Author Topic: What comes after the ACA?  (Read 347367 times)

Iplawyer

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Re: What comes after the ACA?
« Reply #100 on: January 09, 2017, 07:59:33 AM »
couldnt all this simply be fixed with insurance regulation and reform.  It seems to me the largest complaint against the old system is my house burned down and now insurance says they arent gonna pay and dropped me.  How is this insurance.  A simple rule could fix that i'd think. 

still putting everyone in a big pot and then giving credits for being healthier and getting preventative treatments done/ attempting to be healthier and taking classes much like are offered thru large employer group plans seems to be a better cheaper overall system.  then the higher risk people are either taking steps towards becoming less high risk and the rest of the healthy people can keep on about their lives as they have been.  I'm sure invasion of privacy will come up with this but its a credit you dont have to participate if you want to just pay the full tax.

boarder42 - I am going to try one more time.  How do you know you don't have a defective gene that you are passing on?  Many genetic disorders aren't discovered until they become issues.  And what about people who don't have genetic disorders but have operable and curable cancer but then are considered to have a pre existing condition who exercise, run marathons, eat right, and don't procreate?  what would you do with them?  How do they take steps to get less "high risk" according to you?  You cannot erase having cancer.  Or maybe you think those people should just curl up in a hole and die? 

You - boarder42- aren't a force or nature nor are you God. You have no idea what your genetic makeup is.  Have you procreated anyway?  I really find you one of the most offensive and awful people here.  Karma is a bitch.  It might catch up with you. In the meantime - please don't procreate.  The world doesn't need anymore people without love in their hearts.  Clearly 25% of our country is already there.


For everyone else - just a little reminder to PUT A LITTLE LOVE IN YOUR HEARTS:
https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=lyrics%20to%20put%20a%20little%20love%20in%20your%20heart

 Think of your fellow man
Lend him a helping hand
Put a little love in your heart
You see it's getting late
Oh, please don't hesitate
Put a little love in your heart
And the world will be a better place [x2]
For you and me
You just wait and see
Another day goes by
Still the children cry
Put a little love in your heart
If you want the world to know
We won't let hatred grow
Put a little love in your heart
And the world (and the world) will be a better place
All the world (all the world) will be a better place
For you (for you)
And me (and me)
You just wait (just wait)
And see, wait and see
Take a good look around
And if you're looking down
Put a little love in your heart
I hope when you decide
Kindness will be your guide
Put a little love in your heart
« Last Edit: January 09, 2017, 08:08:56 AM by ddmesser »

packlawyer04

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Re: What comes after the ACA?
« Reply #101 on: January 09, 2017, 08:09:52 AM »
The ACA did not fix anything which is why it failed. And make no mistake, it failed. It was simply changing who is paying for healthcare and shifted the burdens around.  Dumping $14,000 deductibles with $1,200 a month premiums on working class families is a failure. The underlying problems are still present, i.e. the actual costs of healthcare.

Until a law actually addresses the costs of healthcare, you can play the hide the ball under the cup game until you are blue in the face but it won't do anything.  Nobody wants to actually discuss the problems, folks just want to talk about how to pay for the problems, ACA, private insurance, single payer, on and on and on.

The reality is we are a fat, sick and out of shape country.
« Last Edit: January 09, 2017, 08:11:34 AM by packlawyer04 »

boarder42

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Re: What comes after the ACA?
« Reply #102 on: January 09, 2017, 08:10:39 AM »
couldnt all this simply be fixed with insurance regulation and reform.  It seems to me the largest complaint against the old system is my house burned down and now insurance says they arent gonna pay and dropped me.  How is this insurance.  A simple rule could fix that i'd think. 

still putting everyone in a big pot and then giving credits for being healthier and getting preventative treatments done/ attempting to be healthier and taking classes much like are offered thru large employer group plans seems to be a better cheaper overall system.  then the higher risk people are either taking steps towards becoming less high risk and the rest of the healthy people can keep on about their lives as they have been.  I'm sure invasion of privacy will come up with this but its a credit you dont have to participate if you want to just pay the full tax.

boarder42 - I am going to try one more time.  How do you know you don't have a defective gene that you are passing on?  Many genetic disorders aren't discovered until they become issues.  And what about people who don't have genetic disorders but have operable and curable cancer but then are considered to have a pre existing condition who exercise, run marathons, eat right, and don't procreate?  what would you do with them? 

You - boarder42- aren't a force or nature nor are you God. You have no idea what your genetic makeup is.  Have yo procreated anyway?  I really find you one of the most offensive and awful people here.  Karma is a bitch.  It might catch up with you. In the meantime - please don't procreate.  The world doesn't need anymore people without love in their hearts.


never said i was god.  I have yet to procreate but would not knowlingly procreate with a genetic disorder that could be past on.  Curable things like cancer etc. arent something i brought up, i was tlaking of genetic disorders that are passed on.  and i was playing a devils advocate to all of you who think everyone deserves everything.
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NoStacheOhio

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Re: What comes after the ACA?
« Reply #103 on: January 09, 2017, 08:25:59 AM »
My mother was diagnosed with colon cancer 8 years ago.  It was a genetic type.  No worries, she is fine.  My siblings and I, if we had the gene (50% chance- none of us have it) have a ~100% chance of getting colon cancer.  No matter how healthy we are before then.  If we were on individual insurance we would be dropped instantly.

On a positive note, this is actually untrue. Congress passed the Genetic Information Nondiscrimination Act in 2008, so they can't drop you (or raise premiums) for carrying a genetic mutation. In the pre-ACA world, as long as you didn't have any coverage gaps, you would be fine.

Minor downside: you will spend months arguing with the insurance company about this. Ask me how I know.
The first step is acknowledging you have a problem, right?

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packlawyer04

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Re: What comes after the ACA?
« Reply #104 on: January 09, 2017, 08:27:39 AM »
Great summary Sol, and great discussion. In my opinion health care costs are the biggest concern for early retirees. There is nothing that can destroy a budget faster than a serious medical problem. The ACA was a gift to the early retiree, too good to be true in many ways. I think the biggest lesson here is that changes in health care, tax or entitlement policy can have a massively negative impact.

Working in medicine I can tell you that using the 'free market' to control your costs will probably not work, because you are not the customer. The insurance company is the customer and you are just along for the ride. Insurance companies will fight to control their costs, but they don't really care what you pay. Navigating the 'in/out of network' maze is infuriating, and many times there is a shortage of specialists in your geographic area anyways so it's a moot point. Sure, you can negotiate on non-emergent services if you are self-pay and save a bit, but the big costs come from medical emergencies where you don't have any negotiating power. A trip to the ICU for a few days can wipe out a decade worth of HSA contributions. Cancer or some other chronic illness can max your deductible every year. It's a real problem.

What we really need is to find  way to decrease costs of medical care in the US. I'm not sure how to do this. The ACA was designed to get everyone insured, but it didn't really address the cost issue. Until this problem is solved there is no math that will make medical care affordable on a population level. We spend over $10,000 per person each year. There is no magical way to pay for this without people paying huge premiums and out of pocket costs. The ACA was designed to smooth this cost out a bit, mainly by forcing healthy and rich people to pay more. http://www.pbs.org/newshour/rundown/new-peak-us-health-care-spending-10345-per-person/

Insane. There is no solution to this problem with any of the proposals. Maybe a single payer could accomplish this, but as others have stated this is politically impossible. Whatever comes next will be great for healthy people, and not so great for sick people. You will likely be OK if you are either really rich or really poor (assuming Medicaid isn't destroyed). Don't get sick in the United States.

Thank you. Nobody wants to talk about this because it is not easy and simple. It is simple to just talk about how to pay for things.

The facts are the ACA does not need to be replaced. It needs to be repealed, slowly. There then needs to be a whole bunch of legislation passed to actually address the problem. Not who is paying for the problem.  Sure you can move to single payer, U.S. government is simply going to go belly up paying for healthcare then.  There is not an easy answer to actuall adress healthcare costs but it affects tons of industries from education to big pharma to the court system.

And please, lets just stop with the comparisons between the U.S and Europe.  American's drive their cars to the end of their driveway to get their mail in route to the all you can eat buffet.  Europeans don't think twice about a vacation that involves biking around for a week. You can't compare the two.
« Last Edit: January 09, 2017, 08:29:20 AM by packlawyer04 »

protostache

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Re: What comes after the ACA?
« Reply #105 on: January 09, 2017, 08:35:37 AM »
Great summary Sol, and great discussion. In my opinion health care costs are the biggest concern for early retirees. There is nothing that can destroy a budget faster than a serious medical problem. The ACA was a gift to the early retiree, too good to be true in many ways. I think the biggest lesson here is that changes in health care, tax or entitlement policy can have a massively negative impact.

Working in medicine I can tell you that using the 'free market' to control your costs will probably not work, because you are not the customer. The insurance company is the customer and you are just along for the ride. Insurance companies will fight to control their costs, but they don't really care what you pay. Navigating the 'in/out of network' maze is infuriating, and many times there is a shortage of specialists in your geographic area anyways so it's a moot point. Sure, you can negotiate on non-emergent services if you are self-pay and save a bit, but the big costs come from medical emergencies where you don't have any negotiating power. A trip to the ICU for a few days can wipe out a decade worth of HSA contributions. Cancer or some other chronic illness can max your deductible every year. It's a real problem.

What we really need is to find  way to decrease costs of medical care in the US. I'm not sure how to do this. The ACA was designed to get everyone insured, but it didn't really address the cost issue. Until this problem is solved there is no math that will make medical care affordable on a population level. We spend over $10,000 per person each year. There is no magical way to pay for this without people paying huge premiums and out of pocket costs. The ACA was designed to smooth this cost out a bit, mainly by forcing healthy and rich people to pay more. http://www.pbs.org/newshour/rundown/new-peak-us-health-care-spending-10345-per-person/

Insane. There is no solution to this problem with any of the proposals. Maybe a single payer could accomplish this, but as others have stated this is politically impossible. Whatever comes next will be great for healthy people, and not so great for sick people. You will likely be OK if you are either really rich or really poor (assuming Medicaid isn't destroyed). Don't get sick in the United States.

Thank you. Nobody wants to talk about this because it is not easy and simple. It is simple to just talk about how to pay for things.

The facts are the ACA does not need to be replaced. It needs to be repealed, slowly. There then needs to be a whole bunch of legislation passed to actually address the problem. Not who is paying for the problem.  Sure you can move to single payer, U.S. government is simply going to go belly up paying for healthcare then.  There is not an easy answer to actuall adress healthcare costs but it affects tons of industries from education to big pharma to the court system.

And please, lets just stop with the comparisons between the U.S and Europe.  American's drive their cars to the end of their driveway to get their mail in route to the all you can eat buffet.  Europeans don't think twice about a vacation that involves biking around for a week. You can't compare the two.

ACA was never intended to be the end all be all of health care legislation. It was always a first step toward a better future. Cost controls were next on the docket, but we had to get everyone covered first. Of course, ACA was followed immediately by six years of congressional obstruction and so the cost control component never happened and now here we are.

scantee

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Re: What comes after the ACA?
« Reply #106 on: January 09, 2017, 08:39:29 AM »
Access to health care is a basic human right. Development of this right has been a quickly-evolving phenomenon over the past century. 100 years ago, health insurance was completely unnecessary because we didn't have the knowledge or technology to really effect health outcomes through health care. By 50 years ago, that had changed drastically: huge leaps were made in our understanding of disease such that health care did have a noticeable effect on outcomes and insurance was a way to subsidize access to those new technologies. Today, health care technology has improved so quickly that barring access to it constitutes a violation of basic human rights. Now, you might not agree with that, you can think that health care and the insurance to pay for it should only be available to those who can afford it, but realize that the rest of western society has moved on without you and considers that viewpoint barbaric.

Once we acknowledge that access to basic health care is a human right, there are really two main concerns in administering it across a large population like that of the US: 1) determining the most efficient way to provide health care services to hundreds of millions of people, in drastically different economic and social contexts, and 2) figuring out how to keep costs manageable, since access to unlimited care is infeasible.

Obamacare was our first attempt as a society to address these concerns. As most first attempts at addressing extremely complicated problems go, it was far from perfect. It's hard to imagine that anyone who thinks it should be perfect is arguing in good faith. Trashing the ACA entirely because it wasn't perfect is not a good faith solution. A true commitment to improving the ACA would involve identifying what has worked with the system, what has not, and then testing alternative solutions to address the systems defects to figure out which one best addresses the concerns listed above.

The Better Way plan does none of this. It basically knocks down the ACA house of cards, only to rebuild it with the same cards in the same configuration. It a political move and nothing more. The reason it does not offer a compelling alternative to the ACA is because there is no compelling alternative. Republicans absolutely know this, but they also know that they can't go back to the old private insurer market because it will be a political nightmare for them (it's very hard to take away benefits that are available to the middle-class, once they have access to them) and the alternative of a public option or single payer are even more ideologically offensive to them. So we get this Better Way plan, which is just ACA repackaged with a few Paul Ryans bitch slaps thrown in (i.e., Medicaid block grant).

What is the primary complaint of those in the ACA market? Cost. Premiums are too high. How do we lower cost? By increasing subsidies. How do we increases subsidies? Higher taxes or diverting funds from other public programs. That's it, that is what needs to happen. That is what will happen after all of this political showmanship. There is no short cut. And really, once subsidies are raised, that in itself is just a one stop in our inevitable progression to a public option, and then single payer.

iowajes

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Re: What comes after the ACA?
« Reply #107 on: January 09, 2017, 08:41:15 AM »
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

boarder42

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Re: What comes after the ACA?
« Reply #108 on: January 09, 2017, 08:48:06 AM »
access isnt the issue.  cost is.
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jim555

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Re: What comes after the ACA?
« Reply #109 on: January 09, 2017, 08:51:14 AM »
The Emergency Medical Treatment & Labor Act (EMTALA) ensures public access to emergency services regardless of ability to pay.  The Republicans should repeal this and make sure no free loaders are getting free stuff.  Let the market work and thin out the weak.  Perhaps an area can be set up where the poor can go to die.

wenchsenior

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Re: What comes after the ACA?
« Reply #110 on: January 09, 2017, 08:52:16 AM »
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

There's a lot of people on this board that I'm quite sure don't accept it either.   This vast philosophical gulf is the main reason we can't progress politically on this issue.

iowajes

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Re: What comes after the ACA?
« Reply #111 on: January 09, 2017, 08:52:31 AM »
access isnt the issue.  cost is.

If you can't pay, you don't have access.

What most people need care for isn't things the ER treats, but for chronic conditions that are going to end up killing them.

protostache

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Re: What comes after the ACA?
« Reply #112 on: January 09, 2017, 08:53:05 AM »
access isnt the issue.  cost is.

Access and cost are effectively the same thing. If your choices are putting food on the table, paying for premiums, or bankruptcy after emergency stabilizing treatment, that's not really access. If you can't get insurance because you don't qualify for a high risk pool and no private company will touch you and you can't get a job with benefits for whatever reason, that's not really access.

boarder42

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Re: What comes after the ACA?
« Reply #113 on: January 09, 2017, 08:53:32 AM »
correct everyone has access.  now how do we fund that access. 

i assume what is meant by basic access is a right is that if you have cancer you have a right to have it treated.  you 100% do but how are you going to pay for it.  and are those costs correct or too high. 

Money doesnt grow on trees someone has to pay for all of it.
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Iplawyer

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Re: What comes after the ACA?
« Reply #114 on: January 09, 2017, 08:54:22 AM »
My mother was diagnosed with colon cancer 8 years ago.  It was a genetic type.  No worries, she is fine.  My siblings and I, if we had the gene (50% chance- none of us have it) have a ~100% chance of getting colon cancer.  No matter how healthy we are before then.  If we were on individual insurance we would be dropped instantly.

On a positive note, this is actually untrue. Congress passed the Genetic Information Nondiscrimination Act in 2008, so they can't drop you (or raise premiums) for carrying a genetic mutation. In the pre-ACA world, as long as you didn't have any coverage gaps, you would be fine.

Minor downside: you will spend months arguing with the insurance company about this. Ask me how I know.

And of course the law did nothing at all for an insurance company dropping you after the onset of the genetic disorder.  It just guaranteed you got insurance to begin with.

protostache

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Re: What comes after the ACA?
« Reply #115 on: January 09, 2017, 08:54:36 AM »
access isnt the issue.  cost is.

If you can't pay, you don't have access.

What most people need care for isn't things the ER treats, but for chronic conditions that are going to end up killing them.

Right. The ER doesn't administer chemo and they don't do maintenance dialysis and they won't write you a long term scrip for thyroid maintenance.

scantee

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Re: What comes after the ACA?
« Reply #116 on: January 09, 2017, 08:55:11 AM »
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

I'm sure they don't. But they're smart enough to realize that most Americans, the people they represent, even the very conservative ones, do. If there is one thing that is clear, it's that Americans really love health care. They like it a lot. Too much, really, which is why containing costs is and has been so hard.

It's also important to note that the health care industry is huge and pays ten of millions of Americans at middle-class wages. A lot the exorbitant costs of health care are baked-in inefficiencies that allow a huge segment of the population to have good jobs and good lives. When we start to contain costs, that will almost certainly negatively impact the individual people who work in the health care industry. People will lose jobs, wages will flatten. What is our plan for that? What do we want these people to do, if we don't have jobs for them in health care?

All of this is interconnected and there is no easy solution. Anyone trying to suggest there is, is lying to you.

packlawyer04

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Re: What comes after the ACA?
« Reply #117 on: January 09, 2017, 08:57:08 AM »
Great summary Sol, and great discussion. In my opinion health care costs are the biggest concern for early retirees. There is nothing that can destroy a budget faster than a serious medical problem. The ACA was a gift to the early retiree, too good to be true in many ways. I think the biggest lesson here is that changes in health care, tax or entitlement policy can have a massively negative impact.

Working in medicine I can tell you that using the 'free market' to control your costs will probably not work, because you are not the customer. The insurance company is the customer and you are just along for the ride. Insurance companies will fight to control their costs, but they don't really care what you pay. Navigating the 'in/out of network' maze is infuriating, and many times there is a shortage of specialists in your geographic area anyways so it's a moot point. Sure, you can negotiate on non-emergent services if you are self-pay and save a bit, but the big costs come from medical emergencies where you don't have any negotiating power. A trip to the ICU for a few days can wipe out a decade worth of HSA contributions. Cancer or some other chronic illness can max your deductible every year. It's a real problem.

What we really need is to find  way to decrease costs of medical care in the US. I'm not sure how to do this. The ACA was designed to get everyone insured, but it didn't really address the cost issue. Until this problem is solved there is no math that will make medical care affordable on a population level. We spend over $10,000 per person each year. There is no magical way to pay for this without people paying huge premiums and out of pocket costs. The ACA was designed to smooth this cost out a bit, mainly by forcing healthy and rich people to pay more. http://www.pbs.org/newshour/rundown/new-peak-us-health-care-spending-10345-per-person/

Insane. There is no solution to this problem with any of the proposals. Maybe a single payer could accomplish this, but as others have stated this is politically impossible. Whatever comes next will be great for healthy people, and not so great for sick people. You will likely be OK if you are either really rich or really poor (assuming Medicaid isn't destroyed). Don't get sick in the United States.

Thank you. Nobody wants to talk about this because it is not easy and simple. It is simple to just talk about how to pay for things.

The facts are the ACA does not need to be replaced. It needs to be repealed, slowly. There then needs to be a whole bunch of legislation passed to actually address the problem. Not who is paying for the problem.  Sure you can move to single payer, U.S. government is simply going to go belly up paying for healthcare then.  There is not an easy answer to actuall adress healthcare costs but it affects tons of industries from education to big pharma to the court system.

And please, lets just stop with the comparisons between the U.S and Europe.  American's drive their cars to the end of their driveway to get their mail in route to the all you can eat buffet.  Europeans don't think twice about a vacation that involves biking around for a week. You can't compare the two.

ACA was never intended to be the end all be all of health care legislation. It was always a first step toward a better future. Cost controls were next on the docket, but we had to get everyone covered first. Of course, ACA was followed immediately by six years of congressional obstruction and so the cost control component never happened and now here we are.

I never saw any plans or proposals or ideas from Obama or anyone else regarding the next step.  We were told when the law was in the works that it would reduce healthcare costs but anyone that has actually read the law, which is probably less than 1,000 people knew that was al lie.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #118 on: January 09, 2017, 08:57:36 AM »
In the good old days (pre-2010) insurers would look for any excuse not to pay out a claim.  They would go back in the medical history to find if a person omitted ANYTHING and use that as an excuse not to pay.  The business model is the more they deny claims the more profit to the bottom line.  The free market rewards such behaviour.  The ACA is a reaction to the abuses of the pre-2010 era.

The biggest part of the ACA is expanded Medicaid.  Those on Medicaid have no way to afford medical insurance and survive at the same time without the ACA expansion.  So they flood the ER and go bankrupt when the bills come in.  People should not have to loose everything due to a medical event.  The US is so far behind the rest of the world on this topic it is stunning.

I once had an insurance company try to deny coverage based on my BMI of 19.5 (just let that sink in for a minute). This was after they tried (and failed) to deny based on genetic information. All this to avoid writing a policy on an early twenties graduate student.
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packlawyer04

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Re: What comes after the ACA?
« Reply #119 on: January 09, 2017, 08:59:51 AM »
The Emergency Medical Treatment & Labor Act (EMTALA) ensures public access to emergency services regardless of ability to pay.  The Republicans should repeal this and make sure no free loaders are getting free stuff.  Let the market work and thin out the weak.  Perhaps an area can be set up where the poor can go to die.

I love how this is all republicans. Republicans didn't pass this trash law that is crushing the middle class.  Democrats did.  Along with all of the crap companies had to to to comply with this law, implement EMR, on and on and on.  It didn't work. Time to actually address the problem.  But, I doubt republicans will actually address the problem.  They will pass another bill that just talks about paying for insurance and the saga will continue.
« Last Edit: January 09, 2017, 09:06:29 AM by packlawyer04 »

Iplawyer

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Re: What comes after the ACA?
« Reply #120 on: January 09, 2017, 09:02:34 AM »
couldnt all this simply be fixed with insurance regulation and reform.  It seems to me the largest complaint against the old system is my house burned down and now insurance says they arent gonna pay and dropped me.  How is this insurance.  A simple rule could fix that i'd think. 

still putting everyone in a big pot and then giving credits for being healthier and getting preventative treatments done/ attempting to be healthier and taking classes much like are offered thru large employer group plans seems to be a better cheaper overall system.  then the higher risk people are either taking steps towards becoming less high risk and the rest of the healthy people can keep on about their lives as they have been.  I'm sure invasion of privacy will come up with this but its a credit you dont have to participate if you want to just pay the full tax.

boarder42 - I am going to try one more time.  How do you know you don't have a defective gene that you are passing on?  Many genetic disorders aren't discovered until they become issues.  And what about people who don't have genetic disorders but have operable and curable cancer but then are considered to have a pre existing condition who exercise, run marathons, eat right, and don't procreate?  what would you do with them? 

You - boarder42- aren't a force or nature nor are you God. You have no idea what your genetic makeup is.  Have yo procreated anyway?  I really find you one of the most offensive and awful people here.  Karma is a bitch.  It might catch up with you. In the meantime - please don't procreate.  The world doesn't need anymore people without love in their hearts.


never said i was god.  I have yet to procreate but would not knowlingly procreate with a genetic disorder that could be past on.  Curable things like cancer etc. arent something i brought up, i was tlaking of genetic disorders that are passed on.  and i was playing a devils advocate to all of you who think everyone deserves everything.

boarder42 - please make SURE you are genetically perfect before procreating.  It is possible to KNOW your genetic disorders - so not finding out would be the same thing as knowingly procreating and passing that on to some poor unsuspecting child - that - in your mind - doesn't deserve to be here - even he or she turned out to be like Stephen Hawking. And yes - having curable cancer places you in the pre-existing pot that you talked about being unhealthy. 

You can say you were acting as a devil's advocate - but I think these are your true spots.  I never said "everyone deserves everything." Ever. I'm a self-made person.  But I do think that every human being in this - one of the richest countries on earth -  deserves a basic level of healthcare.  And I don't think that after contributing to society at the maximum level for over 35 years - I should be denied the mere opportunity to pay for health insurance.

Iplawyer

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Re: What comes after the ACA?
« Reply #121 on: January 09, 2017, 09:09:49 AM »
The Emergency Medical Treatment & Labor Act (EMTALA) ensures public access to emergency services regardless of ability to pay.  The Republicans should repeal this and make sure no free loaders are getting free stuff.  Let the market work and thin out the weak.  Perhaps an area can be set up where the poor can go to die.

I love how this is all republicans. Republicans didn't pass this trash law that is crushing the middle class.  Democrats did.

Crushing the middle class?  What are talking about?  Most middle class people are insured through their employer.  Most people helped by the ACA are the poor now on medicaid and the lower middle class now getting subsidies paid for upper middle class people - ie the 1% charge on married couple earning over $250K, the 4+% charge on capital gains for those making more than $250K etc.  I am one of those people subsidizing.  I doubt many people here are.  So how is this "crushing" the middle class?

http://www.motherjones.com/politics/2015/03/obamacare-charts-stats-health-care-reform

NoStacheOhio

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Re: What comes after the ACA?
« Reply #122 on: January 09, 2017, 09:13:46 AM »
The Emergency Medical Treatment & Labor Act (EMTALA) ensures public access to emergency services regardless of ability to pay.  The Republicans should repeal this and make sure no free loaders are getting free stuff.  Let the market work and thin out the weak.  Perhaps an area can be set up where the poor can go to die.

I love how this is all republicans. Republicans didn't pass this trash law that is crushing the middle class.  Democrats did.  Along with all of the crap companies had to to to comply with this law, implement EMR, on and on and on.  It didn't work. Time to actually address the problem.  But, I doubt republicans will actually address the problem.  They will pass another bill that just talks about paying for insurance and the saga will continue.

Plenty of good things came from ACA, and I would strongly argue that EMR is one of them. The next step should be to work on linking EMR across health systems. Does ACA have problems? Absolutely. But I'm firmly on the side of "let's work on improving what we did in 2009-10."
The first step is acknowledging you have a problem, right?

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boarder42

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Re: What comes after the ACA?
« Reply #123 on: January 09, 2017, 09:15:47 AM »
couldnt all this simply be fixed with insurance regulation and reform.  It seems to me the largest complaint against the old system is my house burned down and now insurance says they arent gonna pay and dropped me.  How is this insurance.  A simple rule could fix that i'd think. 

still putting everyone in a big pot and then giving credits for being healthier and getting preventative treatments done/ attempting to be healthier and taking classes much like are offered thru large employer group plans seems to be a better cheaper overall system.  then the higher risk people are either taking steps towards becoming less high risk and the rest of the healthy people can keep on about their lives as they have been.  I'm sure invasion of privacy will come up with this but its a credit you dont have to participate if you want to just pay the full tax.

boarder42 - I am going to try one more time.  How do you know you don't have a defective gene that you are passing on?  Many genetic disorders aren't discovered until they become issues.  And what about people who don't have genetic disorders but have operable and curable cancer but then are considered to have a pre existing condition who exercise, run marathons, eat right, and don't procreate?  what would you do with them? 

You - boarder42- aren't a force or nature nor are you God. You have no idea what your genetic makeup is.  Have yo procreated anyway?  I really find you one of the most offensive and awful people here.  Karma is a bitch.  It might catch up with you. In the meantime - please don't procreate.  The world doesn't need anymore people without love in their hearts.


never said i was god.  I have yet to procreate but would not knowlingly procreate with a genetic disorder that could be past on.  Curable things like cancer etc. arent something i brought up, i was tlaking of genetic disorders that are passed on.  and i was playing a devils advocate to all of you who think everyone deserves everything.

boarder42 - please make SURE you are genetically perfect before procreating.  It is possible to KNOW your genetic disorders - so not finding out would be the same thing as knowingly procreating and passing that on to some poor unsuspecting child - that - in your mind - doesn't deserve to be here - even he or she turned out to be like Stephen Hawking. And yes - having curable cancer places you in the pre-existing pot that you talked about being unhealthy. 

You can say you were acting as a devil's advocate - but I think these are your true spots.  I never said "everyone deserves everything." Ever. I'm a self-made person.  But I do think that every human being in this - one of the richest countries on earth -  deserves a basic level of healthcare.  And I don't think that after contributing to society at the maximum level for over 35 years - I should be denied the mere opportunity to pay for health insurance.

so you're on a FIRE forum why? 35 years of working jobs others could have held so you can sit on your high horse and tell all us yunguns how it should be.  you've had a lifetime to fix the issues you've seen ... what have you personally done about it besides "working at the maximum level" for 35 years.
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packlawyer04

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Re: What comes after the ACA?
« Reply #124 on: January 09, 2017, 09:19:13 AM »
The Emergency Medical Treatment & Labor Act (EMTALA) ensures public access to emergency services regardless of ability to pay.  The Republicans should repeal this and make sure no free loaders are getting free stuff.  Let the market work and thin out the weak.  Perhaps an area can be set up where the poor can go to die.

I love how this is all republicans. Republicans didn't pass this trash law that is crushing the middle class.  Democrats did.  Along with all of the crap companies had to to to comply with this law, implement EMR, on and on and on.  It didn't work. Time to actually address the problem.  But, I doubt republicans will actually address the problem.  They will pass another bill that just talks about paying for insurance and the saga will continue.

Plenty of good things came from ACA, and I would strongly argue that EMR is one of them. The next step should be to work on linking EMR across health systems. Does ACA have problems? Absolutely. But I'm firmly on the side of "let's work on improving what we did in 2009-10."

Won't be too hard to link the EMR systems now since every provider is moving to working for a large conglomerate due to overhead costs.

bacchi

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Re: What comes after the ACA?
« Reply #125 on: January 09, 2017, 09:24:56 AM »
Plenty of good things came from ACA, and I would strongly argue that EMR is one of them. The next step should be to work on linking EMR across health systems. Does ACA have problems? Absolutely. But I'm firmly on the side of "let's work on improving what we did in 2009-10."

Won't be too hard to link the EMR systems now since every provider is moving to working for a large conglomerate due to overhead costs.

No, they're not. Relax and stop with the hyperbole.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #126 on: January 09, 2017, 09:34:08 AM »
The Emergency Medical Treatment & Labor Act (EMTALA) ensures public access to emergency services regardless of ability to pay.  The Republicans should repeal this and make sure no free loaders are getting free stuff.  Let the market work and thin out the weak.  Perhaps an area can be set up where the poor can go to die.

I love how this is all republicans. Republicans didn't pass this trash law that is crushing the middle class.  Democrats did.  Along with all of the crap companies had to to to comply with this law, implement EMR, on and on and on.  It didn't work. Time to actually address the problem.  But, I doubt republicans will actually address the problem.  They will pass another bill that just talks about paying for insurance and the saga will continue.

Plenty of good things came from ACA, and I would strongly argue that EMR is one of them. The next step should be to work on linking EMR across health systems. Does ACA have problems? Absolutely. But I'm firmly on the side of "let's work on improving what we did in 2009-10."

Won't be too hard to link the EMR systems now since every provider is moving to working for a large conglomerate due to overhead costs.

Full disclosure: I work for an absolutely massive 501c3 health system.

I've received care in pretty much every model of practice over the course of my life, but I much prefer what I have right now.

I've seen some insanely remarkable things first-hand. Yes, there are problems, but we work really hard to fix them when they happen. Private practice has plenty of problems too.
The first step is acknowledging you have a problem, right?

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Iplawyer

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Re: What comes after the ACA?
« Reply #127 on: January 09, 2017, 09:51:38 AM »
couldnt all this simply be fixed with insurance regulation and reform.  It seems to me the largest complaint against the old system is my house burned down and now insurance says they arent gonna pay and dropped me.  How is this insurance.  A simple rule could fix that i'd think. 

still putting everyone in a big pot and then giving credits for being healthier and getting preventative treatments done/ attempting to be healthier and taking classes much like are offered thru large employer group plans seems to be a better cheaper overall system.  then the higher risk people are either taking steps towards becoming less high risk and the rest of the healthy people can keep on about their lives as they have been.  I'm sure invasion of privacy will come up with this but its a credit you dont have to participate if you want to just pay the full tax.

boarder42 - I am going to try one more time.  How do you know you don't have a defective gene that you are passing on?  Many genetic disorders aren't discovered until they become issues.  And what about people who don't have genetic disorders but have operable and curable cancer but then are considered to have a pre existing condition who exercise, run marathons, eat right, and don't procreate?  what would you do with them? 

You - boarder42- aren't a force or nature nor are you God. You have no idea what your genetic makeup is.  Have yo procreated anyway?  I really find you one of the most offensive and awful people here.  Karma is a bitch.  It might catch up with you. In the meantime - please don't procreate.  The world doesn't need anymore people without love in their hearts.


never said i was god.  I have yet to procreate but would not knowlingly procreate with a genetic disorder that could be past on.  Curable things like cancer etc. arent something i brought up, i was tlaking of genetic disorders that are passed on.  and i was playing a devils advocate to all of you who think everyone deserves everything.

boarder42 - please make SURE you are genetically perfect before procreating.  It is possible to KNOW your genetic disorders - so not finding out would be the same thing as knowingly procreating and passing that on to some poor unsuspecting child - that - in your mind - doesn't deserve to be here - even he or she turned out to be like Stephen Hawking. And yes - having curable cancer places you in the pre-existing pot that you talked about being unhealthy. 

You can say you were acting as a devil's advocate - but I think these are your true spots.  I never said "everyone deserves everything." Ever. I'm a self-made person.  But I do think that every human being in this - one of the richest countries on earth -  deserves a basic level of healthcare.  And I don't think that after contributing to society at the maximum level for over 35 years - I should be denied the mere opportunity to pay for health insurance.

so you're on a FIRE forum why? 35 years of working jobs others could have held so you can sit on your high horse and tell all us yunguns how it should be.  you've had a lifetime to fix the issues you've seen ... what have you personally done about it besides "working at the maximum level" for 35 years.

I'm on a FIRE forum because I thought I could learn more about being frugal in a retirement I hope to have soon.  I did not know that the board was limited to "yunguns" as you put it. And as I've already said here - we have committed a large portion of our income in all of those 35 years to healthcare, housing, education, and feeding those less advantaged than us.  We are both on local and national boards and both have committed our time to the same causes.

What are you doing other than spouting your mouth off about natural selection here on this forum?

Finally - could a moderator please tell me if those of us that have worked for 35 years are not welcome here.  If so - I'll immediately sign off.

boarder42

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Re: What comes after the ACA?
« Reply #128 on: January 09, 2017, 09:57:49 AM »
but the system is still broke.  so nothing has changed in your lifetime ... its just gotten worse?
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packlawyer04

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Re: What comes after the ACA?
« Reply #129 on: January 09, 2017, 10:03:21 AM »
Plenty of good things came from ACA, and I would strongly argue that EMR is one of them. The next step should be to work on linking EMR across health systems. Does ACA have problems? Absolutely. But I'm firmly on the side of "let's work on improving what we did in 2009-10."

Won't be too hard to link the EMR systems now since every provider is moving to working for a large conglomerate due to overhead costs.

No, they're not. Relax and stop with the hyperbole.

A 5 second google search shows I'm correct.

MayDay

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Re: What comes after the ACA?
« Reply #130 on: January 09, 2017, 10:04:14 AM »
My mother was diagnosed with colon cancer 8 years ago.  It was a genetic type.  No worries, she is fine.  My siblings and I, if we had the gene (50% chance- none of us have it) have a ~100% chance of getting colon cancer.  No matter how healthy we are before then.  If we were on individual insurance we would be dropped instantly.

On a positive note, this is actually untrue. Congress passed the Genetic Information Nondiscrimination Act in 2008, so they can't drop you (or raise premiums) for carrying a genetic mutation. In the pre-ACA world, as long as you didn't have any coverage gaps, you would be fine.

Minor downside: you will spend months arguing with the insurance company about this. Ask me how I know.

And of course the law did nothing at all for an insurance company dropping you after the onset of the genetic disorder.  It just guaranteed you got insurance to begin with.

Correct. I could be privately insured now. But as soon as I got cancer, an individual plan could drop me, and no other individual plan will take me.

So I might sit for 2 years on my states high risk pool waiting list to get that insurance. Except not really because I'll be dead by then! Yay!
Journal:  http://forum.mrmoneymustache.com/journals/mayday's-journal/350/  featuring children, chickens (new!) and other ch words.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #131 on: January 09, 2017, 10:13:41 AM »
Plenty of good things came from ACA, and I would strongly argue that EMR is one of them. The next step should be to work on linking EMR across health systems. Does ACA have problems? Absolutely. But I'm firmly on the side of "let's work on improving what we did in 2009-10."

Won't be too hard to link the EMR systems now since every provider is moving to working for a large conglomerate due to overhead costs.

No, they're not. Relax and stop with the hyperbole.

A 5 second google search shows I'm correct.

Correct sentence is correct? What are you even talking about? Is this supposed to be ironic? Is five seconds the amount of research time we're not going to allow for an authoritative statement?
The first step is acknowledging you have a problem, right?

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

Iplawyer

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Re: What comes after the ACA?
« Reply #132 on: January 09, 2017, 10:16:25 AM »
but the system is still broke.  so nothing has changed in your lifetime ... its just gotten worse?

The ACA made the system much better - yes - because this person could not get dropped for developing the disease.  And that went across every health insurance policy sold on the exchange or not - that is right - this rule applied to every health insurance policy sold - even that provided by employers. And this person's rate could not be jacked up either - so that they could actually afford insurance.

For all of the bad things you talk about - whatever they are - the ACA made insurance a guarantee for people when it wasn't before AT ANY PRICE.  That was a huge improvement for everyone. 

BFGirl

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Re: What comes after the ACA?
« Reply #133 on: January 09, 2017, 10:42:32 AM »
The part that fascinates me in all of this ridiculous debate is how we seem to struggle mightily with these moral quandaries of taxing some folks to provide coverage for other folks and the idea of risk pools and whatnot. All of this while every other rich, industrialized country has figured this shit out years ago and gets better results for less money. It is like we are getting into crazy bar fights over whether to require catalytic converters on our gas-guzzling land yachts while the rest of the world is using hydrogen fuel cells or electric cars to get around. We do a lot of things great in this country but this is one of those topics that completely confuses me and makes me want to run to another country to hide among people who actually see the value in human decency and universal health.

I agree... what seems to get lost in this debate is the moral issue of whether or not healthcare should be a right or a privilege.  It is hard to fashion a solution while our country has not settled on this basic answer.  If it is a right, then universal healthcare seems to be the best and most fair answer.  If it is a privilege, then our society has made a moral judgement that those who have health issues should carry the burden of their own care.

mm1970

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Re: What comes after the ACA?
« Reply #134 on: January 09, 2017, 10:44:40 AM »
The ACA did not fix anything which is why it failed. And make no mistake, it failed. It was simply changing who is paying for healthcare and shifted the burdens around.  Dumping $14,000 deductibles with $1,200 a month premiums on working class families is a failure. The underlying problems are still present, i.e. the actual costs of healthcare.

Until a law actually addresses the costs of healthcare, you can play the hide the ball under the cup game until you are blue in the face but it won't do anything.  Nobody wants to actually discuss the problems, folks just want to talk about how to pay for the problems, ACA, private insurance, single payer, on and on and on.

The reality is we are a fat, sick and out of shape country.

I don't know if it really failed everyone though.  It certainly helped several of my friends who were not able to get insurance AT ALL due to pre-existing conditions.  And these were reasonably healthy, fit, trim individuals.

From someone else's post:
Quote
People should not have to loose everything due to a medical event.

I agree with this statement.  Though there has to be a caveat on spending.  I know people don't like the term "death panels".  I have a friend whose brother died in his 30s because he could not afford insurance.  I have a friend whose father just died last week in his 90s, and for the last 20 years was undergoing extremely expensive medical treatments to keep him alive, because he had great insurance.  So why not?  I see that happening in my family too.  I have retired family members who were lucky enough to have state sponsored pensions.  Once the doctors see that insurance that comes with the pension, they order way more tests and treatments.

It's a sliding scale and I personally don't know where to draw the line.

bender

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Re: What comes after the ACA?
« Reply #135 on: January 09, 2017, 10:44:55 AM »
Best thing about ACA is guarantee of coverage.  Regardless of the plans being put forward currently, I don't think the guarantee will go away.

Worst thing is the ACA did nothing to address underlying costs of healthcare.  Addressing this issue should be the main focus as it will make all the other problems less severe. 

I think it would also be good to incentivize people to become healthier as this will reduce consumption of health care resources and lower costs overall.  Many or our issues are self-inflicted...


mm1970

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Re: What comes after the ACA?
« Reply #136 on: January 09, 2017, 10:47:13 AM »
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.
I simply don't understand. Honestly, if you are going to repeal the ACA, then you simply MUST remove all health care from Congress members and their staffers.  Let them purchase their own insurance on the open market, no exceptions.

boarder42

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Re: What comes after the ACA?
« Reply #137 on: January 09, 2017, 10:49:02 AM »
Best thing about ACA is guarantee of coverage.  Regardless of the plans being put forward currently, I don't think the guarantee will go away.

Worst thing is the ACA did nothing to address underlying costs of healthcare.  Addressing this issue should be the main focus as it will make all the other problems less severe. 

I think it would also be good to incentivize people to become healthier as this will reduce consumption of health care resources and lower costs overall.  Many or our issues are self-inflicted...

Agree

There is even scientific evidence relating eating animal products ESP dairy to increased heart disease and cancer. I eat smoked foods linked to increases in stomach cancer risk. Should society as a whole be responsible for these choices people made? 
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mm1970

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Re: What comes after the ACA?
« Reply #138 on: January 09, 2017, 10:51:56 AM »
Quote
Finally - could a moderator please tell me if those of us that have worked for 35 years are not welcome here.  If so - I'll immediately sign off.

I've been working for 25 years, so I'd say you're good.

To add to my prior post on my friends who now can finally get insurance...

I see it as important now, not just for the poor.  Because honestly, I don't know that many people who are that poor.  Some are poor enough to be on Medi-Cal or the like. 

In my circle, it's generally friends who are unemployed or self-employed in their 40s to 60s whom it benefited.  Some who had pre-existing conditions, some who were laid off and not able to find another job with insurance.

protostache

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Re: What comes after the ACA?
« Reply #139 on: January 09, 2017, 11:03:38 AM »
Best thing about ACA is guarantee of coverage.  Regardless of the plans being put forward currently, I don't think the guarantee will go away.

Worst thing is the ACA did nothing to address underlying costs of healthcare.  Addressing this issue should be the main focus as it will make all the other problems less severe. 

I think it would also be good to incentivize people to become healthier as this will reduce consumption of health care resources and lower costs overall.  Many or our issues are self-inflicted...

The ACA does many things to attempt to control costs. Primarily it changed out Medicaid payouts happened, but it also funded lots of experiments on different ways to pay. It also mandated EHRs which would have allowed extensive data collection on costs and outcomes which allowed measurements of the experiments.

Over time costs would have come down as markets settled and data from the experiments started to come in. Indeed, the inflation curve has been coming down. Two years was not enough time for all of this to settle, however, and now it's all going to change again and costs will probably start rising faster again.

boarder42

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Re: What comes after the ACA?
« Reply #140 on: January 09, 2017, 11:09:39 AM »
Incorporate things properly thru the legislative process and we won't be whipsawed with every organizational change

Fixed
« Last Edit: January 09, 2017, 11:28:40 AM by boarder42 »
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Iplawyer

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Re: What comes after the ACA?
« Reply #141 on: January 09, 2017, 11:26:03 AM »
Inactive things properly thru the legislative process and we won't be whipsawed with every organizational change

I cannot parse this sentence anyway to make any sense of it at all.

boarder42

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Re: What comes after the ACA?
« Reply #142 on: January 09, 2017, 11:30:51 AM »
Inactive things properly thru the legislative process and we won't be whipsawed with every organizational change

I cannot parse this sentence anyway to make any sense of it at all.

Fixed it. The reason this is so easily thrown out is the way it was put in place.  Executive order and fillibuster blocks can be done away with every time we have a simple majority party change in Congress and the president.
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BFGirl

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Re: What comes after the ACA?
« Reply #143 on: January 09, 2017, 11:34:53 AM »
couldnt all this simply be fixed with insurance regulation and reform.  It seems to me the largest complaint against the old system is my house burned down and now insurance says they arent gonna pay and dropped me.  How is this insurance.  A simple rule could fix that i'd think. 

still putting everyone in a big pot and then giving credits for being healthier and getting preventative treatments done/ attempting to be healthier and taking classes much like are offered thru large employer group plans seems to be a better cheaper overall system.  then the higher risk people are either taking steps towards becoming less high risk and the rest of the healthy people can keep on about their lives as they have been.  I'm sure invasion of privacy will come up with this but its a credit you dont have to participate if you want to just pay the full tax.

boarder42 - I am going to try one more time.  How do you know you don't have a defective gene that you are passing on?  Many genetic disorders aren't discovered until they become issues.  And what about people who don't have genetic disorders but have operable and curable cancer but then are considered to have a pre existing condition who exercise, run marathons, eat right, and don't procreate?  what would you do with them? 

You - boarder42- aren't a force or nature nor are you God. You have no idea what your genetic makeup is.  Have yo procreated anyway?  I really find you one of the most offensive and awful people here.  Karma is a bitch.  It might catch up with you. In the meantime - please don't procreate.  The world doesn't need anymore people without love in their hearts.


never said i was god.  I have yet to procreate but would not knowlingly procreate with a genetic disorder that could be past on.  Curable things like cancer etc. arent something i brought up, i was tlaking of genetic disorders that are passed on.  and i was playing a devils advocate to all of you who think everyone deserves everything.

From a purely logical non-emotional standpoint, your arguments could make sense, if society's main criteria is that a person's value to society is their genetic makeup and that the resources available should only be allocated to the strongest and brightest.  However, we are creatures that have emotions and individual ideas.  We do not operate on a purely logical basis, so a completely "logical" solution is unlikely to address the reality of the situation. What happens if criteria are put in place to prevent procreation/treatment of a certain genetic disorder/disease that is much more prevalent in one race over another?  Can that effectively be used to reduce the numbers of a certain race?  If we are truly going to try natural selection, then why not take your argument one step further and decree that based on some objective criteria, that medical care should be withheld from people not meeting a certain level of contribution to society?

I don't think that we need a system that pays for every possible treatment for every possible situation, but I do believe that since we have developed the technology and have resources beyond just the means to feed, clothe and shelter ourselves, that there should be some level of healthcare provided to individuals and paid for by the collective.


Iplawyer

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Re: What comes after the ACA?
« Reply #144 on: January 09, 2017, 11:38:23 AM »
Inactive things properly thru the legislative process and we won't be whipsawed with every organizational change

I cannot parse this sentence anyway to make any sense of it at all.

Fixed it. The reason this is so easily thrown out is the way it was put in place.  Executive order and fillibuster blocks can be done away with every time we have a simple majority party change in Congress and the president.

And even if it wasn't filibustered it could be done away with - what is your point?  Right now the Republicans aren't even going to try and pass legislation - they are going to kill it with budget reconciliation. 

By the way - I answered your question about what I've been doing for 35 years to make things better.  I've not heard what you've been doing to make healthcare more accessible. 

boarder42

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Re: What comes after the ACA?
« Reply #145 on: January 09, 2017, 11:44:55 AM »
Inactive things properly thru the legislative process and we won't be whipsawed with every organizational change

I cannot parse this sentence anyway to make any sense of it at all.

Fixed it. The reason this is so easily thrown out is the way it was put in place.  Executive order and fillibuster blocks can be done away with every time we have a simple majority party change in Congress and the president.

And even if it wasn't filibustered it could be done away with - what is your point?  Right now the Republicans aren't even going to try and pass legislation - they are going to kill it with budget reconciliation. 

By the way - I answered your question about what I've been doing for 35 years to make things better.  I've not heard what you've been doing to make healthcare more accessible.

I didn't reply BC i was done having a dick measuring contest with an internet stranger that was adding no value to this discussion.  But if you'd like to continue to grow yours feel free

Please read the forum rules.  I don't care who "started" what, being rude is not okay.
« Last Edit: January 09, 2017, 04:19:04 PM by ForumModerator »
PM me about how to save 6% on your annual grocery Bill!

There is a 35k starwood bonus right now as well. PM me for the info.

Iplawyer

  • Bristles
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  • Posts: 308
Re: What comes after the ACA?
« Reply #146 on: January 09, 2017, 12:04:51 PM »
Inactive things properly thru the legislative process and we won't be whipsawed with every organizational change

I cannot parse this sentence anyway to make any sense of it at all.


Fixed it. The reason this is so easily thrown out is the way it was put in place.  Executive order and fillibuster blocks can be done away with every time we have a simple majority party change in Congress and the president.

And even if it wasn't filibustered it could be done away with - what is your point?  Right now the Republicans aren't even going to try and pass legislation - they are going to kill it with budget reconciliation. 

By the way - I answered your question about what I've been doing for 35 years to make things better.  I've not heard what you've been doing to make healthcare more accessible.

I didn't reply BC i was done having a dick measuring contest with an internet stranger that was adding no value to this discussion.  But if you'd like to continue to grow yours feel free

You start a dick measuring contest and then duck out when you don't measure up?

That is nice - it is a classic gas lighting move to try and prove to the forum with your challenge that somebody that disagreed with you 1.) shouldn't be on the forum (I've been assured you are VERY wrong about that), and 2.) somehow spend the last 35 years not contributing to society to back up my beliefs.

And then when challenged AFTER you have challenged first - you do the immature thing and talk about your dick.  Really?

Since you started - as you call it - "a dick measuring contest" - with your challenge - you should have checked to make sure I had one first.

Grow up.


Please read the forum rules.  I don't care who "started" what, being rude is not okay.
« Last Edit: January 09, 2017, 04:19:39 PM by ForumModerator »

tct

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Re: What comes after the ACA?
« Reply #147 on: January 09, 2017, 01:03:08 PM »
Exacltly.  Put everyone on an HDHP like real "insurance" should be (a safety net).  And have people pay attention to where their ACTUAL money is going in terms of heath care costs.  Then, watch Americans start to pay attention to heath care and actually shop around a bit.  That keeps health care suppliers in check with competition and health care users in check with the funds they actually have available since they have real skin in the game.

This idea of people having "skin in the game" in order to reduce medical costs is popular, but there's almost no evidence to back up that it works.
For example, just a random recent study looking at individual behavior:
"They found that even when people were responsible for more of their health costs, they weren’t more likely to consider cost or shop around for the best deal on medical treatments."

And an analysis of amount of "skin in the game" across different countries: http://theincidentaleconomist.com/wordpress/skin-in-the-game/
American's pay more out of pocket than other countries, but have higher healthcare costs.

I like the idea that the market will fix our healthcare problems as much as anyone else. But it's not hard to find arguments why market failures show up so readily in healthcare

I think the big ones are the information asymmetry and also the nature and often time sensitiveness of the product being delivered. If your child fell and hit their head, the first doctor you saw says the smartest thing to do would be a CT scan to rule out cranial hemorrhaging, are you going to argue with them, are you going to shop around? Even if you did shop around, and the second doctor said you should do an MRI instead, and then the third doctor said you should do both, are you equipped to choose from the most effective and most cost effective choice?

Let's not forget that there is a very heavily enforced monopoly on who can offer these services. I could perform surgery on you a lot cheaper than most surgeons, hell even give you a CT scan pretty cheap if I had enough capital. I can't guarantee the effectiveness, but you and the population as a whole are smart enough to gauge me for effectiveness right? Unfortunately or fortunately, the government restricts who can legally cut people up or irradiate them. I have no comment on the matter, but some libertarian somewhere is muttering "fucking government" under their breath.
Whenever you have a monopoly of one sort or another, it's hard to see market forces working fully

see also http://theincidentaleconomist.com/wordpress/health-care-market-failures-and-what-can-be-done-about-them/

Health care providers must be forced to publish pricing. After time the decision to go with one provider over the another  will be the same as choosing to purchase your clothes at Walmart as opposed to Neiman Marcus.

Iplawyer

  • Bristles
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  • Posts: 308
Re: What comes after the ACA?
« Reply #148 on: January 09, 2017, 01:16:08 PM »
Exacltly.  Put everyone on an HDHP like real "insurance" should be (a safety net).  And have people pay attention to where their ACTUAL money is going in terms of heath care costs.  Then, watch Americans start to pay attention to heath care and actually shop around a bit.  That keeps health care suppliers in check with competition and health care users in check with the funds they actually have available since they have real skin in the game.

This idea of people having "skin in the game" in order to reduce medical costs is popular, but there's almost no evidence to back up that it works.
For example, just a random recent study looking at individual behavior:
"They found that even when people were responsible for more of their health costs, they weren’t more likely to consider cost or shop around for the best deal on medical treatments."

And an analysis of amount of "skin in the game" across different countries: http://theincidentaleconomist.com/wordpress/skin-in-the-game/
American's pay more out of pocket than other countries, but have higher healthcare costs.

I like the idea that the market will fix our healthcare problems as much as anyone else. But it's not hard to find arguments why market failures show up so readily in healthcare

I think the big ones are the information asymmetry and also the nature and often time sensitiveness of the product being delivered. If your child fell and hit their head, the first doctor you saw says the smartest thing to do would be a CT scan to rule out cranial hemorrhaging, are you going to argue with them, are you going to shop around? Even if you did shop around, and the second doctor said you should do an MRI instead, and then the third doctor said you should do both, are you equipped to choose from the most effective and most cost effective choice?

Let's not forget that there is a very heavily enforced monopoly on who can offer these services. I could perform surgery on you a lot cheaper than most surgeons, hell even give you a CT scan pretty cheap if I had enough capital. I can't guarantee the effectiveness, but you and the population as a whole are smart enough to gauge me for effectiveness right? Unfortunately or fortunately, the government restricts who can legally cut people up or irradiate them. I have no comment on the matter, but some libertarian somewhere is muttering "fucking government" under their breath.
Whenever you have a monopoly of one sort or another, it's hard to see market forces working fully

see also http://theincidentaleconomist.com/wordpress/health-care-market-failures-and-what-can-be-done-about-them/

Health care providers must be forced to publish pricing. After time the decision to go with one provider over the another  will be the same as choosing to purchase your clothes at Walmart as opposed to Neiman Marcus.

That would be nice.  Right now the pricing on anything is dependent on so many things - including if you have insurance and who the insurance is with - that I doubt anybody at any doctor's office anywhere can quote a price.

coppertop

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Re: What comes after the ACA?
« Reply #149 on: January 09, 2017, 01:24:07 PM »
My personal pet peeve is credential bloat in medical staff. It takes us 11-15 years after high school to train a doctor in the US (BA+MD+residency), but most other countries, including in europe, manage the same training in 8. Then once we train those doctors, we insistent that you need an MD to take care of all sorts of cuts and bruises and sniffles at the local doctors office when 90% of cases could be properly treated by someone with only a couple of years training as a medic without having to pass them on up the chain to someone with more expertise. The same thing is starting to happen with Nurse Practitioners, which used to just be an additional 1-2 year masters after a bachelors in nursing (5-6 years total) but is now being pushed towards requiring doctorate level degree after the bachelors degree  (8-10 years total). And of course more school means more student debt, which means you need to pay people in the field more, which means total medical spending goes up.

My husband is a radiologic technician.  He received his education for this in a certificate program at a community college at quite a reasonable cost.  However, the ARRT and other organizations for rad techs are now pushing to require a bachelor's degree to be licensed for this job.  The compensation does not support it and it is not necessary at any rate to do the job.  But that's the way we roll in America.  Everyone has to have a college degree for every job.