Author Topic: Impending repeal of Obamacare--what to do?  (Read 26668 times)

Schaefer Light

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Re: Impending repeal of Obamacare--what to do?
« Reply #100 on: November 11, 2016, 11:37:42 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.

I'll quote myself,

Quote
And conservatives wonder why they're so maligned.
Again, I said from a strictly economic perspective.

bacchi

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Re: Impending repeal of Obamacare--what to do?
« Reply #101 on: November 11, 2016, 11:43:44 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.

I'll quote myself,

Quote
And conservatives wonder why they're so maligned.
Again, I said from a strictly economic perspective.

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untreated cancer patient isn't designing bridges or writing code -- she's at home, dying, because her health care was rescinded and she's on the wait list for the high risk pool.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.

NoStacheOhio

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Re: Impending repeal of Obamacare--what to do?
« Reply #102 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.
The first step is acknowledging you have a problem, right?

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Schaefer Light

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Re: Impending repeal of Obamacare--what to do?
« Reply #103 on: November 11, 2016, 11:49:15 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.

I'll quote myself,

Quote
And conservatives wonder why they're so maligned.
Again, I said from a strictly economic perspective.

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.

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.


bacchi

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Re: Impending repeal of Obamacare--what to do?
« Reply #105 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.

Finally, not everything is about saving money, especially in one of the richest countries on the planet.

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.

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.

geekette

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Re: Impending repeal of Obamacare--what to do?
« Reply #106 on: November 11, 2016, 11:54:38 AM »
The republicans have spoken:  you're in the way of my profits, just go ahead and die.

bacchi

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Re: Impending repeal of Obamacare--what to do?
« Reply #107 on: November 11, 2016, 11:56:00 AM »

Schaefer Light

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Re: Impending repeal of Obamacare--what to do?
« Reply #108 on: November 11, 2016, 12:07:34 PM »
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.

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.

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.
No.  I just don't want the government to force me to do that.  That government is best which governs least.

accolay

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Re: Impending repeal of Obamacare--what to do?
« Reply #109 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.

Schaefer Light

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Re: Impending repeal of Obamacare--what to do?
« Reply #110 on: November 11, 2016, 12:10:32 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.
That's true.  But the government doesn't force me to participate in that system.  I can choose not to drive a car.

NoStacheOhio

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Re: Impending repeal of Obamacare--what to do?
« Reply #111 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.
The first step is acknowledging you have a problem, right?

https://forum.mrmoneymustache.com/journals/digging-out-of-a-hole/

accolay

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Re: Impending repeal of Obamacare--what to do?
« Reply #112 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.

Northwestie

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Re: Impending repeal of Obamacare--what to do?
« Reply #113 on: November 11, 2016, 12:27:11 PM »
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.
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.

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.

FIFoFum

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Re: Impending repeal of Obamacare--what to do?
« Reply #114 on: November 11, 2016, 12:33:23 PM »

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.
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.

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.
« Last Edit: November 11, 2016, 01:03:05 PM by FIFoFum »
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Northwestie

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Re: Impending repeal of Obamacare--what to do?
« Reply #115 on: November 11, 2016, 12:36:17 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

Schaefer Light

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Re: Impending repeal of Obamacare--what to do?
« Reply #116 on: November 11, 2016, 12:40:15 PM »
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.
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.

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.
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.

NoStacheOhio

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Re: Impending repeal of Obamacare--what to do?
« Reply #117 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?   

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.
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.

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.
The first step is acknowledging you have a problem, right?

https://forum.mrmoneymustache.com/journals/digging-out-of-a-hole/

daverobev

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Re: Impending repeal of Obamacare--what to do?
« Reply #118 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?
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jim555

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Re: Impending repeal of Obamacare--what to do?
« Reply #119 on: November 11, 2016, 01:04:17 PM »
Someone always pays.  Unpaid bills get paid too.  Taxpayers will pay through uncompensated care payments to hospitals, insurance premiums reflect prices that are padded for uncompensated bills.  Either way it gets paid.

It is much better to have a system in place that pays this before the bill and not after.

Schaefer Light

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Re: Impending repeal of Obamacare--what to do?
« Reply #120 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.

Schaefer Light

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Re: Impending repeal of Obamacare--what to do?
« Reply #121 on: November 11, 2016, 01:08:51 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?
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.

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.

bacchi

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Re: Impending repeal of Obamacare--what to do?
« Reply #122 on: November 11, 2016, 03:44:33 PM »
Interesting. The WSJ and BBC are reporting that Trump may keep the pre-existing ban, contrary to his written proposal.

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.

FireLane

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Re: Impending repeal of Obamacare--what to do?
« Reply #123 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.

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mtnrider

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Re: Impending repeal of Obamacare--what to do?
« Reply #125 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

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.


« Last Edit: November 11, 2016, 08:42:16 PM by mtnrider »

obstinate

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Re: Impending repeal of Obamacare--what to do?
« Reply #126 on: November 11, 2016, 09:54:59 PM »
Perhaps all is not lost:

http://www.cnn.com/2016/11/11/politics/donald-trump-obamacare-interview/index.html
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.

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.
« Last Edit: November 11, 2016, 09:56:39 PM by obstinate »

mtnrider

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Re: Impending repeal of Obamacare--what to do?
« Reply #127 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.

sol

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Re: Impending repeal of Obamacare--what to do?
« Reply #128 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.

obstinate

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Re: Impending repeal of Obamacare--what to do?
« Reply #129 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.

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.
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.

(Except that he'd also like to toss seniors into that shark tank by dismantling Medicare.)

Metric Mouse

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Re: Impending repeal of Obamacare--what to do?
« Reply #130 on: November 11, 2016, 11:29:46 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?
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obstinate

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Re: Impending repeal of Obamacare--what to do?
« Reply #131 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?

sol

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Re: Impending repeal of Obamacare--what to do?
« Reply #132 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.

gerardc

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Re: Impending repeal of Obamacare--what to do?
« Reply #133 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

gerardc

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Re: Impending repeal of Obamacare--what to do?
« Reply #134 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.

firedup

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Re: Impending repeal of Obamacare--what to do?
« Reply #135 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"......


« Last Edit: November 12, 2016, 02:57:44 AM by firedup »

jim555

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Re: Impending repeal of Obamacare--what to do?
« Reply #136 on: November 12, 2016, 06:03:06 AM »
Obamacare to be replaced with WeDontCare.  Get sick, go bankrupt, nice plan.

rtrnow

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Re: Impending repeal of Obamacare--what to do?
« Reply #137 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.

brooklynguy

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Re: Impending repeal of Obamacare--what to do?
« Reply #138 on: November 12, 2016, 06:20:11 AM »
It's unfortunate (and perhaps not coincidental) that the popular parts of the ACA that Trump now says he supports also happen to be the same parts of the law the repeal of which the Republicans couldn't steamroll through over Democratic opposition via budget reconciliation in any event.  That leaves the Democrats with little leverage in the battle for public perception--they would have more hold-up value if it were the popular legs of the stool the Republicans had to sever in order to dismantle it.

Metric Mouse

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Re: Impending repeal of Obamacare--what to do?
« Reply #139 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.
« Last Edit: November 12, 2016, 11:48:34 AM by Metric Mouse »
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rweba

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Re: Impending repeal of Obamacare--what to do?
« Reply #140 on: November 12, 2016, 07:12:49 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!"

accolay

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Re: Impending repeal of Obamacare--what to do?
« Reply #141 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?

wenchsenior

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Re: Impending repeal of Obamacare--what to do?
« Reply #142 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.
« Last Edit: November 12, 2016, 08:46:43 AM by wenchsenior »

bacchi

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Re: Impending repeal of Obamacare--what to do?
« Reply #143 on: November 12, 2016, 09:35:04 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.

rubybeth

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Re: Impending repeal of Obamacare--what to do?
« Reply #144 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.
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jim555

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Re: Impending repeal of Obamacare--what to do?
« Reply #145 on: November 12, 2016, 09:59:55 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.

FIRE me

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Re: Impending repeal of Obamacare--what to do?
« Reply #146 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.   
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wenchsenior

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Re: Impending repeal of Obamacare--what to do?
« Reply #147 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.

FIRE Artist

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Re: Impending repeal of Obamacare--what to do?
« Reply #148 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. 

sol

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Re: Impending repeal of Obamacare--what to do?
« Reply #149 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.