Consulting and the Affordable Care Act 11

[Mr168]

I'm curious as to the thoughts of the Eng-Tips community as to whether we will see the Affordable Care Act have a significant impact on the Engineering Consulting industry.

For a moment, lets put aside the turmoil associated with Obamacare, and operate under the assumption that the ACA won't be repealed any time soon.

The single greatest factor in me not venturing into the world of private consulting has been healthcare. As someone with a number of preexisting medical conditions and a history of cancer, any sort of private health insurance is either a pipe dream, or tremendously cost prohibitive. As much as I hate to entertain the though, Obamacare does provide at least some inkling of a possibility that I could leave the big Fortune 100 EPC's and venture off on my own, with premiums and care much worse than my corporate policy, but not unbearable.

If the ACA manages to stick around, do the folks here anticipate any sort of significant influx of private consultants? Any other anticipated consequences or thoughts on the matter?

 

[Compositepro]

Stalin and Lennin already tried that. It didn't work.

 

[DRWeig]

We need to shoot all the CEOs and continue to do so until things start working the way they're supposed to

I agree, IRstuff, but you left out shooting all the lawyers too.

Anyone supporting the current system of enriching them what has and letting them what don't just perish should read The Puritan Gift

I wish somebody would show some care for the have-nots like me.

Best to you,

Goober Dave

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[IRstuff]

That's only because they stopped shooting when it came to the party itself. ;-)
1986... that was a Republican admin, wasn't it? ...interesting that in a country where "a stitch in time," etc., we were willing to have people wait until their illnesses got to the most expensive point before treating them. This is, of course, contrary to every economic concept in every production environment. But, I soapbox, so fie on that.

TTFN
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[cranky108]

What's wrong with a dual system?
1. You pay for the care you can afford (or have the insurance for).
2. You get for free, treated by doctors that can't be procuscuted for malpractice. Who can't keep a private practice, or who just don't care. You can wait in long lines for what passes for treatment.

You choose.

 

[IRstuff]

"You choose."

Not really a choice when you're poor. Moreover, unless it's a medical emergency, there's actually no treatment at all for the poor. So they wait until it becomes an emergency, and what could have dealt with a few bucks worth of drugs now costs $10k/night in the intensive care. And, they still don't have to pay for it, but I do. The other side of the coin is those that have insurance also have no incentive to manage costs, and demand the latest and "greatest" drugs/therapies/instruments, even though there's no proof that the "new" stuff is any better than the "old" stuff, and the only thing that gets "better" are the suppliers' bottom lines.

The only reason some drugs exist is to maintain the patent rights. When minoxidil first came out, the maker insisted that quantity and concentration were irrelevant. The instant the patent ran out, a new, patented, more concentrated version hit the market.

If I have to pay the bills, I rather it have at least the semblance of efficacy and common sense. Treat things before they get out of hand, promote healthy living/foods, don't use new drugs and therapies unless there's some objective, and non-miniscule, improvement in outcome, etc.

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[PeterVenkman]

In the states, something around 60% of bankruptcies are medically related. I would take substandard care by state paid doctors and longer waits any day over the possibility of being completely cleaned out.

 

[cranky108]

So are you suggesting that poor people never use the "free clinics"? So who uses them?

As far as managing costs, when was the last time you saw a hospitel menu that actually listed the costs? Most people don't bother managing costs, because there is no way to know the cost ahead of time. Just like there is no way to know the death rates of hospitals. Maybe to fix this there needs to be a rating system like restrants have.

In the states it is much cheeper to take a flight to South America and have it preformed there than to have it done in the states. So why does insurance not pay for overseas medicel?
Because most insurance is regulated by the goverment, that's why. The goverment created this problem.

The whole shop around thing dosen't work if you don't know the costs. Besides, percription drugs are cheeper than over the counter, if you have a percription drug plan.

 

[IRstuff]

Just how many "free" clinics are there, really? My impression is that they are far and few between, as demonstrated by the annual free-for-all trying to get a slot in the annual Los Angeles free clinic at the Staples CEnter. Waits are long, and not manageable for people that are hourly and unable to take time off work.


re:costs Of course they don't tell you the true cost. The multipayer insurance system means that you can arbitrarily charge whatever the particular insurance company is willing to pay. Given that many of the engineers complain about the concept of bidding, since that tends to lower the profit line, that forcing the same on doctors would be suggested.

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[cranky108]

So you are saying "free clinics" do work, if you have the time to spend. And apperently with the number of people with medical weed cards, the cost of doctor visits isen't that expencive.

There was a time when my doctor would not give Flu shots. She would send us to the Health Department for that. Now I work for a company that offers them to employees and family.
And some companies have health fairs that do blood pressure, weight, and blood testing. Sure saves on Dr office visits.

We also have discounts for these small care centers, which take care of things like ear infections, which costs much less than the ER.

 

[IRstuff]

There's the hidden cost of losing up to a day's pay, because they have to travel and they have to wait, taking money away from food and shelter. I can certainly understand why someone who gets $7.25/hr might hesitate to essentially blow an entire day's pay as a co-pay to see a "free" doctor. Likewise, I would certainly balk at having to pay a day's wages as a co-pay to see my doctor.

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[cranky108]

Maybe a days pay is the difference between poor, and being a free loader. Poor people can afford to spend a days pay waiting in line.

Just look at the hoops one has to jump through to get into a charter school, versis a normal school. Don't have that with privite schools.

Everything has a cost, and nothing is for free. Someone pays, and if the resources are in short supply you have to pay with your time. It's a sign of how short the supply is, and goverment will never be able to buy all the supply of medical that people demand. There must be a regulating mechanic somewhere. With Free market it is cost. With Socialism it is time.

 

[brandonbw]

I was just in the office of my first job asking what they thought would happen when ACA goes into affect in 2015 for businesses. The office manager didn't have any good things to say about it. I was asking because my company is small and I have my own private health insurance. Grand fathered in but some type of luck. We are looking to maybe expand but everyone tells me just do contract work, don't actually hire anyone. There is something very wrong when a small up and coming company like mine is being told do not hire people. My take is that I would have to pay 3 times as much for the most similar PPO plan and have less benefits.

I don't think the ACA should be the thing to determine if you want to start a business or not. Its just something that you have to be aware of.

B+W Engineering and Design
Los Angeles Civil Engineer and Structural Engineer

http://bwengr.com

 

[JohnRBaker]

And this is exactly the same argument that was made when Social Security and unemployment insurance was first introduced.

Anyone or any business that thinks that they are not already paying the costs of people without insurance should be asking themselves who pays for the $600 ER visits for a sore throat or the person who misses four days of work for something that if they had been able to go to a doctor before it debilitated them they might have been able to have stayed on the job with a minimal lost of productivity? Or the other side of that coin, a person who DOES come to work but who's so ill that they give something to their fellow employees that ends up costing a lot more than just one employee missing work, all because they could not afford to see a doctor on their own? Society as a whole is already bearing the costs of medical care, just not always in a direct or visible manner, but it's all comes out of someone's pocket. It would be different if the US was currently paying significantly less per person for medical care than in those countries which already has some sort of universal health care, be it outright socialized medicine, which the ACA it a LONG ways from, or something closer where citizens are required to purchase insurance coverage, often thru some national plan not all that different than Medicare and where the poor are covered by either a public medical service or by subsidized coverage like Medicaid. But that is NOT the case. While the US has the highest per capita health care costs in the developed world, we are not necessarily getting the best overall medical care or getting the best medical results.

http://www.pbs.org/newshour/rundown...how-the-us-compares-with-other-countries.html

http://www.huffingtonpost.com/2013/10/03/health-care-costs-_n_3998425.html#

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

 

[NorthCivil]

As a Canadian looking into hanging my own shingle, worrying about healthcare has never crossed my mind. I cant imagine having to worry about healthcare as a burden in regards to starting my own business.

As a driven, hard working guy, I've often idealized the American system. My perspective has been that, due to lower taxes, an entrepreneur could make much more money. I had never thought about the realities of healthcare, and the lack of a public system, which serves as a major barrier to entrepreneurship in the US.

Gives an interesting perspective. Though once a business is established and making real money, business may pay more tax in Canada than the US, there is easier access to the market for individuals looking to open shop in the frozen north.

 

[beej67]

I would like to take this time to remind everyone that the NSA's affiliates reads discussion forums.

http://www.nrc.nl/nieuws/2013/11/30/dutch-intelligence-agency-aivd-hacks-internet-fora/

And that they compile a threat matrix score for everyone.

http://www.dailykos.com/story/2013/...rd-What-NSA-Does-With-All-They-Know-About-You

"Throw the bums out of Washington" is a very valid and worthwhile opinion, until the bums decide they want to fight back, and they've been practicing murdering insurgent goat farmers with flying death robots for over a decade. In today's age, you have to watch what you post.

Hydrology, Drainage Analysis, Flood Studies, and Complex Stormwater Litigation for Atlanta and the South East -

http://www.campbellcivil.com

 

[KENAT]

"flying death robots"

beej67, I fear your tin foil hat may be on a little tight.

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[JohnRBaker]

And yet after warning us, you still saw fit to write something like "...and they've been practicing murdering insurgent goat farmers with flying death robots for over a decade." which contains at least a few words that I'm sure would 'ring some bells' along the Washington Parkway ;-)

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.

 

[MacGyverS2000]

beej67, I fear your tin foil hat may be on a little tight.

It's squeezing the logical thought right out of him...

Dan - Owner

http://www.Hi-TecDesigns.com

 

[cranky108]

You know if we all followed logical thought, we might all come to about the same conclusions. And worse, there would not be most of the crap that are in the stores today.

You know there is a type of freedom in being stupid. "50 thousand a year will buy a lot of beer".

After all isen't the Affordable care act about spreading and reducing the cost of being stupid?

 

[JohnRBaker]

Just like any other actuarial-based underwriting scheme.

John R. Baker, P.E.
Product 'Evangelist'
Product Engineering Software
Siemens PLM Software Inc.
Industry Sector
Cypress, CA
Siemens PLM:
UG/NX Museum:

To an Engineer, the glass is twice as big as it needs to be.