Post by: Zoot on November 09, 2016, 04:15:00 AM
Today, I'm still petrified, but I seem to have activated the steely-spined pragmatist that lives within me for times such as these.
I have many questions about what to do now--on both the micro and macro scale. The most important practical question right now, given that open enrollment ends on 11/10 for DH and 11/11 for me is what to do about health insurance.
I was ready to move to a HDP with an HSA (away from the HMO plan I've been on for a number of years). However, given that Obamacare is likely to be repealed on Day 1 of the new Congress, I am strongly re-considering that decision.
My belief is that everything related to pre-existing conditions will be blown away once Obamacare is repealed: that insurers will go back to being able to DENY coverage to new customers for pre-existing conditions, and that if you are not denied coverage in general, that they can and will deny PAYING for treatments related to pre-existing conditions.
I would pay < $500/year for the HDP/HSA that I was about to sign up for through my employer. Coverage under DH's employer with the HMO would cost about $3000/year, give or take.
My question to you, for myself and for the many whom I'm sure are in similar situations: is all of the above true? Should I stay put, or go ahead and make the move?
Post by: ShoulderThingThatGoesUp on November 09, 2016, 04:33:23 AM
Post by: KBecks on November 09, 2016, 05:04:46 AM
Post by: slb59 on November 09, 2016, 05:11:23 AM
Absolute worst case scenario is that the provisions aren't there in 2018. Since they are calling for repeal and replace now, instead of the repeal of four years ago, it's pretty likely there will be something regardless. That said, the part of Obamacare you're most concerned about is pretty popular. Maybe it'll be replaced, but I can see it sticking around, too.
Post by: mskyle on November 09, 2016, 06:02:57 AM
Remember how the Democrats weren't very good at passing universal health care when they had control of Congress and the Presidency? Republicans won't be very good at repealing it. Trump isn't even an economic conservative.
This, however, sounds like very wishful thinking to me - the Republicans have been promising to dismantle ACA ever since it was implemented and with control of the House, Senate, and Presidency I don't see what would stop them (filibuster, maybe). I guess if they want to do it well, that will take time, but if they just want to repeal, they will probably be able to do that pretty soon.
Post by: Malum Prohibitum on November 09, 2016, 08:02:14 AM
with control of the House, Senate, and Presidency I don't see what would stop themPolitical will - there is a big difference between talking about something and actually doing it. For instance, I do not see coverage of pre-existing conditions going away even with Republicans in control of Congress. They will do something, sure, but I am not at all hopeful that it is going to make insurance affordable for me again like it was before the ACA.
Post by: TheInsuranceMan on November 09, 2016, 08:08:39 AM
with control of the House, Senate, and Presidency I don't see what would stop themPolitical will - there is a big difference between talking about something and actually doing it. For instance, I do not see coverage of pre-existing conditions going away even with Republicans in control of Congress. They will do something, sure, but I am not at all hopeful that it is going to make insurance affordable for me again like it was before the ACA.
This, so much this.
They won't take away pre-existing coverage. It'd be a slap in the face to the nation, and I don't see that part being repealed. However, something new will come down the line, remove the mandate on carrying health insurance, remove the subsidy, and make it once again affordable. Yes, for those that are low income (me, I'd have a subsidy, but I have insurance through work), it might have worked. But, in my area, which is rural, and heavy in farming, the premiums are ranging from $700-$1500 a month, for 2 people, husband and wife, with deductibles over $5k. Seems affordable, right?
Post by: dividendman on November 09, 2016, 08:21:25 AM
Post by: mskyle on November 09, 2016, 08:31:16 AM
with control of the House, Senate, and Presidency I don't see what would stop themPolitical will - there is a big difference between talking about something and actually doing it. For instance, I do not see coverage of pre-existing conditions going away even with Republicans in control of Congress. They will do something, sure, but I am not at all hopeful that it is going to make insurance affordable for me again like it was before the ACA.
This, so much this.
They won't take away pre-existing coverage. It'd be a slap in the face to the nation, and I don't see that part being repealed. However, something new will come down the line, remove the mandate on carrying health insurance, remove the subsidy, and make it once again affordable. Yes, for those that are low income (me, I'd have a subsidy, but I have insurance through work), it might have worked. But, in my area, which is rural, and heavy in farming, the premiums are ranging from $700-$1500 a month, for 2 people, husband and wife, with deductibles over $5k. Seems affordable, right?
You can't have coverage for pre-existing conditions without a mandate. Otherwise any sensible person will just pay out of pocket until something expensive happens, then sign up for insurance.
Post by: ZiziPB on November 09, 2016, 08:37:24 AM
Post by: Malum Prohibitum on November 09, 2016, 08:51:51 AM
If I remember right, employer provided insurance did not have exclusions for pre-existing conditions even before ACA.Your remember right.
Post by: BlueHouse on November 09, 2016, 08:54:03 AM
If I remember right, employer provided insurance did not have exclusions for pre-existing conditions even before ACA.Back when I had employer provided insurance, pre-existing conditions were covered as long as you could show proof of insurance through another insurance company. There was also a 12-month waiting period and then all conditions were covered.
But on private insurance, I've never seen a policy that covered pre-existing conditions with non-interupted coverage. It had to be with the same company. And private insurance can drop you because of a condition (new or pre-existing). Because I was on private insurance for so many years, I started to become afraid to tell my doctors of any symptoms or have them check into anything because I was so afraid of losing medical insurance if they found something. It seems crazy, right?
First year of ACA, I joined Kaiser and got everything that had worried me over the past 10 years checked out. Luckily, no problems. But I also think Kaiser is good for maintaining health and avoiding preventable illness but not so great for fixing something that is already wrong. They do the bare minimum on certain health issues, and go beyond all expectations for weight, nutrition, stress, etc.
I think I may change to another insurer because at my age, this is when things start to go wrong and I will want to make sure I can see the best doctors, not just who they have on staff. And if I want a fucking mole removed, I want it removed. I don't want someone telling me there is no medical reason to have it removed. This mole has been sitting right under my bra strap for 10 years. It gets irritated all the time. Any doctor in their right mind would remove it when I explain this. But not at kaiser. /rant over
Post by: soccerluvof4 on November 09, 2016, 09:04:12 AM
Post by: Dezrah on November 09, 2016, 09:44:14 AM
Post by: HeadedWest2029 on November 09, 2016, 10:04:19 AM
For those who want to know the nuts and bolts of repealing ACA
http://www.newsweek.com/how-hard-repeal-obamacare-433590 (http://www.newsweek.com/how-hard-repeal-obamacare-433590)
Obviously written before election results. Republicans don't have the 60 vote majority to close a filibuster, but budget reconciliation still seems possible.
Post by: FIFoFum on November 09, 2016, 10:22:28 AM
For 2017, though, you will be ok. Even if this gets pushed through the first day, the law will require a transition period. This is expected to range for 1 to 2 years depending on whether you are talking about coverage at all or ACA subsidies/Medicaid expansion. There may then be movement on state level to replace some of what's lost, though I don't expect the funding to be there. Unclear what happens to the ban on denial for pre-existing conditions at state level. Insurance markets are heavily regulated by state.
I expect we'll know more about 2018 once it is early in 2017 (February or so). Then we'll see how motivated Congress is (my guess is very!) and whether Trump will care (who knows?) about dumping health insurance for 20 million people.
Post by: NextTime on November 09, 2016, 10:34:37 AM
I mentioned this on another thread and maybe its wishful thinking BUT if the republicans really want to make the ACA look worse than it already was and I think they need to if they want more than a one term candidate(and lets not kid ourselves it was going bad in a hurry) is to rename it and improve it. No one will be able to take away that the Dems got this started no matter what its called and again I just feel the Republicans want to show they can do better. But as others mentioned at the very least you will have some time.
This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.
Post by: Gin1984 on November 09, 2016, 10:44:11 AM
But now they can, so why would they change their behavior?I mentioned this on another thread and maybe its wishful thinking BUT if the republicans really want to make the ACA look worse than it already was and I think they need to if they want more than a one term candidate(and lets not kid ourselves it was going bad in a hurry) is to rename it and improve it. No one will be able to take away that the Dems got this started no matter what its called and again I just feel the Republicans want to show they can do better. But as others mentioned at the very least you will have some time.
This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.
Sent from my SPH-L710 using Tapatalk
Post by: Tris Prior on November 09, 2016, 01:49:02 PM
Because I was on private insurance for so many years, I started to become afraid to tell my doctors of any symptoms or have them check into anything because I was so afraid of losing medical insurance if they found something. It seems crazy, right?
I did the same thing for the same reason.
After Obamacare took effect, I finally sought help for my severe anxiety. Even though I was on insurance through my job at that point, I had been fearful of doing so in case I ever lost that coverage and had to go on the open market again for insurance. Now I'm kicking myself for doing that; I am in an unstable industry and I now have a mental health diagnosis on my records that, in the past, would often get you an automatic denial.
I mean, when I was getting my private insurance, they tried to deny me for *allergies*, FFS. Seasonal allergies. For which I have to take OTC meds in the late summer and fall and that's it; I don't see a doctor for them any more and haven't in 20 years.
Post by: daverobev on November 09, 2016, 02:09:40 PM
Because I was on private insurance for so many years, I started to become afraid to tell my doctors of any symptoms or have them check into anything because I was so afraid of losing medical insurance if they found something. It seems crazy, right?
I did the same thing for the same reason.
After Obamacare took effect, I finally sought help for my severe anxiety. Even though I was on insurance through my job at that point, I had been fearful of doing so in case I ever lost that coverage and had to go on the open market again for insurance. Now I'm kicking myself for doing that; I am in an unstable industry and I now have a mental health diagnosis on my records that, in the past, would often get you an automatic denial.
I mean, when I was getting my private insurance, they tried to deny me for *allergies*, FFS. Seasonal allergies. For which I have to take OTC meds in the late summer and fall and that's it; I don't see a doctor for them any more and haven't in 20 years.
This is one thing I don't understand - how so many people are so vehemently against ACA. I'm from the UK; universal healthcare is just... just... better! It's better! Like, miles better! You don't have people not going to the doctor to get things that could be life-threatening checked because then they might not get care?
I get that the free market blah blah, but it just so blatantly isn't working *for the masses* in the US. Fuck me, everyone should get health covered, because it is better for everyone! Well, except certain biotech companies, but you know what I mean.
The saddest thing is that the people so strongly against it are the ones to benefit. That, and the fact it had to be such a shitty system in order to get past the bastards in power blocking everything else, rather than something actually sensible.
That, and the guns. Those two things basically take me from "yeah, I kind've get the US, sort've" to "you're all fucking nuts".
Post by: boarder42 on November 09, 2016, 02:18:16 PM
Because I was on private insurance for so many years, I started to become afraid to tell my doctors of any symptoms or have them check into anything because I was so afraid of losing medical insurance if they found something. It seems crazy, right?
I did the same thing for the same reason.
After Obamacare took effect, I finally sought help for my severe anxiety. Even though I was on insurance through my job at that point, I had been fearful of doing so in case I ever lost that coverage and had to go on the open market again for insurance. Now I'm kicking myself for doing that; I am in an unstable industry and I now have a mental health diagnosis on my records that, in the past, would often get you an automatic denial.
I mean, when I was getting my private insurance, they tried to deny me for *allergies*, FFS. Seasonal allergies. For which I have to take OTC meds in the late summer and fall and that's it; I don't see a doctor for them any more and haven't in 20 years.
This is one thing I don't understand - how so many people are so vehemently against ACA. I'm from the UK; universal healthcare is just... just... better! It's better! Like, miles better! You don't have people not going to the doctor to get things that could be life-threatening checked because then they might not get care?
I get that the free market blah blah, but it just so blatantly isn't working *for the masses* in the US. Fuck me, everyone should get health covered, because it is better for everyone! Well, except certain biotech companies, but you know what I mean.
The saddest thing is that the people so strongly against it are the ones to benefit. That, and the fact it had to be such a shitty system in order to get past the bastards in power blocking everything else, rather than something actually sensible.
That, and the guns. Those two things basically take me from "yeah, I kind've get the US, sort've" to "you're all fucking nuts".
the ACA isnt universal healthcare its awful. universal healthcare i'm for.
Post by: Axecleaver on November 09, 2016, 02:29:01 PM
The ACA will be repealed. Republicans would use budget reconciliation to counter a filibuster, and vote to de-fund. They only need 50 votes for that (with Pence providing the tie-breaker). That would break ACA by removing the APTC tax credits. And budget reconciliation debate is limited to a day, so it can't itself be filibustered.
Medicaid block grants will really hurt, too. This translates into a massive shrinking of Medicaid (less fed dollars means more state dollars , which don't exist), which will massively inflate the ranks of the uninsured. Medicaid services will be rationed in some way - shrinking the rolls, or cutting services, or both. Meanwhile, the price of services is increasing.
Over the next year, we'll know more about our options. It's too soon to panic.
Post by: jim555 on November 09, 2016, 02:38:23 PM
Post by: boarder42 on November 09, 2016, 02:42:15 PM
Post by: Schaefer Light on November 09, 2016, 02:48:40 PM
There have actually been several Republicans who have published plans to replace it. They haven't put them up for a vote because they know Obama would veto them.I mentioned this on another thread and maybe its wishful thinking BUT if the republicans really want to make the ACA look worse than it already was and I think they need to if they want more than a one term candidate(and lets not kid ourselves it was going bad in a hurry) is to rename it and improve it. No one will be able to take away that the Dems got this started no matter what its called and again I just feel the Republicans want to show they can do better. But as others mentioned at the very least you will have some time.
This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.
Post by: MattyP on November 09, 2016, 02:54:56 PM
Post by: GizmoTX on November 09, 2016, 03:00:24 PM
Take some deep breaths. Is your health care contracted for one year, or are you able to switch whenever you want? Take the best one for you as things are now, and then if things change, re-evaluate and cross that bridge when you get there.
I happened to be seeing a doctor this am as a pre-exam for a colonoscopy. His take on replacing ACA involves providing a very basic level of care for everyone, meaning it doesn't need to include everything under the sun that is now causing premiums & deductibles to balloon & insurers to bail, and no mandate to try to force everyone to pay 'insurance' when those rates are truly unaffordable. This could be in the form of public health clinics and/or making basic Medicare accessible to the entire population. (Medicare is not free but it is affordable.) The VA might be rolled into this -- there's no need to have a separate (and unequal) set of hospitals run by the government. For those of us who need or want more extensive coverage and/or services, we'd be free to purchase supplemental insurance or concierge doctor services the same way that some of us do with Medicare.
Post by: bacchi on November 09, 2016, 03:02:09 PM
There have actually been several Republicans who have published plans to replace it. They haven't put them up for a vote because they know Obama would veto them.
This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.
Well, that and the fact that the replacement plans had little heft to them. Ryan's plan might even require a tax increase. How well will that go over? Are there other plans out there?
http://www.nationalreview.com/article/442019/republican-congress-president-trumps-obamacare-path-forward-what-now
Interestingly, Trump could defund the ACA on Jan 21.
Quote from: NationalReview
As I previously noted, Mr. Trump could immediately cut off these funds to insurers upon taking office.
More importantly, the ACA plans allow for their cancellation if the subsidies go away.
Quote from: NationalReview
But others have reported that the Obama administration has negotiated language in insurers’ contracts for next year allowing them to cancel plans immediately should a future Trump administration cut off insurers’ access to the cost-sharing subsidies during the middle of the 2017 plan year.
This means that any ACA plan is not guaranteed for 1 year.
Post by: Singularity on November 09, 2016, 03:09:10 PM
So last night, I despaired. I was petrified. I cried.
Today, I'm still petrified, but I seem to have activated the steely-spined pragmatist that lives within me for times such as these.
Nothing will realistically change until 2018. Insurance companies were dropping out of the exchanges and premiums are increasing excessively. This plan was sold to the US as saving the average family $2500 a year yet it failed. Yes it did have some nice features but also some issues.
Even NYT is reporting 22% increase with some areas increasing 145%, which is clearly crazy and unsustainable long term:
http://www.nytimes.com/2016/10/26/upshot/rising-obamacare-rates-what-you-need-to-know.html
Post by: Axecleaver on November 09, 2016, 03:20:07 PM
Quote
This means that any ACA plan is not guaranteed for 1 yearThis article (thanks for that, by the way) talks about contract language between the Federal Exchange and insurers. On the surface, this appears to conflict with state Insurance Dept regs. Many folks are covered under state Exchanges, which may or may not have negotiated similar language with their insurers. Suffice to say, this is a complicated problem. And it assumes Republicans are willing to dump 21 million people off their current plan with no warning. I am not sure they've got 50 votes to do that.
Quote
What are the options for healthcare without the ACA? What do early retirees do?We really won't know for a while. Worst case, if you're healthy, then you can buy a policy on the open market, but without any subsidies. If you have a pre-existing condition, you will either have to return to work for insurance (assuming group plans do not exclude pre-existing conditions or subject people to a waiting period - they might), or you may be forced into a high-risk pool, with correspondingly high premiums. These existed prior to the ACA, but medical costs were a lot cheaper then, too.
It's possible that full dismantling of the ACA will take more than a year. We'll know more in the days ahead.
Post by: smoghat on November 09, 2016, 03:23:39 PM
I'm post-FIRE and 49. If the market is bad next year, I would be subsidized. If not, I won't be.
Which plan to choose?
Post by: bacchi on November 09, 2016, 03:32:43 PM
I called up Blue Cross Friday. They had two plans available, one on the marketplace, on off. Otherwise identical.
I'm post-FIRE and 49. If the market is bad next year, I would be subsidized. If not, I won't be.
Which plan to choose?
Subsidized. If it gets repealed without a replacement, BC/BS will probably* convert you to a non-marketplace plan or keep you on for the rest of the year.
*This is a complete WAG. Follow at your own risk.
Post by: ChpBstrd on November 09, 2016, 03:33:18 PM
For a preview of what a one-party country will do to the ACA, look at what a one-party-state did. Arkansas replaced its "private option" program (enacted bipartisanly in 2014ish) with the more Republican-friendly "Arkansas Works" program about 2 years later. Changes were minor. A brief Republican civil war broke out between pragmatists and purists, but the bill just barely passed with help from some pork spending. Then the Republicans claimed credit for fixing the ACA and avoided the drama of kicking a quarter-million people off their plans and bankrupting most of the state's hospitals.
Post by: gillstone on November 09, 2016, 04:00:27 PM
with control of the House, Senate, and Presidency I don't see what would stop themPolitical will - there is a big difference between talking about something and actually doing it. For instance, I do not see coverage of pre-existing conditions going away even with Republicans in control of Congress. They will do something, sure, but I am not at all hopeful that it is going to make insurance affordable for me again like it was before the ACA.
This, so much this.
They won't take away pre-existing coverage. It'd be a slap in the face to the nation, and I don't see that part being repealed. However, something new will come down the line, remove the mandate on carrying health insurance, remove the subsidy, and make it once again affordable. Yes, for those that are low income (me, I'd have a subsidy, but I have insurance through work), it might have worked. But, in my area, which is rural, and heavy in farming, the premiums are ranging from $700-$1500 a month, for 2 people, husband and wife, with deductibles over $5k. Seems affordable, right?
You keep the restrictions on the bad stuff like pre-existing conditions, lifetime caps and retroactive denial and ALSO junk the mandate. They are part and parcel. Those provisions are expensive and the way to pay for them is to broaden the pool by forcing everyone to have insurance. Even if they block grant funds to state to create high-risk pools those high risk pools will be astoundingly expensive. Cancer treatment can easily runs over $200,000. Diabetes is a chronic condition which requires a steady stream of testing supplies and medications.
Health insurance was NOT cheap before the ACA. Price hikes in excess of 20% were common and coverage was a patchwork if you didn't start the plan perfectly healthy.
I'm banking on Senate Democrats holding the line on any Repeal Replace BS. The GOP is now in a position to deliver on the absurd promises they've made (Repeal ACA day 1, build a wall, balance the budget by raising spedning and cutting revenues) and I hope they choke on them.
Post by: mtnrider on November 09, 2016, 05:16:30 PM
- In many states, individuals ran the risk of losing coverage at their first health event.
- Many individuals with preexisting conditions were listed as automatically uninsurable. Insurance companies would require documentation of good health and continuous coverage. I know someone who was denied coverage due to a note in his files reading that he was slightly depressed after a minor accident. He was unaware of the note, until the insurance company told him about it. One doctor had told me he wouldn't write down a very minor issue because he was concerned I would be denied coverage later.
- Some states' regulations required that companies continue offering an insurance product to a sick individual. Insurance companies would funnel healthy customers into other products, leaving only the sick customers in the old product, and then they'd raise the rates on the old product.
- If you worked at a small company, the company may have been forced to drop health insurance benefits if one worker got very sick.
- Did you forget to list a minor illness/accident when applying for coverage? If you had a major health care event, insurance companies could claw back the payouts, claiming insurance fraud.
- Good individual coverage generally increased pa at ridiculous rates.
- You MAY have been able to buy some very affordable, but limited individual insurance. But this insurance would have very low payout caps, high deductibles, and very restricted coverage. It's OK for ER if you break your arm (once), but not if you get cancer.
- Some states had very expensive high risk pools for uncovered residents. They were hard to get into, and may have had a waiting list.
- Some hospitals would give charity coverage for catastrophic health events, typically at the ED only.
Add to this:
- Coverage for children was generally dropped at age 18.
- If a child was in college, some regulations would allow coverage until 21.
(This list is from memory, from when I looked into it in 2007-2010 while planning FIRE, please correct me where I'm wrong.)
For those considering ER soon - this is an ideological, almost religious, disagreement about individualism vs collectivism. Health insurance is a major risk. Stay healthy. And stay employed. Or maybe, move to a state with an insurance mandate.
Post by: frugaldrummer on November 09, 2016, 06:17:10 PM
Many people will be trapped in their current insurance plan, so make sure the one you choose this year is the one you want to stay with. (My son was going to drop his private Kaiser plan in favor of the inexpensive PPO offered by his work. But now I'm concerned that he'll never be able to get back on Kaiser if he drops it, because he has some - relatively mild- preexisting conditions. )
My niece, who is adopted and was born with a severe heart defect, is a lovely and vibrant teenager. But she will need a heart transplant eventually, probably around 30 or 35. She'll be uninsurable when she ages off her parent's insurance. And getting a job with a big company that offers insurance is not a solution, because her health will deteriorate to the point that she can't work LONG before she ends up on the transplant list - so any COBRA would have long since expired. So pretty much her only option will be to remain poor enough to qualify for Medicaid for the rest of her life.
Women, if you need an IUD, do it this year before that benefit gets repealed.
Another son of mine is on a COBRA after aging off his dad's insurance (he's still in college). We chose the COBRA instead of an individual policy because the medication coverage was much better, and this son has pre-existing conditions that require some pretty expensive medications. Now, however, I have to decide this month whether to switch him to a private policy with less coverage, but that he can keep past the 18 months that the COBRA would expire.
I imagine the new Republican sham-of-a-plan will include some provision that you can't be thrown off your insurance if you've been continuously covered. There may or may not be something that says we all pay the same price per age regardless of pre-existing conditions. (In the past, people who developed serious medical conditions just faced their premiums being jacked up to three times the normal rate until they couldn't afford it.) But they'll get rid of the mental health and addiction coverage, get rid of the mandate, won't implement any restrictions on the larcenous practices of the pharmaceutical companies (which, btw, is a big reason why your costs have been going up. Steroid inhalers that used to cost $30 now cost $200, old cheap drugs suddenly triple or more in price because some carpet bagger cornered the market etc. When people's day to day medications start costing more per month than their premiums it's not sustainable. Yet Republicans voted to pass laws that keep us from negotiating drug prices.)
They'll also return to the old days when you couldn't buy insurance if you had a pre-existing condition (leaving many people trapped in their jobs) and not covering preventive health care.
WE ARE THE ONLY RICH COUNTRY THAT DOESN'T PROVIDE HEALTH CARE TO OUR PEOPLE! And we spend way more than anyone else on our care.
The flaws in Obamacare came from the lack of teeth in the mandate. Where people buy insurance the costs did not go up that much. When I divorced the COBRA on my very good plan cost $700/mo. When that ran out I had a choice of a similar plan for $800, or a high deductible plan with HSA account for $500 a month. This year it's $525. So over 7 years, very little increase. It's in areas where people, fired up by anti-Obama rhetoric, refused to buy health insurance that premiums surged out of control.
Catastrophic plans sound nice but actually when they were available they saved very little over a regular plan (because most healthcare dollars go to end-of-life care). Also many of the cheaper ones, as mentioned before, had ridiculously low caps like $250k which doesn't begin to cover a true catastrophy. So the rest of us foot the bill in higher charges for the uninsured idiot who crashes his motorcycle and spends months in the ICU.
Post by: Cerastez on November 10, 2016, 12:05:29 AM
I am going to be writing letters...lots of letters.
Post by: Metric Mouse on November 10, 2016, 12:19:29 AM
But now they can, so why would they change their behavior?I mentioned this on another thread and maybe its wishful thinking BUT if the republicans really want to make the ACA look worse than it already was and I think they need to if they want more than a one term candidate(and lets not kid ourselves it was going bad in a hurry) is to rename it and improve it. No one will be able to take away that the Dems got this started no matter what its called and again I just feel the Republicans want to show they can do better. But as others mentioned at the very least you will have some time.
This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.
Would the president have signed it?
Post by: obstinate on November 10, 2016, 12:25:45 AM
Post by: Metric Mouse on November 10, 2016, 12:28:48 AM
I'm not FIREd yet. Planning to earn for an extra couple of years at least to offset the risks here.
I'm very sorry to hear that.
Post by: Bateaux on November 10, 2016, 03:36:23 AM
Post by: redcedar on November 10, 2016, 03:59:21 AM
Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.
Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.
Post by: rtrnow on November 10, 2016, 06:09:22 AM
I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.
Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.
Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.
HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!
Post by: chasesfish on November 10, 2016, 06:15:35 AM
Regardless of who is in power, the country is heading down the path of some minimal level of healthcare for all.
Employers that generally support one side hate carrying the burden for insurance...
Uninsured who generally support the other hates not having insurance...
The economics of the pre-Obamacare heath plan and current obamacare health plan don't work.
I'm optimistic we'll see a medicare-light baseline plan and then give people HSAs and the ability to buy private insurance for the same quality care we see today. I actually think having someone who's been in business and isn't beholden to special interests might make this happen. Businesses HATE carrying the burden of insuring their employees.
Post by: Malum Prohibitum on November 10, 2016, 06:31:36 AM
This is one thing I don't understand - how so many people are so vehemently against ACA.Well, Brit, maybe I am just a fucking nuts American, as you say, but I paid $450 a month for insurance with a $1500 annual deductible just a few years ago, before the ACA, to cover my entire family. Now, I have the cheapest plan available, with a $12,500 deductible, an HSA eligible plan, meaning I pay the first $12,500 each year, and for that I pay $1026 monthly. A plan like my old one would be over $2000 monthly. Even my current plan is going away. It is not available in 2017. My insurance company can't make money at that rate. In 2017, the absolute cheapest plan available is $1380 monthly, a 35% increase for worse coverage. It goes up from there, i.e., each plan is successively more expensive. Comparing prices for 2017 is pretty easy, because in my geographic area, there is only one plan left, thanks to the damn ACA.
It does not take a Nobel prize in economics to realize that the premium for a person like me (inhumanly low cholesterol with good ratios, such an absurdly healthy diet that friends and family poke fun at it, and intense gym sessions 6 days a week) would rise if the government mandates that anybody else will pay the exact premium I pay, no matter their state of health, no matter the preexisting conditions. Every fat slob with diabetes or pre-diabetes pays the same as me. Aids patients pay the same as me.
What idiot thought that would be a good idea?
I was against the ACA before it passed, because it was blatantly obvious what was going to happen to anybody with half a brain. Now that I have had to suffer the consequences of others' delusions for a few years, yeah, I am "vehemently against ACA."
Do you still not understand, or do you at least halfway understand, even if you somehow think this is for my own good?
Health insurance went from something I did not think about very much to a burdensome, oppressive monster. It is by far my largest bill.
Quote
The saddest thing is that the people so strongly against it are the ones to benefit.Benefit?
Quote
That, and the guns. Those two things basically take me from "yeah, I kind've get the US, sort've" to "you're all fucking nuts".Since I used a gun when two armed robbers confronted me and my wife last year, I just have to say that maybe the one who is nuts is the one who does not recognize my or my beautiful wife's right to exist and defend our lives as we see fit. What is "fucking nuts" about not wanting to be at the mercy of violent criminals?
Is everybody in England so blind to other points of view?
Try opening your mind a little. There is a whole big, wide world out there. People in that world think differently from you, and they are not "nuts" for doing so.
Post by: rtrnow on November 10, 2016, 06:47:34 AM
Quote
Every fat slob with diabetes or pre-diabetes pays the same as me. Aids patients pay the same as me.
What idiot thought that would be a good idea?
Seriously, fuck those aids patients. I'm all for adjusting rates based on lifestyle choices like already happens with smoking, but to me its just shitty to say "well I'm blessed with good health so the hell with those that aren't." There's a lot one can do to improve their heath, but there's also a lot of genetic or just shit happens stuff out there. I'm completely willing to pay more despite my health to not bankrupt those with chronic or acute expensive conditions.
[MOD NOTE: FYI - you might want to be a little clearer about your sarcasm, there]
Post by: jim555 on November 10, 2016, 06:59:57 AM
Post by: Mississippi Mudstache on November 10, 2016, 07:07:05 AM
- If you worked at a small company, the company may have been forced to drop health insurance benefits if one worker got very sick.
I'm terrified of this risk. I just accepted a position with a small company (I will be their 6th employee), and the only reason I was able to do so was because of the changes to health insurance laws brought about by the ACA. I have a son with spina bifida, and his health care costs tens of thousands of dollars per year. If my new employer isn't able to provide health insurance to their other employees because of my son, I will be out of a job. I was planning to buy a house in the next year, but I am seriously re-thinking whether that's a wise decision, in case I have to move again to accept a job with a larger company that could afford to insure my family.
Post by: zhelud on November 10, 2016, 07:18:00 AM
http://theincidentaleconomist.com/
Post by: StarBright on November 10, 2016, 07:23:56 AM
I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.
Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.
Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.
HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!
+1 to all this. I've had an HSA since 2008 (it is the only plan my work has offered) and I am not a fan when you actually need to use them.
It was fine until I actually had a few real medical issues pop up. I had been fighting a birthcontrol charge since 2013 that was only resolved this summer. In that case it was the facility where I had gone for all of my OB coverage, gave birth, etc and that was all in network, but for some reason 2 specific types of birth control from the same facility were considered out of network and I ended up with a bill over a thousand bucks when it should have been free under ACA. The facility didn't even know that it was considered an out of network charge. I paid it back in 2014 but kept fighting for my 1k refund which I finally got this July (and that was only because of a federal lawsuit against the insurance company).
My DH also had an emergency appendectomy and we even stated that we needed in-network coverage but ended up with an out of network anesthetist. Again we had to fight the multi-thousand dollar bill for over a year.
It is almost impossible to "shop" for procedures and especially not in the case of an emergency.
And I also +1 that Pence is *ss.
Post by: Guesl982374 on November 10, 2016, 07:24:17 AM
QuoteThe saddest thing is that the people so strongly against it are the ones to benefit.Benefit?
um...How about the fact that pre-ACA you would have been dropped/unable to be insured if something did happen to you? You had the illusion that you had indefinite coverage when in fact you only really had coverage until your contract year was up.
While you habits of eating kale and working out 6 days a week are outstanding and will lower your risk, eventually something will happen to you or your family that is outside of our control (sports injury, car accident, cancer, etc).
Post by: OurTown on November 10, 2016, 07:32:57 AM
Post by: daverobev on November 10, 2016, 07:55:56 AM
This is one thing I don't understand - how so many people are so vehemently against ACA.Well, Brit, maybe I am just a fucking nuts American, as you say, but I paid $450 a month for insurance with a $1500 annual deductible just a few years ago, before the ACA, to cover my entire family. Now, I have the cheapest plan available, with a $12,500 deductible, an HSA eligible plan, meaning I pay the first $12,500 each year, and for that I pay $1026 monthly. A plan like my old one would be over $2000 monthly. Even my current plan is going away. It is not available in 2017. My insurance company can't make money at that rate. In 2017, the absolute cheapest plan available is $1380 monthly, a 35% increase for worse coverage. It goes up from there, i.e., each plan is successively more expensive. Comparing prices for 2017 is pretty easy, because in my geographic area, there is only one plan left, thanks to the damn ACA.
It does not take a Nobel prize in economics to realize that the premium for a person like me (inhumanly low cholesterol with good ratios, such an absurdly healthy diet that friends and family poke fun at it, and intense gym sessions 6 days a week) would rise if the government mandates that anybody else will pay the exact premium I pay, no matter their state of health, no matter the preexisting conditions. Every fat slob with diabetes or pre-diabetes pays the same as me. Aids patients pay the same as me.
What idiot thought that would be a good idea?
I was against the ACA before it passed, because it was blatantly obvious what was going to happen to anybody with half a brain. Now that I have had to suffer the consequences of others' delusions for a few years, yeah, I am "vehemently against ACA."
Do you still not understand, or do you at least halfway understand, even if you somehow think this is for my own good?
Health insurance went from something I did not think about very much to a burdensome, oppressive monster. It is by far my largest bill.QuoteThe saddest thing is that the people so strongly against it are the ones to benefit.Benefit?QuoteThat, and the guns. Those two things basically take me from "yeah, I kind've get the US, sort've" to "you're all fucking nuts".Since I used a gun when two armed robbers confronted me and my wife last year, I just have to say that maybe the one who is nuts is the one who does not recognize my or my beautiful wife's right to exist and defend our lives as we see fit. What is "fucking nuts" about not wanting to be at the mercy of violent criminals?
Is everybody in England so blind to other points of view?
Try opening your mind a little. There is a whole big, wide world out there. People in that world think differently from you, and they are not "nuts" for doing so.
Chance of being confronted by armed robbers when nobody has guns? Low.
Chance of being covered when your private healthcare lapses for whatever reason in a country with universal cover? High.
I know ACA is not perfect. Universal is what you need. Maybe I'm not the one that needs to open my mind.
Post by: Malum Prohibitum on November 10, 2016, 07:56:27 AM
Yeah, it is just good fortune I suppose that I do not have Aids. Could happen to anybody, right?QuoteEvery fat slob with diabetes or pre-diabetes pays the same as me. Aids patients pay the same as me.
What idiot thought that would be a good idea?
Seriously, fuck those aids patients. I'm all for adjusting rates based on lifestyle choices like already happens with smoking, but to me its just shitty to say "well I'm blessed with good health so the hell with those that aren't." There's a lot one can do to improve their heath, but there's also a lot of genetic or just shit happens stuff out there. I'm completely willing to pay more despite my health to not bankrupt those with chronic or acute expensive conditions.
I just shake my head at some of these posts.
I do like one part of your post, though, as it actually addressed what I wrote about the ACA. You wrote, "I'm all for adjusting rates based on lifestyle choice . . ." and that change alone would make the ACA a lot easier to live with.
The truth is that my insurance for my family, if I were to purchase comparable insurance to what I had before the ACA, is more than 5 times as expensive. Even the most rabid fan of the ACA has to recognize some injustice in this fact.
Yes, my premiums would have increased anyway. They almost always did by small amounts. But more than 500%???
But, no, I am not willing to increase my burden by 500% to cover all of these people surrounding me who are harming their own health daily. Three quarters of men are overweight or obese. That is not a genetic condition. It is just what people do, kind of like spending all of their money. The average woman in the US is heavier than the average man was in 1960. 40% of women are obese (not overweight, obese) while saying things like "real women have curves." The culture accepts and encourages this, and the effects on health, both for the woman and her kids, are negative.
The one change to the ACA that should be made is adjusting costs based on risk.
That includes looking at pre-existing conditions. There is a MAJOR difference between somebody who has carried coverage for years and then suffers an expensive health condition as compared to somebody who does not, suffers a health condition, and then shows up at the next enrollment window and cannot be turned away. It's like buying car insurance after a huge wreck and expecting the car insurance company to pay to fix your car and all the judgments for personal injury damages against you from the occupants of the other car. That scenario just does not make sense, even if you would be happy to have your car insurance go up to pay for it.
Post by: Malum Prohibitum on November 10, 2016, 08:02:12 AM
Maybe I'm not the one that needs to open my mind.I am not the one describing those who disagree with me as "fucking nuts." Closed minds, fallacious arguments. Opening your mind does not mean you need to convert to believing in free markets and liberty (including the right to bear arms). Perhaps it does mean that you need to be able to open your mind a little, just a narrow, ajar, opening, to be able to understand the other side of something, rather then dismissing it with an ad hominem fallacy.
Post by: rubybeth on November 10, 2016, 08:04:21 AM
If I remember right, employer provided insurance did not have exclusions for pre-existing conditions even before ACA.
You needed to prove you had coverage before, though, and you usually had a waiting period of 30 days before you new coverage would kick in.
And, lifetime maximums were real. Get cancer or type 1 diabetes or premie baby or other chronic condition and $1 million of medical bills? You'd be booted from your plan, even with employer coverage.
And any families covering kids up to age 26 can kiss that goodbye.
Post by: BlueHouse on November 10, 2016, 08:04:46 AM
TL;DR: Like others said, good insurance was not affordable pre-ACA.+10,000
- If you worked at a small company, the company may have been forced to drop health insurance benefits if one worker got very sick.One company I worked for was dropped by its carrier after one of our employees adopted a baby from another country.
Quote
- Did you forget to list a minor illness/accident when applying for coverage? If you had a major health care event, insurance companies could claw back the payouts, claiming insurance fraud.Oh gawd, I forgot how hard and time-consuming it is to fill out the applications for (private) health insurance. Those of you on employer-sponsored group plans that have never had to do this, consider yourself extremely lucky. These applications can be hundreds of pages. When I was 17, I had an infection in my liver. Any infection in the liver was called (look it up) Hepatitis. Well, a few years later and Hepatitis starts to become associated with VIRAL forms of the disease. So 30 years after the fact, I start getting denied insurance because insurers think I have an incurable viral disease. Not only did I have to get a battery of tests and doctors' notes to attest to the fact that I've never had viral hepatitis, I still have to fully document that I've been rejected for insurance previously, and the reasons why, and I have to fully document both the original diagnosis, and the secondary tests. It's so frustrating that you can't just erase a mistake or misunderstanding. You have to document the error, document the effect of the error, document the fix to the error. Ugh!
Post by: Malum Prohibitum on November 10, 2016, 08:06:18 AM
Best argument yet, and of course something I was well aware of. Such things did happen, of course (well, not the cancer), and I was not dropped, although I have heard arguments. Knee surgery, kids being born, heck, I had a kid break a bone this week (sports injury).QuoteThe saddest thing is that the people so strongly against it are the ones to benefit.Benefit?
um...How about the fact that pre-ACA you would have been dropped/unable to be insured if something did happen to you? You had the illusion that you had indefinite coverage when in fact you only really had coverage until your contract year was up.
While you habits of eating kale and working out 6 days a week are outstanding and will lower your risk, eventually something will happen to you or your family that is outside of our control (sports injury, car accident, cancer, etc).
I had no illusions.
I am just relating my experience here.
The ACA has has a HUGELY negative impact on my savings and thus my ability to FIRE. That is reality. I am sorry if my experience does not fit anybody's political preferences here, but my experience is what it is.
Post by: StarBright on November 10, 2016, 08:08:42 AM
QuoteEvery fat slob with diabetes or pre-diabetes pays the same as me. Aids patients pay the same as me.
What idiot thought that would be a good idea?
Seriously, fuck those aids patients. I'm all for adjusting rates based on lifestyle choices like already happens with smoking, but to me its just shitty to say "well I'm blessed with good health so the hell with those that aren't." There's a lot one can do to improve their heath, but there's also a lot of genetic or just shit happens stuff out there. I'm completely willing to pay more despite my health to not bankrupt those with chronic or acute expensive conditions.
Yes, my premiums would have increased anyway. They almost always did by small amounts. But more than 500%???
But, no, I am not willing to increase my burden by 500% to cover all of these people surrounding me who are harming their own health daily. Three quarters of men are overweight or obese. That is not a genetic condition. It is just what people do, kind of like spending all of their money. The average woman in the US is heavier than the average man was in 1960. 40% of women are obese (not overweight, obese) while saying things like "real women have curves." The culture accepts and encourages this, and the effects on health, both for the woman and her kids, are negative.
Just a reminder that the 500% increase is not just based on covering other people. It also takes into account the likelihood that people of your specific age and demographic will develop a pre-existing condition and/or have a catastrophic event in the next year, 5, 10, 15 years (etc) and lifetime (I believe those are some of the actuarial windows) because there are no longer lifetime caps and they can't cancel your coverage anymore after a medical event.
And pre-existing conditions aren't just things like diabetes and AIDS. I had stress related migraines in undergrad and had a scrip written for them. Imagine my surprise a few years later when perfectly healthy me, who had only filled that prescription once, was denied health insurance because of a pre-existing condition.
Post by: Gin1984 on November 10, 2016, 08:19:18 AM
If it was a fix like fixing the family gap, yes. If it actually improved it, yes.But now they can, so why would they change their behavior?I mentioned this on another thread and maybe its wishful thinking BUT if the republicans really want to make the ACA look worse than it already was and I think they need to if they want more than a one term candidate(and lets not kid ourselves it was going bad in a hurry) is to rename it and improve it. No one will be able to take away that the Dems got this started no matter what its called and again I just feel the Republicans want to show they can do better. But as others mentioned at the very least you will have some time.
This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.
Would the president have signed it?
Sent from my SPH-L710 using Tapatalk
Post by: Paul der Krake on November 10, 2016, 08:29:35 AM
Quote
what to do?Sit, wait, ignore the noise. Nobody knows what's going to happen.
Early retirement was viable before the ACA. Options will emerge.
If you live in the recently expanded group of jurisdiction with legal marijuana, go smoke some.
Post by: Mississippi Mudstache on November 10, 2016, 08:33:10 AM
Sit, wait, ignore the noise. Nobody knows what's going to happen.
Early retirement was viable before the ACA. Options will emerge.
If you live in the recently expanded group of jurisdiction with legal marijuana, go smoke some.
Best advice I've heard so far. To be clear, though, many things that were not viable for me pre-ACA (entrepreneurship, working for a small company, and early retirement) will once again become non-viable for me, due to my son's condition, if the ACA is repealed in its entirety. This is especially troubling to me, given that I begin my new job with a small company on January 1.
Post by: Malum Prohibitum on November 10, 2016, 08:35:40 AM
Just a reminder that the 500% increase is not just based on covering other people. It also takes into account the likelihood that people of your specific age and demographic will develop a pre-existing condition and/or have a catastrophic event in the next year, 5, 10, 15 years (etc) and lifetime (I believe those are some of the actuarial windows) because there are no longer lifetime caps and they can't cancel your coverage anymore after a medical event.Of course it is not - like I said, the premiums increased before the ACA, too. Some small part of that 500% would have been a normal increase. Increases before the ACA were always nominal, though, StarBright, something I shrugged off. Like I said, before the ACA health insurance was not a cost that was burdensome or even something I thought much about.
Now, to buy the same coverage I had previously, would be about $30,000 annually.
Can anybody characterize this as not burdensome?
I have not aged that much since the ACA passed! LOL! :)
Post by: Car Jack on November 10, 2016, 08:47:22 AM
I am concerned about pre-existing conditions. I changed jobs before ACA took effect and my new company insurance contacted me after my first doctor's visit looking for proof that I had continuous coverage from my old job. If I had not, they would not cover my chronic condition. Under ACA, I changed jobs once again and for the first time ever, took a week off between jobs (I'm 59 and have changed jobs many times). I would fear that going forward, I can never have a gap in insurance again, if the GOP has their way. I really believe that the GOP's slogan for health car is "Just Die, already".
Post by: StarBright on November 10, 2016, 08:50:35 AM
Just a reminder that the 500% increase is not just based on covering other people. It also takes into account the likelihood that people of your specific age and demographic will develop a pre-existing condition and/or have a catastrophic event in the next year, 5, 10, 15 years (etc) and lifetime (I believe those are some of the actuarial windows) because there are no longer lifetime caps and they can't cancel your coverage anymore after a medical event.Of course it is not - like I said, the premiums increased before the ACA, too. Some small part of that 500% would have been a normal increase. Increases before the ACA were always nominal, though, StarBright, something I shrugged off. Like I said, before the ACA health insurance was not a cost that was burdensome or even something I thought much about.
Now, to buy the same coverage I had previously, would be about $30,000 annually.
Can anybody characterize this as not burdensome?
I have not aged that much since the ACA passed! LOL! :)
I think the actuarial difference is not age, but the fact that they can no longer cap your coverage or cancel it :) It is entirely possible that you had a great plan pre-ACA with no caps but most people had something like a million dollar cap and the insurance company had a right to cancel your coverage for basically any reason. The fact that insurance companies can no longer do must now be factored into the cost of everyone's coverage. I was just pointing out the that the total increase is not just for covering overweight people and folks with AIDS, but the increases also make sure that you have access to health insurance until you turn 65 (that was not factored in before the ACA). They help you too.
I agree it is burdensome, on middle class families in particular, but is also what happens when you get a two party compromise. I'm pro universal healthcare myself - Even with the increased taxes I suspect I would pay less for coverage than I do now, and I would have to wade through far less paperwork, and everyone would be covered. I consider it a triple win :)
Post by: hoping2retire35 on November 10, 2016, 08:53:44 AM
I'm not FIREd yet. Planning to earn for an extra couple of years at least to offset the risks here.
I'm very sorry to hear that.
almost choked on my apple when reading that :D
Post by: frugaldrummer on November 10, 2016, 09:33:39 AM
Quote
Every fat slob with diabetes or pre-diabetes pays the same as me. Aids patients pay the same as me.
What idiot thought that would be a good idea?
Malum - people who know that DISEASE is not always the patient's fault!!!! You think you're immune because you have a healthy lifestyle? Think again! Plenty of diseases are also due to genetic or infectious causes. That diabetic might have hemochromatosis - a genetic condition that has nothing to do with lifestyle and is often missed. That AIDS patient might have gotten it from a transfusion after a car accident.
The UNCHRISTIAN, unkind, uncaring thinking that we should not be helpful to our fellow man (because, after all, someday that may be YOU that needs help) is a disgusting feature of our culture today. Oh, and btw? Science now shows that obesity may be due to gut bacteria - and not a lack of willpower.
Yes, there are lots of things that we can do to try to protect our health, but you never know when disaster will strike - this is the whole point of insurance, to spread that risk around.
Post by: Gimesalot on November 10, 2016, 09:43:09 AM
I have heard the BS argument that 5 years ago I was paying much less for a plan... Not a single person factors in the fact that 5 years ago you and your family were younger. They never factor in that health insurance costs were rising so fast, that they brought about the ACA. No one mentions the fact that even employer plans are getting more expensive, but it's not necessary just because insurance is getting more expensive but also because employers want to spend less and less. For example, my company used to cover about $5500 of my costs every year, now they only cover about $3000. That's not the ACA, that's business cutting the bottom line.
I am for single payer healthcare. I think that's the best solution out there because even if people know the cost of services, I don't think it will be much of a deterrent. Who's going to consider if spending $250k to save their kid or loved one is worth it?
Post by: Zoot on November 10, 2016, 10:03:45 AM
For example, someone with a condition that is controlled with medication who changes insurers could have claims for items unrelated to that condition because of the "pre-existing condition" clause.
According to the reading I've done in the past 24 hours, prior to the ACA the states controlled both the "lookback period" (meaning how far the insurer could look back in your medical record to identify a pre-existing condition) and the waiting period required before claims would be covered. Different states had different periods for both of these--some states had no limit on the lookback period (so presumably they could look back to birth). I don't recall what the waiting period was, but it was either 12 months or 24 months.
In this climate, when nobody knows what the rules are going to be, we figured it was best to keep me where I am right now until we know what the new rules are going to be. It kills me to be paying the extra $300/month for coverage when I'd be paying $30/month for coverage from my own employer.
I really, really, really hate this. All of it. I can't even believe we're having to have this kind of conversation.
Post by: Gin1984 on November 10, 2016, 10:06:43 AM
So for the record, DH and I decided to keep me on my current plan, and pay the higher premium, because of fears of what would happen with pre-existing conditions.Actually pre-birth. I have a MD friend who had a patient who was denied care because her parents had testing done on the fetus. The insurance company said that the damage to the fetus was pre-existing because the child (once born) had the condition prior to coverage.
For example, I have high blood pressure (controlled via medication), but if I change insurers and the pre-existing condition claim denial is reinstated, I could be denied by my new insurer if I had any claims related to high blood pressure. I have had issues with my shoulder that have required physical therapy, and I was called a "good candidate" for eventual shoulder replacement, so that's also in my record.
According to the reading I've done in the past 24 hours, prior to the ACA the states controlled both the "lookback period" (meaning how far the insurer could look back in your medical record to identify a pre-existing condition) and the waiting period required before claims would be covered. Different states had different periods for both of these--Georgia, the state where I live, had no limit on the lookback period (so presumably they could look back to birth). I don't recall what the waiting period was, but it was either 12 months or 24 months.
In this climate, when nobody knows what the rules are going to be, we figured it was best to keep me where I am right now until we know what the new rules are going to be. It kills me to be paying the extra $300/month to Kaiser for the coverage when I'd be paying $30/month to Cigna for the HDP/HSA plan under my own employer--but at least we had budgeted to max the HSA for 2017 anyway, so the difference to the bottom-line take-home salary is negligible. It's just that the money will be going AWAY now instead of into a fat little HSA account.
I really, really, really hate this. All of it. I can't even believe we're having to have this kind of conversation.
Post by: bacchi on November 10, 2016, 10:17:24 AM
The problem that is not being addressed is the cost of services. It doesn't matter who pays it, single payer or private pay. As long as the medical establishment has free reign to charge whatever they feel like we are going to keep getting extorted.
Yes, the elephant in the room, the taboo subject. Why are MRIs so much cheaper in Japan?
Post by: NoStacheOhio on November 10, 2016, 10:35:04 AM
Take a deep breath, everything will probably be okay.
Regardless of who is in power, the country is heading down the path of some minimal level of healthcare for all.
Employers that generally support one side hate carrying the burden for insurance...
Uninsured who generally support the other hates not having insurance...
The economics of the pre-Obamacare heath plan and current obamacare health plan don't work.
I'm optimistic we'll see a medicare-light baseline plan and then give people HSAs and the ability to buy private insurance for the same quality care we see today. I actually think having someone who's been in business and isn't beholden to special interests might make this happen. Businesses HATE carrying the burden of insuring their employees.
Great, are those employers going to pass the savings on to employees in the form of higher wages to afford paying for 100% of their healthcare? Color me skeptical.
Post by: Malloy on November 10, 2016, 10:36:49 AM
There have actually been several Republicans who have published plans to replace it. They haven't put them up for a vote because they know Obama would veto them.I mentioned this on another thread and maybe its wishful thinking BUT if the republicans really want to make the ACA look worse than it already was and I think they need to if they want more than a one term candidate(and lets not kid ourselves it was going bad in a hurry) is to rename it and improve it. No one will be able to take away that the Dems got this started no matter what its called and again I just feel the Republicans want to show they can do better. But as others mentioned at the very least you will have some time.
This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.
That's funny. The threat of presidential veto didn't stop Republicans from voting to repeal the ACA 60 times. So why does a veto threat stop them from actually voting on a real plan? I posit that it's because grandstanding is more politically effective than governance. And, the presidential election this week has proven me right.
Republicans have paid no political cost for the "repeal" having no "replace" component. I suspect that they will repeal, make some noises about HSAs (gee, thanks-this $5000 sure is going to help me pay my $250k chemotherapy bill!), and we'll go back to seeing those jars at every gas station to pay for some sick local kid's leukemia treatment. You know, I had actually noticed that I stopped seeing them in the last couple of years.
The ACA is not perfect, but it's better than it was before. As for the guy who is mad about AIDS patients who pay what he pays, would it make you feel better if they were cancer patients? How about families who have children with Downs Syndrome? Not all medical calamities can be blamed on the patient.
Post by: Mississippi Mudstache on November 10, 2016, 10:54:19 AM
Republicans have paid no political cost for the "repeal" having no "replace" component. I suspect that they will repeal, make some noises about HSAs (gee, thanks-this $5000 sure is going to help me pay my $250k chemotherapy bill!), and we'll go back to seeing those jars at every gas station to pay for some sick local kid's leukemia treatment. You know, I had actually noticed that I stopped seeing them in the last couple of years.
Funny you should say that. I actually saw one in a gas station this morning for the first time in years, and for the first time in my life, I put my change in it.
Post by: daverobev on November 10, 2016, 12:49:33 PM
Maybe I'm not the one that needs to open my mind.I am not the one describing those who disagree with me as "fucking nuts." Closed minds, fallacious arguments. Opening your mind does not mean you need to convert to believing in free markets and liberty (including the right to bear arms). Perhaps it does mean that you need to be able to open your mind a little, just a narrow, ajar, opening, to be able to understand the other side of something, rather then dismissing it with an ad hominem fallacy.
Obviously I didn't literally mean that you are *all* fucking nuts.
I understand it, I guess - people are selfish (I don't want to pay for fat slobs... well, fair enough, but it is better for society as a whole to have a comprehensive health system that deals with the whole thing - ie, educating people so they don't *become* fat slobs; not subsidising things that don't need it, encouraging people to live an at least somewhat healthy lifestyle).
But you're right, my tongue in cheek "fucking nuts" was simply exasperation. America is, at least for the time being, the richest country on the planet. But a significant number of people live in fear of visiting the doctor because of the financial cost. That's not right. I understand it's not simply "give everyone, everything, all the time; we'll make the maths work somehow" - healthcare is expensive. But it is more expensive in the US system than in pretty much all developed countries. Which makes it even harder for the poor to get it. Which, well, see above - it's madness in the wealthiest country. Ahem. Fucking nuts, so to speak. I mean, you'll riot - pretty much - to keep your access to firearms, but not to make sure everyone has access to good medical coverage.
That I cannot understand. Just can't.
Post by: NoStacheOhio on November 10, 2016, 01:18:50 PM
That's funny. The threat of presidential veto didn't stop Republicans from voting to repeal the ACA 60 times. So why does a veto threat stop them from actually voting on a real plan? I posit that it's because grandstanding is more politically effective than governance. And, the presidential election this week has proven me right.
IIRC, when the legislation was being written it went something like this:
-Democrats introduce a bill they want
-Republicans counter with list of changes
-Debate
-Changes made to bill
-Republicans say no
-More debate
-More changes
-Republicans say no
-And on and on until they finally just pushed it through and quit trying to compromise
Personally, I have some faith that Obama (and enough Democratic legislators) would've listened to calm discussion of specific problems and changes, and given them real consideration, that we could've made some positive changes to a massive piece of legislation that was never going to be perfect the first go-round.
Post by: TheGrimSqueaker on November 10, 2016, 01:39:02 PM
Post by: Trudie on November 10, 2016, 02:30:29 PM
But it's what they replace it with that worries me...
Here's something that dawned on me this morning, however. The story reported that hospitals have enjoyed significant ("YUGE") decreases in losses for care of the uninsured since the ACA went into effect. Not surprising, really. The hospital/medical system is a powerful lobby with a strong vested interest in keeping people insured. I keep hoping that, even out of pure self interest, they'll unleash lobbyists and resources to fight the fight.
I'm interested in learning more about what more progressive states with exchanges might do if the ACA gets gutted. Will they still work hard to fully insure their citizens? Offer some sort of public option to the uninsured? Because the way I see it, this would strongly influence where I live my FIRED life.
Post by: Trudie on November 10, 2016, 02:32:52 PM
[/quote]
Back when I had employer provided insurance, pre-existing conditions were covered as long as you could show proof of insurance through another insurance company. There was also a 12-month waiting period and then all conditions were covered.
[/quote]
You'd think that since we have to have proof of coverage for our income taxes this would be reasonably easy to do with systems that are already in place.
Post by: FireLane on November 10, 2016, 02:39:06 PM
This, so much this.
They won't take away pre-existing coverage. It'd be a slap in the face to the nation, and I don't see that part being repealed. However, something new will come down the line, remove the mandate on carrying health insurance, remove the subsidy, and make it once again affordable. Yes, for those that are low income (me, I'd have a subsidy, but I have insurance through work), it might have worked. But, in my area, which is rural, and heavy in farming, the premiums are ranging from $700-$1500 a month, for 2 people, husband and wife, with deductibles over $5k. Seems affordable, right?
You can't have coverage for pre-existing conditions without a mandate. Otherwise any sensible person will just pay out of pocket until something expensive happens, then sign up for insurance.
This is something I wish everyone understood better. It's economically impossible for Republicans to preserve the ban on denial for pre-existing conditions, but get rid of the mandate. Either both have to be kept, or both have to be thrown out.
That's why Obamacare has been described as a three-legged stool. If you require insurance companies to accept all applicants (the first leg), people will just wait until they get sick and sign up. Without healthy people paying into the system via premiums, it will collapse in a death spiral.
So, the second leg of the stool: the mandate. Everyone has to carry insurance, even if they don't actively need it.
But then you have the problem of people potentially being forced to buy insurance they can't afford. So you create subsidies that scale with income level, so insurance is affordable for everyone. That's the third leg of the stool.
All three of these parts work together and all of them are necessary. If you repeal any part of Obamacare, the whole thing collapses.
Post by: FireLane on November 10, 2016, 02:54:18 PM
I'm certain we're going back to the bad old days when insurance companies would drop you because you had a sniffle twenty years ago. Everyone who isn't lucky enough to work for a large corporation is going to lose their coverage. Obviously, this is an enormous problem for those of us who want to retire early.
The one slender reed of hope I'm clinging to is that state-level Obamacare-type programs will continue to exist without federal support, in Massachusetts and possibly elsewhere. But that means FIRE will only be possible in those states.
Post by: redcedar on November 10, 2016, 04:21:51 PM
I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.
Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.
Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.
HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!
I think there is a alot of confusion here between HDHP and HSA. The primary purpose of an HSA is to allow you to save for and pay for your healthcare out-of-pocket costs in a tax-free manner. Other than a few plan requirements such as deductible floor and max out-of-pocket ceiling, an HSA has very little to nothing to do with plan specifics. An HSA does not impact your ability to get clear information on coverage. An HSA has nothing to do with the scenario you describe above.
My point on the staring points for ACA reform is that solutions are likely to focus on reducing the rate of healthcare cost increase. You can do that by making the covered individual more responsible for their own cost of care, ie. end of the HMO "I just pay a co-pay and don't care after that" mentality. Increased individual responsibility can be done by offering HDHPs. To help offset this cost shift, HSA expansion is likely.
Post by: redcedar on November 10, 2016, 05:02:15 PM
But think creatively, outside the box. What if a few more legs are introduced and then a few legs slowly removed? What if we have 10-15 thin and less burdensome legs?
Some of the biggest innovations were created by people who took the "it can't be done" challenge.
Post by: bacchi on November 10, 2016, 05:10:21 PM
Firelane's three legged stool is a great analytical way to look at the challenges for Trump. It is going to be HARD to change.
But think creatively, outside the box. What if a few more legs are introduced and then a few legs slowly removed? What if we have 10-15 thin and less burdensome legs?
Some of the biggest innovations were created by people who took the "it can't be done" challenge.
It'd be great if it was fixed. The big problem, of course, is that healthcare in the US is fuckin' expensive. Can't get around that. It's also difficult to make decisions while bleeding out in an ambulance.
Post by: therethere on November 10, 2016, 05:39:37 PM
My point on the staring points for ACA reform is that solutions are likely to focus on reducing the rate of healthcare cost increase. You can do that by making the covered individual more responsible for their own cost of care, ie. end of the HMO "I just pay a co-pay and don't care after that" mentality. Increased individual responsibility can be done by offering HDHPs. To help offset this cost shift, HSA expansion is likely.
Hm... I see HMO's as "Hey, I can feel free to go to the doctor on something I'm concerned about and not have to worry about random 1k bills coming in for months afterwards...." You know. Using health insurance as preventative measure to find things early. Instead of not going to the doctor because you are afraid of the bills even with HDHP insurance. Then you let something lag farther and it becomes a bigger deal. If you actually care about people's health you shouldn't be adding barriers for them to be proactive. Leaving it up to high deductibles and more on the individual just turns healthcare into a deep reactive cycle. I mean we are lucky that we are able to put the maximum amount in an HSA now. Lots of people don't have that luxury.
The problem is not individual responsibility putting it more on the individual will only make things worse. The problem is the actual cost of care, malpractice insurance, medication monopolies, inability to have transparent costs, etc.
Post by: Fishingmn on November 10, 2016, 06:55:40 PM
The problem is not individual responsibility putting it more on the individual will only make things worse. The problem is the actual cost of care, malpractice insurance, medication monopolies, inability to have transparent costs, etc.
Agree.
2 Things that seem like good ideas.
1 - Address end of life care. A Planet Money podcast talked about how people in La Crosse, WI have the highest percentage of end of life directives and thus the lowest end of life costs. We need to have open discussions with patients and families. And no, this isn't death panels.
2 - Drug reimportation. Why do US patients pay so much more than Canadians and other first world countries? Big Pharma talks about "safety" but that's baloney.
Post by: FireLane on November 10, 2016, 06:56:56 PM
https://twitter.com/MortuaryReport/status/796862287822798848
Post by: Indexer on November 10, 2016, 07:19:43 PM
Every STATE had different rules for insurance!
In many(maybe most) states an insurance company couldn't kick someone off their insurance unless they lied on the application, and in some states you couldn't kick them off after 2 years even if they lied on the application. You could have a pre-existing condition, lie about it, keep quiet about it for 2 years, hope they didn't find out, and then the insurance company would pay for anything after that. In other states, oh you broke your foot, well no more insurance for you![Which completely defeats the point of insurance.]
This is also the reason insurance cost different amounts in different states. Low regulation, they can kick you whenever they want, cheap insurance. High regulation, they can't kick you, expensive insurance.
Post by: bacchi on November 10, 2016, 07:26:14 PM
Update: Trump says he wants to scrap the ban on discrimination for pre-existing conditions and bring back high-risk pools instead. Sorry, FIRE folk, and sorry to the millions of people who are about to lose their coverage entirely.
https://twitter.com/MortuaryReport/status/796862287822798848
Wow. The rest of that post is pretty scary, too.
https://www.greatagain.gov/policy/healthcare.html
So, yeah, things could get as worse as we fear.
Post by: simplified on November 10, 2016, 11:46:22 PM
Similarly, if you have preexisting conditions either because of unexpected/unfortunate circumstances or willful negligence of your health, you can expect to pay more than others for healthcare.
Post by: sol on November 11, 2016, 12:22:32 AM
t's like buying car insurance after a huge wreck and expecting the car insurance company to pay to fix your car and all the judgments for personal injury damages against you from the occupants of the other car. That scenario just does not make sense,
I agree that we would have problems if insurance companies were required to cover costs for people who were not previously uninsured.
The difference is that some people want to remedy this situation by refusing to provide medical care (the old US system) and some people want to remedy it by insuring everyone (universal healthcare).
Post by: Metric Mouse on November 11, 2016, 01:16:58 AM
The difference is that some people want to remedy this situation by refusing to provide medical care (the old US system) and some people want to remedy it by insuring everyone (universal healthcare).
I think the biggest mistake in this discussion is that many people somehow confuse mandated health insurance with universal healthcare. They are separate things and are not interchangeable.
Post by: rubybeth on November 11, 2016, 08:13:56 AM
Firelane's three legged stool is a great analytical way to look at the challenges for Trump. It is going to be HARD to change.
But think creatively, outside the box. What if a few more legs are introduced and then a few legs slowly removed? What if we have 10-15 thin and less burdensome legs?
Some of the biggest innovations were created by people who took the "it can't be done" challenge.
It'd be great if it was fixed. The big problem, of course, is that healthcare in the US is fuckin' expensive. Can't get around that. It's also difficult to make decisions while bleeding out in an ambulance.
Yes. Watch this for a pretty in-depth analysis of US health care costs: https://www.youtube.com/watch?v=qSjGouBmo0M
I think the best part of the video is around the 6 minute mark. Health care providers can charge what they want--because of inelastic demand. You can't negotiate when you're bleeding out is exactly right. Right now, my husband is on a medication that would cost us over $2,000 per month, but there's no way to negotiate that down. The only way we can afford is through one of those weird "lower your Rx cost" cards from the company who makes the drug (?!?!?), and having a low enough deductible on our High Deductible Health Plan of $3,000 that we can "afford" it.
Post by: Axecleaver on November 11, 2016, 08:53:51 AM
http://www.modernhealthcare.com/article/20160428/blog/160429901
"House Speaker Paul Ryan said Wednesday he wants to eliminate that ban and replace it with an alternative way of covering sicker people—high-risk pools. But similar pools had a long and rocky history in many states before Obamacare's guaranteed coverage took effect, and they would cost taxpayers billions of dollars a year.
...annual public cost would exceed $24 billion. Even in such an expensive program, the pools likely would impose mandatory waiting periods, as state high-risk pools did in the past, to protect against adverse selection and high costs, and that would lead to patient hardships and poor health outcomes."
Post by: bacchi on November 11, 2016, 10:45:35 AM
Here's a preview of Paul Ryan's plan: a return to high-risk pools for anyone with a pre-existing condition. Lower rates for healthy people, high rates for sick people. God help you if you can't afford the premiums.
http://www.modernhealthcare.com/article/20160428/blog/160429901
"House Speaker Paul Ryan said Wednesday he wants to eliminate that ban and replace it with an alternative way of covering sicker people—high-risk pools. But similar pools had a long and rocky history in many states before Obamacare's guaranteed coverage took effect, and they would cost taxpayers billions of dollars a year.
...annual public cost would exceed $24 billion. Even in such an expensive program, the pools likely would impose mandatory waiting periods, as state high-risk pools did in the past, to protect against adverse selection and high costs, and that would lead to patient hardships and poor health outcomes."
So it's basically the "Fuck you if you're chronically ill" plan?
And conservatives wonder why they're so maligned.
Post by: Axecleaver on November 11, 2016, 11:26:22 AM
Chronic conditions include some rather common ones - hypertension, for example, which 70m Americans have today. About 35-40% would be forced into a high risk pool plan.
Post by: Schaefer Light on November 11, 2016, 11:31:09 AM
Lower rates for healthy people, high rates for sick people.Bad drivers have to pay substantially higher rates than good drivers for automobile insurance. From a strictly economic perspective, I don't see why health insurance would be any different.
Post by: Northwestie on November 11, 2016, 11:33:35 AM
Lower rates for healthy people, high rates for sick people.Bad drivers have to pay substantially higher rates than good drivers for automobile insurance. From a strictly economic perspective, I don't see why health insurance would be any different.
So - careless driving is now on par with getting cancer. Brilliant.
Post by: accolay on November 11, 2016, 11:33:50 AM
There have actually been several Republicans who have published plans to replace it. They haven't put them up for a vote because they know Obama would veto them.I mentioned this on another thread and maybe its wishful thinking BUT if the republicans really want to make the ACA look worse than it already was and I think they need to if they want more than a one term candidate(and lets not kid ourselves it was going bad in a hurry) is to rename it and improve it. No one will be able to take away that the Dems got this started no matter what its called and again I just feel the Republicans want to show they can do better. But as others mentioned at the very least you will have some time.
This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.
Because Obama? The reality is that there was never a plan. I'll wait for a source. They've had seven years to improve this shitshow, but did not. I have little faith that they will provide anything better than what already is.
Post by: Schaefer Light on November 11, 2016, 11:36:33 AM
I said from a strictly economic perspective. What I really think most people need is just catastrophic coverage. Find a way to do that without taking 25% of people's paychecks and you may have a winner.Lower rates for healthy people, high rates for sick people.Bad drivers have to pay substantially higher rates than good drivers for automobile insurance. From a strictly economic perspective, I don't see why health insurance would be any different.
So - careless driving is now on par with getting cancer. Brilliant.
Post by: Schaefer Light on November 11, 2016, 11:37:42 AM
Again, I said from a strictly economic perspective.Lower rates for healthy people, high rates for sick people.Bad drivers have to pay substantially higher rates than good drivers for automobile insurance. From a strictly economic perspective, I don't see why health insurance would be any different.
I'll quote myself,QuoteAnd conservatives wonder why they're so maligned.
Post by: bacchi on November 11, 2016, 11:43:44 AM
Again, I said from a strictly economic perspective.Lower rates for healthy people, high rates for sick people.Bad drivers have to pay substantially higher rates than good drivers for automobile insurance. From a strictly economic perspective, I don't see why health insurance would be any different.
I'll quote myself,QuoteAnd conservatives wonder why they're so maligned.
Maybe. It also behooves a nation to make sure that it has healthy workers. Sick workers aren't productive. Untreated diabetes leads to vision loss, even if it is their own fault for not exercising and eating poorly. The untreated cancer patient isn't designing bridges or writing code -- she's at home, dying, because her health care was rescinded and she's on the wait list for the high risk pool.
Finally, not everything is about saving money, especially in one of the richest countries on the planet.
Post by: NoStacheOhio on November 11, 2016, 11:47:30 AM
Again, I said from a strictly economic perspective.
Not everything boils down to economics. These are other human beings we're talking about.
Inequality of outcomes is a fact of life. I get that. But we're talking about excluding huge swaths of the population from basic medical care solely on the basis of their poorness.
A colonoscopy is far cheaper than taking care of someone dying of colon cancer (forget even treating it). If someone went to the trouble of getting a colonoscopy, and did happen to have a polyp removed, they now have a pre-existing condition, and are ineligible for (expensive to begin with) health care? Fuck that bullshit.
Post by: Schaefer Light on November 11, 2016, 11:49:15 AM
No, it isn't. But when you design a system that so blatantly takes money from one group of people and transfers it to another, then some people are going to be pretty pissed off. I keep coming back to the need for a plan that just provides catastrophic coverage. I don't want my insurance to pay for annual checkups, or going to see the doctor when I have the flu. I just want it to pay for broken bones, major surgeries, cancer, etc.Again, I said from a strictly economic perspective.Lower rates for healthy people, high rates for sick people.Bad drivers have to pay substantially higher rates than good drivers for automobile insurance. From a strictly economic perspective, I don't see why health insurance would be any different.
I'll quote myself,QuoteAnd conservatives wonder why they're so maligned.
Maybe. It also behooves a nation to make sure that it has healthy workers. Sick workers aren't productive. Untreated diabetes leads to vision loss, even if it is their own fault for not exercising and eating poorly. The untreated cancer patient isn't designing bridges or writing code -- she's at home, dying, because her health care was rescinded and she's on the wait list for the high risk pool.
Finally, not everything is about saving money, especially in one of the richest countries on the planet.
Post by: accolay on November 11, 2016, 11:50:28 AM
Post by: bacchi on November 11, 2016, 11:54:20 AM
Maybe. It also behooves a nation to make sure that it has healthy workers. Sick workers aren't productive. Untreated diabetes leads to vision loss, even if it is their own fault for not exercising and eating poorly. The untreated cancer patient isn't designing bridges or writing code -- she's at home, dying, because her health care was rescinded and she's on the wait list for the high risk pool.No, it isn't. But when you design a system that so blatantly takes money from one group of people and transfers it to another, then some people are going to be pretty pissed off. I keep coming back to the need for a plan that just provides catastrophic coverage. I don't want my insurance to pay for annual checkups, or going to see the doctor when I have the flu. I just want it to pay for broken bones, major surgeries, cancer, etc.
Finally, not everything is about saving money, especially in one of the richest countries on the planet.
Nostache said it better.
What you bolded is what we're trying to get at. If you don't have cancer, and someone else does, you don't want any of your precious money to help that person pay for their treatment if they're unable to pay for it themselves? Really? That's who you want to be? That's what kind of world you want to live in? That is...sad.
Post by: geekette on November 11, 2016, 11:54:38 AM
Post by: bacchi on November 11, 2016, 11:56:00 AM
http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html?pagewanted=all (http://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html?pagewanted=all)
Shiit. Who wants to be like that dump of a country, Switzerland? New Zealand? Whatever. Their standard of living sucks.
Post by: Schaefer Light on November 11, 2016, 12:07:34 PM
No. I just don't want the government to force me to do that. That government is best which governs least.Maybe. It also behooves a nation to make sure that it has healthy workers. Sick workers aren't productive. Untreated diabetes leads to vision loss, even if it is their own fault for not exercising and eating poorly. The untreated cancer patient isn't designing bridges or writing code -- she's at home, dying, because her health care was rescinded and she's on the wait list for the high risk pool.No, it isn't. But when you design a system that so blatantly takes money from one group of people and transfers it to another, then some people are going to be pretty pissed off. I keep coming back to the need for a plan that just provides catastrophic coverage. I don't want my insurance to pay for annual checkups, or going to see the doctor when I have the flu. I just want it to pay for broken bones, major surgeries, cancer, etc.
Finally, not everything is about saving money, especially in one of the richest countries on the planet.
Nostache said it better.
What you bolded is what we're trying to get at. If you don't have cancer, and someone else does, you don't want any of your precious money to help that person pay for their treatment if they're unable to pay for it themselves? Really? That's who you want to be? That's what kind of world you want to live in? That is...sad.
Post by: accolay on November 11, 2016, 12:07:48 PM
No, it isn't. But when you design a system that so blatantly takes money from one group of people and transfers it to another, then some people are going to be pretty pissed off. I keep coming back to the need for a plan that just provides catastrophic coverage. I don't want my insurance to pay for annual checkups, or going to see the doctor when I have the flu. I just want it to pay for broken bones, major surgeries, cancer, etc.
I'm pretty sure that's what insurance already does. Just like an example about car insurance provided earlier.
Post by: Schaefer Light on November 11, 2016, 12:10:32 PM
That's true. But the government doesn't force me to participate in that system. I can choose not to drive a car.No, it isn't. But when you design a system that so blatantly takes money from one group of people and transfers it to another, then some people are going to be pretty pissed off. I keep coming back to the need for a plan that just provides catastrophic coverage. I don't want my insurance to pay for annual checkups, or going to see the doctor when I have the flu. I just want it to pay for broken bones, major surgeries, cancer, etc.
I'm pretty sure that's what insurance already does. Just like an example about car insurance provided earlier.
Post by: NoStacheOhio on November 11, 2016, 12:12:06 PM
No. I just don't want the government to force me to do that. That government is best which governs least.
Coverage for pre-existing conditions doesn't work if you let people opt-out.
Insurance, by its very definition, is pooled risk. It doesn't work if you don't spread the costs.
Post by: accolay on November 11, 2016, 12:12:26 PM
No. I just don't want the government to force me to do that. That government is best which governs least.
Sure. But what does that mean? I can come up with hundreds, if not thousands of examples where I want government involved.
"I don't like it, even if it makes economic/environmental/whatever sense" I really have never understood this viewpoint.
Post by: Northwestie on November 11, 2016, 12:27:11 PM
I said from a strictly economic perspective. What I really think most people need is just catastrophic coverage. Find a way to do that without taking 25% of people's paychecks and you may have a winner.Lower rates for healthy people, high rates for sick people.Bad drivers have to pay substantially higher rates than good drivers for automobile insurance. From a strictly economic perspective, I don't see why health insurance would be any different.
So - careless driving is now on par with getting cancer. Brilliant.
So well-child visits, pre-natal care, checkups, vaccines, any type of needed medicine - how does that get paid for?? Catastrophic is great - if you can manage to pay for even minor emergencies - your kid steps on a nail or breaks their arm. For those that can't afford this?
And without financial access to normal health care checkups its shown that folks get more unhealthy and then land in the emergency room sooner or later - which, in the long run, costs all of us more. Not to mention the burden it puts on those less financially secure.
Post by: FIFoFum on November 11, 2016, 12:33:23 PM
I said from a strictly economic perspective. What I really think most people need is just catastrophic coverage. Find a way to do that without taking 25% of people's paychecks and you may have a winner.Lower rates for healthy people, high rates for sick people.Bad drivers have to pay substantially higher rates than good drivers for automobile insurance. From a strictly economic perspective, I don't see why health insurance would be any different.
So - careless driving is now on par with getting cancer. Brilliant.
Congratulations! You just made the case for universal health care, because that is what makes the most sense from an economic perspective.
Now if only there was some model anywhere we could see this in practice.
Post by: Northwestie on November 11, 2016, 12:36:17 PM
Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
Belgium 1945 Insurance Mandate
United Kingdom 1948 Single Payer
Kuwait 1950 Single Payer
Sweden 1955 Single Payer
Bahrain 1957 Single Payer
Brunei 1958 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Austria 1967 Insurance Mandate
United Arab Emirates 1971 Single Payer
Finland 1972 Single Payer
Slovenia 1972 Single Payer
Denmark 1973 Two-Tier
Luxembourg 1973 Insurance Mandate
France 1974 Two-Tier
Australia 1975 Two Tier
Ireland 1977 Two-Tier
Italy 1978 Single Payer
Portugal 1979 Single Payer
Cyprus 1980 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
South Korea 1988 Insurance Mandate
Iceland 1990 Single Payer
Hong Kong 1993 Two-Tier
Singapore 1993 Two-Tier
Switzerland 1994 Insurance Mandate
Israel 1995
Post by: Schaefer Light on November 11, 2016, 12:40:15 PM
What you're talking about sounds more like a comprehensive health coverage plan than an insurance plan, though. I think the fundamental difference between me and a lot of the folks on this board is that I don't believe people are entitled to health care....or much of anything else, for that matter.I said from a strictly economic perspective. What I really think most people need is just catastrophic coverage. Find a way to do that without taking 25% of people's paychecks and you may have a winner.Lower rates for healthy people, high rates for sick people.Bad drivers have to pay substantially higher rates than good drivers for automobile insurance. From a strictly economic perspective, I don't see why health insurance would be any different.
So - careless driving is now on par with getting cancer. Brilliant.
So well-child visits, pre-natal care, checkups, vaccines, any type of needed medicine - how does that get paid for?? Catastrophic is great - if you can manage to pay for even minor emergencies - your kid steps on a nail or breaks their arm. For those that can't afford this?
And without financial access to normal health care checkups its shown that folks get more unhealthy and then land in the emergency room sooner or later - which, in the long run, costs all of us more. Not to mention the burden it puts on those less financially secure.
Post by: NoStacheOhio on November 11, 2016, 01:00:15 PM
So well-child visits, pre-natal care, checkups, vaccines, any type of needed medicine - how does that get paid for?? Catastrophic is great - if you can manage to pay for even minor emergencies - your kid steps on a nail or breaks their arm. For those that can't afford this?What you're talking about sounds more like a comprehensive health coverage plan than an insurance plan, though. I think the fundamental difference between me and a lot of the folks on this board is that I don't believe people are entitled to health care....or much of anything else, for that matter.
And without financial access to normal health care checkups its shown that folks get more unhealthy and then land in the emergency room sooner or later - which, in the long run, costs all of us more. Not to mention the burden it puts on those less financially secure.
So you'd rather pay for the treatment/death of a child with whooping cough instead of a vaccine.
Make no mistake, we still pay for these people to be treated. It's just less direct than pooled-risk insurance.
I work at a hospital. Our patients population hasn't really changed much, but our charity care numbers have gone down while our Medicaid and private insurance numbers have gone up. These are the same people we were treating before ACA, we were just eating the costs and charging everyone else the difference. If you think that's a better system, your fundamental understanding of economics is flawed.
Post by: daverobev on November 11, 2016, 01:02:53 PM
I think the fundamental difference between me and a lot of the folks on this board is that I don't believe people are entitled to health care....or much of anything else, for that matter.
So a child, someone that hasn't had the chance to earn enough money to look after themselves, has no chance for medical if their parents are too poor?
So, in a recession when lots of jobs are lost in industries where people tend to stay in a job for life, unemployed people that become sick shouldn't be able to get care?
So, someone born with asthma, missing an arm, a twisted spine, a weak heart, whatever, shouldn't be able to get cover, despite not really being able to work?
We should just strangle imperfect children at birth, stops them being a drain on society, right? (sarcasm, very heavy sarcasm)
Don't get me wrong - I get it - but presumably you don't want to pay for other people's children's primary and secondary education. Presumably you don't want to pay for street lighting as you don't go out at night. Presumably you wouldn't want to pay for coastal erosion prevention because you don't live near the ocean.
I really don't want to be impolite, but my God.
You think giving someone medicine to make their every waking hour not, or less, painful, is not something a society should do?
Post by: jim555 on November 11, 2016, 01:04:17 PM
It is much better to have a system in place that pays this before the bill and not after.
Post by: Schaefer Light on November 11, 2016, 01:06:14 PM
I work at a hospital. Our patients population hasn't really changed much, but our charity care numbers have gone down while our Medicaid and private insurance numbers have gone up. These are the same people we were treating before ACA, we were just eating the costs and charging everyone else the difference. If you think that's a better system, your fundamental understanding of economics is flawed.
I don't think that's a better system, but I don't work at a hospital and am not as familiar with it as those that do.
Post by: Schaefer Light on November 11, 2016, 01:08:51 PM
I don't want people dying in the streets. I just tend to think government should err on the side of being smaller rather than larger.I think the fundamental difference between me and a lot of the folks on this board is that I don't believe people are entitled to health care....or much of anything else, for that matter.
So a child, someone that hasn't had the chance to earn enough money to look after themselves, has no chance for medical if their parents are too poor?
So, in a recession when lots of jobs are lost in industries where people tend to stay in a job for life, unemployed people that become sick shouldn't be able to get care?
So, someone born with asthma, missing an arm, a twisted spine, a weak heart, whatever, shouldn't be able to get cover, despite not really being able to work?
We should just strangle imperfect children at birth, stops them being a drain on society, right? (sarcasm, very heavy sarcasm)
Don't get me wrong - I get it - but presumably you don't want to pay for other people's children's primary and secondary education. Presumably you don't want to pay for street lighting as you don't go out at night. Presumably you wouldn't want to pay for coastal erosion prevention because you don't live near the ocean.
I really don't want to be impolite, but my God.
You think giving someone medicine to make their every waking hour not, or less, painful, is not something a society should do?
And with that, I've had enough of defending a guy I didn't even vote for (I just like to argue ;) and I'm on my way to the golf course. The first tee and a cold beer are calling my name. Have a good weekend, folks.
Post by: bacchi on November 11, 2016, 03:44:33 PM
http://www.cnn.com/2016/11/11/politics/donald-trump-obamacare-interview/index.html
Quote
Trump said he would like to keep the provision forbidding discrimination based on pre-existing conditions and to allow young Americans to remain on their parents' healthcare plans.
This guy is all over the place.
Post by: FireLane on November 11, 2016, 04:02:12 PM
Country Start Date of Universal Health Care System Type
Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
Belgium 1945 Insurance Mandate
United Kingdom 1948 Single Payer
Kuwait 1950 Single Payer
Sweden 1955 Single Payer
Bahrain 1957 Single Payer
Brunei 1958 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Austria 1967 Insurance Mandate
United Arab Emirates 1971 Single Payer
Finland 1972 Single Payer
Slovenia 1972 Single Payer
Denmark 1973 Two-Tier
Luxembourg 1973 Insurance Mandate
France 1974 Two-Tier
Australia 1975 Two Tier
Ireland 1977 Two-Tier
Italy 1978 Single Payer
Portugal 1979 Single Payer
Cyprus 1980 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
South Korea 1988 Insurance Mandate
Iceland 1990 Single Payer
Hong Kong 1993 Two-Tier
Singapore 1993 Two-Tier
Switzerland 1994 Insurance Mandate
Israel 1995
I just wanted to quote this again to emphasize that health care is a solved problem in basically every other industrialized country in the world. It's a goddamn travesty that the U.S., the richest and most powerful nation that's ever existed, is the one country where we haven't figured this out. It's the one country where ordinary people have to skip medical care because they can't afford it, or die from not being able to afford it, or go bankrupt in an attempt to afford it.
Lots of countries that are nowhere near as rich as we are have solved this. The reason we haven't isn't because we lack the resources, it's because we lack the political will.
Post by: dividendman on November 11, 2016, 04:15:40 PM
http://www.cnn.com/2016/11/11/politics/donald-trump-obamacare-interview/index.html (http://www.cnn.com/2016/11/11/politics/donald-trump-obamacare-interview/index.html)
Post by: mtnrider on November 11, 2016, 08:35:35 PM
Perhaps all is not lost:
http://www.cnn.com/2016/11/11/politics/donald-trump-obamacare-interview/index.html (http://www.cnn.com/2016/11/11/politics/donald-trump-obamacare-interview/index.html)
I want to believe.
There's a lot to this: http://www.politico.com/story/2016/11/gop-obamacare-rift-231272 But Trump acts more as a filter than a generator of policy. Congress wants it gone, and they pass the laws. He only gets to veto them.
As was eloquently said here recently
Quote from: FireLane
That's why Obamacare has been described as a three-legged stool. If you require insurance companies to accept all applicants (the first leg), people will just wait until they get sick and sign up. Without healthy people paying into the system via premiums, it will collapse in a death spiral.
So, the second leg of the stool: the mandate. Everyone has to carry insurance, even if they don't actively need it.
But then you have the problem of people potentially being forced to buy insurance they can't afford. So you create subsidies that scale with income level, so insurance is affordable for everyone. That's the third leg of the stool.
All three of these parts work together and all of them are necessary. If you repeal any part of Obamacare, the whole thing collapses.
Post by: obstinate on November 11, 2016, 09:54:59 PM
Perhaps all is not lost:This cannot work. The individual mandate is necesary to make the guaranteed issuance (no consideration of preexisting conditions) requirement work. Without it, healthy people will begin trickling out of the risk pool. This will drive up the average sickness, and thus the average price, for those who remain. Then more healthy people will leave, driving up the price further. Also, without an individual mandate, there's not really much downside to being out of the risk pool if you're healthy, since you can always just buy the insurance if you get sick.
http://www.cnn.com/2016/11/11/politics/donald-trump-obamacare-interview/index.html (http://www.cnn.com/2016/11/11/politics/donald-trump-obamacare-interview/index.html)
The end state is a very expensive pool with nothing but sick people in it. And healthy people without insurance. This effect is known as adverse selection. Mr. Trump doesn't know about it because he is ignorant of basic economic principles.
Post by: mtnrider on November 11, 2016, 10:12:01 PM
The end state is a very expensive pool with nothing but sick people in it. And healthy people without insurance. This effect is known as adverse selection. Mr. Trump doesn't know about it because he is ignorant of basic economic principles.
I can't imagine that Trump is that ignorant?! Even if he hadn't heard of this (in all his years of business?), someone must have briefed him on it during the election.
We do know that Paul Ryan understands. And he's the guy who'll be putting the repeal bill on a President Trump's desk.
Post by: sol on November 11, 2016, 10:21:27 PM
This cannot work. The individual mandate is necesary to make the guaranteed issuance (no consideration of preexisting conditions) requirement work. Without it, healthy people will begin trickling out of the risk pool. This will drive up the average sickness, and thus the average price, for those who remain. Then more healthy people will leave, driving up the price further. Also, without an individual mandate, there's not really much downside to being out of the risk pool if you're healthy, since you can always just buy the insurance if you get sick.
I'm pretty confident that this paragraph encompasses more knowledge about American health insurance than Trump knew on Monday. I'm hoping he's learned some more by now.
Post by: obstinate on November 11, 2016, 11:08:44 PM
I can't imagine that Trump is that ignorant?! Even if he hadn't heard of this (in all his years of business?), someone must have briefed him on it during the election.Ryan's proposal up until now basically consists of returning to the status quo c.a. 2008. That is, availability, price, and quality of private insurance will vary drastically from state to state, depending on what requirements each state places on insurance companies. Only in states like Massachusetts that have an individual mandate will quality and availability be high with reasonable prices.
We do know that Paul Ryan understands. And he's the guy who'll be putting the repeal bill on a President Trump's desk.
(Except that he'd also like to toss seniors into that shark tank by dismantling Medicare.)
Post by: Metric Mouse on November 11, 2016, 11:29:46 PM
Post by: obstinate on November 11, 2016, 11:36:47 PM
So has no one heard that Trump will keep most of the popular parts of the ACA, or are we stillooking freaking out I need ignorance?Yes, we talked about that starting in this message: http://forum.mrmoneymustache.com/off-topic/impending-repeal-of-obamacare-what-to-do/msg1301646/#msg1301646. You need ignorance?
Post by: sol on November 11, 2016, 11:43:06 PM
So has no one heard that Trump will keep most of the popular parts of the ACA, or are we stillooking freaking out I need ignorance?
I've heard him say he wants to keep the popular parts, but repeal all of the parts that make the popular parts possible.
He also says he's going to raise the budget of the military and slash taxes and somehow that will balance the budget. He's clearly insane. Or he just reeealllly likes deficits.
If you repeal the individual mandate and keep the preexisting ban, then no one will buy insurance until they get sick and insurance companies will go out of business, or jack rates through the roof. If he wants to keep rates down he has to have some kind of subsidy. The Republicans already know this, which is they wrote the ACA law the way they did in the first place.
Trump can promise everyone ice cream for dinner if he likes, but the reality is that it just doesn't work that way. Insurance has to be economical for all parties involved, or it falls apart. Maybe he's planning to just enforce rate limits and keep the preexisting ban, and then nationalize all of the health insurers when they go bankrupt? Swoop in like a venture capital fund and buy them with taxpayer money, as depressed assets? I don't see any other way to do what he's promising.
Post by: gerardc on November 12, 2016, 01:20:39 AM
You can't have coverage for pre-existing conditions without a mandate. Otherwise any sensible person will just pay out of pocket until something expensive happens, then sign up for insurance.
What's wrong with having non-sensible persons subsidize sensible ones? Seems like a good deal to me, in a Darwinian sense
Post by: gerardc on November 12, 2016, 01:31:52 AM
This is something I wish everyone understood better. It's economically impossible for Republicans to preserve the ban on denial for pre-existing conditions, but get rid of the mandate. Either both have to be kept, or both have to be thrown out.
That's why Obamacare has been described as a three-legged stool. If you require insurance companies to accept all applicants (the first leg), people will just wait until they get sick and sign up. Without healthy people paying into the system via premiums, it will collapse in a death spiral.
So, the second leg of the stool: the mandate. Everyone has to carry insurance, even if they don't actively need it.
But then you have the problem of people potentially being forced to buy insurance they can't afford. So you create subsidies that scale with income level, so insurance is affordable for everyone. That's the third leg of the stool.
All three of these parts work together and all of them are necessary. If you repeal any part of Obamacare, the whole thing collapses.
Interestingly, those three legs work similarly to universal health care:
- Everyone gets care if they need it
- Everyone pays for it even if they don't need it
- Everyone pays for it roughly proportionally to their income (implemented via subsidies by ACA and progressive taxation by universal care)
Universal just eliminates paperwork, which is a big part of the cost.
Any idea how we could reduce prices of health care in general? Seems like competition and "shopping around" isn't working, and price fixing is actually what happens.
Post by: firedup on November 12, 2016, 02:53:02 AM
........ I mean, you'll riot - pretty much - to keep your access to firearms, but not to make sure everyone has access to good medical coverage.
That I cannot understand. Just can't.
+1,000,000.......WELL said!!!!
Our state just legalized pot and rejected firearm background checks and people came out in record numbers to vote this year. ARGH!
I came here tonight for some intelligent, well thought out perspectives on this subject and found some really good posts. Thanks.
My hope is Trump will want to put his signature on "the BEST healthcare in the world" and highjack Hillary and Bernie's ideas for universal. Hubby insists he wants something GREAT he can put his name on. And this has been a huge issue. He was a Democrat in 2012 and in one of his many interviews he said "everyone will be covered". Of course he flips on everything so who knows. We all have our dreams right?
I saw he was putting Ben Carson on this so the whole thing gives me little hope. Sigh...
HSAs do nothing with no earned income. And if income is low, full deduction does nothing either. Crap for plans for "repeal & replace" for what they are showing at this point.
Then there's the SS & Medicare issues. Ryan is still pushing to tear all that up. Best thing Trump could do is get rid of Ryan.
Clicking heals three times........" I do not want to go back to work"......." I do not want to go back to work"........ " I do not want to go back to work"......
Post by: jim555 on November 12, 2016, 06:03:06 AM
Post by: rtrnow on November 12, 2016, 06:17:49 AM
I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.
Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.
Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.
HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!
I think there is a alot of confusion here between HDHP and HSA. The primary purpose of an HSA is to allow you to save for and pay for your healthcare out-of-pocket costs in a tax-free manner. Other than a few plan requirements such as deductible floor and max out-of-pocket ceiling, an HSA has very little to nothing to do with plan specifics. An HSA does not impact your ability to get clear information on coverage. An HSA has nothing to do with the scenario you describe above.
My point on the staring points for ACA reform is that solutions are likely to focus on reducing the rate of healthcare cost increase. You can do that by making the covered individual more responsible for their own cost of care, ie. end of the HMO "I just pay a co-pay and don't care after that" mentality. Increased individual responsibility can be done by offering HDHPs. To help offset this cost shift, HSA expansion is likely.
I understand HSA's perfectly. As I said, I've had one and maxed it for years. The tax benefits are great. I've kept my HSA with no less than 4 different health plans. However, republicans push HSA as a health solution. The reasoning is always that it will make people more conscience of cost. My point is that that is impossible. Forget the emergency situation all together. If I need a routine service, I cannot easily compare costs from different doctors and facilities. The costs and fees are not at all transparent. I have tried with many different doctors and at least 3 different health companies. So yes, I max and never spend my HSA money bc it's a great tax dodge. However, it does not function the way it's sold to consumers.
Post by: brooklynguy on November 12, 2016, 06:20:11 AM
Post by: Metric Mouse on November 12, 2016, 06:30:08 AM
So has no one heard that Trump will keep most of the popular parts of the ACA, or are we stillooking freaking out I need ignorance?
I've heard him say he wants to keep the popular parts, but repeal all of the parts that make the popular parts possible.
He also says he's going to raise the budget of the military and slash taxes and somehow that will balance the budget. He's clearly insane. Or he just reeealllly likes deficits.
If you repeal the individual mandate and keep the preexisting ban, then no one will buy insurance until they get sick and insurance companies will go out of business, or jack rates through the roof. If he wants to keep rates down he has to have some kind of subsidy. The Republicans already know this, which is they wrote the ACA law the way they did in the first place.
Trump can promise everyone ice cream for dinner if he likes, but the reality is that it just doesn't work that way. Insurance has to be economical for all parties involved, or it falls apart. Maybe he's planning to just enforce rate limits and keep the preexisting ban, and then nationalize all of the health insurers when they go bankrupt? Swoop in like a venture capital fund and buy them with taxpayer money, as depressed assets? I don't see any other way to do what he's promising.
Not a bad idea though. Maybe a good step towards national health care, instead of national insurance. Rates have not been kept lower, subsidies have just masked the high rates from some people. There has to be a better way to provide health care to American citizens , I think this is a dialogue we need to have.
I just dont understand how one can simultaneously believe he will do the things he said, but also not do the things he said...
Since it's beyond the sphere of my control, I choose to remain positive.
Post by: accolay on November 12, 2016, 08:01:44 AM
The best case scenario: Republicans do some cosmetic tweaks to the ACA, rename the whole thing "TrumpCare" and declare victory.
-The individual mandate will be renamed "The Patriotic American Personal Responsibility Fee" (because hardworking Americans shouldn't have to subsidize moochers)
-The subsidies will be renamed "The Deserving Hardworking American Discount" (because hardworking Americans deserve a break)
I can see Trump's speech: "I reformed Health care and it was so easy. But Obama and Hillary couldn't do it. They couldn't do it. And they had eight years! Sad. Now you'll have TrumpCare, which is much much better. You'll be amazed when you get it. Only Trump could fix it!"
Wonder if those certain Red States would then accept Medicaid subsidies?
Post by: wenchsenior on November 12, 2016, 08:42:29 AM
The best case scenario: Republicans do some cosmetic tweaks to the ACA, rename the whole thing "TrumpCare" and declare victory.
-The individual mandate will be renamed "The Patriotic American Personal Responsibility Fee" (because hardworking Americans shouldn't have to subsidize moochers)
-The subsidies will be renamed "The Deserving Hardworking American Discount" (because hardworking Americans deserve a break)
I can see Trump's speech: "I reformed Health care and it was so easy. But Obama and Hillary couldn't do it. They couldn't do it. And they had eight years! Sad. Now you'll have TrumpCare, which is much much better. You'll be amazed when you get it. Only Trump could fix it!"
This is exactly what I think would be likely to happen if only the Tea Party faction of the House didn't have so much power .
The current problems with the ACA are mostly confined to the insurance pools (which is a smaller segment of those being covered), as opposed to the larger expansion of Medicaid, which is working fairly well and appears to be keeping inflation of costs reasonable. But, 1) fewer businesses dropped coverage and dumped their employees onto the exchanges than was originally expected (fewer healthy people than expected in the exchange pools); and 2) a bunch of big insurers raced in with 'competitive' pricing during the first few seasons to grab market share in the exchanges, but due to number 1, they soon discovered that mostly sick people signed up; so now 3) a few years in, the big insurers in many (though not all) of the markets are spiking their prices to cover the gap in their projected profits [ETA...and also the insurers are pulling out of some markets (mostly rural counties with small populations) altogether, leaving people no insurance to buy at all]. This potentially leads to some people dropping out of the exchanges (ie potential 'death spiral').
There are ways to fix this problem and to allow big insurers to smooth out their future prices using better actuarial projections and for smaller insurers to potentially come into these under-served markets, if we only had a Congress that could pass shit. We know this because there are several other developed nations with better health care systems (cheaper, better outcomes, everyone insured) than ours use the same type of system as the ACA, rather than single payer or socialized. Essentially, Congress would have to pass laws capping premiums in some form (perhaps pegging them to some general health care inflation value); AND Congress would have to dramatically increase the penalties of not carrying insurance with very large fines or threat of jail.
Since the 90s, the ACA model has been the GOP's answer to the heath care crisis. Until it was passed by Dems. It would not shock me if the tweaked it and re-passed essentially the same law. On the other hand, good sense is not a feature of the activist base in the House, sooo....
I am absolutely certain that the last few posts contained more knowledge about the health care program than Trump understood during the campaign. Suspect he's gonna be learning fast now. At least I hope so.
Post by: bacchi on November 12, 2016, 09:35:04 AM
Post by: rubybeth on November 12, 2016, 09:51:04 AM
The pre-existing fix will be to go back to the state high-risk pools. That'll jack up the rates for those people who need it, unless the pools are heavily subsidized. They'll also have waiting lists, unless the pools are heavily subsidized.
That's what our state congresspeople were crowing about on the radio just last month. "We need those high risk pools back!" I'm sorry, I was in one of those (for the terribly debilitating pre-existing conditions of ALLERGIES and TEENAGE ACNE), and my deductible was $10,000. No, thanks! I'd rather pay a bit more for my premiums and have a low enough deductible that I can actually afford.
As others have said, you can't keep parts of the ACA you like and do away with "the bad parts," because they all work together.
The only way I can see this ever getting better is to do away with insurance companies entirely. But oh wait--that's a huge industry and provides probably millions of jobs, including in your community hospitals and clinics (medical billing, medical coding, etc.). I don't exactly look forward to the crumbling of that industry in our economy.
Post by: jim555 on November 12, 2016, 09:59:55 AM
It is not as easy as just undo it. I think they will regret ever going near it. It is a political hornet's nest and they are whacking it with a stick.
Post by: FIRE me on November 12, 2016, 10:08:35 AM
So has no one heard that Trump will keep most of the popular parts of the ACA, or are we stillooking freaking out I need ignorance?
The popular part of Obamacare that is least likely to survive is the subsidy. It would be replaced by a tax credit that will be nearly useless to Mustachians living a low expenses, low income, low tax, Root of Good type of early retirement.
Post by: wenchsenior on November 12, 2016, 10:16:50 AM
I would not want to be the one trying to get rid of it. The whole issue is VERY complex, with many powerful interest groups involved. There is no clear alternative to it.
It is not as easy as just undo it. I think they will regret ever going near it. It is a political hornet's nest and they are whacking it with a stick.
Well, look for the very first thing they do as part of 'repeal' is to change their current proposal for sunsetting the existing ACA (~2 years), to sunsetting later. Because the current proposal would cause ~20 million people newly insured under the ACA to be thrown off and lose coverage right before the 2018 midterm elections. They likely won't risk that, even if it is mostly poor people who won't vote in midterms.
Post by: FIRE Artist on November 12, 2016, 10:17:57 AM
The pre-existing fix will be to go back to the state high-risk pools. That'll jack up the rates for those people who need it, unless the pools are heavily subsidized. They'll also have waiting lists, unless the pools are heavily subsidized.
That's what our state congresspeople were crowing about on the radio just last month. "We need those high risk pools back!" I'm sorry, I was in one of those (for the terribly debilitating pre-existing conditions of ALLERGIES and TEENAGE ACNE), and my deductible was $10,000. No, thanks! I'd rather pay a bit more for my premiums and have a low enough deductible that I can actually afford.
As others have said, you can't keep parts of the ACA you like and do away with "the bad parts," because they all work together.
The only way I can see this ever getting better is to do away with insurance companies entirely. But oh wait--that's a huge industry and provides probably millions of jobs, including in your community hospitals and clinics (medical billing, medical coding, etc.). I don't exactly look forward to the crumbling of that industry in our economy.
As a Canadian who enjoys our single payer system, I can tell you that we still have an insurance industry, they insure all supplemental health things, like dental, eye, prescriptions, physiotherapy etc. The insurance industry does not die, nor does the medical billing and coding as doctors offices still need to bill the single payer just like a doctor in the US needs to bill the insurance companies. The only disadvantage is you have to get past the concept of McHealthcare that those of privilege in the US are so used to.
Post by: sol on November 12, 2016, 10:20:06 AM
The popular part of Obamacare that is least likely to survive is the subsidy. It would be replaced by a tax credit that will be nearly useless to Mustachians living a low expenses, low income, low tax, Root of Good type of early retirement.
Well that's not entirely true. For some of us, at least, additional tax credits would allow us to move larger annual chunks of money out of our 401ks and into our Roth IRAs as part of the 5 year Roth pipeline process, if it effectively expands the 0% tax bracket.
Which is not to say I support a return to high-risk pools as good for anyone. We've been trying to fix American healthcare for decades now, from both sides of the isle, and the insurance industry has been the only consistent opposition. For some reason, House Republicans have now sided with the insurance industry on this issue. Maybe I shouldn't be surprised that they've chosen to support American businesses over American citizens, yet again?
I just want Americans to have affordable medical care. I don't care what we call it, or which party gets credit for it. The Democrats were the only group that was actually willing to try something, but if the Republicans can pull something together I'm all for that too. Just don't tear the whole thing down and send us back to the obviously badly broken system we had before.
Post by: obstinate on November 12, 2016, 10:28:44 AM
What's wrong with having non-sensible persons subsidize sensible ones? Seems like a good deal to me, in a Darwinian senseSure. And in a Darwinian sense, I should be able to shoot you and take all your money if I want to. Hope that answers your question.
Post by: Trudie on November 12, 2016, 12:46:15 PM
We have a little time. Open enrollment now, means your plan will last until 12/31/2017. Insurance plans and rates are governed at the state level by your Dept of Insurance.
The ACA will be repealed. Republicans would use budget reconciliation to counter a filibuster, and vote to de-fund. They only need 50 votes for that (with Pence providing the tie-breaker). That would break ACA by removing the APTC tax credits. And budget reconciliation debate is limited to a day, so it can't itself be filibustered.
Medicaid block grants will really hurt, too. This translates into a massive shrinking of Medicaid (less fed dollars means more state dollars , which don't exist), which will massively inflate the ranks of the uninsured. Medicaid services will be rationed in some way - shrinking the rolls, or cutting services, or both. Meanwhile, the price of services is increasing.
Over the next year, we'll know more about our options. It's too soon to panic.
Can we just vote Axe Cleaver into office to take care of this problem? So calm, cool, and collected.
Post by: Axecleaver on November 12, 2016, 12:58:52 PM
My impression is that Trump is saying he wants to keep the popular parts today, so that later he can tell us "it's too expensive, just not going to work. You have Obama to thank for that. But, good news! We can implement high risk pools for those unhealthy people who don't take care of themselves. And we will have affordable plans for people who do." Never mind that 40% of us have hypertension, high cholesterol, type 1 diabetes, or cancer from genetic inheritance. This is just a step of his marketing. I predict high risk pools in 2019, with a 40% chance they jam them into 2018.
Post by: gerardc on November 12, 2016, 01:30:00 PM
Post by: sol on November 12, 2016, 01:38:08 PM
For those saying a pre-existing ban cannot work without the individual mandate, could we have a pre-existing ban (no expulsion, no price change) for those who always maintained continuous coverage? This way, people who want to opt in health insurance (likely 50%+ of people) will all be in a single risk pool, but people could also completely opt out if they choose (for life).
What about people who opt out at age 21 because they feel invincible, and then get cancer at 35? We just let them die?
The whole idea here is for society to find a way to take care of it's least fortunate members. If lady luck fucks you, America is supposed to have your back.
Post by: bacchi on November 12, 2016, 01:47:28 PM
For those saying a pre-existing ban cannot work without the individual mandate, could we have a pre-existing ban (no expulsion, no price change) for those who always maintained continuous coverage? This way, people who want to opt in health insurance (likely 50%+ of people) will all be in a single risk pool, but people could also completely opt out if they choose (for life).
Yeah, this would work. But what if the person who skipped insurance was working class and it was either rent or insurance premiums? Who gets to tell the formerly healthy person, who now has cancer, that "Dying sucks. Good luck with that."?
I'm skeptical it would ever happen that way, though. We have to consider why they're trying to shuffle chronically ill people to weak-ass high-risk pools. It's not for better care or lower premiums.
Post by: gerardc on November 12, 2016, 01:56:19 PM
What about people who opt out at age 21 because they feel invincible, and then get cancer at 35? We just let them die?
Well, those are the people who decided that they were healthy and they absolutely did not want to pay for other people's sickness. People who thought that by exercising and eating healthy, they wouldn't need subsidies and would be fine in the old system. So, yes, we can just let them participate in the high risk pools then, as was the case in the old system.
Basically, at 18, you decide if you want to live in old America, or a more socialized America. You have been warned.
Yeah, this would work. But what if the person who skipped insurance was working class and it was either rent or insurance premiums? Who gets to tell the formerly healthy person, who now has cancer, that "Dying sucks. Good luck with that."?
We may need subsidies for the "opted into the ACA" people, for whom (progressive) income tax would be higher at higher income.
Probably way too complicated to segregate Americans like that, but I could see it theoretically work.
Post by: obstinate on November 12, 2016, 02:24:51 PM
Of course, Trump understands you can't have the pre-existing condition exclusion exclusion (not sure the best way to write that) without the individual mandate. But the exclusion is popular. So he says he supports it. It will then be up to the insurance companies to voice that you can't keep it without the mandate. And Trump can say, shoot, I tried to keep it, but nothing can be done because the insurance companies won't go along, and we're not going to be socialists. And then he comes out the winner.This is wishful thinking. If his actions lead to people being unable to get insurance, he will take some damage. Also, it's not at all clear that he does understand things like this. Walk like a buffoon, talk like a buffoon . . . you might just be a buffoon. I'd need to see some more evidence of his cleverness before I buy the idea that it's just an act.
All of this election fallout has been misguided because most people understand that politicians make promises they can't keep, but somehow then try to take Trump at face value.This is not in line with reality. Studies have demonstrated that elected officials keep a majority of their promises, and even the ones they can't keep, they normally try their best. http://fivethirtyeight.com/features/trust-us-politicians-keep-most-of-their-promises/
Post by: obstinate on November 12, 2016, 02:38:29 PM
Basically, at 18, you decide if you want to live in old America, or a more socialized America. You have been warned.Yeah, that's not really gonna fly. People don't want other people, even those who've made bad decisions, to go to their deaths early. Even when our policies tacitly endorsed this state of affairs (GWBush years pre-ACA), what actually happened is we gave these folks just enough care to limp along and be a huge drain on the system, generally by mandating that emergency rooms treat anyone, regardless of ability to pay.
Post by: wenchsenior on November 12, 2016, 02:57:46 PM
Basically, at 18, you decide if you want to live in old America, or a more socialized America. You have been warned.Yeah, that's not really gonna fly. People don't want other people, even those who've made bad decisions, to go to their deaths early. Even when our policies tacitly endorsed this state of affairs (GWBush years pre-ACA), what actually happened is we gave these folks just enough care to limp along and be a huge drain on the system, generally by mandating that emergency rooms treat anyone, regardless of ability to pay.
Not to mention the fact that most people are barely starting to understand economics and politics at 18, and are notoriously bad at making decisions that have long term consequences. Maybe if we had mandatory courses in school that covered this decision and its ramifications, but even then...
Post by: obstinate on November 12, 2016, 02:59:28 PM
Post by: Christof on November 12, 2016, 03:15:40 PM
Country Start Date of Universal Health Care System Type
...
Germany 1941 Insurance Mandate
...
That is short, but misleading... Health insurance in Germany is mandatory since 2009, pretty much like in the US. We also do not have a universal health care system. Instead we have public insurance for employees, welfare coverage for various groups on benefits, governmental coverage for state and federal employees and private insurance for highly paid employees and freelancers. Public insurance is a percentage of income for family coverage, private insurance is a fixed price based on plan and benefits, welfare and governmental insurance is included because one is either receiving welfare or working for the government.
For certain groups (like me) we actually have less governmental required payments than the US. For instance, social security is optional for some groups in Germany, but mandatory in the US.
Post by: gerardc on November 12, 2016, 06:16:39 PM
Not to mention the fact that most people are barely starting to understand economics and politics at 18, and are notoriously bad at making decisions that have long term consequences. Maybe if we had mandatory courses in school that covered this decision and its ramifications, but even then...
Another issue is that your life until 18 years old is a non-perfect, but non-negligible indicator of your future health. The full coverage plan would probably attract slightly more people with chronic or developing conditions. Everytime you allow healthier people to opt out, you basically skew the distribution of the 2 groups, and prices can go up in the less healthy group.
Tangentially, there's a similar phenomenon with emigration/immigration into countries where universal care is provided (or states with subsidies). If the US gets universal care, it may attract more unhealthy people in general. For example, I'm a Canadian citizen living in the US, and I know I can get back to Canada if I get really sick in the future. This is a bad deal for Canada. Granted, crossing borders isn't as easy as hopping in and out of a plan, but with globalization and cheap air travel, it may be easier than before. What we really need is WORLDWIDE fully universal care :D
Post by: gerardc on November 12, 2016, 06:34:20 PM
Post by: obstinate on November 12, 2016, 06:47:13 PM
Post by: gerardc on November 12, 2016, 07:08:23 PM
gerardc, it seems very far-fetched to believe that is the main line of reasoning, since I've never heard anyone vocalize it before. More likely, folks who have (health in this case) just don't want to pay to help those who have not.
One thing I've learned from US companies is that you don't need to be malicious to unintentionally optimize for an "evil" outcome that advantages you. You just need a blind optimization process (e.g. survival of the fittest and emulating successful people) that preserves your good intentions and plausible deniability. Examples: monopolies and price fixing via merges/acquisitions, deception with click-bait ads, bait-and-switch. In those cases, your advantageous position is only possible with evil consequences, whether you realize it or not.
Post by: oldtoyota on November 12, 2016, 08:04:57 PM
Broken campaign promise #1.
Who knows? He could change his mind tomorrow.
Post by: mtnrider on November 12, 2016, 08:19:48 PM
The latest I heard is he doesn't plan to repeal Obamacare.
Broken campaign promise #1.
Who knows? He could change his mind tomorrow.
I wonder if he's mincing words? News sites have listed a number of ways of killing Obamacare, and repealing is among the hardest.
Other options:
- There's at least one lawsuit in-flight that is on appeal by the executive. He could drop the appeal. Easy.
- Have congress removing funding for it (this is a budgetary processes and not subject to filibuster).
- Issue an executive order not to run the exchanges or some other necessary part.
All are technical not a "repeal" but will also effectively kill it.
Post by: waltworks on November 12, 2016, 08:37:00 PM
Repeal EMTALA.
See, we already made the decision (with a signature from Ronald Reagan himself) that we wouldn't, as a society, let the less fortunate die on the doorstep of the hospital.
Socialized healthcare. Who knew?
Yet we insist on denying this and needlessly wasting money by not actually offering the useful "let's catch it early!" type of care that would save money, and we give a fortune to useless middlemen (insurance companies) for basically no benefit to anyone. Instead, we'll wait until you're almost dead, then spend a fortune to keep you alive and probably fail - instead of keeping you alive for good and making it possible for you/your kid to contribute something awesome to society.
Nice work, America.
So yes, president-elect Trump - the system needs blowing up. Maybe you're the guy to do it. Maybe it's time to think about it as the president of the biggest company on earth - the USA. You need your employees kicking ass, not sick and dying. You want to do it as cheaply as possible.
Let me know what you come up with.
-W
Post by: jim555 on November 13, 2016, 03:05:59 AM
Catastrophic plans would come to the front.
Post by: FIRE me on November 13, 2016, 10:23:33 AM
The popular part of Obamacare that is least likely to survive is the subsidy. It would be replaced by a tax credit that will be nearly useless to Mustachians living a low expenses, low income, low tax, Root of Good type of early retirement.
Well that's not entirely true. For some of us, at least, additional tax credits would allow us to move larger annual chunks of money out of our 401ks and into our Roth IRAs as part of the 5 year Roth pipeline process, if it effectively expands the 0% tax bracket.
Which is not to say I support a return to high-risk pools as good for anyone. We've been trying to fix American healthcare for decades now, from both sides of the isle, and the insurance industry has been the only consistent opposition. For some reason, House Republicans have now sided with the insurance industry on this issue. Maybe I shouldn't be surprised that they've chosen to support American businesses over American citizens, yet again?
I just want Americans to have affordable medical care. I don't care what we call it, or which party gets credit for it. The Democrats were the only group that was actually willing to try something, but if the Republicans can pull something together I'm all for that too. Just don't tear the whole thing down and send us back to the obviously badly broken system we had before.
Sol, that's true for some, but not all. And not for me. A Roth ladder would not do much for me, as once I'm retired (in 7 weeks) my Federal tax would run about $670 per year. Obviously $670 isn't going to buy a year of unsubsidized health insurance.
I do well on my $52,000 gross income to put $30,500 (I'm over 55) in my tax advantaged 401k and traditional IRA, so I currently have no Roth accounts.
One update though. Paul Ryan is now talking about a refundable tax credit! To be used as a voucher to buy insurance. By refundable, I am assuming he means fully payable in a tax refund check, as opposed simply reducing your Federal tax liability to zero.
From:
http://www.cnn.com/2016/11/13/politics/paul-ryan-donald-trump-obamacare-deportation-force/index.html
“Ryan said the GOP plans to push refundable tax credits that would allow low-income Americans to essentially use those tax credits as vouchers to buy insurance, rather than receiving government-funded Medicaid.”
Not sure how paying for the first year would work for most people. But I could afford to pay a year in advance, as long as 80% or better of the cost were refunded at year end.
Prior to Ryan's recent statement, if I could not afford to pay full price for a high deductible plan, I was already resigned to the worst case possibility of going “bare” until old enough for Medicare, which was a risk I did not want to take.
Post by: sol on November 13, 2016, 10:53:34 AM
“Ryan said the GOP plans to push refundable tax credits that would allow low-income Americans to essentially use those tax credits as vouchers to buy insurance, rather than receiving government-funded Medicaid.”
So the new GOP plan is to keep the preexisting conditions ban, keep age 26, repeal the individual mandate, and replace ACA subsidies with refundable tax credits.
Whether the subsidies come through the ACA or through the IRS seems insignificant, in both cases the federal deficit is paying private companies to provide people healthcare.
So thus far the only other proposed change to Obamacare under the new plan is to repeal the individual mandate. Great! I'm totally on board with this plan. The individual mandate was just a gift to the insurance companies, it does nothing to help Americans (except help their insurance providers turn a profit). Of course, the insurance lobby is going to bring billions of dollars of pressure to keep the individual mandate because it's how they make money, but I'm also okay with the government telling the insurance industry to fuck off. Your profit margins are obscene, maybe consider helping more people and funding fewer top-level CEO golden parachutes.
Without an individual mandate, insurance companies will just raise rates on people who have insurance to pay for the ban on excluding people with pre-existing conditions. That's just basic capitalist economics. If the government were to effectively nationalize the insurance industry by capping rates, they will either be less profitable (my preference) or go bankrupt (nobody's preference). If they don't cap rates, and rates go through the roof, and they offer people refundable tax credits (ACA subsidies in disguise), then that just continues the problem of Uncle Sam escalating every higher insurance rates for everyone. That's the exact opposite of the cost controls that the ACA was designed to impose (and that Republicans claim to want).
So far, this whole thing is a clusterfuck of the highest order. We're only getting bits and pieces of the discussion that must be going on behind closed doors, but I fee like Republicans are having an oh-shit moment when suddenly faced with the prospect of actually fixing American healthcare in some way that is demonstrably different from the ACA plan they previously tried (proposed by the Heritage Foundation, piloted by Romney in MA), which they now have to oppose because Democrats endorsed it. They're on record as violently opposed to their own plan A, so what's their plan B?
I admit there's a certain sense of schadenfreude in it for me, as a liberal. You didn't like your own idea when we tried to pass it for you? Fine, you now have 100% control of all branches of government, it's your turn to try something else and there is absolutely no excuse for not getting exactly everything that you want. If only you could figure out what that is. Once you decide, you will own it. Good luck!
Post by: golden1 on November 13, 2016, 12:11:19 PM
Post by: jim555 on November 13, 2016, 12:13:29 PM
Post by: Metric Mouse on November 13, 2016, 12:18:44 PM
“Ryan said the GOP plans to push refundable tax credits that would allow low-income Americans to essentially use those tax credits as vouchers to buy insurance, rather than receiving government-funded Medicaid.”
So the new GOP plan is to keep the preexisting conditions ban, keep age 26, repeal the individual mandate, and replace ACA subsidies with refundable tax credits.
Whether the subsidies come through the ACA or through the IRS seems insignificant, in both cases the federal deficit is paying private companies to provide people healthcare.
So thus far the only other proposed change to Obamacare under the new plan is to repeal the individual mandate. Great! I'm totally on board with this plan. The individual mandate was just a gift to the insurance companies, it does nothing to help Americans (except help their insurance providers turn a profit). Of course, the insurance lobby is going to bring billions of dollars of pressure to keep the individual mandate because it's how they make money, but I'm also okay with the government telling the insurance industry to fuck off. Your profit margins are obscene, maybe consider helping more people and funding fewer top-level CEO golden parachutes.
Without an individual mandate, insurance companies will just raise rates on people who have insurance to pay for the ban on excluding people with pre-existing conditions. That's just basic capitalist economics. If the government were to effectively nationalize the insurance industry by capping rates, they will either be less profitable (my preference) or go bankrupt (nobody's preference). If they don't cap rates, and rates go through the roof, and they offer people refundable tax credits (ACA subsidies in disguise), then that just continues the problem of Uncle Sam escalating every higher insurance rates for everyone. That's the exact opposite of the cost controls that the ACA was designed to impose (and that Republicans claim to want).
So far, this whole thing is a clusterfuck of the highest order. We're only getting bits and pieces of the discussion that must be going on behind closed doors, but I fee like Republicans are having an oh-shit moment when suddenly faced with the prospect of actually fixing American healthcare in some way that is demonstrably different from the ACA plan they previously tried (proposed by the Heritage Foundation, piloted by Romney in MA), which they now have to oppose because Democrats endorsed it. They're on record as violently opposed to their own plan A, so what's their plan B?
I admit there's a certain sense of schadenfreude in it for me, as a liberal. You didn't like your own idea when we tried to pass it for you? Fine, you now have 100% control of all branches of government, it's your turn to try something else and there is absolutely no excuse for not getting exactly everything that you want. If only you could figure out what that is. Once you decide, you will own it. Good luck!
All the good parts of the current plan, none of the bad. Its not like costs haven't skyrocketed before the ACA, and they hardly even slowed down with the current plan. Now, at least people will have a choice to pay for assured ly overpriced care, can't be denied if they want it, and will still be reimbursed if they are low income, and the insurance industry gets a big middle finger. This sounds pretty damn good to me.
Post by: sol on November 13, 2016, 12:32:45 PM
Now, at least people will have a choice to pay for assured ly overpriced care, can't be denied if they want it, and will still be reimbursed if they are low income, and the insurance industry gets a big middle finger. This sounds pretty damn good to me.
Now we're in fantasy land again. The system you describe is basically rich people paying for insurance for poor people. What are the odds Republicans will endorse a plan like that? This seems like the antithesis of everything they have campaigned on for my entire lifetime.
Post by: Metric Mouse on November 13, 2016, 01:00:21 PM
Now, at least people will have a choice to pay for assured ly overpriced care, can't be denied if they want it, and will still be reimbursed if they are low income, and the insurance industry gets a big middle finger. This sounds pretty damn good to me.
Now we're in fantasy land again. The system you describe is basically rich people paying for insurance for poor people. What are the odds Republicans will endorse a plan like that? This seems like the antithesis of everything they have campaigned on for my entire lifetime.
Thats the plan we have now? So it wouldnt really be that different; it would just allow people to opt out if they choose. A good compromise; i could see it happening. I can't say the exact odds on endorsing that plan, but it seems to be the direction they are claiming they are going.
Post by: sol on November 13, 2016, 01:08:49 PM
So it wouldnt really be that different; it would just allow people to opt out if they choose. A good compromise; i could see it happening.
It's the exact opposite of the Republican narrative about individual responsibility, for one thing. Emergency rooms won't turn away people who show up gravely sick without insurance, so hospitals will continue to provide care and then write off the expenses as an uncollectable debt. Insurers will charge people more to carry insurance to pay for people who sign up after they get a cancer diagnosis, so if you're a hard working employee at a big corporation you will be punished with more aggressively rising rates because you're not a deadbeat.
It would probably work out fine for my family. We'll quit our jobs and give up employer-sponsored health insurance, just in time to bank those refundable tax credits year after year, until someone actually gets sick or injured. At which point I can apparently sign up for insurance right there on the spot, with blood spurting forth, and pay for it with all those years of tax rebates I've had invested in the stock market. Then I'll cancel again as soon as I get care. I won't even have to wait until the provider has been paid, because hey that's not my problem anymore!
Post by: Metric Mouse on November 13, 2016, 01:14:43 PM
Post by: mtnrider on November 13, 2016, 03:30:31 PM
“Ryan said the GOP plans to push refundable tax credits that would allow low-income Americans to essentially use those tax credits as vouchers to buy insurance, rather than receiving government-funded Medicaid.”
So the new GOP plan is to keep the preexisting conditions ban, keep age 26, repeal the individual mandate, and replace ACA subsidies with refundable tax credits.
Whether the subsidies come through the ACA or through the IRS seems insignificant, in both cases the federal deficit is paying private companies to provide people healthcare.
So thus far the only other proposed change to Obamacare under the new plan is to repeal the individual mandate. Great! I'm totally on board with this plan. The individual mandate was just a gift to the insurance companies, it does nothing to help Americans (except help their insurance providers turn a profit). Of course, the insurance lobby is going to bring billions of dollars of pressure to keep the individual mandate because it's how they make money, but I'm also okay with the government telling the insurance industry to fuck off. Your profit margins are obscene, maybe consider helping more people and funding fewer top-level CEO golden parachutes.
Without an individual mandate, insurance companies will just raise rates on people who have insurance to pay for the ban on excluding people with pre-existing conditions. That's just basic capitalist economics. If the government were to effectively nationalize the insurance industry by capping rates, they will either be less profitable (my preference) or go bankrupt (nobody's preference). If they don't cap rates, and rates go through the roof, and they offer people refundable tax credits (ACA subsidies in disguise), then that just continues the problem of Uncle Sam escalating every higher insurance rates for everyone. That's the exact opposite of the cost controls that the ACA was designed to impose (and that Republicans claim to want).
So far, this whole thing is a clusterfuck of the highest order. We're only getting bits and pieces of the discussion that must be going on behind closed doors, but I fee like Republicans are having an oh-shit moment when suddenly faced with the prospect of actually fixing American healthcare in some way that is demonstrably different from the ACA plan they previously tried (proposed by the Heritage Foundation, piloted by Romney in MA), which they now have to oppose because Democrats endorsed it. They're on record as violently opposed to their own plan A, so what's their plan B?
I admit there's a certain sense of schadenfreude in it for me, as a liberal. You didn't like your own idea when we tried to pass it for you? Fine, you now have 100% control of all branches of government, it's your turn to try something else and there is absolutely no excuse for not getting exactly everything that you want. If only you could figure out what that is. Once you decide, you will own it. Good luck!
I think there's a regulatory cap on insurance company profits, so they can't artificially raise rates. Most of their revenue is used.
http://healthcare-economist.com/2012/01/31/does-obamacare-limit-profits-for-health-insurance-companies-in-your-state/
Quote
The ACA requires health insurers in the individual and small group market to spend 80 percent of their premiums (after subtracting taxes and regulatory fees) on medical costs. The corresponding figure for large groups is 85 percent.
I don't know if that survived the 2013 supreme court ruling though.
Post by: gerardc on November 13, 2016, 04:01:37 PM
It would probably work out fine for my family. We'll quit our jobs and give up employer-sponsored health insurance, just in time to bank those refundable tax credits year after year, until someone actually gets sick or injured. At which point I can apparently sign up for insurance right there on the spot, with blood spurting forth, and pay for it with all those years of tax rebates I've had invested in the stock market. Then I'll cancel again as soon as I get care. I won't even have to wait until the provider has been paid, because hey that's not my problem anymore!
I'm not convinced anymore that the mandate is necessary for the pre-existing conditions ban to function correctly.
Think about it. You still need to sign up for insurance in an enrollment window. So, the strategy of waiting to get cancer to sign up doesn't really work, because you have to wait up to a year uninsured in the meantime, and 1 year of health expenses can absolutely wreck you financially. So, a sensible person will still stay insured even without a mandate. They may jump on a catastrophic plan though, and switch to a Platinum plan once they get a chronic condition. However, that's still the case even with a mandate -- you can cruise on a high-deductible plan until you need coverage for consistent expenses. So, removing the mandate won't change much IMO.
Mandate or not, it seems only the HDP will stay at competitive prices, since only chronically ill folks would buy the comprehensive plans. But that's not what happens in pratice because of the subsidies, and because many rich people are very risk adverse.
Post by: FireLane on November 13, 2016, 05:24:33 PM
Prior to Ryan's recent statement, if I could not afford to pay full price for a high deductible plan, I was already resigned to the worst case possibility of going “bare” until old enough for Medicare, which was a risk I did not want to take.
Yeah, about that...
http://talkingpointsmemo.com/edblog/ryan-plans-to-phase-out-medicare-in-2017 (http://talkingpointsmemo.com/edblog/ryan-plans-to-phase-out-medicare-in-2017)
Waiting for Medicare isn't the "worst case" possibility anymore. Paul Ryan wants to eliminate Medicare and replace it with a check for a fixed amount of money. If that's not enough to pay for the medical care you need, tough shit!
Post by: geekette on November 13, 2016, 07:47:37 PM
I think there's a regulatory cap on insurance company profits, so they can't artificially raise rates. Most of their revenue is used.Interesting chat with my doctor a while ago. Per him, this means they have no incentive to negotiate lower costs because the higher the costs, the higher the rates, therefore their 20% cut is correspondingly higher.
http://healthcare-economist.com/2012/01/31/does-obamacare-limit-profits-for-health-insurance-companies-in-your-state/QuoteThe ACA requires health insurers in the individual and small group market to spend 80 percent of their premiums (after subtracting taxes and regulatory fees) on medical costs. The corresponding figure for large groups is 85 percent.
I don't know if that survived the 2013 supreme court ruling though.
Post by: Metric Mouse on November 14, 2016, 05:17:49 AM
I think there's a regulatory cap on insurance company profits, so they can't artificially raise rates. Most of their revenue is used.Interesting chat with my doctor a while ago. Per him, this means they have no incentive to negotiate lower costs because the higher the costs, the higher the rates, therefore their 20% cut is correspondingly higher.
http://healthcare-economist.com/2012/01/31/does-obamacare-limit-profits-for-health-insurance-companies-in-your-state/QuoteThe ACA requires health insurers in the individual and small group market to spend 80 percent of their premiums (after subtracting taxes and regulatory fees) on medical costs. The corresponding figure for large groups is 85 percent.
I don't know if that survived the 2013 supreme court ruling though.
Genius... who could have forseen that?
Post by: NoStacheOhio on November 14, 2016, 06:28:47 AM
Thinking about it some more, could it be that this skew in the health distribution of different groups is the reason Americans are reluctant to universal care or even ACA? With ACA, everyone is basically covering the cost of the average. However, if anyone can come to the US and buy off-the-shelf insurance plans, then these plans would attract unhealthy potential immigrants from other regions/countries, and the US would end up paying more for them, due to the different distribution that jack up prices. Maybe Americans want the contrary to happen by keeping the old system, i.e. keep a healthy population in the US, and have sick people expatriate themselves and seek cheaper or subsidized care elsewhere in the world. That would be extremely evil, surely that's not how American people think.
That would make sense if Americans were healthier than other people. They're not.
Post by: obstinate on November 14, 2016, 07:36:00 AM
Post by: deadlymonkey on November 14, 2016, 08:21:03 AM
Look at Paul Ryan's healthcare plan because that is probably what you are going to get.
Pretty much the same as before but expanded options for HSAs
Tort reform to shaft patients in Malpractice suits
Tax credits for insurance premiums or health expenses
Getting rid of Medicare and replacing it with block grants to help defray costs of private insurance.
Post by: Paul der Krake on November 14, 2016, 08:57:05 AM
@geekette, your doctor is wrong. Forgivable since he's not an economist. But insurance companies still have plenty of incentive to control prices. Particularly, people tend not to buy higher priced policies that do the same thing. This effect is obvious when you consider how insurance companies were cutting prices to capture more of the market in the first years of the exchanges.This is a little bit like saying that grocery stores have an incentive to keep prices low- look, they have tomatoes on sale for no reason!
Policies sold on the exchange were opening up a brand new market, of course they want to make sure as many people sign up.
Post by: Northwestie on November 14, 2016, 09:06:33 AM
In reply to the original post:
Look at Paul Ryan's healthcare plan because that is probably what you are going to get.
Pretty much the same as before but expanded options for HSAs
Tort reform to shaft patients in Malpractice suits
Tax credits for insurance premiums or health expenses
Getting rid of Medicare and replacing it with block grants to help defray costs of private insurance.
That's what he has said in the past - never mind trying to get ACA coverage for early retirement, could be more of a challenge just getting coverage after retirement.
Post by: rubybeth on November 14, 2016, 09:34:36 AM
Post by: wenchsenior on November 14, 2016, 09:40:35 AM
If Medicare goes away, we'll all screwed. It's the one thing keeping the old/dying out of our insurance pools. If we have to pay for the 65+ crowd, expect prices to rise very quickly. This would be a true "death panel" situation.
I actually woke up at 3 a.m. and had a full on anxiety attack about this scenario. Couldn't sleep for hours, had to get up and distract myself with work. For years I've figured, "no way would the GOP ACTUALLY mess with Medicare in any serious way...that program has more than 75% approval ratings with the public." But I have been consistently wrong the past few years, so I no longer believe myself.
Post by: jim555 on November 14, 2016, 09:53:53 AM
Everything since FDR is on the table. They have been waiting for this day for decades.
Post by: obstinate on November 14, 2016, 10:45:58 AM
This is a little bit like saying that grocery stores have an incentive to keep prices low- look, they have tomatoes on sale for no reason!Yes, the fact that grocery stores put things on sale is evidence that they have an incentive to keep costs low. I agree. What of it?
Post by: stoaX on November 14, 2016, 10:53:14 AM
@geekette, your doctor is wrong. Forgivable since he's not an economist. But insurance companies still have plenty of incentive to control prices. Particularly, people tend not to buy higher priced policies that do the same thing. This effect is obvious when you consider how insurance companies were cutting prices to capture more of the market in the first years of the exchanges.This is a little bit like saying that grocery stores have an incentive to keep prices low- look, they have tomatoes on sale for no reason!
Policies sold on the exchange were opening up a brand new market, of course they want to make sure as many people sign up.
Also, speaking as an underwriters, the "20%" cut is incorrect. Most large health insurance companies fix their admin expenses and profit (their "cut") on an $x dollar per person basis. So it doesn't change, or change very much when premiums go up or go down. The percentage that their cut represents changes as the premium goes up or down. There's a lot more nuance to it, but that's the essence of it.
And there is strong incentive to find ways to have lower premiums and win marketshare - the hard part is doing that without going in the red.
Post by: Zoot on November 14, 2016, 11:15:05 AM
If Medicare is basically a grant for private insurance, and if pre-existing condition protection goes away, then you basically have a bunch of people over 65 who need to consume health care in ever-greater and ever-more-complicated ways, who can't be covered because they had hemorrhoids or acid reflux or acne decades before.
The whole health care thing really throws a wrench not only in to EARLY retirement, but in to retirement PERIOD.
God help us all.
Post by: chesebert on November 14, 2016, 11:18:07 AM
Post by: Northwestie on November 14, 2016, 11:19:45 AM
Post by: stoaX on November 14, 2016, 11:25:11 AM
Does anyone have a sense why doctors/hospitals cost so much. I have been quoted $7-10k for a full body CT scan. Similar test in other countries costs a fraction of what it costs in the US. Hospital stays are like $1500-2000 per day - WTF!
A few reasons often cited are:
- The US medical costs include a disproportionate share of the research and development costs of new technologies
- Salaries of medical workers in the US are higher if you are comparing to third world hospitals.
Both of these strike me as inadequate explanations. I would be interested to hear if non-US medical providers have less redundancy and less unnecessary care built into their pricing. So I will join you in your WFT!
Post by: sol on November 14, 2016, 11:28:52 AM
1. We have a lot of uninsured people who still consume medical care. People who pay for medical care end up paying for the ones who don't pay for it, since everyone uses it.
2. We have very few protections against malpractice lawsuits. Especially for small private doctor offices, the malpractice insurance can sometimes be the largest expense of the entire business, higher than salaries or rent.
Post by: Northwestie on November 14, 2016, 11:33:56 AM
Post by: KaizenSoze on November 14, 2016, 11:40:54 AM
Any change to Medicare or Society Security generally causes a lot of push back.
Of course, I was wrong on Trump getting elected. So, what do I know.
Post by: bacchi on November 14, 2016, 11:49:33 AM
2. We have very few protections against malpractice lawsuits. Especially for small private doctor offices, the malpractice insurance can sometimes be the largest expense of the entire business, higher than salaries or rent.
In Texas, tort reform didn't make health care less expensive. While malpractice insurance premiums did go down substantially, the difference didn't make it to the consumer's wallet. It just increased the provider's income.
Post by: obstinate on November 14, 2016, 11:57:08 AM
- No national drug pricing board, nor any other low-granularity pricing agent. This gives drug companies more market power to demand higher prices.
- We train doctors later and require them to take on more risk. Therefore, they demand higher compensation.
- We allow a guild (the AMA) to control the flow of new healthcare professionals into the labor market.
Most of the difference in cost comes from differences in physician compensation, medical device and drug costs, and hospital costs. The first comes from the fact that our doctors don't even start medical training until after university, have to mostly pay their own way (with average debt of $150k after graduating), and they as a group control the flow of new physicians. The latter two are higher because there's no low-granularity negotiator of prices with market power.
Post by: bacchi on November 14, 2016, 12:01:00 PM
- We allow a guild (the AMA) to control the flow of new healthcare professionals into the labor market.
Aka, The "strongest trade union in the United States."*
* Milton Friedman
Post by: wenchsenior on November 14, 2016, 12:16:34 PM
I have a hard time understand how Ryan is going to get this past the senior citizen lobby groups.
Any change to Medicare or Society Security generally causes a lot of push back.
Of course, I was wrong on Trump getting elected. So, what do I know.
I would expect this to be political suicide as well, but I think the plan is to grandfather in all the people currently on the plan I think, so nothing would be directly taken from most active voting block. So will older voters want to take this program away from their kids and grandkids? And will the younger voters think they are better off without it? Last year we had a discussion on a different thread about whether or not the giant Millennial voting block was liberal or libertarian. This piece of legislation is a going to be a good test of that.
Post by: deadlymonkey on November 14, 2016, 12:25:06 PM
I have a hard time understand how Ryan is going to get this past the senior citizen lobby groups.
Any change to Medicare or Society Security generally causes a lot of push back.
Of course, I was wrong on Trump getting elected. So, what do I know.
I would expect this to be political suicide as well, but I think the plan is to grandfather in all the people currently on the plan I think, so nothing would be directly taken from most active voting block. So will older voters want to take this program away from their kids and grandkids? And will the younger voters think they are better off without it? Last year we had a discussion on a different thread about whether or not the giant Millennial voting block was liberal or libertarian. This piece of legislation is a going to be a good test of that.
Yes Ryan's plan is to sever Medicare so people currently on it get to keep it but no new enrollees. However, after being severed off from funding (people working not currently on it) how long it lasts is anyone's guess. It will become an orphan entitlement and ripe for raiding.
Post by: Jrr85 on November 14, 2016, 02:01:42 PM
For those saying a pre-existing ban cannot work without the individual mandate, could we have a pre-existing ban (no expulsion, no price change) for those who always maintained continuous coverage? This way, people who want to opt in health insurance (likely 50%+ of people) will all be in a single risk pool, but people could also completely opt out if they choose (for life).
What about people who opt out at age 21 because they feel invincible, and then get cancer at 35? We just let them die?
The whole idea here is for society to find a way to take care of it's least fortunate members. If lady luck fucks you, America is supposed to have your back.
It's not politically on the table to let people die. People who did not maintain continuous health insurance coverage would essentially be put in high risk pools that allowed them to get care with no subsidies until a significant portion of their assets and income are used. It's a pretty small needle to thread. The "penalty" for needing healthcare after not paying for insurance would have to be big enough that it's never or almost never looks like a good deal to just forego insurance and rely on the government, but it also has to be small enough to be politically viable, and it also has to be small enough that when the person has no assets (and realistically, a lot of the people that choose to go this route will have personalities that ensure they have no assets) they are not completely disincentivised from continuing to work.
And that's not even addressing the technical difficulties in making markets work where you can't risk rate people that want to change policies and where there is not a big time potential to game the system (e.g., use poor but cheap insurance in your twenties, jump to better insurance in your thirties when you're having kids, jump back to cheaper insurance in your 40's after it's clear your kids are healthy, and then go back to more expensive insurance).
It's a difficult nut to crack when you are committed to protecting people from the consequences of their decisions. I'm not sure that somethign along the singapore model isn't the best model for developed countries. Huge mandatory savings that can only be used for healthcare or retirement. Even in retirement have some minimum that must be retained for healthcare. Decent safety net after your savings are used. Extremely paternalistic, but at least gives an incentive to minimize costs on the consumer side and is affordable and helps address retirement security also.
Post by: Scandium on November 14, 2016, 02:43:08 PM
There is an outside chance that the super high-deductible "catastrophic" insurance that many here care about (that went away with ACA) will come back. That would actually lower health care costs for a lot of reasonably healthy folks but still keep you covered in case you get cancer or something bad.
I checked my state marketplace and it had plans with $13,000 deductible (two people). How much more catastrophic do you want? Even higher than that?
Post by: Scandium on November 14, 2016, 02:48:16 PM
The "penalty" for needing healthcare after not paying for insurance would have to be big enough that it's never or almost never looks like a good deal to just forego insurance and rely on the government, but it also has to be small enough to be politically viable, and it also has to be small enough that when the person has no assets (and realistically, a lot of the people that choose to go this route will have personalities that ensure they have no assets) they are not completely disincentivised from continuing to work.
Yes, because incentivizing arrogant, hormone-driven, immature young people away from stupid behavior through appealing to the potential bad long-term consequences of their actions always works so well.
Post by: Jrr85 on November 14, 2016, 03:33:21 PM
The "penalty" for needing healthcare after not paying for insurance would have to be big enough that it's never or almost never looks like a good deal to just forego insurance and rely on the government, but it also has to be small enough to be politically viable, and it also has to be small enough that when the person has no assets (and realistically, a lot of the people that choose to go this route will have personalities that ensure they have no assets) they are not completely disincentivised from continuing to work.
Yes, because incentivizing arrogant, hormone-driven, immature young people away from stupid behavior through appealing to the potential bad long-term consequences of their actions always works so well.
As opposed to using the threat of force to keep anybody from making decisions the government views as too risky?
But in this instance, you've actually got it backwards. It's not incentivizing people away from stupid behavior. The incentive is naturally there and would be very strong for most people. It's just avoiding reducing the incentive too much.
Post by: sol on November 14, 2016, 04:13:11 PM
As opposed to using the threat of force to keep anybody from making decisions the government views as too risky?
I don't think it's "using the threat of force" to offer people free healthcare. A single-payer federally-run nationwide health insurance system, easily accomplished by lowering the age at which you qualify for medicare, would be a benefit to the nation and to the people who comprise the nation. How is that threatening?
If this is about to devolve into another "all taxes are theft at gunpoint" argument, then you are clearly not the kind of person who recognizes America's strengths anyway.
Post by: FireLane on November 14, 2016, 06:36:37 PM
If Medicare goes away, we'll all screwed. It's the one thing keeping the old/dying out of our insurance pools. If we have to pay for the 65+ crowd, expect prices to rise very quickly. This would be a true "death panel" situation.
I actually woke up at 3 a.m. and had a full on anxiety attack about this scenario. Couldn't sleep for hours, had to get up and distract myself with work.
Not to be a noodge, but I really hope that everyone who's afraid of this (and I count myself among them) contacts their congressional representatives to tell them so. That goes double if you live in a purple or red state.
For years I've figured, "no way would the GOP ACTUALLY mess with Medicare in any serious way...that program has more than 75% approval ratings with the public." But I have been consistently wrong the past few years, so I no longer believe myself.
The American public also overwhelmingly approves of higher taxes on the rich and many other policy ideas that never get passed. Public opinion as a whole means very little to politicians. They care more about the opinions of their base voters and, especially, their funders. And the kind of people who fund Paul Ryan's campaigns have wanted to slash Social Security and Medicare for a very long time. They call it "starving the beast."
Post by: Metric Mouse on November 14, 2016, 07:00:37 PM
As opposed to using the threat of force to keep anybody from making decisions the government views as too risky?
I don't think it's "using the threat of force" to offer people free healthcare. A single-payer federally-run nationwide health insurance system, easily accomplished by lowering the age at which you qualify for medicare, would be a benefit to the nation and to the people who comprise the nation. How is that threatening?
If this is about to devolve into another "all taxes are theft at gunpoint" argument, then you are clearly not the kind of person who recognizes America's strengths anyway.
Well, perhaps after the Trump/Ryan care fails, maybe we will move in that direction. Bandaging the mess that we have now is not really the most positive or efficient change we could be making.
Post by: jim555 on November 14, 2016, 07:10:42 PM
But they want it to fail, it is not a bug it is a feature of Trump/Ryan care. They purposefully make sure things can't work and then say, look it doesn't work we must get rid of it.As opposed to using the threat of force to keep anybody from making decisions the government views as too risky?
I don't think it's "using the threat of force" to offer people free healthcare. A single-payer federally-run nationwide health insurance system, easily accomplished by lowering the age at which you qualify for medicare, would be a benefit to the nation and to the people who comprise the nation. How is that threatening?
If this is about to devolve into another "all taxes are theft at gunpoint" argument, then you are clearly not the kind of person who recognizes America's strengths anyway.
Well, perhaps after the Trump/Ryan care fails, maybe we will move in that direction. Bandaging the mess that we have now is not really the most positive or efficient change we could be making.
Post by: ketchup on November 14, 2016, 08:29:40 PM
2. We have very few protections against malpractice lawsuits. Especially for small private doctor offices, the malpractice insurance can sometimes be the largest expense of the entire business, higher than salaries or rent.This is absolutely a big part of it. My uncle was a neurosurgeon (recently retired) and I don't know the details but I'm pretty sure his malpractice insurance was six figures annually (granted, I'm sure he was making bank above and beyond that in his specialty, but still).
Post by: gerardc on November 14, 2016, 09:51:50 PM
This is a little bit like saying that grocery stores have an incentive to keep prices low- look, they have tomatoes on sale for no reason!Yes, the fact that grocery stores put things on sale is evidence that they have an incentive to keep costs low. I agree. What of it?
Both grocery stores and insurance companies have 2 incentives: keep prices low compared to competition AND keep prices high in an absolute sense. I'd say insurance companies have an interest in keeping health care costs high in general, because those costs are applied to all payers/insurers, so they get better profits but no significantly changes in market share. This is really a form of price fixing.
Post by: waltworks on November 14, 2016, 09:54:41 PM
But Trump's mandate, if such a word is appropriate, seems to be mostly to give a big middle finger to the establishment so who knows what he (or the folks who voted for him) want the healthcare system to look like. My assumption is that he doesn't really know and plans to just sign off on whatever congress decides.
-W
Post by: obstinate on November 14, 2016, 11:15:07 PM
Post by: Metric Mouse on November 15, 2016, 04:03:47 AM
But they want it to fail, it is not a bug it is a feature of Trump/Ryan care. They purposefully make sure things can't work and then say, look it doesn't work we must get rid of it.
Setting up something to fail to get something better is not always a bad thing in my mind.
Post by: former player on November 15, 2016, 05:44:53 AM
Yes, that's the view of revolutionaries through the ages. Pity about all the people who get hurt in the meantime.But they want it to fail, it is not a bug it is a feature of Trump/Ryan care. They purposefully make sure things can't work and then say, look it doesn't work we must get rid of it.
Setting up something to fail to get something better is not always a bad thing in my mind.
Post by: OurTown on November 15, 2016, 07:23:50 AM
Post by: Gin1984 on November 15, 2016, 10:04:24 AM
Has anyone run the numbers on affordability of HDHP & HSA?Which HDHP? My current one would COBRA at $1600/month for my family.
Post by: sol on November 15, 2016, 10:31:52 AM
Has anyone run the numbers on affordability of HDHP & HSA?
It's going to completely depend on your situation, your tax rate, your family, your employer contribution, and what insurance plans you have available. They typically cost you less per month, and provide little or no reimbursement for your healthcare costs before you reach a certain limit.
For my relatively healthy family, it made financial sense to choose one of the existing HDHP plans available to federal employees. The HSA is an effective (if tiny) retirement vehicle and a portion of my premiums pass through directly as insurer contributions. It is significantly more cost effective for my family in a normal year of three kids and two adults doing regular doctor visits for routine stuff, but it would suck if we had major hospitalizations or cancer treatments or something. In that case, we would take the next open enrollment window to switch back to more traditional comprehensive insurance.
But we also have abundant cashflow which we could use to cover $12-15k out of pocket up front to get care. HDHPs, like many ideologically conservative proposals, work less well for poor people than they do for rich ones.
Post by: Axecleaver on November 15, 2016, 10:50:49 AM
NY has a very unusual insurance market, in part because age discrimination is not permitted. That means younger folks subsidize insurance premiums for older folks. This also reduces the levers insurance companies have to make rates affordable for people earlier in their careers. A large percentage of our insurance policies are "platinum" plans (18% vs. 2% nationally), which are often better deals for people with expensive health conditions.
http://www.politico.com/states/new-york/albany/story/2016/10/why-new-yorks-health-insurance-market-stands-out-106875
Post by: Telecaster on November 15, 2016, 11:50:26 AM
2. We have very few protections against malpractice lawsuits. Especially for small private doctor offices, the malpractice insurance can sometimes be the largest expense of the entire business, higher than salaries or rent.This is absolutely a big part of it. My uncle was a neurosurgeon (recently retired) and I don't know the details but I'm pretty sure his malpractice insurance was six figures annually (granted, I'm sure he was making bank above and beyond that in his specialty, but still).
My professional liability insurance is about 3% of my gross. I understand that professional liability insurance for doctors is pretty close to that number, so insurance cost doesn't seem crazy out of whack compared to other industries.
But you can also see why tort reform does almost nothing to control costs. If insurance suddenly became one third or even two thirds cheaper, that's only a 1 or 2% cost reduction. Just not much there.
Post by: Jrr85 on November 15, 2016, 11:52:28 AM
As opposed to using the threat of force to keep anybody from making decisions the government views as too risky?
I don't think it's "using the threat of force" to offer people free healthcare. A single-payer federally-run nationwide health insurance system, easily accomplished by lowering the age at which you qualify for medicare, would be a benefit to the nation and to the people who comprise the nation. How is that threatening?
If this is about to devolve into another "all taxes are theft at gunpoint" argument, then you are clearly not the kind of person who recognizes America's strengths anyway.
The alternatives being discussed were Obamacare and guaranteed issue with no risk rating for people that maintained continuous coverage. But regardless, yes, you are using teh threat of force. Doesn't have anything to do with whether taxes are theft. The Obamacare model is a little more specific threat of force as compared to single payer, but you shouldn't kid yourself as to what you are doing. Pretty much all of the systems politically viable rely on a healthy dose of the threat of force. That's why it's so hard to get anything workable. People don't like the idea of people having to rely on charitable care, but they are also squeamish about the coerciveness/force necessary to make most other systems work.
Post by: Malum Prohibitum on November 16, 2016, 09:57:38 AM
Has anyone run the numbers on affordability of HDHP & HSA?
It's going to completely depend on your situation, your tax rate, your family, your employer contribution, and what insurance plans you have available. They typically cost you less per month, and provide little or no reimbursement for your healthcare costs before you reach a certain limit.
For my relatively healthy family, it made financial sense to choose one of the existing HDHP plans available to federal employees. The HSA is an effective (if tiny) retirement vehicle and a portion of my premiums pass through directly as insurer contributions. It is significantly more cost effective for my family in a normal year of three kids and two adults doing regular doctor visits for routine stuff, but it would suck if we had major hospitalizations or cancer treatments or something. In that case, we would take the next open enrollment window to switch back to more traditional comprehensive insurance.
But we also have abundant cashflow which we could use to cover $12-15k out of pocket up front to get care. HDHPs, like many ideologically conservative proposals, work less well for poor people than they do for rich ones.
We maxed out the deductible in 2016 and do not even have enough left (because of the contribution limit) to pay several thousand dollars in costs, so we will have to do that with after tax dollars.
It's a gamble, for sure. Sometimes it's cheaper. Sometimes it's not.
And the damn thing is over a thousand dollars a month in premiums and will not be available come January.
Post by: NoStacheOhio on December 07, 2016, 10:20:06 AM
Looks like there is momentum in congress to pass a reconciliation bill that repeals Obamacare but delays it, giving the geniouses in congress enough time to craft a replacement bill. And the democrats are claiming they won't vote for the replacement bill no matter what. So, looks like Obamacare and perhaps our entire health market is dead. Interestingly, this story claims that more people will end up without health insurance than before Obamacare! 30 million would lose health care in 2019.
https://www.washingtonpost.com/opinions/repealing-obamacare-without-replacing-it-would-be-a-disaster/2016/12/06/74ce1fc2-bbf5-11e6-91ee-1adddfe36cbe_story.html?hpid=hp_no-name_opinion-card-d%3Ahomepage%2Fstory&utm_term=.42c4e60bfe28#comments
The one silver lining is that at least this will allow those who have not FIREd yet to get better visibility into whether Early Retirement that is dependent on Obamacare is feasible after a change in administration.
Probably related to people whose employers provided plans before ACA, but sent their people to the exchanges after.
Post by: waltworks on December 07, 2016, 11:45:51 AM
Now *that* would be a useful shakeup of the system. Having health care tied to employment is retarded.
-W
Post by: TheOldestYoungMan on December 07, 2016, 12:58:23 PM
There is an outside chance that the super high-deductible "catastrophic" insurance that many here care about (that went away with ACA) will come back. That would actually lower health care costs for a lot of reasonably healthy folks but still keep you covered in case you get cancer or something bad.
I checked my state marketplace and it had plans with $13,000 deductible (two people). How much more catastrophic do you want? Even higher than that?
Yup. 50-100k would probably do me. I have no problem paying for my day to day care, particularly with how cheap healthcare is when you're paying cash. I see zero benefit for having health insurance at this point, I only carry it because I could develop a long-term treatment need such as cancer. My mother had cancer, and it was something like $1.4 million over 3 years before it went into recession. Paying cash that would have been around $175,000.00 which would still have been a donkey punch.
I think part of the conversation is that people are insuring the wrong thing. You want health insurance to make sure your family doesn't go broke if you suffer a serious injury, incur a lot of medical bills, and then die. This is what life insurance is for. Go get a $2mil life insurance policy, pair that with a high deductible catastrophic healthcare plan, and then a high savings rate.
When you conflate health insurance with a healthcare payment plan that's where this whole thing gets totally screwed up. Also stop over utilizing healthcare. If you're under 60 taking more than one prescription on a regular basis...eat more vegetables or less sugar or just be comfortable with whatever your face biology naturally looks like. You are going to die. It likely isn't going to be all that great an experience. No amount of health insurance, government subsidized or otherwise, is going to improve that for you.
Post by: Gin1984 on December 07, 2016, 01:40:55 PM
And here we have a person with little to no medical knowledge or experience deciding he can just hand wave away medical issue. Guess what, in the real world, that does not work. I worked my way through college as a server. I hurt my back doing so at 23. I am 32 and still have major back issues. I use two different medications just to be able to work and not be incapacitated. I had PT, and injection into my traps for over year and still did not have full range of motion. I use a medical device now every work day to get through. I get sport massages to break my muscle up and get injects every 4 weeks. People get hurt, especially when they have to work 10 hours a day or work a manual labor job. That is not solved by eating vegetables.There is an outside chance that the super high-deductible "catastrophic" insurance that many here care about (that went away with ACA) will come back. That would actually lower health care costs for a lot of reasonably healthy folks but still keep you covered in case you get cancer or something bad.
I checked my state marketplace and it had plans with $13,000 deductible (two people). How much more catastrophic do you want? Even higher than that?
Yup. 50-100k would probably do me. I have no problem paying for my day to day care, particularly with how cheap healthcare is when you're paying cash. I see zero benefit for having health insurance at this point, I only carry it because I could develop a long-term treatment need such as cancer. My mother had cancer, and it was something like $1.4 million over 3 years before it went into recession. Paying cash that would have been around $175,000.00 which would still have been a donkey punch.
I think part of the conversation is that people are insuring the wrong thing. You want health insurance to make sure your family doesn't go broke if you suffer a serious injury, incur a lot of medical bills, and then die. This is what life insurance is for. Go get a $2mil life insurance policy, pair that with a high deductible catastrophic healthcare plan, and then a high savings rate.
When you conflate health insurance with a healthcare payment plan that's where this whole thing gets totally screwed up. Also stop over utilizing healthcare. If you're under 60 taking more than one prescription on a regular basis...eat more vegetables or less sugar or just be comfortable with whatever your face biology naturally looks like. You are going to die. It likely isn't going to be all that great an experience. No amount of health insurance, government subsidized or otherwise, is going to improve that for you.
Post by: Scandium on December 07, 2016, 01:41:49 PM
There is an outside chance that the super high-deductible "catastrophic" insurance that many here care about (that went away with ACA) will come back. That would actually lower health care costs for a lot of reasonably healthy folks but still keep you covered in case you get cancer or something bad.
I checked my state marketplace and it had plans with $13,000 deductible (two people). How much more catastrophic do you want? Even higher than that?
Yup. 50-100k would probably do me. I have no problem paying for my day to day care, particularly with how cheap healthcare is when you're paying cash. I see zero benefit for having health insurance at this point, I only carry it because I could develop a long-term treatment need such as cancer. My mother had cancer, and it was something like $1.4 million over 3 years before it went into recession. Paying cash that would have been around $175,000.00 which would still have been a donkey punch.
I think part of the conversation is that people are insuring the wrong thing. You want health insurance to make sure your family doesn't go broke if you suffer a serious injury, incur a lot of medical bills, and then die. This is what life insurance is for. Go get a $2mil life insurance policy, pair that with a high deductible catastrophic healthcare plan, and then a high savings rate.
When you conflate health insurance with a healthcare payment plan that's where this whole thing gets totally screwed up. Also stop over utilizing healthcare. If you're under 60 taking more than one prescription on a regular basis...eat more vegetables or less sugar or just be comfortable with whatever your face biology naturally looks like. You are going to die. It likely isn't going to be all that great an experience. No amount of health insurance, government subsidized or otherwise, is going to improve that for you.
Ok for one-shot horrible injuries or diseases sure. But what if you get a long term chronic disease that costs you say $70,000 per year for a decade plus? You ok with a constant ongoing $50k+ a year expense that insurance cover zero of?
Post by: geekette on December 07, 2016, 05:53:15 PM
Oh, he thinks he can wave that away with a few lettuce leaves...There is an outside chance that the super high-deductible "catastrophic" insurance that many here care about (that went away with ACA) will come back. That would actually lower health care costs for a lot of reasonably healthy folks but still keep you covered in case you get cancer or something bad.
I checked my state marketplace and it had plans with $13,000 deductible (two people). How much more catastrophic do you want? Even higher than that?
Yup. 50-100k would probably do me. I have no problem paying for my day to day care, particularly with how cheap healthcare is when you're paying cash. I see zero benefit for having health insurance at this point, I only carry it because I could develop a long-term treatment need such as cancer. My mother had cancer, and it was something like $1.4 million over 3 years before it went into recession. Paying cash that would have been around $175,000.00 which would still have been a donkey punch.
I think part of the conversation is that people are insuring the wrong thing. You want health insurance to make sure your family doesn't go broke if you suffer a serious injury, incur a lot of medical bills, and then die. This is what life insurance is for. Go get a $2mil life insurance policy, pair that with a high deductible catastrophic healthcare plan, and then a high savings rate.
When you conflate health insurance with a healthcare payment plan that's where this whole thing gets totally screwed up. Also stop over utilizing healthcare. If you're under 60 taking more than one prescription on a regular basis...eat more vegetables or less sugar or just be comfortable with whatever your face biology naturally looks like. You are going to die. It likely isn't going to be all that great an experience. No amount of health insurance, government subsidized or otherwise, is going to improve that for you.
Ok for one-shot horrible injuries or diseases sure. But what if you get a long term chronic disease that costs you say $70,000 per year for a decade plus? You ok with a constant ongoing $50k+ a year expense that insurance cover zero of?
Post by: Metric Mouse on December 08, 2016, 08:14:52 AM
Ok for one-shot horrible injuries or diseases sure. But what if you get a long term chronic disease that costs you say $70,000 per year for a decade plus? You ok with a constant ongoing $50k+ a year expense that insurance cover zero of?
Wouldn't most diseases that run that expensive fall under the category of catastrophic?
And if not, wouldn't one be able to sign up under the pre-existing condition clause? I mean, no one has argued that should go away.
Post by: geekette on December 08, 2016, 10:56:08 AM
Ok for one-shot horrible injuries or diseases sure. But what if you get a long term chronic disease that costs you say $70,000 per year for a decade plus? You ok with a constant ongoing $50k+ a year expense that insurance cover zero of?
Wouldn't most diseases that run that expensive fall under the category of catastrophic?
And if not, wouldn't one be able to sign up under the pre-existing condition clause? I mean, no one has argued that should go away.
Actually, I've seen the idea floated that pre-ex would only be waived for a new policy if you'd had continuous coverage for x amount of time.
Post by: wenchsenior on December 08, 2016, 11:19:09 AM
Ok for one-shot horrible injuries or diseases sure. But what if you get a long term chronic disease that costs you say $70,000 per year for a decade plus? You ok with a constant ongoing $50k+ a year expense that insurance cover zero of?
Wouldn't most diseases that run that expensive fall under the category of catastrophic?
And if not, wouldn't one be able to sign up under the pre-existing condition clause? I mean, no one has argued that should go away.
Actually, I've seen the idea floated that pre-ex would only be waived for a new policy if you'd had continuous coverage for x amount of time.
Exactly, so again, very poor people or those with temporary severe financial crunches who dropped insurance at some point would be screwed.
Post by: sol on December 08, 2016, 11:28:00 AM
Ok for one-shot horrible injuries or diseases sure. But what if you get a long term chronic disease that costs you say $70,000 per year for a decade plus? You ok with a constant ongoing $50k+ a year expense that insurance cover zero of?
Wouldn't most diseases that run that expensive fall under the category of catastrophic?
And if not, wouldn't one be able to sign up under the pre-existing condition clause? I mean, no one has argued that should go away.
Actually, I've seen the idea floated that pre-ex would only be waived for a new policy if you'd had continuous coverage for x amount of time.
Exactly. They ARE getting rid of it, but then claiming they are not getting rid of it as long as you've maintained continuous coverage. What good is a ban on denying coverage to people with pre-existing conditions if you can still deny people with pre-existing conditions? The guaranteed issue clause is totally meaningless if it doesn't apply to anyone who doesn't already have coverage.
It's just like the 1100 manufacturing jobs at that carrier plant that Trump said he saved. It doesn't matter that he didn't really save them, people want to hear that he did so he publicly claims that he did.
It's just like all those times he said "I'm the least racist person you've ever met." It doesn't matter that he banned black people from his clubs and discriminated against black tenants in his buildings, people want to believe that he's not racist so he says he's not racist.
This is the Trump MO. He's a people pleaser, and he'll say anything regardless of the truth if it's what peoples want to hear. He's going to throw Clinton in jail. Immigrants ruined the economy. You can grab them by the pussy, but it was just locker room talk. Mexico will pay for the wall. He's going to bring back all the jobs. Climate change is a Chinese hoax.
I don't even blame him for being so ridiculous, honestly, it's standard celebrity policy. I blame the rest of us for eating that shit up, because we apparently WANT to be lied to. Trump is just the sycophant symptom of the underlying problem, rising to exploit our fundamental weaknesses.
Weakness that is now being turned into official policy decisions, like the repeal of the ACA and the loss of health insurance for 10% of the country. Is this really making America great again? Because from where I'm standing, we're fucking ourselves pretty badly.
Post by: Kris on December 08, 2016, 11:38:10 AM
You know what would be awesome? If they repealed the preferential tax treatment employers get for providing benefits.
Now *that* would be a useful shakeup of the system. Having health care tied to employment is retarded.
-W
Agreed. The fact that this is how health insurance evolved in our country -- and the fact that people actually think this is normal -- is a huge source of the problem in the first place.
Post by: Scandium on December 08, 2016, 11:39:17 AM
Ok for one-shot horrible injuries or diseases sure. But what if you get a long term chronic disease that costs you say $70,000 per year for a decade plus? You ok with a constant ongoing $50k+ a year expense that insurance cover zero of?
Wouldn't most diseases that run that expensive fall under the category of catastrophic?
And if not, wouldn't one be able to sign up under the pre-existing condition clause? I mean, no one has argued that should go away.
The person I replied to said he wanted only "catastrophic coverage" with a $50-100k annual deductible. I was just wondering if he'd also be ok paying this every year, not just once.
And presumably one of the reasons the plans he wants are gone is exactly because of the mandate to cover everyone, even with preexisting conditions. They can't afford to have people on cheap plans then suddenly switch to a low deductible one when (or before..) something happens.
Post by: NoStacheOhio on December 08, 2016, 01:04:57 PM
I agree with how I don't like that the government is giving a loophole to insurance companies. So you can't be denied for pre-existing conditions as long as you had continuous coverage your whole life. So make sure to keep your records from 1982 of your insurance coverage or else we aren't paying this $100,000 cancer bill.
I've never had a lapse in coverage in my life, but couldn't prove it under any circumstances. I don't even think I'd be able to prove it beyond my five-year tenure with my current employer.
Post by: Metric Mouse on December 08, 2016, 01:16:24 PM
I agree with how I don't like that the government is giving a loophole to insurance companies. So you can't be denied for pre-existing conditions as long as you had continuous coverage your whole life. So make sure to keep your records from 1982 of your insurance coverage or else we aren't paying this $100,000 cancer bill.
I've never had a lapse in coverage in my life, but couldn't prove it under any circumstances. I don't even think I'd be able to prove it beyond my five-year tenure with my current employer.
I don't think that is what the issue is. The issue would be if you left your job, went without coverage for several years, and then re-applied. The fact that you have coverage now makes you 'previously insured' - you don't have to prove that you've always had insurance, only that you had insurance coverage immediately prior to the date that you're applying for new coverage.
Post by: Gin1984 on December 08, 2016, 01:33:03 PM
But that was not how it was used prior, when losing coverage even for a day could allow the insurance to not cover your issue because it was pre-existing. Hell, an MD friend on mine had a case where they did a fetal ultrasound, found issues, treated while in-utero and then the insurance tried to deny the claim for the child after he was born because his condition was pre-existing to his insurance.I agree with how I don't like that the government is giving a loophole to insurance companies. So you can't be denied for pre-existing conditions as long as you had continuous coverage your whole life. So make sure to keep your records from 1982 of your insurance coverage or else we aren't paying this $100,000 cancer bill.
I've never had a lapse in coverage in my life, but couldn't prove it under any circumstances. I don't even think I'd be able to prove it beyond my five-year tenure with my current employer.
I don't think that is what the issue is. The issue would be if you left your job, went without coverage for several years, and then re-applied. The fact that you have coverage now makes you 'previously insured' - you don't have to prove that you've always had insurance, only that you had insurance coverage immediately prior to the date that you're applying for new coverage.
Post by: Metric Mouse on December 08, 2016, 02:38:47 PM
how it was used prior, when losing coverage even for a day could allow the insurance to not cover your issue because it was pre-existing. Hell, an MD friend on mine had a case where they did a fetal ultrasound, found issues, treated while in-utero and then the insurance tried to deny the claim for the child after he was born because his condition was pre-existing to his insurance.
Ugh. That's pretty low. I can't wait until we can do away with insurance companies all together.
Post by: Kris on December 08, 2016, 02:52:05 PM
how it was used prior, when losing coverage even for a day could allow the insurance to not cover your issue because it was pre-existing. Hell, an MD friend on mine had a case where they did a fetal ultrasound, found issues, treated while in-utero and then the insurance tried to deny the claim for the child after he was born because his condition was pre-existing to his insurance.
Ugh. That's pretty low. I can't wait until we can do away with insurance companies all together.
Yes. This was one of the reasons Obama worked so hard to put the ACA in place: stories like this were legion.
Unfortunately, now that it's probably going to be repealed, we're likely to go right back to where we were before.
Post by: iris lily on December 08, 2016, 05:15:20 PM
So, ok, they mailed a letter telling me they would not be mailing a letter.wtf.
Then yesterday, they followed up with another letter to remind me they would not be mailing that card, dammit!
I dont blame this on the ACA, but I gotta say, wtf.
Post by: gerardc on December 08, 2016, 07:58:33 PM
Exactly. They ARE getting rid of it, but then claiming they are not getting rid of it as long as you've maintained continuous coverage. What good is a ban on denying coverage to people with pre-existing conditions if you can still deny people with pre-existing conditions? The guaranteed issue clause is totally meaningless if it doesn't apply to anyone who doesn't already have coverage.
No! We discussed this before. People NEED to get continuous health coverage. If they don't, they implicitly accept to forfeit the right to buy insurance with pre-existing conditions (otherwise, it would be too easy, wouldn't it?). They need to get that into their head!
With Obamacare, you also need continuous coverage, otherwise you pay a penalty, but the penalty is ridiculously low. You can see the continuous coverage condition above as a higher penalty, one that kicks you out of the program. That's fair, esp. with subsidies and an initial open enrollment period before which all "continuous coverage" history is erased.
Post by: projekt on December 08, 2016, 08:00:11 PM
Sorry for resurrecting your comment from a month ago, but this is highly unlikely. Malpractice premium for a single doctor is rarely more than $30,000 per year and for most surgeons it is less than $20,000 per year. http://truecostofhealthcare.net/malpractice/2. We have very few protections against malpractice lawsuits. Especially for small private doctor offices, the malpractice insurance can sometimes be the largest expense of the entire business, higher than salaries or rent.This is absolutely a big part of it. My uncle was a neurosurgeon (recently retired) and I don't know the details but I'm pretty sure his malpractice insurance was six figures annually (granted, I'm sure he was making bank above and beyond that in his specialty, but still).
Post by: Quidnon? on December 08, 2016, 09:48:32 PM
. Having health care tied to employment is retarded.
-W
Agreed. The fact that this is how health insurance evolved in our country -- and the fact that people actually think this is normal -- is a huge source of the problem in the first place.
There is some interesting history that led up to this being a "normal" employment benefit in the US. Mostly due to wage freezes during WW2, resulting in businesses turning towards benefit packages to attract dedicated & experienced labor; which in that time, if you weren't in the army, likely implied that you were an older professional with a family. So sponsorship of a family health insurance plan was a big part of the new benefit packages. Following the war, the dominance of such benefit packages were ensured due to preferential corporate tax treatment that major manufacturers lobbied congress for, and got. Prior to WW2, health insurance, if any, was not a normal employment benefit. That was something that upper middle class or wealthy families would get in the same way people get automobile insurance today, by contacting an insurance agent and seeking it out. The majority of middle class and lower didn't get health care via health insurance, they got it through mutual benefit societies or charities. I'm undecided about whether or not health insurance is a necessary part of health care for a single, young adult; but I am of the opinion that children should be granted special consideration. If a 20 year old with no dependents chooses to forego insurance, I say let'em. But a 20 year old with a 2 year old child should be expected to get the kid insurance at least.
Post by: Kris on December 09, 2016, 09:21:06 AM
. Having health care tied to employment is retarded.
-W
Agreed. The fact that this is how health insurance evolved in our country -- and the fact that people actually think this is normal -- is a huge source of the problem in the first place.
There is some interesting history that led up to this being a "normal" employment benefit in the US. Mostly due to wage freezes during WW2, resulting in businesses turning towards benefit packages to attract dedicated & experienced labor; which in that time, if you weren't in the army, likely implied that you were an older professional with a family. So sponsorship of a family health insurance plan was a big part of the new benefit packages. Following the war, the dominance of such benefit packages were ensured due to preferential corporate tax treatment that major manufacturers lobbied congress for, and got. Prior to WW2, health insurance, if any, was not a normal employment benefit. That was something that upper middle class or wealthy families would get in the same way people get automobile insurance today, by contacting an insurance agent and seeking it out. The majority of middle class and lower didn't get health care via health insurance, they got it through mutual benefit societies or charities. I'm undecided about whether or not health insurance is a necessary part of health care for a single, young adult; but I am of the opinion that children should be granted special consideration. If a 20 year old with no dependents chooses to forego insurance, I say let'em. But a 20 year old with a 2 year old child should be expected to get the kid insurance at least.
Yes, I knew this, but was too lazy to type it out as part of my response above.
The problem is the way things have played out since WW2, and the ways in which having insurance tied to employment has evolved in terms of attitudes and cultural norms, not to mention its intersection with the for-profit insurance industry.
That is a much larger subject. And that is what I was talking about when I said it is complete f'ed up that we think of it all as "normal."
Post by: sol on December 09, 2016, 09:29:59 AM
then in practice the health insurers will make your life miserable.
My experience is that people most need their health insurance when they are already miserable. After a major accident, a debilitating illness, a sick child. Then the insurance company comes along and does everything possible to pay as little as possible. Hiring a minimum wage claims worker to send you fifty rejection letters for payment is heck of a lot cheaper than paying a $65,000 medical bill from a car accident.
In my case, my insurance company paid a lawyer to deny my coverage was valid, for months, because that was cheaper than just paying the bills. I absolutely had legal insurance (through my university) but they had zero qualms about trying to retroactively deactivate my policy. Any why would they? They're a for-profit corporation with stockholders who want to see their income maximized and their expenses minimized, and the easiest way to accomplish that is to continue collecting premiums and then refuse to pay as many claims as possible. The financial incentives for for-profit insurance companies are exactly backwards. They make money by screwing with you in your must vulnerable state.
I was in ICU when my insurance company started breaking their own rules, and then a nursing home after that, and I had to fight them on it while I was unable to use a telephone due to my injuries. Evil, predatory companies. It still makes me angry just thinking about it, all these years later.
Post by: waltworks on December 09, 2016, 09:46:50 AM
I mean, if there was ever a win for everyone, that's gotta be it. I guess companies are saving a little money by paying people via benefit but it can't be *that* huge of a tax savings, certainly not enough to justify all the extra HR staff you need to administer it.
Trump is beholden to nobody, so if anyone could propose it, he could.
-W
Post by: NoStacheOhio on December 09, 2016, 09:53:38 AM
then in practice the health insurers will make your life miserable.
My experience is that people most need their health insurance when they are already miserable. After a major accident, a debilitating illness, a sick child. Then the insurance company comes along and does everything possible to pay as little as possible. Hiring a minimum wage claims worker to send you fifty rejection letters for payment is heck of a lot cheaper than paying a $65,000 medical bill from a car accident.
In my case, my insurance company paid a lawyer to deny my coverage was valid, for months, because that was cheaper than just paying the bills. I absolutely had legal insurance (through my university) but they had zero qualms about trying to retroactively deactivate my policy. Any why would they? They're a for-profit corporation with stockholders who want to see their income maximized and their expenses minimized, and the easiest way to accomplish that is to continue collecting premiums and then refuse to pay as many claims as possible. The financial incentives for for-profit insurance companies are exactly backwards. They make money by screwing with you in your must vulnerable state.
I was in ICU when my insurance company started breaking their own rules, and then a nursing home after that, and I had to fight them on it while I was unable to use a telephone due to my injuries. Evil, predatory companies. It still makes me angry just thinking about it, all these years later.
Just chiming in here to violently agree some more.
While not nearly as bad as your situation, I'll share my anecdote.
I turned 26 seven months before the age 26 provision in ACA kicked in. Many insurers/employers simply left people like me on the plan, rather than processing the removal/re-add. Not Aetna.
So I went to my independent insurance agent and said "please sell me insurance." It so happened that Aetna offered the best option for an individual plan, so I filled out all the paperwork and all that.
I have Factor V Leiden, which is a genetic mutation, but not a disease. Critically, I have no personal history of blood clots. They denied me coverage based on a "pre-existing condition." I called and explained which federal laws they were violating, and they said they didn't care, appeals have to be done in writing, no exceptions.
Fine. So I send them a strongly-worded letter with U.S.C. citations (mostly https://en.wikipedia.org/wiki/Genetic_Information_Nondiscrimination_Act). To which they reply, fine, but we're charging you a higher premium. I sent another letter citing the exact same laws I cited the first time, explaining how this was also illegal.
Four months later I had (retroactive) insurance that I never used, and went back on my parental plan as soon as ACA took effect.
Post by: Gin1984 on December 09, 2016, 10:46:24 AM
My assumption (probably stupid) is that revoking the tax benefits tied to paying employees via health insurance/etc would be popular with basically everyone. Companies *hate* dealing with insurance, there tons of tax code complexity involved, workers could move around and change jobs more easily, people could start a business without risking their whole families' health, etc.You are hilarious. Trump is beholden to many.
I mean, if there was ever a win for everyone, that's gotta be it. I guess companies are saving a little money by paying people via benefit but it can't be *that* huge of a tax savings, certainly not enough to justify all the extra HR staff you need to administer it.
Trump is beholden to nobody, so if anyone could propose it, he could.
-W
Post by: waltworks on December 09, 2016, 11:13:55 AM
So I will stand by my "not beholden to anyone" comment.
-W
Post by: sol on December 09, 2016, 11:18:21 AM
He didn't get any big money donations (at least in the context of a presidential election) either.
What counts as "big money"?
Today the news is reporting that Trump took 7 million dollars in donations from the person he has nominated to lead the small business administration in his cabinet. That sure looks like "beholden" to me. He's repaying his backers with political appointments. What could possibly be more swampy than that?
Post by: waltworks on December 09, 2016, 11:25:40 AM
I agree that his appointments have basically been cronies. I'd say that shows that *loyalty* matters to him (unduly, IMO, since most of the appointments would on the face of it seem unqualified for their positions) but I don't think it has anything to do with money.
My point more generally was that, should he be so inclined, he could propose things (decoupling healthcare from employment, for example) that other people probably wouldn't/couldn't. I have very little faith that he'll do any such thing, but you never know.
-W
Post by: projekt on December 09, 2016, 12:11:28 PM
http://talkingpointsmemo.com/edblog/he-won-t-because-he-can-t
He had been using campaign funds to pay his own businesses a lot:
http://www.politico.com/story/2016/09/donald-trump-business-campaign-trail-228500
Hypothetically, if he were trying to keep cash flow up, he might take a campaign loan and funnel the money back to his companies in the form of revenue for services, so that he can eventually either raise enough campaign money to pay off the campaign loan or let the campaign loan default without hurting his companies.
Everyone knew that if Trump released his tax returns and it showed operating losses, he'd have been toast in the campaign. Perhaps he'd also be toast in business because people have often traded on his appearance of success.
Post by: TheOldestYoungMan on December 09, 2016, 12:36:25 PM
I don't like Trump at all, but he basically flipped the bird to the entire establishment (both parties, lots of big business/wall street, foreign countries and leaders, the press in general, celebrities, random people on twitter, etc, etc, etc) for the entire campaign. He didn't get any big money donations (at least in the context of a presidential election) either. He's by far the most disliked president-elect in modern American history.
So I will stand by my "not beholden to anyone" comment.
-W
There's a subtle but important difference between "asked for money but was rejected because they didn't like him" and "flipped the bird to the entire establishment." Trump was not an anti-establishment candidate, he was the candidate neither establishment wanted to support. He got the support of anti-establishment folks because enemy of my enemy, but mostly because the alternative was HRC.
Post by: Daleth on December 09, 2016, 12:53:34 PM
I don't like Trump at all, but he basically flipped the bird to the entire establishment (both parties, lots of big business/wall street, foreign countries and leaders, the press in general, celebrities, random people on twitter, etc, etc, etc) for the entire campaign. He didn't get any big money donations (at least in the context of a presidential election) either. He's by far the most disliked president-elect in modern American history.
So I will stand by my "not beholden to anyone" comment.
Vladimir Putin heard that remark and is chuckling to himself as he lubes up behind a trouserless Trump.
Having declared bankruptcy 4 times, been sued for fraud, had casinos and other businesses fail, etc., Trump can't get bank loans anymore. He gets his money from Russian oligarchs. That's who he's beholden to. Good call, America.
Post by: Quidnon? on December 09, 2016, 01:00:49 PM
If a 20 year old with no dependents chooses to forego insurance, I say let'em. But a 20 year old with a 2 year old child should be expected to get the kid insurance at least.
Health insurance is not like other kinds of insurance because everyone eventually uses health care as we are all not immortal,
Heath insurance and health care are not quite the same thing.
Quote
and our hospitals policy is to provide emergency care to everyone regardless of insurance. Even 20 year old invicibles need health care when they get in a car wreck, etc. So when these young people without jobs go to the ER, if they have no insurance, they can't pay, and they are judgment proof because they have no assets, and so the hospital writes it off and then increases everyone else's bill. This is why it costs $20 for a Tylenol in a hospital. So we all end up paying for them regardless.
Well, yes & no. I can see that argument, but there are much better ways to encourage a minimum standard of civic health care than what we ended up with.
Post by: Quidnon? on December 09, 2016, 01:06:12 PM
Exactly. They ARE getting rid of it, but then claiming they are not getting rid of it as long as you've maintained continuous coverage. What good is a ban on denying coverage to people with pre-existing conditions if you can still deny people with pre-existing conditions? The guaranteed issue clause is totally meaningless if it doesn't apply to anyone who doesn't already have coverage.
No! We discussed this before. People NEED to get continuous health coverage. If they don't, they implicitly accept to forfeit the right to buy insurance with pre-existing conditions (otherwise, it would be too easy, wouldn't it?). They need to get that into their head!
With Obamacare, you also need continuous coverage, otherwise you pay a penalty, but the penalty is ridiculously low. You can see the continuous coverage condition above as a higher penalty, one that kicks you out of the program. That's fair, esp. with subsidies and an initial open enrollment period before which all "continuous coverage" history is erased.
I think we are in violent agreement here. Yes, everyone needs continuous coverage. However, in practical terms if the government allows insurers to treat people differently unless they can prove that they have had continuous coverage their entire lives, with documents dating from 1982 in triplicate, then in practice the health insurers will make your life miserable.
There is a better way. Rather than depending upon a yearly risk pool, start a lifespan risk pool of one. That's pretty much the idea behind the HSA. I've ran the numbers many years in a row, and my own health kinda sucks, but the actual cost to me is within 2% one way or the other every year I've had it.
Post by: NoStacheOhio on December 09, 2016, 01:22:14 PM
Exactly. They ARE getting rid of it, but then claiming they are not getting rid of it as long as you've maintained continuous coverage. What good is a ban on denying coverage to people with pre-existing conditions if you can still deny people with pre-existing conditions? The guaranteed issue clause is totally meaningless if it doesn't apply to anyone who doesn't already have coverage.
No! We discussed this before. People NEED to get continuous health coverage. If they don't, they implicitly accept to forfeit the right to buy insurance with pre-existing conditions (otherwise, it would be too easy, wouldn't it?). They need to get that into their head!
With Obamacare, you also need continuous coverage, otherwise you pay a penalty, but the penalty is ridiculously low. You can see the continuous coverage condition above as a higher penalty, one that kicks you out of the program. That's fair, esp. with subsidies and an initial open enrollment period before which all "continuous coverage" history is erased.
I think we are in violent agreement here. Yes, everyone needs continuous coverage. However, in practical terms if the government allows insurers to treat people differently unless they can prove that they have had continuous coverage their entire lives, with documents dating from 1982 in triplicate, then in practice the health insurers will make your life miserable.
There is a better way. Rather than depending upon a yearly risk pool, start a lifespan risk pool of one. That's pretty much the idea behind the HSA. I've ran the numbers many years in a row, and my own health kinda sucks, but the actual cost to me is within 2% one way or the other every year I've had it.
If we add some sort of safety net, this might work. Otherwise you get outliers like the person who gets cancer at 23 having been in an entry-level job for a whopping two years. Now they're looking at medical bills that are multiples of their annual salary. It's not the norm, but it's absolutely going to happen to somebody.
Post by: Quidnon? on December 09, 2016, 03:31:45 PM
If we add some sort of safety net, this might work. Otherwise you get outliers like the person who gets cancer at 23 having been in an entry-level job for a whopping two years. Now they're looking at medical bills that are multiples of their annual salary. It's not the norm, but it's absolutely going to happen to somebody.
It will happen to somebody eventually anyway. There is no perfect solution.
Post by: Unique User on December 09, 2016, 03:39:58 PM
I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.
Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.
Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.
HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!
+1 to all this. I've had an HSA since 2008 (it is the only plan my work has offered) and I am not a fan when you actually need to use them.
It was fine until I actually had a few real medical issues pop up. I had been fighting a birthcontrol charge since 2013 that was only resolved this summer. In that case it was the facility where I had gone for all of my OB coverage, gave birth, etc and that was all in network, but for some reason 2 specific types of birth control from the same facility were considered out of network and I ended up with a bill over a thousand bucks when it should have been free under ACA. The facility didn't even know that it was considered an out of network charge. I paid it back in 2014 but kept fighting for my 1k refund which I finally got this July (and that was only because of a federal lawsuit against the insurance company).
My DH also had an emergency appendectomy and we even stated that we needed in-network coverage but ended up with an out of network anesthetist. Again we had to fight the multi-thousand dollar bill for over a year.
It is almost impossible to "shop" for procedures and especially not in the case of an emergency.
And I also +1 that Pence is *ss.
This. This is exactly what I thought when I read Ryan's plan. I realized none of the idiot Republicans that tout HSAs and HDHPs as the saviors of health insurance have ever tried to ACTUALLY get a price from a doctor's office. Doctor's offices won't tell you, flat out won't tell you. It's a crap shoot. The ONLY time I have been able to estimate coverage was when my husband was diagnosed with cancer early in the year and we knew we would have the pay the out of pocket maximum that year. His company only has HDHP plans also and fund HSAs to a certain amount.
And sounds like we all agree Pence is a sanctimonious *&%.
Post by: Unique User on December 09, 2016, 03:49:19 PM
Meh, what does he care about a few mill, assuming that's true?
I agree that his appointments have basically been cronies. I'd say that shows that *loyalty* matters to him (unduly, IMO, since most of the appointments would on the face of it seem unqualified for their positions) but I don't think it has anything to do with money.
-W
You're kidding, right? Trump whored himself on the Apprentice for a couple hundred thousand per episode, cheated people out of thousands through Trump U and would stiff contractors for a $30k or less bill. And as other people pointed out no US or European bank will lend him money and he's been lining his own pockets with campaign money. I think he is much, much less rich that he says he is and a few mil, as you put it, means a lot to him. But that is meaningless now since he will double deal and steal his way to real riches with the Presidency.
Post by: Quidnon? on December 09, 2016, 06:09:13 PM
This. This is exactly what I thought when I read Ryan's plan. I realized none of the idiot Republicans that tout HSAs and HDHPs as the saviors of health insurance have ever tried to ACTUALLY get a price from a doctor's office. Doctor's offices won't tell you, flat out won't tell you. .
I've done it dozens of times. I think it depends upon state regulations more than the ACA or whatever. I can get "cash price" radiology care pretty cheap, but I have to drive across the state line into Indiana, and there is a law that prohibits the radiology office from verifying the actual cost of "cash price" care to my insurance company. When I asked about this, the receptionist said, "you can try to turn in the receipt, but if the insurance company calls to check, we are prohibited by law from verifying that is what you paid us, or even that you were a patient." So my trips to the radiologist do nothing for my annual deductible. Also, my main doctor is a 'Doctor of Internal Medicine', not a general prac; and she will not deal with insurance forms of any kind. That is actually in her contract. I pay a monthly "membership fee" that covers any office visits, as well as my regular meds (that I get through my doctor's office, not a pharmacy), and I have her cell phone number. Her only employee, that I know of, is a nurse. No secretaries at all. She does keep a real doctor's office, though; but I'm pretty sure it's a shared office deal of some kind. The last time I went to that radiologist's office for two x-rays, it cost me $37 in cash. But they do mean cash, even credit won't fly.
Post by: gerardc on December 09, 2016, 08:57:06 PM
No! We discussed this before. People NEED to get continuous health coverage. If they don't, they implicitly accept to forfeit the right to buy insurance with pre-existing conditions (otherwise, it would be too easy, wouldn't it?). They need to get that into their head!
With Obamacare, you also need continuous coverage, otherwise you pay a penalty, but the penalty is ridiculously low. You can see the continuous coverage condition above as a higher penalty, one that kicks you out of the program. That's fair, esp. with subsidies and an initial open enrollment period before which all "continuous coverage" history is erased.
I think we are in violent agreement here. Yes, everyone needs continuous coverage. However, in practical terms if the government allows insurers to treat people differently unless they can prove that they have had continuous coverage their entire lives, with documents dating from 1982 in triplicate, then in practice the health insurers will make your life miserable.
Not continuous coverage their entire lives! there'd be a one-time open enrollment window in 2017 or 2018 where everyone could reset their continuous coverage history and start anew.
You'd only need documentation from 2017/2018 on, and it would be digitally recorded, and automatic. Further, insurance companies wouldn't be allowed to retroactively deny coverage; it they accept the policy, then you're good to go forever.
Post by: former player on December 10, 2016, 02:56:57 AM
Good to go as long as you can come up with the cash for the premiums, on the nail, every time, for the rest of your life, without fail.
You'd only need documentation from 2017/2018 on, and it would be digitally recorded, and automatic. Further, insurance companies wouldn't be allowed to retroactively deny coverage; it they accept the policy, then you're good to go forever.
What do you do when it is a choice of paying health insurance or paying the rent, or buying food, or keeping your car on the road so you can work, or paying the copays so that your cancer treatment can continue?
Post by: gerardc on December 10, 2016, 12:24:33 PM
Good to go as long as you can come up with the cash for the premiums, on the nail, every time, for the rest of your life, without fail.
What do you do when it is a choice of paying health insurance or paying the rent, or buying food, or keeping your car on the road so you can work, or paying the copays so that your cancer treatment can continue?
That's the case with Obamacare too, isn't it? The key is providing enough subsidies for those who cannot afford premiums, like in Obamacare, which is an orthogonal problem. I'm merely saying pre-existing ban + mandate with cash penalties of Obamacare can be replaced with pre-existing ban condtional on continuous coverage.
We can also be more flexible with the continuous coverage rule without messing with the actuarial value too much:
- Allow 2-3 months of interruption without coverage being considered broken
- Allow to "reset" your coverage history every 5 years, e.g. with an open enrollment window with no pre-existing checks.
Post by: Paul der Krake on December 10, 2016, 01:34:49 PM
https://www.healthcare.gov/apply-and-enroll/health-insurance-grace-period/
It's not much, but the whole idea behind the ACA was that subsidies would make premiums affordable and people wouldn't skimp on them.
Post by: wenchsenior on December 10, 2016, 02:24:07 PM
Good to go as long as you can come up with the cash for the premiums, on the nail, every time, for the rest of your life, without fail.
What do you do when it is a choice of paying health insurance or paying the rent, or buying food, or keeping your car on the road so you can work, or paying the copays so that your cancer treatment can continue?
That's the case with Obamacare too, isn't it? The key is providing enough subsidies for those who cannot afford premiums, like in Obamacare, which is an orthogonal problem. I'm merely saying pre-existing ban + mandate with cash penalties of Obamacare can be replaced with pre-existing ban condtional on continuous coverage.
We can also be more flexible with the continuous coverage rule without messing with the actuarial value too much:
- Allow 2-3 months of interruption without coverage being considered broken
- Allow to "reset" your coverage history every 5 years, e.g. with an open enrollment window with no pre-existing checks.
There is a big difference, though.
Let's say you have some sort of preexisting condition. And let's say you have finally been able to get some sort of coverage under the ACA and you have been maintaining coverage for several years. Now let's say you run into an ongoing cash crunch that causes you to drop the coverage for a few months. You will then have to pay the ACA penalty, which sucks, but IT IS A ONE TIME PAYMENT. Come next enrollment period, your cash flow has improved again and you can buy back in on the same policy as before WITH NO PRICE PENALTY.
Under the GOP versions of the pre-existing conditions clause, if you had to drop coverage and then buy back in at some later point, the insurance company couldn't turn you away, but they COULD permanently jack up your premium. ETA, one of the most detailed GOP plans (the Price one, I think), would allow insurers to jack your premiums up to 150% every time you let your policy lapse.
So the difference of dropped coverage for people of uncertain cash flow is a single penalty payment 'ding' under the ACA, versus a permanent 'ding' under the GOP plan, that is, an ongoing payment increase for every occasion they let coverage lapse.
That is a big difference.
Post by: Metric Mouse on December 12, 2016, 01:14:01 PM
Post by: Metric Mouse on December 12, 2016, 01:56:29 PM
Why would you have to keep documentation your whole life? If you were required to have insurance to get pre-existing insurance, wouldn't you just have to prove that you had it last year? Each year at renewal, you'd show your policy from last year, and get insurance. Don't have a policy from last year? Then you'd be placed in the other risk pool. Doesn't sound so burdensome of a level of proof.
Because you are assuming a perfect process and perfect people and I am not. Because insurers have a reputation for looking for any loophole possible to get out of paying large claims.
Hey, you don't have to convince me. The quicker we can get away from needing to deal with health insurance companies for anything, the better.
Post by: Gin1984 on December 12, 2016, 02:44:21 PM
Why would you have to keep documentation your whole life? If you were required to have insurance to get pre-existing insurance, wouldn't you just have to prove that you had it last year? Each year at renewal, you'd show your policy from last year, and get insurance. Don't have a policy from last year? Then you'd be placed in the other risk pool. Doesn't sound so burdensome of a level of proof.Because employer insurance does not require proof of prior insurance. They only go for that, once you have claim.
Post by: wenchsenior on December 19, 2016, 09:43:54 AM
Why would you have to keep documentation your whole life? If you were required to have insurance to get pre-existing insurance, wouldn't you just have to prove that you had it last year? Each year at renewal, you'd show your policy from last year, and get insurance. Don't have a policy from last year? Then you'd be placed in the other risk pool. Doesn't sound so burdensome of a level of proof.
Because you are assuming a perfect process and perfect people and I am not. Because insurers have a reputation for looking for any loophole possible to get out of paying large claims.
Hey, you don't have to convince me. The quicker we can get away from needing to deal with health insurance companies for anything, the better.
I think we can all agree on that. Here are some ideas (all of which will not happen under Republican government):
1. Enable everyone to get Medicare. This would be the most efficient system as doctors / patients wouldn't have to deal with multiple insurance companies. The government would have massive bargaining power to keep prices down as well. All the complexity would be removed and the administrative costs would go down for all involved. However, many health care insurance provider employees, and administrative people would lose their jobs.
2. Keep Obamacare, but with stronger regulations. Make the individual mandate penalty jail time or some other huge penalty that would make it crazy to not get insurance. This would get all the young healthy people into the insurance market, reducing premiums for all. However, those who don't want insurance would now be forced to have it.
3. Abolish the usage of corporations for health insurance. Make them all government organizations / associations / non-profits / credit unions or something with their mission to improve health outcomes instead of maximizing profits.
I can't remember which countries have private insurance companies, and an insurance system very similar to the ACA, but do exactly this to enforce it (Germany and Switzerland, possibly, I can't remember which). But they have strict regulations for insurance companies about coverage requirements, and caps on what the private companies can charge, and then they make absolutely sure everyone MUST carry insurance or face huge fines or jail. And it works well for those countries. So a single payer system isn't necessary (though I think it is preferable).
Post by: Malloy on December 19, 2016, 03:18:13 PM
I don't like Trump at all, but he basically flipped the bird to the entire establishment (both parties, lots of big business/wall street, foreign countries and leaders, the press in general, celebrities, random people on twitter, etc, etc, etc) for the entire campaign. He didn't get any big money donations (at least in the context of a presidential election) either. He's by far the most disliked president-elect in modern American history.Vladimir Putin heard that remark and is chuckling to himself as he lubes up behind a trouserless Trump.
So I will stand by my "not beholden to anyone" comment.
Having declared bankruptcy 4 times, been sued for fraud, had casinos and other businesses fail, etc., Trump can't get bank loans anymore. He gets his money from Russian oligarchs. That's who he's beholden to. Good call, America.
I don't believe Donald Trump has ever filed for bankruptcy.
So, corporations aren't people after all!
Post by: Quidnon? on December 19, 2016, 05:48:11 PM
I don't like Trump at all, but he basically flipped the bird to the entire establishment (both parties, lots of big business/wall street, foreign countries and leaders, the press in general, celebrities, random people on twitter, etc, etc, etc) for the entire campaign. He didn't get any big money donations (at least in the context of a presidential election) either. He's by far the most disliked president-elect in modern American history.
So I will stand by my "not beholden to anyone" comment.
Vladimir Putin heard that remark and is chuckling to himself as he lubes up behind a trouserless Trump.
Having declared bankruptcy 4 times, been sued for fraud, had casinos and other businesses fail, etc., Trump can't get bank loans anymore. He gets his money from Russian oligarchs. That's who he's beholden to. Good call, America.
I don't believe Donald Trump has ever filed for bankruptcy.
Technically, no he hasn't. He has filed Chapter 9 (corporate bankruptcy) on behalf of several of his independent companies, but has never done so personally.
Post by: Metric Mouse on December 21, 2016, 05:09:32 AM
1. Enable everyone to get Medicare. This would be the most efficient system as doctors / patients wouldn't have to deal with multiple insurance companies. The government would have massive bargaining power to keep prices down as well. All the complexity would be removed and the administrative costs would go down for all involved. However, many health care insurance provider employees, and administrative people would lose their jobs.
2. Keep Obamacare, but with stronger regulations. Make the individual mandate penalty jail time or some other huge penalty that would make it crazy to not get insurance. This would get all the young healthy people into the insurance market, reducing premiums for all. However, those who don't want insurance would now be forced to have it.
3. Abolish the usage of corporations for health insurance. Make them all government organizations / associations / non-profits / credit unions or something with their mission to improve health outcomes instead of maximizing profits.
I can't remember which countries have private insurance companies, and an insurance system very similar to the ACA, but do exactly this to enforce it (Germany and Switzerland, possibly, I can't remember which). But they have strict regulations for insurance companies about coverage requirements, and caps on what the private companies can charge, and then they make absolutely sure everyone MUST carry insurance or face huge fines or jail. And it works well for those countries. So a single payer system isn't necessary (though I think it is preferable).
Yes.. jail time is such a deterrent. It's worked great to stamp out drug crime and gun deaths... Maybe we should just jail people who are unhealthy? Mandatory prison sentences for people who consume more than 6 ounces of red meat or 2 alcoholic drinks per week. This would focus on healthcare outcomes, instead of funneling money through an insurance grinder to enrich companies, which is the basic premise of Obamacare.
It would be interesting to see the costs of having universal medicare, and discussions of who should shoulder those costs. I think that any push for improving the current system is going to be fought hard by democrats, sadly.
Post by: NoStacheOhio on December 21, 2016, 05:52:08 AM
Yes.. jail time is such a deterrent. It's worked great to stamp out drug crime and gun deaths... Maybe we should just jail people who are unhealthy? Mandatory prison sentences for people who consume more than 6 ounces of red meat or 2 alcoholic drinks per week. This would focus on healthcare outcomes, instead of funneling money through an insurance grinder to enrich companies, which is the basic premise of Obamacare.
It would be interesting to see the costs of having universal medicare, and discussions of who should shoulder those costs. I think that any push for improving the current system is going to be fought hard by democrats, sadly.
Optics matter in this fight. If they frame it as fixing and improving ACA, I think the democrats will at least come to the table. If they repeal first without a plan (which is what it looks like they're trying to do), then yeah, they're going to have a tough time getting any democrats on board, even if they propose a revised version of ACA in the end.
Post by: Gin1984 on December 21, 2016, 06:11:15 AM
The democrats have been fine with improving the current system for years. What they are not fine with is is worsening the current system which is what the GOP wants. Removing people from care, having people lose access are all main points of the Ryan plan especially when you look at his wish for medicare. That is not improvement.1. Enable everyone to get Medicare. This would be the most efficient system as doctors / patients wouldn't have to deal with multiple insurance companies. The government would have massive bargaining power to keep prices down as well. All the complexity would be removed and the administrative costs would go down for all involved. However, many health care insurance provider employees, and administrative people would lose their jobs.
2. Keep Obamacare, but with stronger regulations. Make the individual mandate penalty jail time or some other huge penalty that would make it crazy to not get insurance. This would get all the young healthy people into the insurance market, reducing premiums for all. However, those who don't want insurance would now be forced to have it.
3. Abolish the usage of corporations for health insurance. Make them all government organizations / associations / non-profits / credit unions or something with their mission to improve health outcomes instead of maximizing profits.
I can't remember which countries have private insurance companies, and an insurance system very similar to the ACA, but do exactly this to enforce it (Germany and Switzerland, possibly, I can't remember which). But they have strict regulations for insurance companies about coverage requirements, and caps on what the private companies can charge, and then they make absolutely sure everyone MUST carry insurance or face huge fines or jail. And it works well for those countries. So a single payer system isn't necessary (though I think it is preferable).
Yes.. jail time is such a deterrent. It's worked great to stamp out drug crime and gun deaths... Maybe we should just jail people who are unhealthy? Mandatory prison sentences for people who consume more than 6 ounces of red meat or 2 alcoholic drinks per week. This would focus on healthcare outcomes, instead of funneling money through an insurance grinder to enrich companies, which is the basic premise of Obamacare.
It would be interesting to see the costs of having universal medicare, and discussions of who should shoulder those costs. I think that any push for improving the current system is going to be fought hard by democrats, sadly.
Post by: jim555 on December 21, 2016, 06:43:24 AM
Post by: wenchsenior on December 21, 2016, 07:53:21 AM
1. Enable everyone to get Medicare. This would be the most efficient system as doctors / patients wouldn't have to deal with multiple insurance companies. The government would have massive bargaining power to keep prices down as well. All the complexity would be removed and the administrative costs would go down for all involved. However, many health care insurance provider employees, and administrative people would lose their jobs.
2. Keep Obamacare, but with stronger regulations. Make the individual mandate penalty jail time or some other huge penalty that would make it crazy to not get insurance. This would get all the young healthy people into the insurance market, reducing premiums for all. However, those who don't want insurance would now be forced to have it.
3. Abolish the usage of corporations for health insurance. Make them all government organizations / associations / non-profits / credit unions or something with their mission to improve health outcomes instead of maximizing profits.
I can't remember which countries have private insurance companies, and an insurance system very similar to the ACA, but do exactly this to enforce it (Germany and Switzerland, possibly, I can't remember which). But they have strict regulations for insurance companies about coverage requirements, and caps on what the private companies can charge, and then they make absolutely sure everyone MUST carry insurance or face huge fines or jail. And it works well for those countries. So a single payer system isn't necessary (though I think it is preferable).
Yes.. jail time is such a deterrent. It's worked great to stamp out drug crime and gun deaths... Maybe we should just jail people who are unhealthy? Mandatory prison sentences for people who consume more than 6 ounces of red meat or 2 alcoholic drinks per week. This would focus on healthcare outcomes, instead of funneling money through an insurance grinder to enrich companies, which is the basic premise of Obamacare.
It would be interesting to see the costs of having universal medicare, and discussions of who should shoulder those costs. I think that any push for improving the current system is going to be fought hard by democrats, sadly.
Jail time might not deter Americans from doing shit, that's true. I was just making the point that apparently it DOES deter people from going without health insurance in the handful of countries that use it as part of their incentive package, because in those countries most people are covered by private insurers and yet their system works fine apparently, and there is near universal coverage. Would Americans behave differently? Probably. We're definitely 'special'.
Post by: Metric Mouse on December 21, 2016, 10:01:07 AM
The democrats have been fine with improving the current system for years. What they are not fine with is is worsening the current system which is what the GOP wants. Removing people from care, having people lose access are all main points of the Ryan plan especially when you look at his wish for medicare. That is not improvement.
Which is how I think the democrats will frame it. As mentioned above, it won't really be about improving the debacle that is the ACA (it probably can't be 'fixed' by its nature, but it could be improved) it will be about how the ACA is so perfect, and any change that changes coverage or allows people to opt out or doesn't increase penalties will be seen as 'worsening the current system.' So that was my point - the democrats will fight any improvements in the general system because of small deficiencies in the changes, without offering working suggestions of their own, and then blame the republicans, which is what the R's have been doing for years. Unsurprising, but not really helpful.
Post by: jim555 on December 21, 2016, 11:47:02 AM
They could cease their lawsuit to block cost sharing reductions for the Silver plans.
They could increase the subsidies and lower the OOP on the plans.
When Republicans say "improve it" they are really saying "make sure it can't work and monkey wrench it".
Post by: stoaX on December 28, 2016, 11:57:46 AM
I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.
Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.
Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.
HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!
+1 to all this. I've had an HSA since 2008 (it is the only plan my work has offered) and I am not a fan when you actually need to use them.
It was fine until I actually had a few real medical issues pop up. I had been fighting a birthcontrol charge since 2013 that was only resolved this summer. In that case it was the facility where I had gone for all of my OB coverage, gave birth, etc and that was all in network, but for some reason 2 specific types of birth control from the same facility were considered out of network and I ended up with a bill over a thousand bucks when it should have been free under ACA. The facility didn't even know that it was considered an out of network charge. I paid it back in 2014 but kept fighting for my 1k refund which I finally got this July (and that was only because of a federal lawsuit against the insurance company).
My DH also had an emergency appendectomy and we even stated that we needed in-network coverage but ended up with an out of network anesthetist. Again we had to fight the multi-thousand dollar bill for over a year.
It is almost impossible to "shop" for procedures and especially not in the case of an emergency.
And I also +1 that Pence is *ss.
This. This is exactly what I thought when I read Ryan's plan. I realized none of the idiot Republicans that tout HSAs and HDHPs as the saviors of health insurance have ever tried to ACTUALLY get a price from a doctor's office. Doctor's offices won't tell you, flat out won't tell you. It's a crap shoot. The ONLY time I have been able to estimate coverage was when my husband was diagnosed with cancer early in the year and we knew we would have the pay the out of pocket maximum that year. His company only has HDHP plans also and fund HSAs to a certain amount.
And sounds like we all agree Pence is a sanctimonious *&%.
The practice my doctor is associated with has a cost estimator on their website. Put in the type of visit or procedure and you get an estimate of the total cost. And many people (not me) have a cost estimator called "castlight" associated with their health insurance plans that gives them insight to the cost of whatever procedures or services they are anticipating.
It sounds like your doctors need to join the 21st century...
Post by: Gin1984 on December 28, 2016, 12:41:49 PM
Except those estimates are not binding in anyway EVEN if you get only the testament exactly posted.I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.
Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.
Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.
HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!
+1 to all this. I've had an HSA since 2008 (it is the only plan my work has offered) and I am not a fan when you actually need to use them.
It was fine until I actually had a few real medical issues pop up. I had been fighting a birthcontrol charge since 2013 that was only resolved this summer. In that case it was the facility where I had gone for all of my OB coverage, gave birth, etc and that was all in network, but for some reason 2 specific types of birth control from the same facility were considered out of network and I ended up with a bill over a thousand bucks when it should have been free under ACA. The facility didn't even know that it was considered an out of network charge. I paid it back in 2014 but kept fighting for my 1k refund which I finally got this July (and that was only because of a federal lawsuit against the insurance company).
My DH also had an emergency appendectomy and we even stated that we needed in-network coverage but ended up with an out of network anesthetist. Again we had to fight the multi-thousand dollar bill for over a year.
It is almost impossible to "shop" for procedures and especially not in the case of an emergency.
And I also +1 that Pence is *ss.
This. This is exactly what I thought when I read Ryan's plan. I realized none of the idiot Republicans that tout HSAs and HDHPs as the saviors of health insurance have ever tried to ACTUALLY get a price from a doctor's office. Doctor's offices won't tell you, flat out won't tell you. It's a crap shoot. The ONLY time I have been able to estimate coverage was when my husband was diagnosed with cancer early in the year and we knew we would have the pay the out of pocket maximum that year. His company only has HDHP plans also and fund HSAs to a certain amount.
And sounds like we all agree Pence is a sanctimonious *&%.
The practice my doctor is associated with has a cost estimator on their website. Put in the type of visit or procedure and you get an estimate of the total cost. And many people (not me) have a cost estimator called "castlight" associated with their health insurance plans that gives them insight to the cost of whatever procedures or services they are anticipating.
It sounds like your doctors need to join the 21st century...
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Post by: Quidnon? on December 28, 2016, 01:51:57 PM
Except those estimates are not binding in anyway EVEN if you get only the testament exactly posted.
True, those estimates are high as a rule. Show up with cash for an outpatient procedure and ask for a discount. It has worked for me every time, even when an estimate was not available.
Post by: Gin1984 on December 28, 2016, 01:53:07 PM
Oh no, I'm not saying they are high. I have had an estimate and then, with exactly what I had put in, my cost was double.
Except those estimates are not binding in anyway EVEN if you get only the testament exactly posted.
True, those estimates are high as a rule. Show up with cash for an outpatient procedure and ask for a discount. It has worked for me every time, even when an estimate was not available.
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Post by: Quidnon? on December 28, 2016, 01:53:33 PM
If Republicans want to improve it they can expand Medicaid in those states where they have blocked it. They could do this today with no Democrats.
They could cease their lawsuit to block cost sharing reductions for the Silver plans.
They could increase the subsidies and lower the OOP on the plans.
When Republicans say "improve it" they are really saying "make sure it can't work and monkey wrench it".
I don't think we share the same ideas about what an improvement would look like.
Post by: Quidnon? on December 28, 2016, 01:54:41 PM
Oh no, I'm not saying they are high. I have had an estimate and then, with exactly what I had put in, my cost was double.
Except those estimates are not binding in anyway EVEN if you get only the testament exactly posted.
True, those estimates are high as a rule. Show up with cash for an outpatient procedure and ask for a discount. It has worked for me every time, even when an estimate was not available.
Oh, I understood what you had implied, I was contradicting you. My experience is different.
Post by: Gin1984 on December 28, 2016, 01:57:41 PM
Yes, people's experiences can be different. That is not actually contradicting me (at least not with any actual base). That still does not negate my point which is that IMO those estimates are not worth anything and therefore that is not a sufficient solution if people have HSAs.Oh no, I'm not saying they are high. I have had an estimate and then, with exactly what I had put in, my cost was double.
Except those estimates are not binding in anyway EVEN if you get only the testament exactly posted.
True, those estimates are high as a rule. Show up with cash for an outpatient procedure and ask for a discount. It has worked for me every time, even when an estimate was not available.
Oh, I understood what you had implied, I was contradicting you. My experience is different.
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Post by: Quidnon? on December 28, 2016, 02:19:50 PM
That still does not negate my point which is that IMO those estimates are not worth anything and therefore that is not a sufficient solution if people have HSAs.
Neither sufficient, nor necessary. Since I don't pay my medical bills out of the HSA anyway, I'm effectively a cash patient, so I am in the habit of asking for a cash discount. Sometimes I can get one even if I'm going to end up getting billed, but I have always gotten one when I had any significant portion of the expected bill with me, in cash form. When I first started doing things this way, it seemed that most places didn't know how to handle it, but now most of them know what to do with a large cash payment and what kind of discount is available. How long ago was this experience that you refer to?
Post by: Freedom2016 on December 28, 2016, 02:33:16 PM
That still does not negate my point which is that IMO those estimates are not worth anything and therefore that is not a sufficient solution if people have HSAs.
Neither sufficient, nor necessary. Since I don't pay my medical bills out of the HSA anyway, I'm effectively a cash patient, so I am in the habit of asking for a cash discount. Sometimes I can get one even if I'm going to end up getting billed, but I have always gotten one when I had any significant portion of the expected bill with me, in cash form. When I first started doing things this way, it seemed that most places didn't know how to handle it, but now most of them know what to do with a large cash payment and what kind of discount is available. How long ago was this experience that you refer to?
Seems to me you could obtain the "cash discount" price from the provider, and then turn around and reimburse yourself from the HSA.
But more broadly, I don't get how far one can take this "cash patient" idea once you get into serious disease. I had breast cancer 6 years ago and just 3 weeks ago I had the last of 5 expensive surgeries. How would this HSA/cash patient idea work in a situation like mine?
The bill from this surgery was ~$18K billed to/paid by insurance (on a ~$23K rack rate).
Post by: Quidnon? on December 28, 2016, 02:54:51 PM
That still does not negate my point which is that IMO those estimates are not worth anything and therefore that is not a sufficient solution if people have HSAs.
Neither sufficient, nor necessary. Since I don't pay my medical bills out of the HSA anyway, I'm effectively a cash patient, so I am in the habit of asking for a cash discount. Sometimes I can get one even if I'm going to end up getting billed, but I have always gotten one when I had any significant portion of the expected bill with me, in cash form. When I first started doing things this way, it seemed that most places didn't know how to handle it, but now most of them know what to do with a large cash payment and what kind of discount is available. How long ago was this experience that you refer to?
Seems to me you could obtain the "cash discount" price from the provider, and then turn around and reimburse yourself from the HSA.
I can, indeed. But I generally don't. I try to leave the HSA funds in there, as another retirement account. Better than a roth. If I need the cash later, I can reimburse myself at any time.
Quote
But more broadly, I don't get how far one can take this "cash patient" idea once you get into serious disease. I had breast cancer 6 years ago and just 3 weeks ago I had the last of 5 expensive surgeries. How would this HSA/cash patient idea work in a situation like mine?
Most of the cash discounts are small percentages, somewhere between 2% and 10%. It's really a discount for completely avoiding the costs & risks of medical billing, which can be considerable depending upon what we are talking about. If you have a large HSA balance, and you know that an expensive procedure is soon coming, you can arrange a discount from the sponsoring hospital in advance with a cash deposit. Even 2% would save you serious cash on a surgery. Honestly, if there is an emergency procedure in there somewhere, it would be difficult to get a discount after the fact, but I have actually done that also. After a certain point, though, I depend upon the high deductible insurance policy that comes with my HSA; I'm mostly talking about the more common expenses that occur in advance of hitting that deductible. If it were still an option, I'd only carry catastrophic care with my HSA, and participate in a health cost sharing group; but the ACA prohibits me from getting a catastrophic policy and also prohibits HSA's paired with a health cost sharing group. I'm not opposed to insurance to limit risks, but I want the option to be mostly self-insured, because it is both possible & cheaper than what the ACA now permits. If I could just get an HSA paired with a catastrophic policy that covers anything over $50K in a single year, without also getting hit with the ACA uninsured tax, I'd do that. I actually still can get such a catastrophic policy, it just can't legally count as medical insurance, even though I can prove that I have $50K+ of HSA funds/Roth IRA contributions that I could withdraw in a pinch. Prior to the ACA, such a catastrophic policy was around $80 a year, as a rider to my "umbrella" insurance policy.
EDIT: I also have a set of 3 month rolling CD's, 16 in total, that function as my own unemployment insurance. I should be able to count those funds also.
Post by: Gin1984 on December 28, 2016, 02:57:00 PM
Within this fiscal year.That still does not negate my point which is that IMO those estimates are not worth anything and therefore that is not a sufficient solution if people have HSAs.
Neither sufficient, nor necessary. Since I don't pay my medical bills out of the HSA anyway, I'm effectively a cash patient, so I am in the habit of asking for a cash discount. Sometimes I can get one even if I'm going to end up getting billed, but I have always gotten one when I had any significant portion of the expected bill with me, in cash form. When I first started doing things this way, it seemed that most places didn't know how to handle it, but now most of them know what to do with a large cash payment and what kind of discount is available. How long ago was this experience that you refer to?
Post by: Quidnon? on December 28, 2016, 02:58:35 PM
Within this fiscal year.That still does not negate my point which is that IMO those estimates are not worth anything and therefore that is not a sufficient solution if people have HSAs.
Neither sufficient, nor necessary. Since I don't pay my medical bills out of the HSA anyway, I'm effectively a cash patient, so I am in the habit of asking for a cash discount. Sometimes I can get one even if I'm going to end up getting billed, but I have always gotten one when I had any significant portion of the expected bill with me, in cash form. When I first started doing things this way, it seemed that most places didn't know how to handle it, but now most of them know what to do with a large cash payment and what kind of discount is available. How long ago was this experience that you refer to?
Well, I guess you got screwed. Sorry.
Post by: Unique User on December 28, 2016, 03:06:13 PM
I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.
Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.
Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.
HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!
+1 to all this. I've had an HSA since 2008 (it is the only plan my work has offered) and I am not a fan when you actually need to use them.
It was fine until I actually had a few real medical issues pop up. I had been fighting a birthcontrol charge since 2013 that was only resolved this summer. In that case it was the facility where I had gone for all of my OB coverage, gave birth, etc and that was all in network, but for some reason 2 specific types of birth control from the same facility were considered out of network and I ended up with a bill over a thousand bucks when it should have been free under ACA. The facility didn't even know that it was considered an out of network charge. I paid it back in 2014 but kept fighting for my 1k refund which I finally got this July (and that was only because of a federal lawsuit against the insurance company).
My DH also had an emergency appendectomy and we even stated that we needed in-network coverage but ended up with an out of network anesthetist. Again we had to fight the multi-thousand dollar bill for over a year.
It is almost impossible to "shop" for procedures and especially not in the case of an emergency.
And I also +1 that Pence is *ss.
This. This is exactly what I thought when I read Ryan's plan. I realized none of the idiot Republicans that tout HSAs and HDHPs as the saviors of health insurance have ever tried to ACTUALLY get a price from a doctor's office. Doctor's offices won't tell you, flat out won't tell you. It's a crap shoot. The ONLY time I have been able to estimate coverage was when my husband was diagnosed with cancer early in the year and we knew we would have the pay the out of pocket maximum that year. His company only has HDHP plans also and fund HSAs to a certain amount.
And sounds like we all agree Pence is a sanctimonious *&%.
The practice my doctor is associated with has a cost estimator on their website. Put in the type of visit or procedure and you get an estimate of the total cost. And many people (not me) have a cost estimator called "castlight" associated with their health insurance plans that gives them insight to the cost of whatever procedures or services they are anticipating.
It sounds like your doctors need to join the 21st century...
I've lived in three different cities in two different states (NC, MO) since we've had this insurance and no such luck. When we lived in CO and had catastrophic insurance only, all the docs in the area had their prices clearly posted. I did try the cash patient route recently and got the price ahead of time. Had my husband pay them at the time of service exactly what they told me it would be, I wasn't with him and they asked for his insurance card. I got a bill that was more than double was I should have paid just because we have insurance. Insurance that paid nothing and no amount of discussion with them would change it. It was a too bad, just pay it, this is the bill. The only reason we went was because it was close by my house and we were brand new to the area, we certainly never went again. Maybe it's just me and maybe it's because we move so much and don't have relationships with physicians, but in general, we have not had good experiences since we left CO with the exception of my husband's oncologist.
Post by: sol on December 28, 2016, 04:04:47 PM
no amount of discussion with them would change it. It was a too bad, just pay it, this is the bill.
My experience with large medical bills is that they will always say "too bad, just pay it" until you say "I don't have any money and won't be paying this" and then suddenly you have all sorts of options for payment plans and discounts and such. They are in the business of extracting your money and they are good at it, and they don't want to sell your debt to a collection agency because they get even less for it then.
I still occasionally get debt collection notices from a bill that was settled years ago. My impression is that the whole industry is a wild west style black market with little oversight or regulation or record keeping. In that environment, you only lose when you cave in to the bullying and agree to pay someone.
If you just say no, and are willing to live with the consequences, their price will come down. It's a contest of wills between a well staffed bureaucratic machine and an injured or sick individual. They exploit that imbalance with fraudulent charges that border on blackmail.
Post by: Quidnon? on December 28, 2016, 04:45:15 PM
no amount of discussion with them would change it. It was a too bad, just pay it, this is the bill.
My experience with large medical bills is that they will always say "too bad, just pay it" until you say "I don't have any money and won't be paying this" and then suddenly you have all sorts of options for payment plans and discounts and such. They are in the business of extracting your money and they are good at it, and they don't want to sell your debt to a collection agency because they get even less for it then.
I still occasionally get debt collection notices from a bill that was settled years ago. My impression is that the whole industry is a wild west style black market with little oversight or regulation or record keeping. In that environment, you only lose when you cave in to the bullying and agree to pay someone.
If you just say no, and are willing to live with the consequences, their price will come down. It's a contest of wills between a well staffed bureaucratic machine and an injured or sick individual. They exploit that imbalance with fraudulent charges that border on blackmail.
Yes, that is my experience also. This is why getting a post event discount is difficult for most people, but usually a pre-event discount is not. I once told a medical debt collector to "go ahead and sue me" and 24 hours later received a call about a 20% discount on the amount remaining. I had it put into writing, and then paid it with a 401k loan. This was before I had either the roth ira or the HSA. I figured that a 20% discount that made the bill go away was worth the losses from taking a 401k loan. I was mostly right.
Post by: Metric Mouse on December 31, 2016, 05:02:55 AM
That still does not negate my point which is that IMO those estimates are not worth anything and therefore that is not a sufficient solution if people have HSAs.
Neither sufficient, nor necessary. Since I don't pay my medical bills out of the HSA anyway, I'm effectively a cash patient, so I am in the habit of asking for a cash discount. Sometimes I can get one even if I'm going to end up getting billed, but I have always gotten one when I had any significant portion of the expected bill with me, in cash form. When I first started doing things this way, it seemed that most places didn't know how to handle it, but now most of them know what to do with a large cash payment and what kind of discount is available. How long ago was this experience that you refer to?
Seems to me you could obtain the "cash discount" price from the provider, and then turn around and reimburse yourself from the HSA.
But more broadly, I don't get how far one can take this "cash patient" idea once you get into serious disease. I had breast cancer 6 years ago and just 3 weeks ago I had the last of 5 expensive surgeries. How would this HSA/cash patient idea work in a situation like mine?
The bill from this surgery was ~$18K billed to/paid by insurance (on a ~$23K rack rate).
Would these treatments be covered under the HDHP portion of the HSA/HDHP umbrella?
Post by: sol on March 07, 2017, 11:33:37 AM
It's not so much a health care plan as it is a standard republican wish list of conservative fantasy legislation. Frankly I'm surprised it doesn't somehow make assault rifles easier to buy or mention trickle down economics.
Post by: jim555 on March 07, 2017, 12:03:48 PM
Post by: brooklynguy on March 07, 2017, 12:23:16 PM
Post by: jim555 on March 07, 2017, 12:26:44 PM
Post by: brooklynguy on March 07, 2017, 12:33:19 PM
They are getting rid of CSRs and subsidies so the Basic Health Programs are almost certainly gone as well.
Yeah, that's what I would have thought too, but so far I don't see how the proposed statutory language accomplishes the removal of the Basic Health Program option. Is it possible the House Republicans overlooked that point in their rush to put together draft legislation? Or, more likely, it's buried in there somewhere but I'm just missing it.
Post by: jim555 on March 07, 2017, 12:40:38 PM
Post by: Daleth on March 07, 2017, 02:03:02 PM
The new plan offers tax cuts for the rich, slashes benefits for the poor, and heavily restricts abortion.
It's not so much a health care plan as it is a standard republican wish list of conservative fantasy legislation. Frankly I'm surprised it doesn't somehow make assault rifles easier to buy or mention trickle down economics.
Exactly.
Post by: brooklynguy on March 07, 2017, 02:24:52 PM
Shhh.. Maybe they will miss it.
The Kaiser Family Foundation put out a plan comparison tool (http://kff.org/interactive/proposals-to-replace-the-affordable-care-act/) that seems to agree with me that the GOP plan would leave the Basic Health Program option unchanged. Under the "State Role" dropdown window, it says "State option to establish a Basic Health Program is not changed." Unless there's something in the bill that would otherwise mess with the federal funding of these programs, that means, for those with low enough income levels, the Essential Plan could still be a viable option in NY (as could Minnesota's comparable program in that state, which is the only other one to have availed itself of the BHP option). And other states would be free to join the club. Though I can't imagine how this could have been an intentional result -- I suspect it's a loophole that will be closed once it draws enough attention to itself, assuming this bill starts to gain any traction.
Post by: Gin1984 on March 07, 2017, 02:37:33 PM
Time to revive this thread. The republicans replaced their plan last night. So they've decided to replace Obamacare by:Can you explain why you think #2 does not happen already?
1. Eliminating the tax on the richest americans
2. Expanding the access to subsidies for insurance to wealthier individuals / families.
3. Reducing the size of the subsidies per person
4. Allowing for a 5 to 1 ratio of premiums for old people to young people instead of 3 to 1, but increasing subsidies by age
5. Keeping the 10 essential benefits, preexisting conditions, and age of 26 provisions
6. Ending Medicaid for new participants after 2020
Here are my opinions for the consequences of this bill:
1. Millionaires get a bit richer
2. Self employed people who make a middle class income get access to subsidies
3. Poor people get their asses handed to them
4. The premiums should go up for old people but the subsidies go up too, so the impact is not clear
5. At least they didn't want to go back to pre-obamacare where the insurers could deny you for preexisting conditions.
6. People that become dirt poor after 2020 get their asses handed to them, unless the Democrats come back into power and repeal this
Overall - this is a laughable bill that enforces all stereotypes of republicans as fat cats twirling their moustaches while the poor suffer.
Post by: jim555 on March 07, 2017, 02:41:43 PM
Good catch, hope it remains.Shhh.. Maybe they will miss it.
The Kaiser Family Foundation put out a plan comparison tool (http://kff.org/interactive/proposals-to-replace-the-affordable-care-act/) that seems to agree with me that the GOP plan would leave the Basic Health Program option unchanged. Under the "State Role" dropdown window, it says "State option to establish a Basic Health Program is not changed." Unless there's something in the bill that would otherwise mess with the federal funding of these programs, that means, for those with low enough income levels, the Essential Plan could still be a viable option in NY (as could Minnesota's comparable program in that state, which is the only other one to have availed itself of the BHP option). And other states would be free to join the club. Though I can't imagine how this could have been an intentional result -- I suspect it's a loophole that will be closed once it draws enough attention to itself, assuming this bill starts to gain any traction.
Post by: Axecleaver on March 07, 2017, 02:45:21 PM
Quote
It's not yet clear to me what the proposed legislation's impact would be on the "Basic Health Program" option made available to states under the ACA (which New York implemented in the form of its "Essential Health Plan" program...Here's the proposed legislation, for anyone who hasn't seen it yet: http://energycommerce.house.gov/sites/republicans.energycommerce.house.gov/files/documents/AmericanHealthCareAct.pdf
Generally speaking, BHP is still intact. I believe it is an oversight which will be corrected shortly. It can be undone in reconciliation.
Don't think they have the votes to pass this. I think Sol's assessment is pretty close, this is going to have to change quite a bit before we see what the real bill is going to say.
The media is getting some things wrong. KFF is 100% accurate as far as I can tell. Don't put a lot of trust in your major media outlets (good advice for all topics, IMHO).
Some of the more esoteric changes - revocation of retroactive eligibility, civil penalties for improper eligibility determinations, for example - sounds very innocuous, but for those of us who work in this field, is a big deal on the policy side. It's all bad news for poor folks. Good news for consultants, though! We're going to be very busy for the next three or four years building this... whatever this turns out to be.
Post by: jim555 on March 07, 2017, 02:49:25 PM
Post by: brooklynguy on March 07, 2017, 03:13:41 PM
Generally speaking, BHP is still intact. I believe it is an oversight which will be corrected shortly. It can be undone in reconciliation.
Upon closer inspection, I believe the bill, as currently drafted, would even work in conjunction with any state-adopted Basic Health Program by treating it no differently than any other eligible individual health insurance coverage. So, in the case of NY's Essential Plan, you could get refundable premium tax credits to cover the $20 per person per month premium (for enrollees whose income is too high to get free coverage), unless the plan renders itself disqualified by, for example, including coverage for abortions.
Post by: sol on March 07, 2017, 03:14:30 PM
Can you explain why you think #2 does not happen already?
I think he meant to say that subsidies would be made available to people earning a much higher income, so this is probably a difference in how you define "middle class".
Under the new GOP plan, married couples would get the full subsidy amount up to $150k per year of income. Under the ACA that couple would not be subsidized. If you think $150k/yr is middle class, then the GOP plan offers subsidies to more middle class people.
They pay for it by reducing subsidies to poor people, of course.
Post by: RangerOne on March 07, 2017, 06:58:53 PM
Most places anything over around $120k a year is not typically considered "middle" currently it seems.
Either way the assistance is phased out from $70k - $150k I believe. So if you are making closer to $150k you likely won't be getting much of a subsidy.
Post by: sol on March 07, 2017, 07:01:42 PM
$150k is middle class in San Francisco. Just barely.
Most places anything over around $120k a year is not typically considered "middle" currently it seems.
Either way the assistance is phased out from $70k - $150k I believe. So if you are making closer to $150k you likely won't be getting much of a subsidy.
Looks like the phase outs START at 75k for singles and 150k for couples.
Post by: waltworks on March 07, 2017, 07:13:52 PM
But almost everyone with a job, even people making $250k (I personally know plenty of people like this) considers themselves "middle class". I even know a mid-6-figure income person who once told me he considered himself "working class"...
-W
Post by: Hotstreak on March 08, 2017, 11:55:28 AM
One aspect of the proposal that would benefit me and others working towards early retirement is the increase in the HSA contribution limit to $6,550 for individuals and $13,100 for families. For sick people who reach their out of pocket maximum, this a large enough limit for all of those expenses to be paid tax-free through an HSA. Healthy people working towards early retirement would have an additional few thousand dollars they can tax-deffer.
Post by: Gin1984 on March 08, 2017, 12:02:14 PM
I do have that estimator and it is useless. It is not accurate at all.I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.
Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.
Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.
HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!
+1 to all this. I've had an HSA since 2008 (it is the only plan my work has offered) and I am not a fan when you actually need to use them.
It was fine until I actually had a few real medical issues pop up. I had been fighting a birthcontrol charge since 2013 that was only resolved this summer. In that case it was the facility where I had gone for all of my OB coverage, gave birth, etc and that was all in network, but for some reason 2 specific types of birth control from the same facility were considered out of network and I ended up with a bill over a thousand bucks when it should have been free under ACA. The facility didn't even know that it was considered an out of network charge. I paid it back in 2014 but kept fighting for my 1k refund which I finally got this July (and that was only because of a federal lawsuit against the insurance company).
My DH also had an emergency appendectomy and we even stated that we needed in-network coverage but ended up with an out of network anesthetist. Again we had to fight the multi-thousand dollar bill for over a year.
It is almost impossible to "shop" for procedures and especially not in the case of an emergency.
And I also +1 that Pence is *ss.
This. This is exactly what I thought when I read Ryan's plan. I realized none of the idiot Republicans that tout HSAs and HDHPs as the saviors of health insurance have ever tried to ACTUALLY get a price from a doctor's office. Doctor's offices won't tell you, flat out won't tell you. It's a crap shoot. The ONLY time I have been able to estimate coverage was when my husband was diagnosed with cancer early in the year and we knew we would have the pay the out of pocket maximum that year. His company only has HDHP plans also and fund HSAs to a certain amount.
And sounds like we all agree Pence is a sanctimonious *&%.
The practice my doctor is associated with has a cost estimator on their website. Put in the type of visit or procedure and you get an estimate of the total cost. And many people (not me) have a cost estimator called "castlight" associated with their health insurance plans that gives them insight to the cost of whatever procedures or services they are anticipating.
It sounds like your doctors need to join the 21st century...
I've lived in three different cities in two different states (NC, MO) since we've had this insurance and no such luck. When we lived in CO and had catastrophic insurance only, all the docs in the area had their prices clearly posted. I did try the cash patient route recently and got the price ahead of time. Had my husband pay them at the time of service exactly what they told me it would be, I wasn't with him and they asked for his insurance card. I got a bill that was more than double was I should have paid just because we have insurance. Insurance that paid nothing and no amount of discussion with them would change it. It was a too bad, just pay it, this is the bill. The only reason we went was because it was close by my house and we were brand new to the area, we certainly never went again. Maybe it's just me and maybe it's because we move so much and don't have relationships with physicians, but in general, we have not had good experiences since we left CO with the exception of my husband's oncologist.
Post by: sol on March 08, 2017, 12:09:25 PM
Is it clear that marketplace coverage would actually be cheaper for people in that $75k or $150k income range?
No, I don't think that is clear at all. Republicans are trying to advance this bill out of committee before the CBO can score it, so that nobody will have any idea how it might effect insurance rates (or coverage).
But republicans want to believe that letting healthy people opt out of insurance will somehow lower premiums for everyone else. All of the comparisons presented here have assumed no change in rates, and have only compared the changes in subsidies.
And that's an important point, because the ACA guarantees your premiums regardless of rate changes, which is why it is both true that premiums have stayed the same AND true the premiums have gone up. They went up for insurance companies and stayed the same for consumers, and the ACA paid the difference.
The GOP's new AHCA plan would remove this feature and pass all premium costs along to the consumer. If rates go up because healthy people opt out, the rest of us will pay more. This is by design, since the whole point of the new AHCA is to reduce federal spending on subsidized healthcare.
Post by: Hotstreak on March 08, 2017, 03:22:47 PM
On the potential upside is that insurers may reduce premium rates to entice younger healthier people to buy a plan if enough of them drop coverage with no mandate. That "may" lower premium prices overall.
I don't have specific #'s to back this up and I think it would nice if it were possible, but it doesn't strike me as economically feasible. It doesn't seem likely for two reasons. First is that by lowering the price for the young, they lower the max limit they can charge older individuals based on the proposed 1:5 rule. Second is that they will only add a marginal number of new healthy customers (those who's price point falls within the range of the change), while simultaneously reducing profitability on their entire non-healthy population, who has already signed up for insurance. Also they won't just add "healthy" people when they reduce the price point, you will also add "sick" people who decided not to buy at the higher cost. For instance, people who earn too much to qualify for medicaid but don't earn enough to purchase insurance with the level of tax credit they qualify for.
Post by: MasterStache on March 09, 2017, 12:15:11 PM
The new plan offers tax cuts for the rich, slashes benefits for the poor, and heavily restricts abortion.
It's not so much a health care plan as it is a standard republican wish list of conservative fantasy legislation. Frankly I'm surprised it doesn't somehow make assault rifles easier to buy or mention trickle down economics.
The Republican are just expanding on the trickle down theory. Trickledown healthcare.
Post by: hoping2retire35 on March 09, 2017, 02:13:07 PM
Post by: Metric Mouse on March 09, 2017, 04:48:08 PM
Well now my employer is insisting on getting my children's SS#. Not gonna happen.You are concerned about them having it?
Post by: former player on March 10, 2017, 04:37:44 AM
Well now my employer is insisting on getting my children's SS#. Not gonna happen.
If you don't provide it, you will be costing your employer a find of $1,000 dollars a day -
http://www.calbizlit.com/00166591.PDF
I don't think you're that valuable to them.
Post by: MasterStache on March 10, 2017, 05:08:18 AM
Post by: Metric Mouse on March 10, 2017, 05:35:34 AM
Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.Maybe it would spur discussion on legalization of drugs, and the taxing of them to fund addiction assistance.
Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them as currently written. Always hope, I guess.
Post by: sol on March 10, 2017, 08:22:04 AM
Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them
I think you might have misunderstood the primary function of the Republican party.
Post by: MasterStache on March 10, 2017, 09:19:58 AM
Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.Maybe it would spur discussion on legalization of drugs, and the taxing of them to fund addiction assistance.
Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them as currently written. Always hope, I guess.
I am not ok with legalizing heroin.
Post by: Metric Mouse on March 10, 2017, 09:29:00 AM
Maybe just the primary objective of them. Though they don't seem to be functioning much lately either: could be that you're right and they are just performing a completely different primary function than I expect.Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them
I think you might have misunderstood the primary function of the Republican party.
Post by: hoping2retire35 on March 10, 2017, 10:21:06 AM
Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.Maybe it would spur discussion on legalization of drugs, and the taxing of them to fund addiction assistance.
Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them as currently written. Always hope, I guess.
I am not ok with legalizing heroin.
Why do you want to control other people?
Well now my employer is insisting on getting my children's SS#. Not gonna happen.You are concerned about them having it?
I think I am now 100% for repeal. We did have adata breach recently, they had to give us physical checks.
Post by: sol on March 10, 2017, 10:34:48 AM
I am not ok with legalizing heroin.
Why do you want to control other people?
...
I think I am now 100% for repeal.
Am I understanding this correctly? The first part of your post protests against infringing someone's freedom to do heroin, and the second part calls to deny someone's freedom to join a union?
Do you not see the contradiction there?
Post by: hoping2retire35 on March 10, 2017, 10:39:10 AM
I don't follow?I am not ok with legalizing heroin.
Why do you want to control other people?
...
I think I am now 100% for repeal.
Am I understanding this correctly? The first part of your post protests against infringing someone's freedom to do heroin, and the second part calls to deny someone's freedom to join a union?
Do you not see the contradiction there?
Post by: MasterStache on March 10, 2017, 11:30:53 AM
Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.Maybe it would spur discussion on legalization of drugs, and the taxing of them to fund addiction assistance.
Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them as currently written. Always hope, I guess.
I am not ok with legalizing heroin.
Why do you want to control other people?
Are you ok with child abuse?
Post by: RangerOne on March 10, 2017, 03:20:54 PM
Median family income is about $52k (as of 2014, might be smidge higher now). About 28% of households are over $75k (and hence 72% below) so it's sort of hard to call anything over that "middle class" by any reasonable standard.
But almost everyone with a job, even people making $250k (I personally know plenty of people like this) considers themselves "middle class". I even know a mid-6-figure income person who once told me he considered himself "working class"...
-W
Most people making $250k a year would probably categorize themselves as upper-middle class to signify that they aren't "rich" but to also recognize that they live better than the vast majority of people. People in that income range generally can afford average homes in the nicest neighborhoods. Send their kids to private schools. Pay for their kids college. And a whole slew of other opportunities not available to average middle class people.
Typically middle class starts as you say in this country at around $40k. Where depending on family size we can generally say someone is not in a state of poverty. Thats all middle class means initially.
Then beyond that we generally assign cutoffs based on earnings relative to the total working population. Because generally we are interested in our wealth with regards to other people. That makes sense since the ultimate purchasing power we have rests with how many competing buyers we can outspend for limited goods.
Pew research defines middle class for the country at large as anyone not in the top 20% or bottom 20% of earners. The other major relevant factors you always have to consider are where you live and how many people that income is supporting. At large ignoring location and family size, middle class is generally around $40k-$140k currently.
The thing that really skews the thinking and makes almost everyone feel middle class, or in other words not feel rich, is that the difference earnings between someone in the top 5%, top 1% and top 0.1% are drastically different than the difference between a top 20% earner and a middle 50% earner.
Of course the other factors that go in to defining middle class and upper class with regards to wealth are, raw net worth and consumption. But generally we are more enamored by income as a means of differentiation.
I would say upper-middle class, from an experience standpoint, begins when you can do things like. Max out your $401k. Easily save 10% or more of take home post tax money a month on top of a full funded retirement. Easily maintain a 3 month + emergency savings. Buy any necessary item short of a house without ever have to go into debt.
I think another interesting metric when considering who is middle class along the lines of consumption would be to look at savings rates. One potential luxury of being middle or upper middle class is that in theory you may never have to live paycheck to paycheck or borrow money for basic necessities and minor luxuries.
Post by: RangerOne on March 10, 2017, 03:32:37 PM
Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.Maybe it would spur discussion on legalization of drugs, and the taxing of them to fund addiction assistance.
Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them as currently written. Always hope, I guess.
I am not ok with legalizing heroin.
Why do you want to control other people?
Are you ok with child abuse?
The whole stop trying to control people argument is really ringing pretty hollow coming from any Republican who voted Trump. He is pretty much all about force and control. He his just directing it at different shit than the Democrats. This is not entirely Trumps doing. Most Libertarians recognize that the Repubs are generally as controlling and spendy as the Democrats. Their priorities are just different.
You want to know the real solution to illegal immigration if you don't like it, instead of creating more laws, spending billions on enforcement and walls? Make sure there are no jobs for them when they come here. The only reason they come and stay is because they can make money and there is demand for their unskilled labor...
Wake me up when you find an army of unskilled white workers that are going to clean houses for $100 or pick fruit for 12-16 hours a day in 100 degree humid weather for $10 an hour....
This is not necessarily meant to say that there isn't a nontrivial percentage of unskilled, see high school drop out, American natives that are being displaced or undercut by immigrants. I think current estimates put that percentage of unskilled native workers at around 10% of the population. I am not sure if that is 10% of the working population or just the population in general...
Post by: Metric Mouse on March 10, 2017, 06:55:23 PM
Why would we have to pay these highschool drop outs the same rate we pay illegal immigrants? Why would they not be paid market rate or minimum wage at the very least? Certainly without immigrants being paid under the table, wages would rise. Nothing wrong with that, except fruit and almonds might cost a bit more. A small price to pay for people to have a living wage.Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.Maybe it would spur discussion on legalization of drugs, and the taxing of them to fund addiction assistance.
Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them as currently written. Always hope, I guess.
I am not ok with legalizing heroin.
Why do you want to control other people?
Are you ok with child abuse?
The whole stop trying to control people argument is really ringing pretty hollow coming from any Republican who voted Trump. He is pretty much all about force and control. He his just directing it at different shit than the Democrats. This is not entirely Trumps doing. Most Libertarians recognize that the Repubs are generally as controlling and spendy as the Democrats. Their priorities are just different.
You want to know the real solution to illegal immigration if you don't like it, instead of creating more laws, spending billions on enforcement and walls? Make sure there are no jobs for them when they come here. The only reason they come and stay is because they can make money and there is demand for their unskilled labor...
Wake me up when you find an army of unskilled white workers that are going to clean houses for $100 or pick fruit for 12-16 hours a day in 100 degree humid weather for $10 an hour....
This is not necessarily meant to say that there isn't a nontrivial percentage of unskilled, see high school drop out, American natives that are being displaced or undercut by immigrants. I think current estimates put that percentage of unskilled native workers at around 10% of the population. I am not sure if that is 10% of the working population or just the population in general...
Post by: MasterStache on March 11, 2017, 06:14:23 AM
Why would we have to pay these highschool drop outs the same rate we pay illegal immigrants? Why would they not be paid market rate or minimum wage at the very least? Certainly without immigrants being paid under the table, wages would rise. Nothing wrong with that, except fruit and almonds might cost a bit more. A small price to pay for people to have a living wage.Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.Maybe it would spur discussion on legalization of drugs, and the taxing of them to fund addiction assistance.
Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them as currently written. Always hope, I guess.
I am not ok with legalizing heroin.
Why do you want to control other people?
Are you ok with child abuse?
The whole stop trying to control people argument is really ringing pretty hollow coming from any Republican who voted Trump. He is pretty much all about force and control. He his just directing it at different shit than the Democrats. This is not entirely Trumps doing. Most Libertarians recognize that the Repubs are generally as controlling and spendy as the Democrats. Their priorities are just different.
You want to know the real solution to illegal immigration if you don't like it, instead of creating more laws, spending billions on enforcement and walls? Make sure there are no jobs for them when they come here. The only reason they come and stay is because they can make money and there is demand for their unskilled labor...
Wake me up when you find an army of unskilled white workers that are going to clean houses for $100 or pick fruit for 12-16 hours a day in 100 degree humid weather for $10 an hour....
This is not necessarily meant to say that there isn't a nontrivial percentage of unskilled, see high school drop out, American natives that are being displaced or undercut by immigrants. I think current estimates put that percentage of unskilled native workers at around 10% of the population. I am not sure if that is 10% of the working population or just the population in general...
Minimum wage is not a living wage. Good luck enticing unemployed High school dropouts to work manual labor jobs for minimum wage, long hours, little to no benefits. Not to mention it's routinely proven immigrants tend to have a much better work ethic and are more reliable. They would actually fair better at their local McDonalds.
Post by: Metric Mouse on March 11, 2017, 06:29:52 AM
Minimum wage is not a living wage. Good luck enticing unemployed High school dropouts to work manual labor jobs for minimum wage, long hours, little to no benefits. Not to mention it's routinely proven immigrants tend to have a much better work ethic and are more reliable. They would actually fair better at their local McDonalds.Perfect! If the work needs to be done, then wages will rise until they are high enough to attract people to do the work. I don't see a downside with this?
Post by: MasterStache on March 11, 2017, 07:45:57 AM
Minimum wage is not a living wage. Good luck enticing unemployed High school dropouts to work manual labor jobs for minimum wage, long hours, little to no benefits. Not to mention it's routinely proven immigrants tend to have a much better work ethic and are more reliable. They would actually fair better at their local McDonalds.Perfect! If the work needs to be done, then wages will rise until they are high enough to attract people to do the work. I don't see a downside with this?
Rising prices of good and services. Yeah, what could go wrong? For the workers themselves, let's just hope they never intend on starting a family. Heck at least at McDonalds there is some mobility.
Post by: Metric Mouse on March 11, 2017, 07:54:42 AM
I would happily pay more for goods and services if it meant more Americans had jobs with living wages.Minimum wage is not a living wage. Good luck enticing unemployed High school dropouts to work manual labor jobs for minimum wage, long hours, little to no benefits. Not to mention it's routinely proven immigrants tend to have a much better work ethic and are more reliable. They would actually fair better at their local McDonalds.Perfect! If the work needs to be done, then wages will rise until they are high enough to attract people to do the work. I don't see a downside with this?
Rising prices of good and services. Yeah, what could go wrong? For the workers themselves, let's just hope they never intend on starting a family. Heck at least at McDonalds there is some mobility.
Post by: AdrianC on March 11, 2017, 07:55:14 AM
Median family income is about $52k (as of 2014, might be smidge higher now). About 28% of households are over $75k (and hence 72% below) so it's sort of hard to call anything over that "middle class" by any reasonable standard.
What would you call it? Just curious. The definition of "middle class" in America has always puzzled me. If we make $250K we are what, upper middle class? Rich? "Millionaires"?
In the UK, where I come from, middle class generally means professional class and/or university educated. Engineers, teachers, nurses are middle class. Factory workers, coal miners, car mechanics, plumbers are working class. My dad was a car mechanic and machinist, mother worked in a factory cafeteria, so we were solidly working class. Never mind that my dad started his own machine shop and made more money than engineers, teachers, nurses and so on.
Post by: Metric Mouse on March 11, 2017, 08:15:48 AM
Wouldn't a small business owner who makes that much money be considered a professional, and thus middle class? Same with a foreman at a factory or a supervisor or department head at a coal mine?Median family income is about $52k (as of 2014, might be smidge higher now). About 28% of households are over $75k (and hence 72% below) so it's sort of hard to call anything over that "middle class" by any reasonable standard.
What would you call it? Just curious. The definition of "middle class" in America has always puzzled me. If we make $250K we are what, upper middle class? Rich? "Millionaires"?
In the UK, where I come from, middle class generally means professional class and/or university educated. Engineers, teachers, nurses are middle class. Factory workers, coal miners, car mechanics, plumbers are working class. My dad was a car mechanic and machinist, mother worked in a factory cafeteria, so we were solidly working class. Never mind that my dad started his own machine shop and made more money than engineers, teachers, nurses and so on.
Post by: AdrianC on March 11, 2017, 09:42:42 AM
Post by: ChpBstrd on March 11, 2017, 11:53:44 AM
We also have a broad "unemployable" class beneath the working class which consists of addicts and people whose attitudes, personal history, untreated mental illness, or chosen cultural practices preclude them from earning money in the economy.
Post by: MasterStache on March 11, 2017, 05:16:42 PM
I would happily pay more for goods and services if it meant more Americans had jobs with living wages.Minimum wage is not a living wage. Good luck enticing unemployed High school dropouts to work manual labor jobs for minimum wage, long hours, little to no benefits. Not to mention it's routinely proven immigrants tend to have a much better work ethic and are more reliable. They would actually fair better at their local McDonalds.Perfect! If the work needs to be done, then wages will rise until they are high enough to attract people to do the work. I don't see a downside with this?
Rising prices of good and services. Yeah, what could go wrong? For the workers themselves, let's just hope they never intend on starting a family. Heck at least at McDonalds there is some mobility.
Your willingness to pay more isn't going to provide more Americans with jobs.
Post by: iris lily on March 11, 2017, 08:42:02 PM
I would happily pay more for goods and services if it meant more Americans had jobs with living wages.Minimum wage is not a living wage. Good luck enticing unemployed High school dropouts to work manual labor jobs for minimum wage, long hours, little to no benefits. Not to mention it's routinely proven immigrants tend to have a much better work ethic and are more reliable. They would actually fair better at their local McDonalds.Perfect! If the work needs to be done, then wages will rise until they are high enough to attract people to do the work. I don't see a downside with this?
Rising prices of good and services. Yeah, what could go wrong? For the workers themselves, let's just hope they never intend on starting a family. Heck at least at McDonalds there is some mobility.
Your willingness to pay more isn't going to provide more Americans with jobs.
But why not?
Post by: DavidAnnArbor on March 11, 2017, 09:26:19 PM
I would happily pay more for goods and services if it meant more Americans had jobs with living wages.Minimum wage is not a living wage. Good luck enticing unemployed High school dropouts to work manual labor jobs for minimum wage, long hours, little to no benefits. Not to mention it's routinely proven immigrants tend to have a much better work ethic and are more reliable. They would actually fair better at their local McDonalds.Perfect! If the work needs to be done, then wages will rise until they are high enough to attract people to do the work. I don't see a downside with this?
Rising prices of good and services. Yeah, what could go wrong? For the workers themselves, let's just hope they never intend on starting a family. Heck at least at McDonalds there is some mobility.
Well then you should be perfectly happy to allow a surtax on incomes above $250K to subsidize the health insurance costs of people who work at low paying jobs lacking insurance benefits.
Post by: Metric Mouse on March 12, 2017, 03:48:42 AM
Post by: MasterStache on March 12, 2017, 06:04:48 AM
I would happily pay more for goods and services if it meant more Americans had jobs with living wages.Minimum wage is not a living wage. Good luck enticing unemployed High school dropouts to work manual labor jobs for minimum wage, long hours, little to no benefits. Not to mention it's routinely proven immigrants tend to have a much better work ethic and are more reliable. They would actually fair better at their local McDonalds.Perfect! If the work needs to be done, then wages will rise until they are high enough to attract people to do the work. I don't see a downside with this?
Rising prices of good and services. Yeah, what could go wrong? For the workers themselves, let's just hope they never intend on starting a family. Heck at least at McDonalds there is some mobility.
Your willingness to pay more isn't going to provide more Americans with jobs.
But why not?
From a general perspective hyperinflation leads to more unemployment. From the perspective of assuming High School dropouts would actively seek long term employment in low cost manual labor jobs once filled by illegal immigrants, you would have to provide credible evidence this would indeed occur, be viable for the employer, and provide a net benefit to the economy.
Post by: iris lily on March 12, 2017, 07:03:37 AM
Ah, the devil is in the details. Ok.I would happily pay more for goods and services if it meant more Americans had jobs with living wages.Minimum wage is not a living wage. Good luck enticing unemployed High school dropouts to work manual labor jobs for minimum wage, long hours, little to no benefits. Not to mention it's routinely proven immigrants tend to have a much better work ethic and are more reliable. They would actually fair better at their local McDonalds.Perfect! If the work needs to be done, then wages will rise until they are high enough to attract people to do the work. I don't see a downside with this?
Rising prices of good and services. Yeah, what could go wrong? For the workers themselves, let's just hope they never intend on starting a family. Heck at least at McDonalds there is some mobility.
Your willingness to pay more isn't going to provide more Americans with jobs.
But why not?
From a general perspective hyperinflation leads to more unemployment. From the perspective of assuming High School dropouts would actively seek long term employment in low cost manual labor jobs once filled by illegal immigrants, you would have to provide credible evidence this would indeed occur, be viable for the employer, and provide a net benefit to the economy.
I really do not know the the consequences of Americans taking over work from illegal aliens. We are told, often, that Americans will not perform this labor. Something mes we are told that A,ericans will nt perform this lanor at aNY wage.
I half way think this is true.
Post by: Metric Mouse on March 12, 2017, 08:42:33 AM
A: while the argument that rasing minimum wages causes hyper inflation have been around since minimum wage discussion began, in America there has been no correlation between higher wages and hyper inflation. Study after study has shown that the former does not cause the latter. Cities and states that have higher minimum wages have not experienced drop offs in employment or runaway inflation; do you have any examples that contradict all of the examples of higher wages working?From a general perspective hyperinflation leads to more unemployment. From the perspective of assuming High School dropouts would actively seek long term employment in low cost manual labor jobs once filled by illegal immigrants, you would have to provide credible evidence this would indeed occur, be viable for the employer, and provide a net benefit to the economy.Ah, the devil is in the details. Ok.
I really do not know the the consequences of Americans taking over work from illegal aliens. We are told, often, that Americans will not perform this labor. Something mes we are told that A,ericans will nt perform this lanor at aNY wage.
I half way think this is true.
B. Do you really think that no one would do this work? Right now Americans are garbage men and farmers and coal miners and fast food workers; all if these jobs suck. the difference is that the employers of immigrants currently are not forced to follow minimum wage laws when employing undocumented workers. Pay a wage and there would be people willing to do the work; no one is jumping at the chance to flip burgers or haul trash, but people do it everyday because the wages are worth the work. There are a lot of people saying no one would do the work, but reality shows that this is clearly unlikely.
Post by: geekette on March 12, 2017, 09:24:15 AM
I don't think you understand the difference between flipping burgers and being a migrant farmworker. Here's an article from a few years ago about about attempting to hire NC unemployed (during the recession) to work in the fields here in NC - before offering the jobs to H-2A workers (i.e. legal wages). If the article is behind a paywall, just the title should give you a hint how well it went. North Carolina needed 6,500 farm workers. Only 7 Americans stuck it out. (https://www.washingtonpost.com/news/wonk/wp/2013/05/15/north-carolina-needed-6500-farm-workers-only-7-americans-stuck-it-out/)
B. Do you really think that no one would do this work? Right now Americans are garbage men and farmers and coal miners and fast food workers; all if these jobs suck. the difference is that the employers of immigrants currently are not forced to follow minimum wage laws when employing undocumented workers. Pay a wage and there would be people willing to do the work; no one is jumping at the chance to flip burgers or haul trash, but people do it everyday because the wages are worth the work. There are a lot of people saying no one would do the work, but reality shows that this is clearly unlikely.
Another drawback - many of these farm jobs require not only back breaking work, but traveling around the region/country following work, another big difference between the jobs you cited and migrant farm work.
Post by: MasterStache on March 12, 2017, 09:56:58 AM
A: while the argument that rasing minimum wages causes hyper inflation have been around since minimum wage discussion began, in America there has been no correlation between higher wages and hyper inflation. Study after study has shown that the former does not cause the latter. Cities and states that have higher minimum wages have not experienced drop offs in employment or runaway inflation; do you have any examples that contradict all of the examples of higher wages working?From a general perspective hyperinflation leads to more unemployment. From the perspective of assuming High School dropouts would actively seek long term employment in low cost manual labor jobs once filled by illegal immigrants, you would have to provide credible evidence this would indeed occur, be viable for the employer, and provide a net benefit to the economy.Ah, the devil is in the details. Ok.
I really do not know the the consequences of Americans taking over work from illegal aliens. We are told, often, that Americans will not perform this labor. Something mes we are told that A,ericans will nt perform this lanor at aNY wage.
I half way think this is true.
B. Do you really think that no one would do this work? Right now Americans are garbage men and farmers and coal miners and fast food workers; all if these jobs suck. the difference is that the employers of immigrants currently are not forced to follow minimum wage laws when employing undocumented workers. Pay a wage and there would be people willing to do the work; no one is jumping at the chance to flip burgers or haul trash, but people do it everyday because the wages are worth the work. There are a lot of people saying no one would do the work, but reality shows that this is clearly unlikely.
a. Nice straw-man. That wasn't my argument. Feel free to reread my comment.
b. I think workers would have no incentive to fill these rolls. Long hours, minimal pay. Little/no benefits. And absolutely no chance of mobility. The employers themselves would struggle to maintain employees creating a host of other issues. Flipping burgers and hauling trash have mobility and often benefits. Fast food is geared towards high turn over rates. Trash men actually make good money. The bolded part is even contradictory to your assumption that workers would fill these rolls. If, as you claim, no one is lining up to flip burgers what makes you think they would line up to work a job with even less benefits?
Post by: Paul der Krake on March 12, 2017, 10:04:41 AM
Post by: former player on March 12, 2017, 10:43:12 AM
Farm work is backbreaking, yes, but so are many other jobs which local workers fill. It's not the backbreaking nature of the work that's the problem, it's the seasonal and mobile nature of it.
Post by: Metric Mouse on March 12, 2017, 01:51:39 PM
All of the issues that make these jobs shitty are absolutely true, and largely the same for any of these (and many other) positions. Why do people work any of these jobs? I mean there are so many shitty jobs that require people to move around the country that if it was truly a barrier, no large infaatructure project could ever be constructed, and all seasonal jobs would be done by immigrants. Since this is clearly not the case, perhaps the type of work or the mobility is not the biggest issue with these farm jobs. The biggest difference I can see is pay.
Post by: MasterStache on March 13, 2017, 05:34:28 AM
There are many Americans that perform this type of work every year. I know many custom harvesters who follow grain harvests from the south of the country to the northern border, (and into Canada, iirc) every single year. (They also employee some migrant workers from south africa, who travel across a friggen ocean every year to work). They have houses and families, but every year turn out for back breaking labor to work several months away from home. I've read of people doing back breaking labor on fishing vessels (that they don't live on) for seasonal work. I'm aware of truck drivers and oil rig workers and construction workers and pipe fitters and boilermakers and sound technicians and roadies that travel far from home to do shitty work all across the country. Is picking fruit really worse or more dead end than all of these? Or does it just pay so much worse because employers can illegally hire immigrants for so much less?
All of the issues that make these jobs shitty are absolutely true, and largely the same for any of these (and many other) positions. Why do people work any of these jobs? I mean there are so many shitty jobs that require people to move around the country that if it was truly a barrier, no large infaatructure project could ever be constructed, and all seasonal jobs would be done by immigrants. Since this is clearly not the case, perhaps the type of work or the mobility is not the biggest issue with these farm jobs. The biggest difference I can see is pay.
They work the jobs you listed because the pay is higher (in some cases much higher), they offer benefits, and often require specialized education/training/license.
Post by: Gin1984 on March 13, 2017, 06:40:33 AM
Have you ever tried picking fruit. I have and I doubt many Americans could do the job. Not willing, physically able. They don't get paid by the hour but by how much they pick. I was young and healthy and only doing about 1/2 of what actual workers did in the same time and I had to do it for less time.Ah, the devil is in the details. Ok.I would happily pay more for goods and services if it meant more Americans had jobs with living wages.Minimum wage is not a living wage. Good luck enticing unemployed High school dropouts to work manual labor jobs for minimum wage, long hours, little to no benefits. Not to mention it's routinely proven immigrants tend to have a much better work ethic and are more reliable. They would actually fair better at their local McDonalds.Perfect! If the work needs to be done, then wages will rise until they are high enough to attract people to do the work. I don't see a downside with this?
Rising prices of good and services. Yeah, what could go wrong? For the workers themselves, let's just hope they never intend on starting a family. Heck at least at McDonalds there is some mobility.
Your willingness to pay more isn't going to provide more Americans with jobs.
But why not?
From a general perspective hyperinflation leads to more unemployment. From the perspective of assuming High School dropouts would actively seek long term employment in low cost manual labor jobs once filled by illegal immigrants, you would have to provide credible evidence this would indeed occur, be viable for the employer, and provide a net benefit to the economy.
I really do not know the the consequences of Americans taking over work from illegal aliens. We are told, often, that Americans will not perform this labor. Something mes we are told that A,ericans will nt perform this lanor at aNY wage.
I half way think this is true.
Post by: Secret Stache on March 13, 2017, 06:47:17 AM
Post by: Metric Mouse on March 13, 2017, 08:53:28 AM
Quote from: BeginnerStache link=topic=64130.msg1472393#msg1472393
Exactly my point. Raise the pay and Americans will be willing to do these jobs. Not all Americans obviously, but as pay and benefits rise to meet demand for workers, it will roughly balance out.
They work the jobs you listed because the pay is higher (in some cases much higher), they offer benefits, and often require specialized education/training/license.
Post by: MasterStache on March 13, 2017, 09:56:54 AM
Quote from: BeginnerStache link=topic=64130.msg1472393#msg1472393Exactly my point. Raise the pay and Americans will be willing to do these jobs. Not all Americans obviously, but as pay and benefits rise to meet demand for workers, it will roughly balance out.
They work the jobs you listed because the pay is higher (in some cases much higher), they offer benefits, and often require specialized education/training/license.
No. You keep arguing the same faulty logic.
https://www.washingtonpost.com/news/wonk/wp/2013/05/15/north-carolina-needed-6500-farm-workers-only-7-americans-stuck-it-out/?utm_term=.f317aa0012c3 (https://www.washingtonpost.com/news/wonk/wp/2013/05/15/north-carolina-needed-6500-farm-workers-only-7-americans-stuck-it-out/?utm_term=.f317aa0012c3)
http://www.nytimes.com/2011/10/05/us/farmers-strain-to-hire-american-workers-in-place-of-migrant-labor.html (http://www.nytimes.com/2011/10/05/us/farmers-strain-to-hire-american-workers-in-place-of-migrant-labor.html)
Post by: NoStacheOhio on March 13, 2017, 10:29:19 AM
Trying to switch the topic from the plight of migrant workers back to Obamacare -
What do you think of the potential for phase 2 of the republican plan where they have the secretary of HHS analyze whether they should curtail the essential benefits of health care plans. For example, there is an argument going around about why men should pay for the healthcare of women, in particular very expensive prenatal care.
My wife and I are not having any more kids so I'd benefit under that scenario, however I don't support it because I feel a duty to support other people's kids. In particular, one of my friends had a premature baby that had multiple surgeries and eventually died. I find it cruel to expect people that want to have kids to have to pay more for insurance.
The bigger problem is the argument that pooled risk is somehow the big problem with health insurance.
In the hypothetical "Medicare-for-all" scenario, where everybody has the option to buy Medicare the way they buy private insurance right now, you get a huge pool of people sharing costs. Yes, healthy people get less out of it than they pay in, but that's no different than any other scenario that isn't self-pay/go fuck yourself. I really, REALLY hope that I pay more for health insurance for my lifetime than I use. If I use more than I pay in, then it means something in my life has gone catastrophically wrong. I'm OK with subsidizing people who lost the genetic lottery or got hit by a bus (although whoever owns and/or drives the bus should really pay in that instance).
Post by: shenlong55 on March 13, 2017, 12:24:11 PM
Most of the cash discounts are small percentages, somewhere between 2% and 10%. It's really a discount for completely avoiding the costs & risks of medical billing, which can be considerable depending upon what we are talking about. If you have a large HSA balance, and you know that an expensive procedure is soon coming, you can arrange a discount from the sponsoring hospital in advance with a cash deposit. Even 2% would save you serious cash on a surgery. Honestly, if there is an emergency procedure in there somewhere, it would be difficult to get a discount after the fact, but I have actually done that also. After a certain point, though, I depend upon the high deductible insurance policy that comes with my HSA; I'm mostly talking about the more common expenses that occur in advance of hitting that deductible. If it were still an option, I'd only carry catastrophic care with my HSA, and participate in a health cost sharing group; but the ACA prohibits me from getting a catastrophic policy and also prohibits HSA's paired with a health cost sharing group. I'm not opposed to insurance to limit risks, but I want the option to be mostly self-insured, because it is both possible & cheaper than what the ACA now permits. If I could just get an HSA paired with a catastrophic policy that covers anything over $50K in a single year, without also getting hit with the ACA uninsured tax, I'd do that. I actually still can get such a catastrophic policy, it just can't legally count as medical insurance, even though I can prove that I have $50K+ of HSA funds/Roth IRA contributions that I could withdraw in a pinch. Prior to the ACA, such a catastrophic policy was around $80 a year, as a rider to my "umbrella" insurance policy.
EDIT: I also have a set of 3 month rolling CD's, 16 in total, that function as my own unemployment insurance. I should be able to count those funds also.
I actually still had some sympathy for this argument until now. I hadn't done the research myself and since people are claiming that the ACA prohibits me from getting a catastrophic policy I just took them at their word. But now you're telling me I actually still can get such a catastrophic policy?
Post by: jim555 on March 13, 2017, 01:23:06 PM
Post by: jrhampt on March 13, 2017, 01:36:54 PM
Post by: sol on March 13, 2017, 01:41:34 PM
I think you can get a catastrophic policy but you still have to pay the penalty for not having a plan that qualifies under the aca.
The "mandate" to have health insurance was always pretty weak. You pay a higher tax rate if you choose to go without insurance, but you also pay a higher tax rate if you choose not to have children.
And yet for some strange reason, no one was complaining about the parenthood "mandate" like it was some sort of communist plot.
Edit: In both cases, you actually save money by paying the extra taxes. Kids and healthcare are expensive. That's why the government incentives them with tax breaks.
Post by: RangerOne on March 13, 2017, 01:55:57 PM
I think you can get a catastrophic policy but you still have to pay the penalty for not having a plan that qualifies under the aca.
The "mandate" to have health insurance was always pretty weak. You pay a higher tax rate if you choose to go without insurance, but you also pay a higher tax rate if you choose not to have children.
And yet for some strange reason, no one was complaining about the parenthood "mandate" like it was some sort of communist plot.
Edit: In both cases, you actually save money by paying the extra taxes. Kids and healthcare are expensive. That's why the government incentives them with tax breaks.
That is because they dressed it up as a deduction for those who had kids. If the fed penalized people for every year past a certain age they went without kids, there would be mass bitching.
However the analogy is a bit weak, since people clearly incur a boat load of financial risk when choosing to forgo health insurance. If you break your leg hiking and take a chopper off the mountain without insurance you just fell into a second mortgage.
Where as choosing not to have kids is kind of the opposite. You incur 0 financial risk by not having kids.
Post by: RangerOne on March 13, 2017, 02:04:29 PM
But the general mandate of the ACA will remain intact. In addition at this point it doesn't seem they have enough support in the senate to pass, since at least 4 Republican's have concerns that this is still pretty much the ACA. The new bill is a repeal only by name in the media. In reality they are just ripping up a bunch of the original rules meant to help fund the law while still trying to achieve a similar outcome...
So it will cost us more money and price some poor people out of the markets, but in general the ACA will remain the new law of the land. If the manage to pass this bill or a similar one.
Post by: jim555 on March 13, 2017, 04:06:32 PM
Post by: sol on March 13, 2017, 04:20:02 PM
They don't have 60 votes and are limited on how much they can change, that is the only thing limiting them.
As we've previously discussed, republicans could repeal any and all portions of the ACA the same way they are repealing the individual mandate: leave the law but remove the penalties for noncompliance.
They are leaving many of the provisions of the ACA intact because thet WANT them intact, because they were conservative ideas to begin with and are now popular with the public. The whole line about "we can't do more because of 60 votes" is just the smokescreen that buys them political cover for supporting policies the radical right doesn't like.
It's all about managing perception, and they have to lie to their extremist base just like they have to lie to everyone else about the coverage being better. It's a sort of compromise bill, and they need an excuse to give ground as part of the compromise.
In the end, I think even the hardcore conservatives will fall in line behind the GOP plan, subsidies and all, because of the abortion ban, the tax cuts for the rich, the reduction of benefits for the poor, and the permanent dismantling of Medicaid. They will accept healthcare subsidies for rich people in order to get those passed.
Post by: jim555 on March 13, 2017, 05:43:36 PM
Post by: brooklynguy on March 13, 2017, 07:17:24 PM
As we've previously discussed, republicans could repeal any and all portions of the ACA the same way they are repealing the individual mandate: leave the law but remove the penalties for noncompliance.
Not really -- if this were true, the budget reconciliation process would be an exception that entirely swallows the rule (and any legislation could always be passed by a simple majority alone), but it isn't. Not every feature of the ACA is tied to a specific penalty removable through reconciliation. The Republicans couldn't, say, eliminate the ban on using pre-existing conditions as a basis for discrimination, or the provision allowing young adults to remain on their parents' policies until age 26, because these are outright requirements of the law unrelated to revenue or spending.
Post by: sol on March 13, 2017, 08:00:24 PM
The Republicans couldn't, say, eliminate the ban on using pre-existing conditions as a basis for discrimination, or the provision allowing young adults to remain on their parents' policies until age 26, because these are outright requirements of the law unrelated to revenue or spending.
Why not? What happens if you break a law that has no penalty? Do you think someone would sue the insurance company for punitive damages? Otherwise, a judge would just force them to face the consequences of the violation, which in this case is... nothing.
We have lots of archaic laws still on the books that everyone ignores, either because they are deliberately not enforced or because the penalty for them has been removed. That's how Obama decriminalized small amounts of marijuana, for example. He just said it's no longer a priority for enforcement, and suddenly it's a meaningless "crime" unless some new administration changes the policy again.
Post by: brooklynguy on March 13, 2017, 09:33:06 PM
Why not?
Because the budget reconciliation process can only be used to implement legislation that is directly related to revenue or spending, which the examples mentioned in my post are not. The individual mandate, as a contrary example, is a tax imposed on people who fail to purchase qualified coverage and don't otherwise qualify for an exception, and the elimination (or imposition) of a tax is entirely within the bounds of the reconciliation rules. The ban on pre-existing discrimination condition, like the ban on possession of marijuana, is not, and therefore cannot be removed via budget reconciliation, even though both of these (like all laws) are toothless without enforcement to back them up.
Post by: sol on March 13, 2017, 10:11:28 PM
The ban on pre-existing discrimination condition, like the ban on possession of marijuana, is not, and therefore cannot be removed via budget reconciliation
I'm not suggesting they remove it, I'm suggesting they make the penalty zero. The individual mandate is still on the books too. The law says everyone must have insurance, or they pay a fine. They just removed the fine, but the law still says everyone has to have insurance.
Post by: marty998 on March 14, 2017, 02:18:55 AM
*Not sure if that is a per annum figure, or in total over the next 10 years. Makes a difference I guess :)
I suppose out of the headline figures both sides will have more ammunition to fire at each other.
Post by: brooklynguy on March 14, 2017, 06:40:51 AM
I'm not suggesting they remove it, I'm suggesting they make the penalty zero. The individual mandate is still on the books too. The law says everyone must have insurance, or they pay a fine. They just removed the fine, but the law still says everyone has to have insurance.
The statutory language giving rise to the individual mandate is a section of the tax code (inserted by the ACA) that says applicable individuals are required to maintain coverage or face a specified penalty. Although the statute uses the word "penalty," the penalty is in fact a "tax" (in substance, if not in name), which is what enabled the individual mandate to pass muster in the eyes of a majority of the members of the Supreme Court when its constitutionality was challenged. In other words, the law does not force anyone to purchase insurance; it simply charges a tax to those who don't. You're not breaking the law by refusing to purchase insurance; you're just rendering yourself subject to an additional tax liability. The ban on using pre-existing conditions as a basis for discrimination, and the ban on possession of marijuana, on the other hand, are absolute requirements of law, unrelated to tax collection -- an insurer who refuses to issue a policy based on pre-existing conditions and an individual who possesses marijuana have both broken the law. The litany of enforcement actions for violations of these laws no doubt includes monetary penalties, but those penalties are not taxes (and those laws are not otherwise related to tax collection, or government spending). The budget reconciliation process can only be used to implement legislation that directly relates to tax revenue or federal spending, so Republicans could not use budget reconciliation to change those laws, even if they structured the bill as one that merely eliminates monetary fines as a remedy for violations of those laws.
Post by: Metric Mouse on March 16, 2017, 09:13:04 AM
I think you're talking past each other - Sol is not saying that these penalties would be removed by budget reconciliation specifically; he is simply saying Republicans do not have an absolute need to change the law to have an effect on some of the regulations that the ACA implemented.I'm not suggesting they remove it, I'm suggesting they make the penalty zero. The individual mandate is still on the books too. The law says everyone must have insurance, or they pay a fine. They just removed the fine, but the law still says everyone has to have insurance.
The statutory language giving rise to the individual mandate is a section of the tax code (inserted by the ACA) that says applicable individuals are required to maintain coverage or face a specified penalty. Although the statute uses the word "penalty," the penalty is in fact a "tax" (in substance, if not in name), which is what enabled the individual mandate to pass muster in the eyes of a majority of the members of the Supreme Court when its constitutionality was challenged. In other words, the law does not force anyone to purchase insurance; it simply charges a tax to those who don't. You're not breaking the law by refusing to purchase insurance; you're just rendering yourself subject to an additional tax liability. The ban on using pre-existing conditions as a basis for discrimination, and the ban on possession of marijuana, on the other hand, are absolute requirements of law, unrelated to tax collection -- an insurer who refuses to issue a policy based on pre-existing conditions and an individual who possesses marijuana have both broken the law. The litany of enforcement actions for violations of these laws no doubt includes monetary penalties, but those penalties are not taxes (and those laws are not otherwise related to tax collection, or government spending). The budget reconciliation process can only be used to implement legislation that directly relates to tax revenue or federal spending, so Republicans could not use budget reconciliation to change those laws, even if they structured the bill as one that merely eliminates monetary fines as a remedy for violations of those laws.
Post by: Metric Mouse on March 16, 2017, 09:15:20 AM
Reports out today from the Congressional Budget Office that TrumpCare will reduce the budget deficit by $336 billion by 2026* however it will result in an 24 million Americans no longer having health insurance.
*Not sure if that is a per annum figure, or in total over the next 10 years. Makes a difference I guess :)
I suppose out of the headline figures both sides will have more ammunition to fire at each other.
Source? Looks like the headline should read "ACA increases budget deficit by $336 billion by 2026 more than ACHA."
Post by: Axecleaver on March 16, 2017, 10:27:37 AM
Here's a great writeup on the (minimal) changes to Medicare from KFF: http://kff.org/medicare/issue-brief/what-are-the-implications-for-medicare-of-the-american-health-care-act/
This one looks DOA, folks. The votes aren't there in the Senate. Let's consider this a conservative wish-list bill, kind of an anchoring point for worst-case scenarios, and wait and see what they come up with that actually has the votes to pass.
Post by: MasterStache on March 17, 2017, 05:32:48 AM
https://thinkprogress.org/trump-health-care-admission-dd759907622f#.qqlhv8dje (https://thinkprogress.org/trump-health-care-admission-dd759907622f#.qqlhv8dje)
Post by: jim555 on March 17, 2017, 06:47:27 AM
Post by: Axecleaver on March 17, 2017, 07:34:04 AM
Post by: DavidAnnArbor on March 17, 2017, 06:08:38 PM
Tonight I will toast to the continued incompetence of this administration.
Malevolence tempered by incompetence
Post by: Metric Mouse on March 20, 2017, 07:07:53 AM
Yes, that would be the point of the headline. The ACA would increase the deficit by 336 billion, when compared to the ACHA.Reports out today from the Congressional Budget Office that TrumpCare will reduce the budget deficit by $336 billion by 2026* however it will result in an 24 million Americans no longer having health insurance.
*Not sure if that is a per annum figure, or in total over the next 10 years. Makes a difference I guess :)
I suppose out of the headline figures both sides will have more ammunition to fire at each other.
Source? Looks like the headline should read "ACA increases budget deficit by $336 billion by 2026 more than ACHA."
No, RyanCare does not increase the budget deficit. It reduces the deficit because it kills Medicaid for new enrollees after 2020 and reduces the Obamacare subsidies, which more than offsets the reduction in taxes that it contains.
Post by: sol on March 20, 2017, 08:51:21 AM
Yes, that would be the point of the headline. The ACA would increase the deficit by 336 billion, when compared to the ACHA.Reports out today from the Congressional Budget Office that TrumpCare will reduce the budget deficit by $336 billion by 2026* however it will result in an 24 million Americans no longer having health insurance.
*Not sure if that is a per annum figure, or in total over the next 10 years. Makes a difference I guess :)
I suppose out of the headline figures both sides will have more ammunition to fire at each other.
Source? Looks like the headline should read "ACA increases budget deficit by $336 billion by 2026 more than ACHA."
No, RyanCare does not increase the budget deficit. It reduces the deficit because it kills Medicaid for new enrollees after 2020 and reduces the Obamacare subsidies, which more than offsets the reduction in taxes that it contains.
Except that headline would be a lie. All of obamacare's spending was paid for with reductions to other programs or with new taxes, so it was deliberately (and somewhat uncharacteristically for DC) budget neutral. It did not increase the deficit.
Not that facts matter to you.
Post by: Metric Mouse on March 21, 2017, 05:08:31 AM
Why are you flipping the baseline in that confusing and awkward way? Like it or not, the ACA was passed several years ago and is now the baseline. It's much more clear to say that the AHCA reduces the deficit by $336 Billion (primarily by gutting Medicare for poor people).Flipping the baseline, as you put it, can be a great way to gain perspective. I'm sorry you find it confusing. On another note, the current budget deficit is $352billion dollars.
Post by: MasterStache on March 21, 2017, 05:28:46 AM
Why are you flipping the baseline in that confusing and awkward way? Like it or not, the ACA was passed several years ago and is now the baseline. It's much more clear to say that the AHCA reduces the deficit by $336 Billion (primarily by gutting Medicare for poor people).Flipping the baseline, as you put it, can be a great way to gain perspective. I'm sorry you find it confusing. On another note, the current budget deficit is $352billion dollars.
I prefer to gain perspective from the content of the article, not the headline. The original headline was appropriate for the article. No need to add confusion. Unless you have some sort of underlying agenda of course.
Post by: Metric Mouse on March 21, 2017, 06:35:25 AM
It was not my intent to confuse. I am sorry you find such things confusing.Why are you flipping the baseline in that confusing and awkward way? Like it or not, the ACA was passed several years ago and is now the baseline. It's much more clear to say that the AHCA reduces the deficit by $336 Billion (primarily by gutting Medicare for poor people).Flipping the baseline, as you put it, can be a great way to gain perspective. I'm sorry you find it confusing. On another note, the current budget deficit is $352billion dollars.
I prefer to gain perspective from the content of the article, not the headline. The original headline was appropriate for the article. No need to add confusion. Unless you have some sort of underlying agenda of course.
Post by: DavidAnnArbor on March 21, 2017, 08:37:10 AM
Why are you flipping the baseline in that confusing and awkward way? Like it or not, the ACA was passed several years ago and is now the baseline. It's much more clear to say that the AHCA reduces the deficit by $336 Billion (primarily by gutting Medicare for poor people).Flipping the baseline, as you put it, can be a great way to gain perspective. I'm sorry you find it confusing. On another note, the current budget deficit is $352billion dollars.
Budget deficits are not the most important metric. The more important one is national debt to GDP ratio. The yearly budget deficit can continue to be around 4 to 5% of the total national debt, and the debt to gdp ratio would not get larger.
But as long as we are talking about deficits, it's unconscionable to grow the deficit by half a trillion dollars or more over the next ten years by growing the military budgets. We should be smarter about the use of military, not bigger.
Post by: Axecleaver on March 21, 2017, 08:42:22 AM
CBO estimate I read, shows AHCA will raise premiums 15-20% ON TOP OF what was already happening from the ACA. That's due to individual mandate repeal. So whatever tax credits you are going to get, will get eaten up by higher premiums. The variance by geography for premiums is so large, I think them giving a quotable estimate of 15-20% is kind of irresponsible. They also noted that their estimates are subject to a wide variance.
Post by: DavidAnnArbor on March 21, 2017, 08:54:43 AM
Right, this is to garner support from the conservative Freedom wing. I don't think it will be enough, we're only getting started on the massive tweaks I referred to last week. The "old people" change starts at age 50. Under that, you're on your own.
CBO estimate I read, shows AHCA will raise premiums 15-20% ON TOP OF what was already happening from the ACA. That's due to individual mandate repeal. So whatever tax credits you are going to get, will get eaten up by higher premiums. The variance by geography for premiums is so large, I think them giving a quotable estimate of 15-20% is kind of irresponsible. They also noted that their estimates are subject to a wide variance.
Age is not a static thing. I'm 37 now but will be 50 someday. And for my early retirement plans, 50-65 are the critical years in order to make it until Medicare starts. Therefore, selfishly I'm hoping that any changes from here forward benefit older people as I can't benefit from changes that benefit young people since I'm in my late 30's. I'm concerned about the rise in premiums for old people due to the 5/1 ratio change. I'm hoping that the bill fails but preparing for the worst.
But wait there's more.
The Republicans will likely try to increase the age at which you can get Medicare to 67.
Good luck with those health care insurance premiums at ages 64 to 66 and a half.
Post by: DavidAnnArbor on March 21, 2017, 09:23:01 AM
Right, this is to garner support from the conservative Freedom wing. I don't think it will be enough, we're only getting started on the massive tweaks I referred to last week. The "old people" change starts at age 50. Under that, you're on your own.
CBO estimate I read, shows AHCA will raise premiums 15-20% ON TOP OF what was already happening from the ACA. That's due to individual mandate repeal. So whatever tax credits you are going to get, will get eaten up by higher premiums. The variance by geography for premiums is so large, I think them giving a quotable estimate of 15-20% is kind of irresponsible. They also noted that their estimates are subject to a wide variance.
Age is not a static thing. I'm 37 now but will be 50 someday. And for my early retirement plans, 50-65 are the critical years in order to make it until Medicare starts. Therefore, selfishly I'm hoping that any changes from here forward benefit older people as I can't benefit from changes that benefit young people since I'm in my late 30's. I'm concerned about the rise in premiums for old people due to the 5/1 ratio change. I'm hoping that the bill fails but preparing for the worst.
But wait there's more.
The Republicans will likely try to increase the age at which you can get Medicare to 67.
Good luck with those health care insurance premiums at ages 64 to 66 and a half.
Source? I know they would love to get rid of all of the government entitlements, but not sure if they want to go against the AARP and it's 38 million members, that have nothing better to do than vote.
https://www.forbes.com/sites/howardgleckman/2016/06/22/what-paul-ryans-latest-health-proposal-would-mean-for-seniors/#34162a378163
Post by: iris lily on March 21, 2017, 04:40:35 PM
Right, this is to garner support from the conservative Freedom wing. I don't think it will be enough, we're only getting started on the massive tweaks I referred to last week. The "old people" change starts at age 50. Under that, you're on your own.
CBO estimate I read, shows AHCA will raise premiums 15-20% ON TOP OF what was already happening from the ACA. That's due to individual mandate repeal. So whatever tax credits you are going to get, will get eaten up by higher premiums. The variance by geography for premiums is so large, I think them giving a quotable estimate of 15-20% is kind of irresponsible. They also noted that their estimates are subject to a wide variance.
Age is not a static thing. I'm 37 now but will be 50 someday. And for my early retirement plans, 50-65 are the critical years in order to make it until Medicare starts. Therefore, selfishly I'm hoping that any changes from here forward benefit older people as I can't benefit from changes that benefit young people since I'm in my late 30's. I'm concerned about the rise in premiums for old people due to the 5/1 ratio change. I'm hoping that the bill fails but preparing for the worst.
But wait there's more.
The Republicans will likely try to increase the age at which you can get Medicare to 67.
Good luck with those health care insurance premiums at ages 64 to 66 and a half.
Source? I know they would love to get rid of all of the government entitlements, but not sure if they want to go against the AARP and it's 38 million members, that have nothing better to do than vote.
Haha to the bolded. True, but now I should probably make noise about the ageist disrespect that shows. Still, haha.
Post by: MasterStache on March 22, 2017, 05:12:47 AM
It was not my intent to confuse. I am sorry you find such things confusing.Why are you flipping the baseline in that confusing and awkward way? Like it or not, the ACA was passed several years ago and is now the baseline. It's much more clear to say that the AHCA reduces the deficit by $336 Billion (primarily by gutting Medicare for poor people).Flipping the baseline, as you put it, can be a great way to gain perspective. I'm sorry you find it confusing. On another note, the current budget deficit is $352billion dollars.
I prefer to gain perspective from the content of the article, not the headline. The original headline was appropriate for the article. No need to add confusion. Unless you have some sort of underlying agenda of course.
I am sorry you didn't understand my post. Seems to be a common theme with you.
Post by: jrhampt on March 22, 2017, 05:52:37 AM
11 million seniors and people with disabilities are covered by both Medicare and Medicaid.
2 out of 3 Medicare beneficiaries in nursing homes have their care covered by Medicaid.
My father in law relies on Medicaid for long term care. This is something that directly impacts the elderly, their families, and people who aspire to become elderly in the future (ALL of us).
Post by: jrhampt on March 22, 2017, 10:13:35 AM
https://www.google.com/amp/m.huffpost.com/us/entry/us_58d01716e4b0be71dcf6d5a7/amp
Hair on fire situation as far as I'm concerned. We'd be better off repealing the ACA with no replacement than padding Trumpcare.
Post by: sol on March 22, 2017, 10:20:18 AM
Supporting facts to above post:
https://www.google.com/amp/m.huffpost.com/us/entry/us_58d01716e4b0be71dcf6d5a7/amp
Hair on fire situation as far as I'm concerned. We'd be better off repealing the ACA with no replacement than padding Trumpcare.
Yesterday the NYTimes said the same thing. The new republican healthcare plan will result in higher costs and fewer people covered than if they just straight up repealed the ACA and we all went back to 2007.
The republican plan is literally worse than nothing at all, like it was deliberately designed to suck as much as possible. This observation lends credence to the theory that republicans want their plan to fail, so they can blame democrats and continue to campaign against the ACA.
Post by: jrhampt on March 22, 2017, 10:27:18 AM
Supporting facts to above post:
https://www.google.com/amp/m.huffpost.com/us/entry/us_58d01716e4b0be71dcf6d5a7/amp
Hair on fire situation as far as I'm concerned. We'd be better off repealing the ACA with no replacement than padding Trumpcare.
Yesterday the NYTimes said the same thing. The new republican healthcare plan will result in higher costs and fewer people covered than if they just straight up repealed the ACA and we all went back to 2007.
The republican plan is literally worse than nothing at all, like it was deliberately designed to suck as much as possible. This observation lends credence to the theory that republicans want their plan to fail, so they can blame democrats and continue to campaign against the ACA.
Yes! The House votes on this Thursday. Call your representative! Even my staunchly Republican Mom opposes this bill.
Post by: Axecleaver on March 22, 2017, 04:47:16 PM
New York treats Medicaid like a jobs program. They're not about to reduce it... if you want gold plated Medicaid benefits, move here!
Details here: http://blog.timesunion.com/capitol/archives/273264/so-what-is-the-faso-collins-amendment-to-the-ahca/
Post by: jim555 on March 22, 2017, 04:52:14 PM
Post by: jrhampt on March 23, 2017, 02:31:40 PM
Post by: sol on March 23, 2017, 02:54:45 PM
House vote delayed.
They don't have the votes to pass it, so holding the vote now would mean shooting it down.
Still no CBO score on the new version, but the last one said we would end up with even fewer people with coverage than we had before the ACA. Think about that, the republican plan is to not only undo all of the gains from Obamacare, but to actually make things worse than they were before Obamacare. It's literally worse than a straight up full repeal of the ACA would be.
So I'm not surprised they are getting pushback from within their own party, some of those folks are smart enough to read the writing on the wall. This plan does not make America great again, it makes it worse than it was before and they already know what a powerful campaign issue healthcare can become.
But they still might get something through, to save face. They have to pass some token version of the bill, or else it looks like the party is completely incapable of governing. After so many years of obstructionism, I'm not sure they even know how to do anything else except grind the gears of government.
Post by: Telecaster on March 23, 2017, 03:55:18 PM
If you don't want to repeal it, then simply say so.
Post by: Axecleaver on March 24, 2017, 09:23:37 AM
"... If the bill were to pass both houses of Congress, Gov. Andrew Cuomo said he'd sue the federal government if the amendment proposed by Reps. Chris Collins and John Faso shift the cost of Medicaid from the counties to the state is approved. Cuomo, in a conference call with reporters, argued that the amendment could be unconstitutional because it violates state sovereignty." (from Politico's local daily mailer on NY Healthcare Reform).
NY Times has a good scoreboard on who's in and who's out here: https://www.nytimes.com/interactive/2017/03/22/upshot/health-care-vote-whip-count-comparison.html?mtrref=t.co&mtrref=undefined&gwh=5BA7080C8D8C12C9642255E011816163&gwt=pay
CBO scored the AHCA revisions. They've covered zero additional lives (so, for those keeping score, 24m will lose coverage), and now saves just $150b over 10 years. That means the latest changes did no good at all, and cost $187b.
I stand by my prior comment: this has no chance to pass in its current form. On the plus side, the Republican plan is so weak, we may keep Obamacare. People seem to like it a lot more today than they did last November.
Post by: Kris on March 24, 2017, 09:40:10 AM
Re: states rights. Looks like our governor is taking a page from the Southern playbook:
"... If the bill were to pass both houses of Congress, Gov. Andrew Cuomo said he'd sue the federal government if the amendment proposed by Reps. Chris Collins and John Faso shift the cost of Medicaid from the counties to the state is approved. Cuomo, in a conference call with reporters, argued that the amendment could be unconstitutional because it violates state sovereignty." (from Politico's local daily mailer on NY Healthcare Reform).
NY Times has a good scoreboard on who's in and who's out here: https://www.nytimes.com/interactive/2017/03/22/upshot/health-care-vote-whip-count-comparison.html?mtrref=t.co&mtrref=undefined&gwh=5BA7080C8D8C12C9642255E011816163&gwt=pay
CBO scored the AHCA revisions. They've covered zero additional lives (so, for those keeping score, 24m will lose coverage), and now saves just $150b over 10 years. That means the latest changes did no good at all, and cost $187b.
I stand by my prior comment: this has no chance to pass in its current form. On the plus side, the Republican plan is so weak, we may keep Obamacare. People seem to like it a lot more today than they did last November.
Strangely enough, Trump might help with keeping the ACA, since he's trying to bully and threaten the GOP into passing the AHCA, giving them the ultimatum that if they don't pass it, Obamacare stays.
(And I think he's just vindictive enough that he'd veto any future version of the AHCA Congress came up with just to spite them for not bowing down to him.)
Post by: dividendman on March 24, 2017, 02:19:32 PM
Post by: brooklynguy on March 24, 2017, 02:27:20 PM
Strangely enough, Trump might help with keeping the ACA, since he's trying to bully and threaten the GOP into passing the AHCA, giving them the ultimatum that if they don't pass it, Obamacare stays.
(And I think he's just vindictive enough that he'd veto any future version of the AHCA Congress came up with just to spite them for not bowing down to him.)
According to the NY Times (https://www.nytimes.com/2017/03/24/us/politics/health-care-affordable-care-act.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=span-ab-top-region®ion=top-news&WT.nav=top-news&_r=0):
Quote from: NY Times
Mr. Trump, in a telephone interview moments after the bill was pulled, blamed Democrats and predicted that they would seek a deal within a year after, he asserted, “Obamacare explodes” because of higher premiums.
In addition, as I type, Paul Ryan is giving a press conference that appears to be focused on how Obamacare remains the law of the land but is only going to get worse and worse.
So it seems the GOP's next step might be to revert to the tactic of trying to sabotage the ACA (refusing to enforce the individual mandate, proclaiming that we are in a death spiral in the hopes of creating a self-fulfilling prophecy, etc.) and then pinning the blame on the Democrats.
Post by: dividendman on March 24, 2017, 02:39:50 PM
Strangely enough, Trump might help with keeping the ACA, since he's trying to bully and threaten the GOP into passing the AHCA, giving them the ultimatum that if they don't pass it, Obamacare stays.
(And I think he's just vindictive enough that he'd veto any future version of the AHCA Congress came up with just to spite them for not bowing down to him.)
According to the NY Times (https://www.nytimes.com/2017/03/24/us/politics/health-care-affordable-care-act.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=span-ab-top-region®ion=top-news&WT.nav=top-news&_r=0):Quote from: NY TimesMr. Trump, in a telephone interview moments after the bill was pulled, blamed Democrats and predicted that they would seek a deal within a year after, he asserted, “Obamacare explodes” because of higher premiums.
In addition, as I type, Paul Ryan is giving a press conference that appears to be focused on how Obamacare remains the law of the land but is only going to get worse and worse.
So it seems the GOP's next step might be to revert to the tactic of trying to sabotage the ACA (refusing to enforce the individual mandate, proclaiming that we are in a death spiral in the hopes of creating a self-fulfilling prophecy, etc.) and then pinning the blame on the Democrats.
Pin schmin. The GOP is in charge of everything. Everything is their fault. That's what the dems should be saying.
Also, all of the law remains in place. So... while they can try to sabotage it, folks will still get subsidies, minimum coverage benefits, Medicaid expansion etc. It will be especially good for the states that work with the ACA (most blue states).
Post by: sol on March 24, 2017, 02:59:55 PM
So it seems the GOP's next step might be to revert to the tactic of trying to sabotage the ACA (refusing to enforce the individual mandate, proclaiming that we are in a death spiral in the hopes of creating a self-fulfilling prophecy, etc.) and then pinning the blame on the Democrats.
See, this is perfect for them. Their constituents get to keep their subsidized healthcare, and they get to continue to campaign against Obamacare as a wedge issue. Everyone wins when the republicans don't get what they want!
It didn't have to be this way. Trump could have abandoned the freedom caucus and tried to triangulate with conservative democrats to fulfill his campaign promises of better cheaper coverage for everyone. Cut the extreme fringe of your own party out of the equation by cooperating with the opposition where you can find common ground, that also happens to be widely popular with the public. Bill Clinton did exactly this trick, from the other side.
But instead of actually becoming the populist he pretended to be during the campaign, trump is such a political noob that he got schooled by his crazy/crafty advisors. Priebus and Ryan and Bannon et al. took him on a ride down to DC 101, and I think he's just now realizing exactly how far in over his head he really is. These guys play rough! They appear to have their own agendas and are not purely loyal to me! I feel so used!
Here's a tip, POTUS. If you're not controlling the people in your administration, then they are controlling you. Maybe try to figure out why.
Post by: wenchsenior on March 24, 2017, 03:18:03 PM
So it seems the GOP's next step might be to revert to the tactic of trying to sabotage the ACA (refusing to enforce the individual mandate, proclaiming that we are in a death spiral in the hopes of creating a self-fulfilling prophecy, etc.) and then pinning the blame on the Democrats.
See, this is perfect for them. Their constituents get to keep their subsidized healthcare, and they get to continue to campaign against Obamacare as a wedge issue. Everyone wins when the republicans don't get what they want!
It didn't have to be this way. Trump could have abandoned the freedom caucus and tried to triangulate with conservative democrats to fulfill his campaign promises of better cheaper coverage for everyone. Cut the extreme fringe of your own party out of the equation by cooperating with the opposition where you can find common ground, that also happens to be widely popular with the public. Bill Clinton did exactly this trick, from the other side.
But instead of actually becoming the populist he pretended to be during the campaign, trump is such a political noob that he got schooled by his crazy/crafty advisors. Priebus and Ryan and Bannon et al. took him on a ride down to DC 101, and I think he's just now realizing exactly how far in over his head he really is. These guys play rough! They appear to have their own agendas and are not purely loyal to me! I feel so used!
Here's a tip, POTUS. If you're not controlling the people in your administration, then they are controlling you. Maybe try to figure out why.
I feel like this is giving Ryan too much credit. He also appears to be an incredibly incompetent schmuck heading up Amateur Hour. However, it's possible that he was trying to present the most un-passable bill possible the entire time.
Post by: sol on March 24, 2017, 03:45:45 PM
I think the problem for republicans was in asking conservatives to vote FOR something, like subsidies they don't like, as part of a larger package deal. If they had instead had just floated a bill to repeal all of the taxes on rich people, and do nothing else, I think every single republican would have voted for that. They love to vote against taxes, and they could then blame the democrats for not being able to do more unless the country elects them a GOP supermajority.
They could have claimed victory for overturning part of the ACA, left good health insurance in place for their constituents, preserved their favorite campaign issue for the base, presented a unified win for the cheetoh monster, and appeased their ultra wealthy party backers with billions of $. While simultaneously undermining the ACAs future by turning it into s budget buster.
That's only one of about five different paths I can see that they could have taken, that would have been better for them. I'm still not sure if their avoidance of these better outcomes was deliberate or due to incompetence.
Post by: Paul der Krake on March 24, 2017, 03:54:58 PM
Post by: Tyson on March 24, 2017, 04:49:26 PM
Post by: MonkeyJenga on March 24, 2017, 06:46:56 PM
Strangely enough, Trump might help with keeping the ACA, since he's trying to bully and threaten the GOP into passing the AHCA, giving them the ultimatum that if they don't pass it, Obamacare stays.
(And I think he's just vindictive enough that he'd veto any future version of the AHCA Congress came up with just to spite them for not bowing down to him.)
According to the NY Times (https://www.nytimes.com/2017/03/24/us/politics/health-care-affordable-care-act.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=span-ab-top-region®ion=top-news&WT.nav=top-news&_r=0):Quote from: NY TimesMr. Trump, in a telephone interview moments after the bill was pulled, blamed Democrats and predicted that they would seek a deal within a year after, he asserted, “Obamacare explodes” because of higher premiums.
In addition, as I type, Paul Ryan is giving a press conference that appears to be focused on how Obamacare remains the law of the land but is only going to get worse and worse.
So it seems the GOP's next step might be to revert to the tactic of trying to sabotage the ACA (refusing to enforce the individual mandate, proclaiming that we are in a death spiral in the hopes of creating a self-fulfilling prophecy, etc.) and then pinning the blame on the Democrats.
Pin schmin. The GOP is in charge of everything. Everything is their fault. That's what the dems should be saying.
Yep. Obamacare, at this point, IS Trumpcare. If the Republicans can't repeal, and the Republicans can't replace, then the Republicans endorse the ACA. If they fuck with it, it is on them. If they can't fix it, it is on them.
Obama ain't the president anymore. And people want their goddamn healthcare.
Post by: DavidAnnArbor on March 27, 2017, 08:24:46 PM
Post by: hoping2retire35 on March 28, 2017, 07:05:45 AM
Strangely enough, Trump might help with keeping the ACA, since he's trying to bully and threaten the GOP into passing the AHCA, giving them the ultimatum that if they don't pass it, Obamacare stays.
(And I think he's just vindictive enough that he'd veto any future version of the AHCA Congress came up with just to spite them for not bowing down to him.)
According to the NY Times (https://www.nytimes.com/2017/03/24/us/politics/health-care-affordable-care-act.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=span-ab-top-region®ion=top-news&WT.nav=top-news&_r=0):Quote from: NY TimesMr. Trump, in a telephone interview moments after the bill was pulled, blamed Democrats and predicted that they would seek a deal within a year after, he asserted, “Obamacare explodes” because of higher premiums.
In addition, as I type, Paul Ryan is giving a press conference that appears to be focused on how Obamacare remains the law of the land but is only going to get worse and worse.
So it seems the GOP's next step might be to revert to the tactic of trying to sabotage the ACA (refusing to enforce the individual mandate, proclaiming that we are in a death spiral in the hopes of creating a self-fulfilling prophecy, etc.) and then pinning the blame on the Democrats.
Pin schmin. The GOP is in charge of everything. Everything is their fault. That's what the dems should be saying.
Yep. Obamacare, at this point, IS Trumpcare. If the Republicans can't repeal, and the Republicans can't replace, then the Republicans endorse the ACA. If they fuck with it, it is on them. If they can't fix it, it is on them.
Obama ain't the president anymore. And people want their goddamn healthcare.
I am curious how the blame will fall. I doubt they quite 'own' it just yet but they can't really say its great, evil democrats doing this now. Maybe it will be seen more abstract in another year as more problems arise from it as something to be fixed, or Trump and Ryan will work with some purple dems. We shall see.
Post by: Poundwise on April 20, 2017, 10:23:01 AM
https://www.washingtonpost.com/blogs/plum-line/wp/2017/04/20/the-gop-has-a-new-plan-to-destroy-obamacare-its-even-crueler-than-the-last-one
Post by: bacchi on April 20, 2017, 11:12:22 AM
But the weakening of preexisting conditions makes it over the top expensive if you have a condition.
The "Fuck you if you're sick" plan is back? Great. The high risk pools worked so well the first time.
Post by: JustGettingStarted1980 on April 20, 2017, 11:23:30 AM
Post by: Axecleaver on April 20, 2017, 07:20:07 PM
Post by: MrMonkeyMoustache on April 20, 2017, 07:35:39 PM
Post by: DavidAnnArbor on April 20, 2017, 07:56:20 PM
https://www.nytimes.com/2017/04/20/upshot/new-republican-health-proposal-evokes-the-old-days.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region®ion=top-news&WT.nav=top-news
Post by: MrMonkeyMoustache on April 20, 2017, 08:00:25 PM
Here's a NY Times overview of it.
https://www.nytimes.com/2017/04/20/upshot/new-republican-health-proposal-evokes-the-old-days.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region®ion=top-news&WT.nav=top-news
Stopped after the first paragraph. Why would I've imply fat people SHOULDN'T pay more? We're higher risks.
Post by: Axecleaver on April 21, 2017, 05:46:11 AM
Post by: MasterStache on April 21, 2017, 06:26:25 AM
African-Americans and Hispanics are at higher risk of obesity and high blood pressure. Shall we institute a black tax, too?
Heck why stop there? Let's examine folks suns exposure so we can determine who's at higher risk for skin cancer. Promiscuous people should be pay more than virgins as they are at higher risk for STDs.
Post by: JustGettingStarted1980 on April 21, 2017, 06:28:59 AM
Let patients and their families ration their own care, being as they are going to pay for it.
I'd only tax it at about 10-20%. So if 200K is spent on Mr. Magoo, who at 98 has been hospitalized 80 times for heart failure, is admitted again for heart failure, and decides to have "Full Code" provisions leading to 10 days in the ICU while on the Ventilator, then the estate would pay back medicare 20K.
Post by: GilbertB on April 21, 2017, 06:44:03 AM
And what about people with guns?African-Americans and Hispanics are at higher risk of obesity and high blood pressure. Shall we institute a black tax, too?
Heck why stop there? Let's examine folks suns exposure so we can determine who's at higher risk for skin cancer. Promiscuous people should be pay more than virgins as they are at higher risk for STDs.
They have a higher chance of shooting themselves than the rest.
There should be a database of who and what they have.
For example someone with a Mosin-Nagant 91/30 tuned to 1" groups at 100yards should pay less than Garth with Glock that has a sticky magazine due to an ice-cream incident who would probably shoot the doorman of the range while aiming at a barn door at arms length.
And felons no premium, besause they don't have guns, obviously.
;)
Post by: MasterStache on April 21, 2017, 06:50:09 AM
Post by: MrMonkeyMoustache on April 21, 2017, 06:53:32 AM
African-Americans and Hispanics are at higher risk of obesity and high blood pressure. Shall we institute a black tax, too?Absolutely ridiculous comparison. Fat people ARE fat. They aren't just risks of being fat, they already are.
Why should insurance companies not be able to charge more for that? They're higher risks.
Let me ask you this. If you own a car insurance company, would you charge someone with a squeaky clean record for 30 years the same as someone that has been in 7 accidents in the last 2 years? Of course not.
I guess that makes me an evil capitalist scum, or whatever you guys call us nowadays.
Post by: MasterStache on April 21, 2017, 07:01:58 AM
African-Americans and Hispanics are at higher risk of obesity and high blood pressure. Shall we institute a black tax, too?Absolutely ridiculous comparison. Fat people ARE fat. They aren't just risks of being fat, they already are.
Why should insurance companies not be able to charge more for that? They're higher risks.
Let me ask you this. If you own a car insurance company, would you charge someone with a squeaky clean record for 30 years the same as someone that has been in 7 accidents in the last 2 years? Of course not.
I guess that makes me an evil capitalist scum, or whatever you guys call us nowadays.
So a fair comparison to someone who is "fat" is someone getting into car accidents? So which car is equivalent to an underactive thyroid? How about a pregnant woman? Would a woman expecting triplets pay 3 times as much since she is 3 times as "fat?"
Post by: MrMonkeyMoustache on April 21, 2017, 07:07:14 AM
It's a fair comparison because they're both more risky insurance holders, thus they should be charged more. Don't see how you don't get that. An underachieve thyroid, first off, is almost never the case when it comes to someone being fat. Even if it is a thyroid issue, it still doesn't change the fact that it's calories in vs. calories out. But, if we really wanted to stretch the comparison out, I guess the best comparison would be a legally blind driver. Sure, if they just started driving, they haven't gotten into an accident yet, but if you're a car insurance company, would you honestly not charge them more, because there's a much higher chance you'll have to pay for it?African-Americans and Hispanics are at higher risk of obesity and high blood pressure. Shall we institute a black tax, too?Absolutely ridiculous comparison. Fat people ARE fat. They aren't just risks of being fat, they already are.
Why should insurance companies not be able to charge more for that? They're higher risks.
Let me ask you this. If you own a car insurance company, would you charge someone with a squeaky clean record for 30 years the same as someone that has been in 7 accidents in the last 2 years? Of course not.
I guess that makes me an evil capitalist scum, or whatever you guys call us nowadays.
So a fair comparison to someone who is "fat" is someone getting into car accidents? So which car is equivalent to an underactive thyroid? How about a pregnant woman? Would a woman expecting triplets pay 3 times as much since she is 3 times as "fat?"
The pregnancy comment is just stupid. Pregnancy =/= obesity.
Post by: MasterStache on April 21, 2017, 07:32:27 AM
The pregnancy comment is just stupid. Pregnancy =/= obesity.African-Americans and Hispanics are at higher risk of obesity and high blood pressure. Shall we institute a black tax, too?Absolutely ridiculous comparison. Fat people ARE fat. They aren't just risks of being fat, they already are.
Why should insurance companies not be able to charge more for that? They're higher risks.
Let me ask you this. If you own a car insurance company, would you charge someone with a squeaky clean record for 30 years the same as someone that has been in 7 accidents in the last 2 years? Of course not.
I guess that makes me an evil capitalist scum, or whatever you guys call us nowadays.
So a fair comparison to someone who is "fat" is someone getting into car accidents? So which car is equivalent to an underactive thyroid? How about a pregnant woman? Would a woman expecting triplets pay 3 times as much since she is 3 times as "fat?"
Actually a pregnant woman gains a considerable amount of fat during pregnancy as her body changes and prepares for the baby. So yes, they could absolutely be considered overweight and/or obese by conventional standards. And after pregnancy, since the body has adapted to natural changes, the ability to lose the weight becomes much more difficult.
Not really the same as driving a car. Not even in the same universe comparison wise.
Post by: MrMonkeyMoustache on April 21, 2017, 07:37:35 AM
Pregnancy is a temporary condition that should already be accounted for in insurance costs anyways. It's not due to bad eating habits or an unhealthy lifestyle. Huge difference.
Actually a pregnant woman gains a considerable amount of fat during pregnancy as her body changes and prepares for the baby. So yes, they could absolutely be considered overweight and/or obese by conventional standards.
Quote
And after pregnancy, since the body has adapted to natural changes, the ability to lose the weight becomes much more difficult.But still calories in vs. calories out.
Quote
Not really the same as driving a car. Not even in the same universe comparison wise.The original comparison is valid. A bad driver is more risk. A fat person is more risk. Both should be charged more.
If you're a health insurance company, and you have two people, one that rarely ever has medical issues, and another who is in the hospital multiple times per month, would you charge them the same? If you say yes, then that's great for you, but that's not how business works.
Post by: MasterStache on April 21, 2017, 07:45:04 AM
If you're a health insurance company, and you have two people, one that rarely ever has medical issues, and another who is in the hospital multiple times per month, would you charge them the same?
Absolutely. Healthcare is a right, not a privilege for those with better genes.
Post by: DavidAnnArbor on April 21, 2017, 07:52:39 AM
Changing behavior of people is definitely a good goal, but insurance shouldn't be used as a cudgel against people you are morally opposed to.
Post by: MrMonkeyMoustache on April 21, 2017, 07:53:47 AM
Obesity is almost never a gene issue, and even when it is, you still have control of just how obese you become.If you're a health insurance company, and you have two people, one that rarely ever has medical issues, and another who is in the hospital multiple times per month, would you charge them the same?
Absolutely. Healthcare is a right, not a privilege for those with better genes.
With that being said, since we disagree that healthcare is a right, I don't think we'll agree on anything that builds upon that idea. Why is it that you believe healthcare is a right?
Post by: MasterStache on April 21, 2017, 07:59:04 AM
Obesity is almost never a gene issue, and even when it is, you still have control of just how obese you become.If you're a health insurance company, and you have two people, one that rarely ever has medical issues, and another who is in the hospital multiple times per month, would you charge them the same?
Absolutely. Healthcare is a right, not a privilege for those with better genes.
With that being said, since we disagree that healthcare is a right, I don't think we'll agree on anything that builds upon that idea. Why is it that you believe healthcare is a right?
Better question. Why do you believe only certain people should be provided healthcare?
Post by: MrMonkeyMoustache on April 21, 2017, 08:02:12 AM
No, that's not a better question. It's a strawman. I never said that.Obesity is almost never a gene issue, and even when it is, you still have control of just how obese you become.If you're a health insurance company, and you have two people, one that rarely ever has medical issues, and another who is in the hospital multiple times per month, would you charge them the same?
Absolutely. Healthcare is a right, not a privilege for those with better genes.
With that being said, since we disagree that healthcare is a right, I don't think we'll agree on anything that builds upon that idea. Why is it that you believe healthcare is a right?
Better question. Why do you believe only certain people should be provided healthcare?
Post by: Jrr85 on April 21, 2017, 08:24:32 AM
The point of insurance is to spread the risk around a large pool of people
Changing behavior of people is definitely a good goal, but insurance shouldn't be used as a cudgel against people you are morally opposed to.
In order to have insurance that spreads the risk around a large pool of people, you have to have different rates for people with different risks, or you have to have a pool of people with similar risks. Insurance is just a financial instrument.
And it's a poor mechanism for pursuing redistribution.
Post by: Gin1984 on April 21, 2017, 08:46:40 AM
I've only ever been on employer insurance so that has not been true IME.The point of insurance is to spread the risk around a large pool of people
Changing behavior of people is definitely a good goal, but insurance shouldn't be used as a cudgel against people you are morally opposed to.
In order to have insurance that spreads the risk around a large pool of people, you have to have different rates for people with different risks, or you have to have a pool of people with similar risks. Insurance is just a financial instrument.
And it's a poor mechanism for pursuing redistribution.
Sent from my SPH-L710 using Tapatalk
Post by: Poundwise on April 21, 2017, 09:04:13 AM
So I'm willing to pay a little extra so that fat guy over there can get his bariatric surgery, so he can have the energy to do his job a little better. Or to improve the status of any seriously ill person so ease the burden on their caregivers.
Post by: MrMonkeyMoustache on April 21, 2017, 09:06:44 AM
My take on this all is that everyone benefits if the people around them are healthier. You don't have to pick up the slack for co-workers taking sick days or personal days to care for sick relatives, the people around you are less stressed and more pleasant, you name it. It's a good thing.And that's fine. But what if I'm not willing to pay a bit extra? Why should I be forced to? It's not my fault that people overeat.
So I'm willing to pay a little extra so that fat guy over there can get his bariatric surgery, so he can have the energy to do his job a little better. Or to improve the status of any seriously ill person so ease the burden on their caregivers.
Post by: Paul der Krake on April 21, 2017, 09:14:03 AM
We've been over this before. We all hate fat lazy people who get multiple surgeries. But since deciding who deserves to live is a slippery slope, we've kind of decided as a society to let it slide.My take on this all is that everyone benefits if the people around them are healthier. You don't have to pick up the slack for co-workers taking sick days or personal days to care for sick relatives, the people around you are less stressed and more pleasant, you name it. It's a good thing.And that's fine. But what if I'm not willing to pay a bit extra? Why should I be forced to? It's not my fault that people overeat.
So I'm willing to pay a little extra so that fat guy over there can get his bariatric surgery, so he can have the energy to do his job a little better. Or to improve the status of any seriously ill person so ease the burden on their caregivers.
Post by: Tyson on April 21, 2017, 09:16:03 AM
My take on this all is that everyone benefits if the people around them are healthier. You don't have to pick up the slack for co-workers taking sick days or personal days to care for sick relatives, the people around you are less stressed and more pleasant, you name it. It's a good thing.And that's fine. But what if I'm not willing to pay a bit extra? Why should I be forced to? It's not my fault that people overeat.
So I'm willing to pay a little extra so that fat guy over there can get his bariatric surgery, so he can have the energy to do his job a little better. Or to improve the status of any seriously ill person so ease the burden on their caregivers.
Uhm yeah. If the law says that we all pay in so that we all get covered, then yeah you pay extra. You can whine about it and throw a tantrum if you want, but you will pay.
Post by: MasterStache on April 21, 2017, 09:19:02 AM
No, that's not a better question. It's a strawman. I never said that.Obesity is almost never a gene issue, and even when it is, you still have control of just how obese you become.If you're a health insurance company, and you have two people, one that rarely ever has medical issues, and another who is in the hospital multiple times per month, would you charge them the same?
Absolutely. Healthcare is a right, not a privilege for those with better genes.
With that being said, since we disagree that healthcare is a right, I don't think we'll agree on anything that builds upon that idea. Why is it that you believe healthcare is a right?
Better question. Why do you believe only certain people should be provided healthcare?
Car insurance companies can drop people for deeming them too high risk. Remember the analogy you said was valid? Is it now no longer valid because it doesn't fit your agenda?
Outside of using your analogy against you, poor people who are discriminated against because of their perceived eating habits and required to pay more in healthcare premiums, will absolutely not be able to afford healthcare. And where do you draw the line and how do you test to determine it's precisely form poor eating habits? Do you follow them into McDonalds? What if they just gave birth and have a considerable amount of weight to lose? How much time do you give them to lose the weight? What if their child develops cancer and they have to spend their free time attending cancer treatments and therefore don't have the time to focus on diet and exercise?
And where do you in fact draw the line? My friend has a genetic pre-disposition to ALS since his mom died form it recently. Should he be charged more?
How about those serving in the military? They are certainly more likely to be injured or die, especially in combat. What about those who drive more? Sit behind a desk more often for their job? All folks making choices that increase certain health risk.
Who knew healthcare was so complex?
Post by: Malloy on April 21, 2017, 09:43:09 AM
African-Americans and Hispanics are at higher risk of obesity and high blood pressure. Shall we institute a black tax, too?Absolutely ridiculous comparison. Fat people ARE fat. They aren't just risks of being fat, they already are.
Why should insurance companies not be able to charge more for that? They're higher risks.
Let me ask you this. If you own a car insurance company, would you charge someone with a squeaky clean record for 30 years the same as someone that has been in 7 accidents in the last 2 years? Of course not.
I guess that makes me an evil capitalist scum, or whatever you guys call us nowadays.
If the bill as drafted read "community rating doesn't apply for fat people (seriously, put down the cheetos, fatties)" then this analysis would be relevant. However, the repeal of community rating and the return of charging based on pre-existing conditions doesn't just apply to fat people who you personally think deserve it. It catches 4 year old with leukemia, premature babies, people with MS, people with breast cancer, people with anemia, people who almost died giving birth, people with sports injuries, and a whole list of other medical problems that can't easily be blamed on the sufferers. The only relevant discussion applies to the bills under consideration, and the AHCA in various versions doesn't have special provisions for making fat people suffer while innocent children with pre-existing conditions are spared. So, we can argue until we are blue in the face about whether fat people deserve it, but the discussion we should be having is whether we should vote for people who think that people with pre-existing conditions of any kind should be charged more/denied insurance.
Post by: NoStacheOhio on April 21, 2017, 03:05:42 PM
If you're a health insurance company, and you have two people, one that rarely ever has medical issues, and another who is in the hospital multiple times per month, would you charge them the same? If you say yes, then that's great for you, but that's not how business works.
Gee, it's almost as if the profit motive confounds the general welfare when it comes to healthcare payment and delivery. WHO KNEW!?
Post by: Poundwise on April 21, 2017, 04:07:45 PM
Quote
Let me ask you this. If you own a car insurance company, would you charge someone with a squeaky clean record for 30 years the same as someone that has been in 7 accidents in the last 2 years? Of course not.
You are correct. But you are forgetting the difference between car insurance/health insurance companies and the government. Insurance companies are supposed to turn a profit. The government is supposed to serve the people, and make our lives better.
Post by: DavidAnnArbor on April 21, 2017, 08:05:44 PM
QuoteLet me ask you this. If you own a car insurance company, would you charge someone with a squeaky clean record for 30 years the same as someone that has been in 7 accidents in the last 2 years? Of course not.
You are correct. But you are forgetting the difference between car insurance/health insurance companies and the government. Insurance companies are supposed to turn a profit. The government is supposed to serve the people, and make our lives better.
For a follower of Ayn Rand, government making people's lives better goes against the individual's will as the primary agent of freedom.
Post by: SpeedReader on April 25, 2017, 07:47:18 PM
[/quote]
So I am curious; how do followers of Ayn Rand deal with things like funding for medical research to cure diseases they don't have yet?
Post by: DavidAnnArbor on April 26, 2017, 07:13:01 AM
For a follower of Ayn Rand, government making people's lives better goes against the individual's will as the primary agent of freedom.
So I am curious; how do followers of Ayn Rand deal with things like funding for medical research to cure diseases they don't have yet?
[/quote]
That's a perfect example of why I wouldn't want to live in an Ayn Rand world, and taking the logic further, why we need taxes, and that government plays a role to improve our lives.
Post by: Tyson on April 26, 2017, 11:06:20 AM
Post by: Malloy on April 26, 2017, 11:45:15 AM
I believe the Randites don't really think about or value the concept of "the common good". If you think there's no such thing as the common good, then the rest of their position is consistent with that.
I guess they think that someone will develop an affordable app to cure cancer if they ever get it and that all that NIH-funded research is just parasitical communism. No, wait, they think that their lifehacker Crossfit and vitamin routine will make them immune to cancer. And that anyone who gets cancer somehow deserved it and could have avoided it through better life choices. And they will never be convinced otherwise until someone they know and love gets cancer and then, and only then, will they come around. Of course, that will be years after they voted for politicians who systematically destroyed every institution and research facility that could have helped them. But they will take no responsibility for such actions, instead blaming Democrats, saying they were forced to vote for politicians who wanted to defund the National Cancer Institute, because HER EMAILS and BENGHAZI and PIZZA.
This is why we can't have nice things.
Post by: JustGettingStarted1980 on April 26, 2017, 12:42:42 PM
The truth is that the best way to do things are often more middle of the road. For example, lets build some factories, but with sufficient regulation (i.e. to avoid poisoning our rivers, lakes and oceans). Lets promote free market enterprise via a national banking system (but with the FED ensuring proper access to money without overflooding the market and getting rampant inflation). Lets encourage large comporations to dominate in the national and international stage (but with the SEC around to dissuade corrupt actions and cheating within the system).
I also note that in her writing, some of the worst actors were the lying, thieving, manipulating, "taker" politician class. What category do you think she'd put "I'm smart cause I don't pay taxes" Trump?
JGS
Post by: SpeedReader on April 26, 2017, 08:15:16 PM
I have to quibble with JustGettingStarted about the quality of Rand's writing; the zillion-page rant at the end of Atlas Shrugged was enough to make me want to slit my wrists. :-)
Post by: JustGettingStarted1980 on April 27, 2017, 05:20:15 AM
Post by: mtnrider on April 27, 2017, 08:02:32 AM
I like Ayn Rand's writing, she is an excellent writer, especially considering she wrote in English as a second language. Ultimately, she was so very pro laissex fair Free Market Capitalism because her formative years were in the corrupt as hell Communist Soviet Union. --->She basically just went ALL THE WAY to the other side. She saw one extreme and opted for the opposite extreme in her "Objectivism."
The truth is that the best way to do things are often more middle of the road.
Fair point about writing in English as a second language - it couldn't have been easy. But I totally disagree that she's an excellent writer. She's OK, with some interesting points, but not excellent. (And, to use her phrase, I think we can say that objectively. :) )
Picking nits: Someone correct me if I'm wrong, but she didn't really live in a pure communist state. The Soviet Union was more of a totalitarian state - the state owned everything. In a communist state the society owns everything. Maybe your point still stands, that she went to the other extreme - from everything being state owned to everything being individually owned?
Totally agree about the best paths being somewhere in the middle.
Post by: Jrr85 on April 27, 2017, 10:31:40 AM
I like Ayn Rand's writing, she is an excellent writer, especially considering she wrote in English as a second language. Ultimately, she was so very pro laissex fair Free Market Capitalism because her formative years were in the corrupt as hell Communist Soviet Union. --->She basically just went ALL THE WAY to the other side. She saw one extreme and opted for the opposite extreme in her "Objectivism."
The truth is that the best way to do things are often more middle of the road.
Fair point about writing in English as a second language - it couldn't have been easy. But I totally disagree that she's an excellent writer. She's OK, with some interesting points, but not excellent. (And, to use her phrase, I think we can say that objectively. :) )
Picking nits: Someone correct me if I'm wrong, but she didn't really live in a pure communist state. The Soviet Union was more of a totalitarian state - the state owned everything. In a communist state the society owns everything. Maybe your point still stands, that she went to the other extreme - from everything being state owned to everything being individually owned?
Totally agree about the best paths being somewhere in the middle.
She lived in the exact sort of communist state that has resulted everytime it's been tried. Considering how many million die with each attempt, I think we should probably forgo on the "they just didn't do communism the right way arguments."
Post by: JustGettingStarted1980 on April 28, 2017, 10:04:40 AM
Post by: sol on April 28, 2017, 10:29:11 AM
Communism is an economic system, like capitalism, in which ownership is shared for mutual benefit instead of held privately for individual benefit. It is a business model, not a government model.
And America has lots of communist institutions that are popular, effective, and profitable. Think of all the things that the American people own collectively, instead of individually, and try to understand WHY we've chosen to organize them that way. I'll get you started with an easy one: national parks. Totally communist!
So I don't really have any problem with communism the economic model. I have problems with authoritarianism and totalitarianism, which are the types of governments that have typically tried to implement economic communism, and have naturally let graft and corruption distort those noble goals. But I don't think those are the inevitable consequence of collectively shared ownership of a resource, as our national parks highlight. The key to successful institutions is good governance, not privately held ownership stakes. That seems so obvious it almost seems silly to have to write it down.
But I'm sure someone here will disagree with me on that point, and argue that personal profit motive is the secret ingredient to America's success. Those people must also bebetotally totally unconcerned with president Trump's conflicts of interest, because they WANT the president to run the nation for the benefit of his personal privately owned business interests.
Post by: Rimu05 on April 28, 2017, 10:34:20 AM
Why all the hate for communism? Is that just residual aftereffects from cold war propaganda?
Communism is an economic system, like capitalism, in which ownership is shared for mutual benefit instead of held privately for individual benefit. It is a business model, not a government model.
And America has lots of communist institutions that are popular, effective, and profitable. Think of all the things that the American people own collectively, instead of individually, and try to understand WHY we've chosen to organize them that way. I'll get you started with an easy one: national parks. Totally communist!
So I don't really have any problem with communism the economic model. I have problems with authoritarianism and totalitarianism, which are the types of governments that have typically tried to implement economic communism, and have naturally let graft and corruption distort those noble goals. But I don't think those are the inevitable consequence of collectively shared ownership of a resource, as our national parks highlight. The key to successful institutions is good governance, not privately held ownership stakes. That seems so obvious it almost seems silly to have to write it down.
But I'm sure someone here will disagree with me on that point, and argue that personal profit motive is the secret ingredient to America's success. Those people must also bebetotally totally unconcerned with president Trump's conflicts of interest, because they WANT the president to run the nation for the benefit of his personal privately owned business interests.
I feel you mistake socialism with communism.
In general, there is no state in the world that functions with one political, economic, and philosophical ideal.
Post by: sol on April 28, 2017, 11:09:46 AM
I feel you mistake socialism with communism.
Isn't socialism just communism plus democracy? In the sense that communism is about collective ownership, and not political structures, I don't see the conflict there. Communism is the opposite of capitalism, not the opposite of democracy.
I think it's easy to find fatal flaws with 20th century communist states (such as the mass murders mentioned above). It's less easy to find fatal flaws with the idea of collective ownership of economic assets. At least in some situations, I think collective ownership by all citizens makes more sense than private ownership. Capitalism's devotion to private ownership has certainly generated its fair share of problems, too.
Post by: GuitarStv on April 29, 2017, 09:56:13 AM
I feel you mistake socialism with communism.
Isn't socialism just communism plus democracy? In the sense that communism is about collective ownership, and not political structures, I don't see the conflict there. Communism is the opposite of capitalism, not the opposite of democracy.
I think it's easy to find fatal flaws with 20th century communist states (such as the mass murders mentioned above). It's less easy to find fatal flaws with the idea of collective ownership of economic assets. At least in some situations, I think collective ownership by all citizens makes more sense than private ownership. Capitalism's devotion to private ownership has certainly generated its fair share of problems, too.
They're very different ideas at their core.
In a communist system there is no private ownership of anything. You are given what the state determines you need, you work the job the state determines you are suited for. It's the extreme opposite of capitalism.
In a socialist system there is private ownership. The government is responsible for regulating things to rein in the excesses of capitalism (an attempt to prevent extreme wealth concentration, wild market swings in price that would hurt people, etc.), but citizens are still free to choose their jobs, to amass fortunes, and to determine their own needs.
Post by: GilbertB on April 30, 2017, 07:56:13 PM
People are often confused because communist regimes add "socialist" to their name for PR...I feel you mistake socialism with communism.
Isn't socialism just communism plus democracy? In the sense that communism is about collective ownership, and not political structures, I don't see the conflict there. Communism is the opposite of capitalism, not the opposite of democracy.
I think it's easy to find fatal flaws with 20th century communist states (such as the mass murders mentioned above). It's less easy to find fatal flaws with the idea of collective ownership of economic assets. At least in some situations, I think collective ownership by all citizens makes more sense than private ownership. Capitalism's devotion to private ownership has certainly generated its fair share of problems, too.
They're very different ideas at their core.
In a communist system there is no private ownership of anything. You are given what the state determines you need, you work the job the state determines you are suited for. It's the extreme opposite of capitalism.
In a socialist system there is private ownership. The government is responsible for regulating things to rein in the excesses of capitalism (an attempt to prevent extreme wealth concentration, wild market swings in price that would hurt people, etc.), but citizens are still free to choose their jobs, to amass fortunes, and to determine their own needs.
Post by: DavidAnnArbor on April 30, 2017, 11:36:02 PM
https://www.nytimes.com/2017/04/30/us/politics/bipartisan-agreement-reached-to-fund-government-through-september.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region®ion=top-news&WT.nav=top-news
Post by: Jrr85 on May 01, 2017, 11:27:22 AM
Why all the hate for communism? Is that just residual aftereffects from cold war propaganda?
Communism is an economic system, like capitalism, in which ownership is shared for mutual benefit instead of held privately for individual benefit. It is a business model, not a government model.
And America has lots of communist institutions that are popular, effective, and profitable. Think of all the things that the American people own collectively, instead of individually, and try to understand WHY we've chosen to organize them that way. I'll get you started with an easy one: national parks. Totally communist!
So I don't really have any problem with communism the economic model. I have problems with authoritarianism and totalitarianism, which are the types of governments that have typically tried to implement economic communism, and have naturally let graft and corruption distort those noble goals. But I don't think those are the inevitable consequence of collectively shared ownership of a resource, as our national parks highlight. The key to successful institutions is good governance, not privately held ownership stakes. That seems so obvious it almost seems silly to have to write it down.
But I'm sure someone here will disagree with me on that point, and argue that personal profit motive is the secret ingredient to America's success. Those people must also bebetotally totally unconcerned with president Trump's conflicts of interest, because they WANT the president to run the nation for the benefit of his personal privately owned business interests.
"communist" does not equal "communal".
And yes, authoritarianism/totalitarianism are pretty much inevitable with communism, as you're not going to get humans on this planet to live in a country without private ownership without also having the threat of force to make things "work".
You can sort of have communes that work without regard to private property (at least within the group) and maybe get up to some small villages, but get any larger than that, and the personal connections necessary to replace personal incentives are too attenuated.
Post by: talltexan on May 05, 2017, 02:00:29 PM
Post by: surfhb on May 07, 2017, 07:48:50 PM
Obesity is almost never a gene issue, and even when it is, you still have control of just how obese you become.If you're a health insurance company, and you have two people, one that rarely ever has medical issues, and another who is in the hospital multiple times per month, would you charge them the same?
Absolutely. Healthcare is a right, not a privilege for those with better genes.
With that being said, since we disagree that healthcare is a right, I don't think we'll agree on anything that builds upon that idea. Why is it that you believe healthcare is a right?
Dude ! cmon. A system where people are forced to go without the correct care and/or forced to go into debt is just plain evil.
Healthcare is not a product we just offer to those who have the means.
You sound like some twenty something kid who hasn't had to deal with what life dishes out sometimes .
. Sorry but I'll gladly pay so my neighbor who's mentally ill or has a preexisting condition is covered by MY taxes.
You're too young to remember what it was like before the ACA. You basically have no opinion which means jack dick to someone like me who's had to deal with these issue.
Sent from my iPhone using Tapatalk
Post by: KBecks on May 08, 2017, 05:41:11 AM
Everyone should take responsibility for their own health and preventative care. IMO, this includes regular moderate excercise, eating a reasonably healthy diet, taking safety precautions and understanding basic first aid, avoiding tobacco and heavy alcohol use.
Yet, hardly any Americans live a healthy lifestyle -- I found an article that says only 3% do. 3%!
https://www.theatlantic.com/health/archive/2016/03/less-than-3-percent-of-americans-live-a-healthy-lifestyle/475065/
Especially as Mustachians, we should want to raise that number. Take care of yourselves, people! In the words of Ben Franklin, an ounce of prevention is worth a pound of cure. And it's often much less painful.
Also, health care is NOT free, it has never been free, it never will be free. People need to understand that and not expect it as a gift or as a right. There are no guarantees, people. If you want products and services without paying for them, that's stealing. You should strive to be able to take care of yourself and your family without depending on others or the government.
https://www.cdc.gov/chronicdisease/overview/
It is important to point out to people that bad lifestyle choices often result in chronic disease, and we should all do better with this. Just as we tell people that overspending on useless crap equals spinning your wheels financially, avoiding responsible health choices has significant negative consequences.
Many people have lots of excuses for not doing better with their health. But that does not eliminate their responsibility to manage the things they have complete control over. And we see people who overcome obesity and succeed all the time. But if people view themselves as entitled victims and are trained to self-pity, well then they're stuck.
The cheapest, easiest thing you can do is live a healthy lifestyle to the best of your ability, and build up an emergency fund. Yes, you also need to do your best to get insurance that you can afford. But first, take care of your eating, exercise and don't self-destruct.
Post by: former player on May 08, 2017, 06:45:41 AM
I've been thinking along some of the same lines, and healthcare is a difficult issue.
Everyone should take responsibility for their own health and preventative care. IMO, this includes regular moderate excercise, eating a reasonably healthy diet, taking safety precautions and understanding basic first aid, avoiding tobacco and heavy alcohol use.
Yet, hardly any Americans live a healthy lifestyle -- I found an article that says only 3% do. 3%!
https://www.theatlantic.com/health/archive/2016/03/less-than-3-percent-of-americans-live-a-healthy-lifestyle/475065/
Especially as Mustachians, we should want to raise that number. Take care of yourselves, people! In the words of Ben Franklin, an ounce of prevention is worth a pound of cure. And it's often much less painful.
Also, health care is NOT free, it has never been free, it never will be free. People need to understand that and not expect it as a gift or as a right. There are no guarantees, people. If you want products and services without paying for them, that's stealing. You should strive to be able to take care of yourself and your family without depending on others or the government.
https://www.cdc.gov/chronicdisease/overview/
It is important to point out to people that bad lifestyle choices often result in chronic disease, and we should all do better with this. Just as we tell people that overspending on useless crap equals spinning your wheels financially, avoiding responsible health choices has significant negative consequences.
Many people have lots of excuses for not doing better with their health. But that does not eliminate their responsibility to manage the things they have complete control over. And we see people who overcome obesity and succeed all the time. But if people view themselves as entitled victims and are trained to self-pity, well then they're stuck.
The cheapest, easiest thing you can do is live a healthy lifestyle to the best of your ability, and build up an emergency fund. Yes, you also need to do your best to get insurance that you can afford. But first, take care of your eating, exercise and don't self-destruct.
Not all injury or disease is due to people failing to make healthy choices. What about people who need health care for reasons that can't possibly be described as their fault? Is being born with a genetic defect and needing health care because of it "stealing"? Is getting a work-related injury and needing healthcare "stealing"? Is getting old and infirm and needing health care because of it "stealing"? Is having someone in an SUV cross the median and crash into you so that you need healthcare for your injuries "stealing"?
What about the people for whom there are compound reasons for needing health care? What if that SUV accident broke your spine so you are in a wheelchair so you can't exercise and get a "lifestyle" disease as a result - is your need for healthcare "stealing"?
Let's suppose someone's unhealthy lifestyle has contributed to their ill health, either wholly or in part. Who judges that? Does the government? Do the insurance companies? Who says to someone "you haven't lived a healthy life, therefore you have diabetes 2, therefore we are not going to treat you"? Would you like to do that job? How much would you need to be paid to do that job, or would you do it for free?
Post by: KBecks on May 08, 2017, 07:37:33 AM
What I refer to as stealing is -- using services without paying for them. If you go to the doctor and do not pay the doctor, and have no intention of ever paying for what you received, that is stealing and it is wrong. You used the service, you received vital care, you are responsible for paying for it so that doctor and health care provider can continue to operate and provide services to others. You might go into debt. It happens. You might file bankruptcy due to medical bills. That happens too. But we cannot say that people are entitled to free health care, because there is no such thing as free care. We need to live in reality. How would it ever be right to receive important care and then say to the provider -- screw you, I'm not paying?
No one judges someone else's health. All I'm saying is that people are responsible for their actions and they are responsible for paying for their health care. In that way, there is an added financial motive for people to pursue a healthy lifestyle. Don't smoke, save on health insurance, maintain a healthy weight, save on health insurance, keep your blood pressure down, save on health insurance, etc.
Post by: KBecks on May 08, 2017, 08:06:04 AM
What do do when you can't pay your medical bills
http://money.usnews.com/money/blogs/my-money/2014/05/25/what-to-do-when-you-cant-pay-medical-bills
When patients can't pay
http://www.physicianspractice.com/medical-billing-collections/when-patients-cant-pay
What doctors do whan a patient can't pay
https://www.quora.com/What-do-doctors-do-when-a-patient-cant-pay-for-life-saving-surgery
Post by: former player on May 08, 2017, 08:11:04 AM
We all of us use resources all the time without paying for them. Every time you burn fossil fuels you are using the earth's carbon sink without paying for it.
You haven't explained what is to be done about people who can't afford to pay for their own healthcare.
Your thinking seems very absolute. This is a messy, compromised, human world in which absolutes don't exist and the desire to eliminate contradictions and compromises is more dangerous than living with them.
Post by: former player on May 08, 2017, 08:15:16 AM
Some articles that may be of interestTwo articles about GP's billing uninsured patients pre-ACA and one example of EMTALA in action. What's your point?
What do do when you can't pay your medical bills
http://money.usnews.com/money/blogs/my-money/2014/05/25/what-to-do-when-you-cant-pay-medical-bills
When patients can't pay
http://www.physicianspractice.com/medical-billing-collections/when-patients-cant-pay
What doctors do whan a patient can't pay
https://www.quora.com/What-do-doctors-do-when-a-patient-cant-pay-for-life-saving-surgery
Post by: sol on May 08, 2017, 08:41:42 AM
I've been thinking along some of the same lines, and healthcare is a difficult issue.
Everyone should take responsibility for their own health and preventative care. IMO, this includes regular moderate excercise, eating a reasonably healthy diet, taking safety precautions and understanding basic first aid, avoiding tobacco and heavy alcohol use.
Yet, hardly any Americans live a healthy lifestyle -- I found an article that says only 3% do. 3%!
https://www.theatlantic.com/health/archive/2016/03/less-than-3-percent-of-americans-live-a-healthy-lifestyle/475065/
Especially as Mustachians, we should want to raise that number. Take care of yourselves, people! In the words of Ben Franklin, an ounce of prevention is worth a pound of cure. And it's often much less painful.
Also, health care is NOT free, it has never been free, it never will be free. People need to understand that and not expect it as a gift or as a right. There are no guarantees, people. If you want products and services without paying for them, that's stealing. You should strive to be able to take care of yourself and your family without depending on others or the government.
https://www.cdc.gov/chronicdisease/overview/
It is important to point out to people that bad lifestyle choices often result in chronic disease, and we should all do better with this. Just as we tell people that overspending on useless crap equals spinning your wheels financially, avoiding responsible health choices has significant negative consequences.
Many people have lots of excuses for not doing better with their health. But that does not eliminate their responsibility to manage the things they have complete control over. And we see people who overcome obesity and succeed all the time. But if people view themselves as entitled victims and are trained to self-pity, well then they're stuck.
The cheapest, easiest thing you can do is live a healthy lifestyle to the best of your ability, and build up an emergency fund. Yes, you also need to do your best to get insurance that you can afford. But first, take care of your eating, exercise and don't self-destruct.
I agree with every word of this, and I still think we need medicare-for-all style universal basic coverage.
Yes, people need to take better care of their health AND they need to have affordable guaranteed health insurance AND they need to pay for it (with taxes).
Don't pretend that "just be healthier" is any kind of solution to America's health care crisis. That's solving the wrong problem. What we need is affordable care for everyone, that everyone pays for and everyone qualifies for. No exclusions, no high risk pools, no for-profit corporations driving up cost overruns, and no freeloaders getting care for free. Universal coverage, universally paid for. This solution currently works in America for disability insurance and survivor insurance, and old age insurance, as well as a lot of non-traditional insurance products like national defense that we all pay for to keep us safe. This solution is not only better for individuals, it's also better for our society as a whole.
Post by: NoStacheOhio on May 08, 2017, 09:12:17 AM
I've been thinking along some of the same lines, and healthcare is a difficult issue.
Everyone should take responsibility for their own health and preventative care. IMO, this includes regular moderate excercise, eating a reasonably healthy diet, taking safety precautions and understanding basic first aid, avoiding tobacco and heavy alcohol use.
Yet, hardly any Americans live a healthy lifestyle -- I found an article that says only 3% do. 3%!
https://www.theatlantic.com/health/archive/2016/03/less-than-3-percent-of-americans-live-a-healthy-lifestyle/475065/
Especially as Mustachians, we should want to raise that number. Take care of yourselves, people! In the words of Ben Franklin, an ounce of prevention is worth a pound of cure. And it's often much less painful.
Also, health care is NOT free, it has never been free, it never will be free. People need to understand that and not expect it as a gift or as a right. There are no guarantees, people. If you want products and services without paying for them, that's stealing. You should strive to be able to take care of yourself and your family without depending on others or the government.
https://www.cdc.gov/chronicdisease/overview/
It is important to point out to people that bad lifestyle choices often result in chronic disease, and we should all do better with this. Just as we tell people that overspending on useless crap equals spinning your wheels financially, avoiding responsible health choices has significant negative consequences.
Many people have lots of excuses for not doing better with their health. But that does not eliminate their responsibility to manage the things they have complete control over. And we see people who overcome obesity and succeed all the time. But if people view themselves as entitled victims and are trained to self-pity, well then they're stuck.
The cheapest, easiest thing you can do is live a healthy lifestyle to the best of your ability, and build up an emergency fund. Yes, you also need to do your best to get insurance that you can afford. But first, take care of your eating, exercise and don't self-destruct.
I agree with every word of this, and I still think we need medicare-for-all style universal basic coverage.
Yes, people need to take better care of their health AND they need to have affordable guaranteed health insurance AND they need to pay for it (with taxes).
Don't pretend that "just be healthier" is any kind of solution to America's health care crisis. That's solving the wrong problem. What we need is affordable care for everyone, that everyone pays for and everyone qualifies for. No exclusions, no high risk pools, no for-profit corporations driving up cost overruns, and no freeloaders getting care for free. Universal coverage, universally paid for. This solution currently works in America for disability insurance and survivor insurance, and old age insurance, as well as a lot of non-traditional insurance products like national defense that we all pay for to keep us safe. This solution is not only better for individuals, it's also better for our society as a whole.
I don't get the "it's not free" argument. I know it's not free. I just would rather pay for it though taxation than the current private insurance premium system. Why is that so horrific?
Post by: pbkmaine on May 08, 2017, 09:12:47 AM
Post by: MasterStache on May 08, 2017, 10:44:40 AM
Also, health care is NOT free, it has never been free, it never will be free. People need to understand that and not expect it as a gift or as a right.
Affordable, quality healthcare FOR ALL should absolutely be a basic human right of every American.
Post by: sol on May 08, 2017, 11:11:56 AM
Also, health care is NOT free, it has never been free, it never will be free. People need to understand that and not expect it as a gift or as a right.
Affordable, quality healthcare FOR ALL should absolutely be a basic human right of every American.
Up to a minimum level of care, at the very least. We can't offer everyone free plastic surgery.
And I accept that in some cases, universal coverage will refuse to offer the potentially lifesaving experimental procedures for a person who is likely to die anyway. There has to be some discretion on what is covered. Basic care should absolutely be covered, including preventative care and emergency care at a minimum. I think everyone agrees on those.
And this guaranteed care world not be free, or a gift. Everyone would pay for it through their taxes. And like roads and schools and everything else taxes pay for, some people who are too poor would pay effectively no taxes while the billionaires would pay more to make up for it. This is the normal way we pay for everything else.
The current republican bill is the worst kind of betrayal imaginable. It means higher premiums, fewer people with coverage, reduced consumer protections, and oh yes don't forget all that savings isn't even being used to reduce the deficit but is instead just handed to rich people as a tax break. It is the exact opposite of everything Trump promised during the campaign.
Even the most hardcore Trump supporters should hate this bill with a burning passion.
Post by: pbkmaine on May 08, 2017, 11:40:45 AM
Also, health care is NOT free, it has never been free, it never will be free. People need to understand that and not expect it as a gift or as a right.
Affordable, quality healthcare FOR ALL should absolutely be a basic human right of every American.
Up to a minimum level of care, at the very least. We can't offer everyone free plastic surgery.
And I accept that in some cases, universal coverage will refuse to offer the potentially lifesaving experimental procedures for a person who is likely to die anyway. There has to be some discretion on what is covered. Basic care should absolutely be covered, including preventative care and emergency care at a minimum. I think everyone agrees on those.
And this guaranteed care world not be free, or a gift. Everyone would pay for it through their taxes. And like roads and schools and everything else taxes pay for, some people who are too poor would pay effectively no taxes while the billionaires would pay more to make up for it. This is the normal way we pay for everything else.
The current republican bill is the worst kind of betrayal imaginable. It means higher premiums, fewer people with coverage, reduced consumer protections, and oh yes don't forget all that savings isn't even being used to reduce the deficit but is instead just handed to rich people as a tax break. It is the exact opposite of everything Trump promised during the campaign.
Even the most hardcore Trump supporters should hate this bill with a burning passion.
I really don't understand why the Republicans voted for this.
Post by: sol on May 08, 2017, 12:02:32 PM
I really don't understand why the Republicans voted for this.
I suspect that the answer here is not some great mystery; they voted for it because it's a huge tax cut for the wealthy and that's ultimately the only thing the republican party really cares about.
Everything else is secondary. They don't really care about how healthcare works, because the wealthy already have good healthcare. They don't really care about entitlement spending, unless it interferes with their tax cuts. They don't even care about the raging undercurrent of populism that got trump elected, except as a means to enact more tax cuts for the wealthy (ironically, very anti-populist).
Post by: Jrr85 on May 08, 2017, 01:14:46 PM
I've been thinking along some of the same lines, and healthcare is a difficult issue.
Everyone should take responsibility for their own health and preventative care. IMO, this includes regular moderate excercise, eating a reasonably healthy diet, taking safety precautions and understanding basic first aid, avoiding tobacco and heavy alcohol use.
Yet, hardly any Americans live a healthy lifestyle -- I found an article that says only 3% do. 3%!
https://www.theatlantic.com/health/archive/2016/03/less-than-3-percent-of-americans-live-a-healthy-lifestyle/475065/
Especially as Mustachians, we should want to raise that number. Take care of yourselves, people! In the words of Ben Franklin, an ounce of prevention is worth a pound of cure. And it's often much less painful.
Also, health care is NOT free, it has never been free, it never will be free. People need to understand that and not expect it as a gift or as a right. There are no guarantees, people. If you want products and services without paying for them, that's stealing. You should strive to be able to take care of yourself and your family without depending on others or the government.
https://www.cdc.gov/chronicdisease/overview/
It is important to point out to people that bad lifestyle choices often result in chronic disease, and we should all do better with this. Just as we tell people that overspending on useless crap equals spinning your wheels financially, avoiding responsible health choices has significant negative consequences.
Many people have lots of excuses for not doing better with their health. But that does not eliminate their responsibility to manage the things they have complete control over. And we see people who overcome obesity and succeed all the time. But if people view themselves as entitled victims and are trained to self-pity, well then they're stuck.
The cheapest, easiest thing you can do is live a healthy lifestyle to the best of your ability, and build up an emergency fund. Yes, you also need to do your best to get insurance that you can afford. But first, take care of your eating, exercise and don't self-destruct.
I agree with every word of this, and I still think we need medicare-for-all style universal basic coverage.
Yes, people need to take better care of their health AND they need to have affordable guaranteed health insurance AND they need to pay for it (with taxes).
Don't pretend that "just be healthier" is any kind of solution to America's health care crisis. That's solving the wrong problem.
It's not solving the problem, but considering how much of government healthcare dollars go to lifestyle conditions, it certainly would solve a big chunk of one. It might end up driving costs in different ways as healthier people live a long time in nursing homes rather than dying from complications from diabetes and heart disease. Not sure if public policy is an appropriate tool to address it, but if so, it certainly would be one of the biggest levers we could pull.
What we need is affordable care for everyone, that everyone pays for and everyone qualifies for. No exclusions, no high risk pools, no for-profit corporations driving up cost overruns, and no freeloaders getting care for free. Universal coverage, universally paid for. This solution currently works in America for disability insurance and survivor insurance, and old age insurance, as well as a lot of non-traditional insurance products like national defense that we all pay for to keep us safe. This solution is not only better for individuals, it's also better for our society as a whole.It has "worked" for long term disability and old age insurance because we had favorable demographic trends that allowed people to enjoy more "insurance" than they were willing to pay for. It's yet to be seen how it works as that is no longer the case.
Post by: Tyson on May 08, 2017, 03:12:33 PM
Post by: stoaX on May 08, 2017, 03:39:14 PM
What demographics are you talking about? Last I checked, Millennials now officially outnumber Boomers. Seems like demographics are just fine.
I think the demographics referred to was when the baby boomers were all well before retirement age, working and contributing to social security. As the term "boomers" suggests, there were lots of them. So while there may be more people younger than boomers themselves, I don't think they quite have the overwhelming numbers as the baby boomers did compared to older generations. Couple that with declining workforce participation rates and the social security programs become more of a challenge to fund.
Post by: Tyson on May 08, 2017, 08:53:40 PM
I think the demographics referred to was when the baby boomers were all well before retirement age, working and contributing to social security. As the term "boomers" suggests, there were lots of them. So while there may be more people younger than boomers themselves, I don't think they quite have the overwhelming numbers as the baby boomers did compared to older generations. Couple that with declining workforce participation rates and the social security programs become more of a challenge to fund.
Another good reason to open our borders - more immigrants means more young workers to pay for the boomer cash suck. Haha, I am only kidding.
Post by: Kris on May 09, 2017, 08:19:21 AM
http://boingboing.net/2017/05/03/greatest-generation.html
Post by: surfhb on May 09, 2017, 09:30:28 AM
I really don't understand why the Republicans voted for this.
I suspect that the answer here is not some great mystery; they voted for it because it's a huge tax cut for the wealthy and that's ultimately the only thing the republican party really cares about.
Everything else is secondary. They don't really care about how healthcare works, because the wealthy already have good healthcare. They don't really care about entitlement spending, unless it interferes with their tax cuts. They don't even care about the raging undercurrent of populism that got trump elected, except as a means to enact more tax cuts for the wealthy (ironically, very anti-populist).
That and anything they can do to undermine the policies of the last 8 years with that darn n**ger in the White House.
It's interesting since every hardened republican I know (I live in "The OC") is a flat out racist to begin with. This country has not passed the civil rights act of the 60s I'm afraid and president trump is living proof of that.
If Obama had been a young, good looking white boy with a beautiful wife and 2 young girls, I'm convinced he'd be one of the most popular presidents since Kennedy.
*shrugs*
Post by: talltexan on May 09, 2017, 09:39:21 AM
I really don't understand why the Republicans voted for this.
I suspect that the answer here is not some great mystery; they voted for it because it's a huge tax cut for the wealthy and that's ultimately the only thing the republican party really cares about.
Everything else is secondary. They don't really care about how healthcare works, because the wealthy already have good healthcare. They don't really care about entitlement spending, unless it interferes with their tax cuts. They don't even care about the raging undercurrent of populism that got trump elected, except as a means to enact more tax cuts for the wealthy (ironically, very anti-populist).
That and anything they can do to undermine the policies of the last 8 years with that darn n****r in the White House.
It's interesting since every hardened republican I know (I live in "The OC") is a flat out racist to begin with. This country has not passed the civil rights act of the 60s I'm afraid and president trump is living proof of that.
Sent from my iPhone using Tapatalk
I think there's support that being perceived as "undoing Obamacare" was absolutely necessary to Republicans. They've been very successful at messaging to keep their base from connecting benefits from that law to the "Obamacare" brand. I think the backlash from conservative media over last week's budget deal made having some achievement--any achievement--seem incredibly urgent.
With the 2018 election season this far away, I think passing a bad bill now is much safer than passing a bad bill later on for Congressmen who will have to face the voters.
Post by: golden1 on May 09, 2017, 09:57:47 AM
Quote
The government was apparently a hell of a lot smarter about insurance seventy years ago:
http://boingboing.net/2017/05/03/greatest-generation.html
This makes a really good point. Roosevelt came up with the "Second Bill of Rights" idea near the end of WW2 when country unity was at it's highest. I believe that the British also formed the British health care system post WW2 out of the same spirit of national unity.
I really think the main reason we don't have single payer is because we don't have that ethic anymore. We have fractured and psychologically divided ourselves into "deserving people" and "freeloaders". When people don't have an outside enemy to fight or other unifying project to work on together , they turn on each other. If anyone here has read the graphic novel "The Watchmen" (I urge everyone to read it btw) the whole idea is that the villain in the story engineered a major crisis in order to unify the world so it would get rid of nuclear weapons. I sometimes wonder of that is what the US needs to draw us together so we can actually move forward to make some of these changes. I don't think it has to be a negative external event necessarily, but until we actually view America as a society and all of it's members as deserving of good health care, then this is a non starter for many people. It isn't a money problem as much as it is a culture problem.
Post by: DavidAnnArbor on May 09, 2017, 10:31:04 AM
50% of all health care dollars are spent on 5% of those using the healthcare system. This means a small number of people use most of the resources, for whatever reason, genetic, accident, lifestyle, or simply because they are very elderly and are facing the constellation of health issues prior to morbidity.
The ACA/Obamacare started to do research to find methods of healthcare that were both cost-effective and still provided good patient outcomes. There were pilot studies that showed that encouraging heavy users of health care to comply with medications and improve lifestyle helped to lower costs. The result of this research suggests that we can lower healthcare costs, improve patient outcomes, and provide guaranteed healthcare to all Americans. Just insuring that physicians and nurses wash their hands frequently helped to lower in hospital acquired diseases - which lowers health care costs.
Post by: ChpBstrd on May 10, 2017, 08:59:23 AM
I suspect mustachians who are motivated enough to invest a million dollars within a 10-20 year timeframe are highly likely to already be exercising, eating right, and be in shape.
50% of all health care dollars are spent on 5% of those using the healthcare system. This means a small number of people use most of the resources, for whatever reason, genetic, accident, lifestyle, or simply because they are very elderly and are facing the constellation of health issues prior to morbidity.
The ACA/Obamacare started to do research to find methods of healthcare that were both cost-effective and still provided good patient outcomes. There were pilot studies that showed that encouraging heavy users of health care to comply with medications and improve lifestyle helped to lower costs. The result of this research suggests that we can lower healthcare costs, improve patient outcomes, and provide guaranteed healthcare to all Americans. Just insuring that physicians and nurses wash their hands frequently helped to lower in hospital acquired diseases - which lowers health care costs.
You are correct, sir. Unfortunately, much of the money for healthcare QI, outcome-based incentives, health info tech, and education was built into the ACA, and will be gutted.
Post by: Axecleaver on May 10, 2017, 01:19:32 PM
But block grants change the funding, which puts all the programs at risk.
Post by: MasterStache on May 10, 2017, 01:32:11 PM
QuoteThe government was apparently a hell of a lot smarter about insurance seventy years ago:If anyone here has read the graphic novel "The Watchmen" (I urge everyone to read it btw) the whole idea is that the villain in the story engineered a major crisis in order to unify the world so it would get rid of nuclear weapons.
http://boingboing.net/2017/05/03/greatest-generation.html
Or watch the movie for the sometimes lazy asses like myself. Same storyline.
Post by: GuitarStv on August 19, 2017, 09:32:59 AM
QuoteThe government was apparently a hell of a lot smarter about insurance seventy years ago:If anyone here has read the graphic novel "The Watchmen" (I urge everyone to read it btw) the whole idea is that the villain in the story engineered a major crisis in order to unify the world so it would get rid of nuclear weapons.
http://boingboing.net/2017/05/03/greatest-generation.html
Or watch the movie for the sometimes lazy asses like myself. Same storyline.
The movie was far inferior for a variety of reasons. I'd say that the only area it surpassed the book was I'd the display of giant blue penis.
Post by: wenchsenior on August 19, 2017, 10:53:52 AM
QuoteThe government was apparently a hell of a lot smarter about insurance seventy years ago:If anyone here has read the graphic novel "The Watchmen" (I urge everyone to read it btw) the whole idea is that the villain in the story engineered a major crisis in order to unify the world so it would get rid of nuclear weapons.
http://boingboing.net/2017/05/03/greatest-generation.html
Or watch the movie for the sometimes lazy asses like myself. Same storyline.
The movie was far inferior for a variety of reasons. I'd say that the only area it surpassed the book was I'd the display of giant blue penis.
Huh. This was not what I was expecting to see when this thread bumped after a long quiet period.
Movie was ok. Never tried to read the graphic novel (I have trouble getting into graphic novels, generally speaking).