parents to get coverage for their children).

Over successive debates and primary battles, Obama hammered the issue as a key difference between himself and Clinton.

“What’s she not telling you about her health-care plan?” said an advertisement for Obama. “It forces everyone to buy insurance, even if you can’t afford it, and you pay a penalty if you don’t.”

“In retrospect, I think Obama had an accurate sense of public opinion about the mandate,” said Paul Starr, a health policy expert at Princeton University, who supports the law but argues that Democrats should have come up with other policies to accomplish the goals of the mandate.

Obama’s views had evolved by December 2008, when, a month after winning the presidential election, he discussed the mandate with former Senate majority leader Thomas A. Daschle (D-S.D.), his nominee for health and human services secretary.

“To my pleasant surprise, the president-elect told us, for the first time, that he might be willing to reconsider his thinking,” Daschle wrote in his book “Getting It Done: How Obama and Congress Finally Broke the Stalemate to Make Way for Health Care Reform.”

The GOP shift

For a while the mandate also retained the support of many prominent Republicans. But as negotiations with Democrats over the health-care bill fell apart in the spring of 2009 — and Republicans spent their August 2009 recess at town hall meetings where furious tea party activists accused them of fomenting a government takeover of health care — positions on the mandate started to shift.

That September, Sen. Charles E. Grassley (R-Iowa), a co-sponsor of the 1993 Chafee bill containing the mandate and a vocal supporter of the idea just three months earlier, declared that “individuals should maintain the freedom to choose whether to purchase health insurance coverage or not.”

During floor debates over the health-care legislation that fall and winter, the mandate took a back seat to more contentious issues relating to abortion, Medicare and the expansion of government regulation.

Still, it continued to build as a political issue after the law’s adoption in 2010, as 27 states began having success with legal challenges largely centered on the mandate’s constitutionality.

Today, opposition to the mandate has become a kind of litmus test of conservative purity. Romney and Gingrich have each struggled, with mixed success, to disavow their former statements in support of it.

Intellectual authors of the idea at the Heritage Foundation have filed legal briefs contesting the mandate and have published mea culpas. “We had made a mistake,” Butler wrote, explaining that “health research and advances in economic analysis have convinced people like me that an insurance mandate isn’t needed to achieve stable, near-universal coverage.”

There is at least one remaining conservative defender: the man who helped start it all, Mark Pauly. He is no fan of the other provisions in 2010 health-care law. Still, he said, when it comes to the mandate, “personally, I think it’s wise public policy.”

"The evidence from Massachusetts would suggest that national health reform does not imply job loss and stymied economic growth," the report concluded.

The Congressional Budget Office projects the law will have complicated effects on the labor market that will shrink it by approximately half a percent -- 800,000 people -- mostly because people will choose to work less or not at all because they will have access to subsidized health care coverage. Some older people who only keep their jobs for the health insurance also would be able to retire, CBO director Douglas Elmendorf testified before Congress in 2010.

Costs for MassHealth, the state's Medicaid program, are expected to grow by $518 million to $11.1 billion. Servicing state debt will increase by $178 million to $2.435 billion and pensions will jump by $74 million to $1.5 billion.

The increase in health care, safety net services and legal obligations such as debt and pensions means that many other state services will receive no increases or even reductions.

Teenage pregnancy prevention, for example, was cut to $2.284 million, down 4 percent, or $94,000, resulting in service losses for 1,000 people, the administration said. A medium-security state prison in the southeastern part of the state would be closed, saving $8.9 million.

Public defenders currently handle about 25 percent of the cases involving people who can't afford to hire their own lawyer. The cost of defense for the indigent would be reduced by about $20 million if the additional staff public defenders are hired, according to the budget.

The budget also seeks to end certain support services for about 1,750 families with developmentally disabled members, saving $5.5 million. The program is funded at $41 million for the new fiscal year.

The budget also calls for an increase of 50 cents in the state's $2.51 per pack tax on cigarettes to take effect on Aug. 1, raising $62.5 million to help pay for court-mandated state subsidized health insurance for legal immigrants who are eligible. Patrick also resurrected a past idea to impose the state's 6.25 percent sales tax on candy and soda, generating $61.5 million for public health services.

The budget also cuts $1.5 million, or 24 percent, from a $6.3 million program to provide free or subsidized meals to elderly people at local councils on aging, eliminating 240,000 lunches, the administration said.

It is a huge risk and to not understand why people oppose such a huge change is just plain ignorant.

A 2004 Institute of Medicine (IOM) report said: "The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population." A 2004 OECD report said: "With the exception of Mexico, Turkey, and the United States, all OECD countries had achieved universal or near-universal (at least 98.4% insured) coverage of their populations by 1990. The 2004 IOM report observed "lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States." while a 2009 Harvard study estimated that 44,800 excess deaths occurred annually due to lack of health insurance.

The 2004 IOM report observed "lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States." while a 2009 Harvard study estimated that 44,800 excess deaths occurred annually due to lack of health insurance