Author Topic: What comes after the ACA?  (Read 306244 times)

Metric Mouse

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Re: What comes after the ACA?
« Reply #1500 on: March 12, 2017, 06:39:07 PM »
I sincerely want to help, but maybe I take my taxes elsewhere.  Darwin can run the show in the U.S., I would prefer to live in a country where the already rich don't openly steal from the already struggling and poor.
While I  think that is the opposite of helping, I  can understand the sentiment.
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EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #1501 on: March 12, 2017, 06:46:55 PM »
As a British citizen (although naturalized US), I can become an independent contractor, pay lower taxes and have free healthcare, or live in Dubai with no income tax and cheap private healthcare.  Why pay in to a system that seems to throw my excess payments into a hole and gives me no guarantees for my old age?
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Metric Mouse

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Re: What comes after the ACA?
« Reply #1502 on: March 12, 2017, 06:50:33 PM »
As a British citizen (although naturalized US), I can become an independent contractor, pay lower taxes and have free healthcare, or live in Dubai with no income tax and cheap private healthcare.  Why pay in to a system that seems to throw my excess payments into a hole and gives me no guarantees for my old age?
Now you're beginning to sound like an American!
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EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #1503 on: March 12, 2017, 07:02:35 PM »
I prefer to think of myself as a global citizen, thanks
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EnjoyIt

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Re: What comes after the ACA?
« Reply #1504 on: March 12, 2017, 08:30:57 PM »
I don't trust our leaders to provide any workable health care plan going forward.   I've met and surpassed my planned FIRE number (1.5 M) needed without health care included.   I'm now working to secure a second FIRE level ( +500K) to pay for expected health care expenses. I estimate that I'll secure that extra amount in about two years.  So new total for FIRE is 2M.  Basically that works out to 20k using the 4% rule for health care alone.  I think many of you should reconsider your FIRE number because of the craziness I'm seeing in Washington.

I too have ZERO faith that our government will do anything regarding the cost of healthcare.  They just want us squabbling about who will be paying for it while the insurance companies make huge profits.  I am saving extra so that I can cover my healthcare costs when I FIRE.



And/or be prepared to move out of the US upon RE.

I am thankful we are well beyond our FI requirements like your planning on.

You moving to another country would benefit the US and its tax payers.  Considering you would be pre medicare age and require tax payers to cover your healthcare costs.



Bateaux

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Re: What comes after the ACA?
« Reply #1505 on: March 12, 2017, 10:40:13 PM »
Pretty much with Escape Velocity on this.  As a high net worth and high income family with a better than average health care plan, why should I worry about the ACA?  Yes I'd like affordable health care for all, that's why I supported Bernie Sanders.   I'd like affordable care in retirement.  Early retirement. For me however it's just a matter of waiting a few more years till FIRE.  We're likely in the top 5% of households NW.  We should love the Ryan Plan.  Why on Earth should poor people that voted for Trump?   I'm ready to bail out.   Move to some paradise in Asia and just pay out of pocket.
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NoStacheOhio

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Re: What comes after the ACA?
« Reply #1506 on: March 13, 2017, 06:44:26 AM »
Quote

You're describing the system working. A practice with say, ten midlevels working with three physicians can take good care of lots of people for a reasonable cost, while still catching the more serious stuff that actually requires a doctor. They just need to be working closely enough to know when to bump someone up the food chain.
EnjoyIt -- Wouldn't you rather deal with challenging cases rather than the mundane colds/coughs/sprains? I agree with NoStacheOhio that the system appears to be working. And as you put it, mid-level providers are good for 95% of the cases and experts such as yourself are needed in the more advanced 5%.

Good question.  The answer is, yes, those patients should go to their primary care doctor/provider and not the ER.  But I as a single physician can not supervise 13 midlevel providers at the same time.  It is physically impossible.  I can in reality supervise 2-3 midlevel providers at a time which I already do and how we can catch those 5% of cases efficiently. 

I have a feeling you may not understand how medicine is practiced and what is required of us.

Go back and read my original post. 10/3 = 3.33. Nowhere did I say 13/1.
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EnjoyIt

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Re: What comes after the ACA?
« Reply #1507 on: March 13, 2017, 07:18:15 AM »
Quote

You're describing the system working. A practice with say, ten midlevels working with three physicians can take good care of lots of people for a reasonable cost, while still catching the more serious stuff that actually requires a doctor. They just need to be working closely enough to know when to bump someone up the food chain.
EnjoyIt -- Wouldn't you rather deal with challenging cases rather than the mundane colds/coughs/sprains? I agree with NoStacheOhio that the system appears to be working. And as you put it, mid-level providers are good for 95% of the cases and experts such as yourself are needed in the more advanced 5%.

Good question.  The answer is, yes, those patients should go to their primary care doctor/provider and not the ER.  But I as a single physician can not supervise 13 midlevel providers at the same time.  It is physically impossible.  I can in reality supervise 2-3 midlevel providers at a time which I already do and how we can catch those 5% of cases efficiently. 

I have a feeling you may not understand how medicine is practiced and what is required of us.

Go back and read my original post. 10/3 = 3.33. Nowhere did I say 13/1.

My apologies...I did misread.  Right now it takes about 30 minutes to care for a patient.  In 1 hour a provider can see about 1.8-2.2 patients depending on equity.  At a 3.33 ratio a doctor would be responsible for 6.6 patients per hour.  That is just too much.  2.5 ratio is much more doable and is a very common practice at many hospitals particularly in the tristate area.  That means it is already being done and cutting costs.

What about some of those solo family practice settings that I described in the samples above.  Well, they do not really have a supervising physician to review every case and lay hands on every patient.  Those are the settings were someone with an uncommon presentation gets missed.  At times a disease process is missed for too long and the patient has a very bad outcome. 

NoStacheOhio

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Re: What comes after the ACA?
« Reply #1508 on: March 13, 2017, 07:30:18 AM »
My apologies...I did misread.  Right now it takes about 30 minutes to care for a patient.  In 1 hour a provider can see about 1.8-2.2 patients depending on equity.  At a 3.33 ratio a doctor would be responsible for 6.6 patients per hour.  That is just too much.  2.5 ratio is much more doable and is a very common practice at many hospitals particularly in the tristate area.  That means it is already being done and cutting costs.

What about some of those solo family practice settings that I described in the samples above.  Well, they do not really have a supervising physician to review every case and lay hands on every patient.  Those are the settings were someone with an uncommon presentation gets missed.  At times a disease process is missed for too long and the patient has a very bad outcome.

You're kind of splitting hairs here. If you want 10 midlevels and 4 MDs, great. That's still more efficient than a solo practice, or a small group.

I work in a system with close to 3,000 providers, and there are two or three other big players in the region. We're all buying up solo practices like crazy, pretty soon there won't be any left. The economies of scale allow for some increased efficiency on logistics, and a common EMR helps with reviewing cases, even if the doctors hate it; our PCP called us to follow-up on our son's last ER visit before he had been home for an hour.
The first step is acknowledging you have a problem, right?

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jim555

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Re: What comes after the ACA?
« Reply #1509 on: March 13, 2017, 07:44:56 AM »

Exflyboy

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Re: What comes after the ACA?
« Reply #1510 on: March 13, 2017, 11:51:42 AM »
GOP Health Plan Would Hit Rural Areas Hard
https://www.wsj.com/articles/gop-health-plan-would-hit-rural-areas-hard-1489364405

Yeah, but at least you haven't got a Commie government telling me I got to have it! I mean that would be Socialism and we all know thats just EVIL!.. They have death panels "over there" don't ya know?

This basically means HC for those that can afford it and the rich subsidising primary care for very unhealthy folks in the ER.. So much better!

Metric Mouse

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Re: What comes after the ACA?
« Reply #1511 on: March 13, 2017, 12:21:12 PM »
GOP Health Plan Would Hit Rural Areas Hard
https://www.wsj.com/articles/gop-health-plan-would-hit-rural-areas-hard-1489364405

Yeah, but at least you haven't got a Commie government telling me I got to have it! I mean that would be Socialism and we all know thats just EVIL!.. They have death panels "over there" don't ya know?

This basically means HC for those that can afford it and the rich subsidising primary care for very unhealthy folks in the ER.. So much better!
As mentioned, this seems to be what Americans voted for. The poor voted to pay fort their own healthcare, even though it would cost the rich less.
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Roland of Gilead

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Re: What comes after the ACA?
« Reply #1512 on: March 13, 2017, 12:41:07 PM »
Because the poor are dumb as rocks generally (exceptions) and the rich are able to swing their view with talk (plus they probably secretly admire the rich).

But this is news?  Hasn't the world been this way since one person had three rocks and the other guy none?

jim555

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Re: What comes after the ACA?
« Reply #1513 on: March 13, 2017, 01:25:41 PM »
New ACHA graphics:

NoStacheOhio

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Re: What comes after the ACA?
« Reply #1514 on: March 13, 2017, 01:29:15 PM »
New ACHA graphics:

Nah, they'd never spring for a luxurious tombstone for the poors who don't try hard enough. Give them a post-it on a popsicle stick.

Actually, just dump them into the ocean. No sense wasting diesel on a backhoe.
The first step is acknowledging you have a problem, right?

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RangerOne

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Re: What comes after the ACA?
« Reply #1515 on: March 13, 2017, 01:38:37 PM »
I wouldn't simply call the poor dumb. Most truly poor people don't even vote, they just assume they are getting screwed. And most of the time they are, partly because they don't vote and partly because the parties take advantage of their inability to do a cursory analysis of their proposals.

This has always been true, the poor only receive help when their interest magically align with the interests of better off voting blocks. For the most part I think tampering with health care is unfortunately politically toxic. The odds of you hurting your constituents pocketbooks is incredibly high. If the Republicans move fast and get this bill through it will undoubtedly hurt them in the midterm and next presidential election.

I think there is a good chance that even if the revised ACA pisses off a large part of the Republican voter block, Trump will be able to deflect all that pain onto the Senate and House Republicans.

I am somewhat torn, because as much as I acknowledge that the Republicans touting HSA's as an amazing tool for everyone is bullshit, I am part of the voting block that gets all the benefits of HSA's and would benefit more from them doubling the contribution limit. I would also in a heartbeat vote to shove through any bill to California legislature to make HSA's tax exempt like IRAs in California. Most of us on this site are probably in that boat.

It will be kind of hard to feel bad for voters hurt by this if the majority of them didn't understand Republicans goals for social services generally lean towards helping those already in a position to help themselves. I think often the lagging/missing component of most decent Republican proposals is that they expect x% of people to be lifted out of poverty by a booming economy so they can benefit from their new laws, but when this doesn't happen those voters end up with less help and worse outcomes.


thenextguy

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Re: What comes after the ACA?
« Reply #1516 on: March 13, 2017, 02:15:11 PM »
The non-partisan CBO score was just released.

https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact.pdf

14 million to lose coverage next year. 26 24 million to lose coverage by  2026.

But hey, rich people get a nice tax cut.
« Last Edit: March 13, 2017, 03:49:46 PM by thenextguy »

OurTown

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Re: What comes after the ACA?
« Reply #1517 on: March 13, 2017, 02:21:22 PM »
"If they would rather die," said Scrooge, "they had better do it, and decrease the surplus population."

Paul der Krake

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Re: What comes after the ACA?
« Reply #1518 on: March 13, 2017, 02:42:16 PM »
The non-partisan CBO score was just released.

https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact.pdf

14 million to lose coverage next year. 26 million to lose coverage by 2026.

But hey, rich people get a nice tax cut.

404 as of 4:30 pm Eastern.


geekette

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Re: What comes after the ACA?
« Reply #1519 on: March 13, 2017, 02:57:23 PM »
It's getting hammered, but I pulled it up here at 5PM.

thenextguy

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Re: What comes after the ACA?
« Reply #1520 on: March 13, 2017, 03:00:29 PM »
Damn, I imagine this is the first time the CBO website was brought down due to too much traffic!

Metric Mouse

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Re: What comes after the ACA?
« Reply #1521 on: March 13, 2017, 03:06:32 PM »
Give me one fine day of plain sailing weather and I can mess up anything.

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Metric Mouse

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Re: What comes after the ACA?
« Reply #1522 on: March 13, 2017, 03:08:19 PM »
The non-partisan CBO score was just released.

https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact.pdf

14 million to lose coverage next year. 26 million to lose coverage by 2026.

But hey, rich people get a nice tax cut.
Thank you for sharing.
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protostache

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Re: What comes after the ACA?
« Reply #1523 on: March 13, 2017, 03:40:32 PM »
So, it's pretty much exactly what everyone thought. 14 million people lose coverage almost immediately, increasing to 24 million by 2026. This is contrasted with the current law which would keep the level at about 10% not covered over that same period.

As a high income self-employed mustachian it's a boon. We get to save more in our HSA, our cash flow needs go down because we'll receive a refundable tax credit, and we don't have to stop being self-employed because they're not repealing the ban on medical underwriting.

As a person with a conscience it's abhorrent. Fourteen million people is a hell of a lot of people. That's 4.4% of the entire population of the United States. That's the entire populations of the 12 smallest states combined.

sol

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Re: What comes after the ACA?
« Reply #1524 on: March 13, 2017, 03:51:07 PM »
As a person with a conscience it's abhorrent. Fourteen million people is a hell of a lot of people. That's 4.4% of the entire population of the United States. That's the entire populations of the 12 smallest states combined.

Don't worry, four those states voted blue.

mm1970

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Re: What comes after the ACA?
« Reply #1525 on: March 13, 2017, 04:44:31 PM »
GOP Health Plan Would Hit Rural Areas Hard
https://www.wsj.com/articles/gop-health-plan-would-hit-rural-areas-hard-1489364405

Yeah, but at least you haven't got a Commie government telling me I got to have it! I mean that would be Socialism and we all know thats just EVIL!.. They have death panels "over there" don't ya know?

This basically means HC for those that can afford it and the rich subsidising primary care for very unhealthy folks in the ER.. So much better!
As mentioned, this seems to be what Americans voted for. The poor voted to pay fort their own healthcare, even though it would cost the rich less.

I don't know, I grew up poor and many of my family members still live in that area. 

When I was a kid, I had surgery.  Emergency surgery.  We had no insurance.  The total cost was approximately half our household income for a year.  I do not know if that was straight up cost, or it was negotiated. My parents paid that off over 5 years.  So, 10% of their income each year for 5 years.

Still these days, when someone gets cancer or gets sicks, the community "rallies around" and has pancake breakfasts or spaghetti dinners to fund raise.  For cancer treatment.  Some people get this even though they have insurance, but a lot of people just didn't have any insurance for  years.

And finally: people die younger.  And, I sometimes feel like they are okay with that.  I mean, some people die young anyway, but at 40?  50?  They ignore issues and just get sick and die.

AdrianC

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Re: What comes after the ACA?
« Reply #1526 on: March 13, 2017, 04:59:22 PM »
As mentioned, this seems to be what Americans voted for. The poor voted to pay fort their own healthcare, even though it would cost the rich less.

Most Trump voters don't get their healthcare from Medicaid or Obamacare. They are a-ok under this plan. For now at least.

And to be fair, Trump promised better health care. None of us believed a word of it, but I guess the poor Trump voters did.

Metric Mouse

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Re: What comes after the ACA?
« Reply #1527 on: March 13, 2017, 05:35:01 PM »
As mentioned, this seems to be what Americans voted for. The poor voted to pay fort their own healthcare, even though it would cost the rich less.

Most Trump voters don't get their healthcare from Medicaid or Obamacare. They are a-ok under this plan. For now at least.

And to be fair, Trump promised better health care. None of us believed a word of it, but I guess the poor Trump voters did.
Do you have stats on that? Seems like a large number of people live in Republican states that expanded medicaid, and they still vited for Trump.  Or is your argument that no poor people voted for Trump?

To be fair, Obama  made similar promises. Better healthcare cheaper. Didn't happen either. Seems like it's a complex issue.
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Metric Mouse

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Re: What comes after the ACA?
« Reply #1528 on: March 13, 2017, 05:39:02 PM »
GOP Health Plan Would Hit Rural Areas Hard
https://www.wsj.com/articles/gop-health-plan-would-hit-rural-areas-hard-1489364405

Yeah, but at least you haven't got a Commie government telling me I got to have it! I mean that would be Socialism and we all know thats just EVIL!.. They have death panels "over there" don't ya know?

This basically means HC for those that can afford it and the rich subsidising primary care for very unhealthy folks in the ER.. So much better!
As mentioned, this seems to be what Americans voted for. The poor voted to pay fort their own healthcare, even though it would cost the rich less.

I don't know, I grew up poor and many of my family members still live in that area. 

When I was a kid, I had surgery.  Emergency surgery.  We had no insurance.  The total cost was approximately half our household income for a year.  I do not know if that was straight up cost, or it was negotiated. My parents paid that off over 5 years.  So, 10% of their income each year for 5 years.

Still these days, when someone gets cancer or gets sicks, the community "rallies around" and has pancake breakfasts or spaghetti dinners to fund raise.  For cancer treatment.  Some people get this even though they have insurance, but a lot of people just didn't have any insurance for  years.

And finally: people die younger.  And, I sometimes feel like they are okay with that.  I mean, some people die young anyway, but at 40?  50?  They ignore issues and just get sick and die.
I see many of these benefit lunches/breakfasts/auctions still happening.  Seems even with the ACA there are still gaps in coverage for people.  I'm so proud that my community supports these people in their time of need.
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Re: What comes after the ACA?
« Reply #1529 on: March 14, 2017, 05:17:23 AM »
I was reading an opinion piece yesterday on Bloomberg and this is a great summary of the underlying problems in our healthcare system:

"... voters don’t want genuine insurance, by which I mean a pool that provides financial assistance for genuinely unforeseeable and unmanageable expenses. Voters want comprehensive coverage that kicks in at close to the first dollar of spending, no restrictions on treatments or their ability to see a doctor, nice American-style facilities, and so forth. They are also fond of their health-care professionals and do not wish to see provider incomes slashed and hospitals closed, nor do they want their taxes to go up, or to pay 10 percent of their annual income in premiums. This conflicting set of deeply held views is one major reason that Obamacare -- and American health-care policy more generally -- has the problems it does."

The problem is we can't have it all.  And until we as a society accept that and are prepared for some individual sacrifice for the greater good, we'll have to live with a Frankenstein monster of a health insurance system that we have in this country. 

I paid both the ACA taxes since the ACA was enacted and I think the Ryancare plan is absolutely ridiculous, even though I would directly and immediately benefit from it.  I would gladly pay a lot more for a national single payer system that covers all Americans.  But at this point, it looks it's just a pipe dream.



AdrianC

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Re: What comes after the ACA?
« Reply #1530 on: March 14, 2017, 05:36:59 AM »
As mentioned, this seems to be what Americans voted for. The poor voted to pay fort their own healthcare, even though it would cost the rich less.

Most Trump voters don't get their healthcare from Medicaid or Obamacare. They are a-ok under this plan. For now at least.

And to be fair, Trump promised better health care. None of us believed a word of it, but I guess the poor Trump voters did.
Do you have stats on that? Seems like a large number of people live in Republican states that expanded medicaid, and they still vited for Trump.  Or is your argument that no poor people voted for Trump?

To be fair, Obama  made similar promises. Better healthcare cheaper. Didn't happen either. Seems like it's a complex issue.

http://www.businessinsider.com/exit-polls-who-voted-for-trump-clinton-2016-11/#the-racial-divide-between-democratic-and-republican-voters-was-clear-3

By income, Clinton led only among voters with a 2015 family income under $50,000

A minority of people in the <$50K group voted Trump.
A majority of people in the >$50K group voted Trump.

Most people in the >$50K group get health insurance through work or Medicare. They aren't on Medicaid.

I think it's correct to say that most Trump voters don't get their healthcare from Medicaid or Obamacare. They are fine under this new plan, because it doesn't affect them. For now at least.

AdrianC

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Re: What comes after the ACA?
« Reply #1531 on: March 14, 2017, 05:38:04 AM »
Our representative in congress, Warren Davidson, member of the Freedom Caucus, in response to my email to his office:

I have significant concerns with the current proposal making its way through the House. While the bill repeals nearly all of Obamacare's taxes and spending, it replaces much of its spending with refundable tax credits that in many ways look similar to those in Obamacare. I also believe the bill's rollback of Obamacare's Medicaid expansion does not go far enough or start soon enough.

jim555

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Re: What comes after the ACA?
« Reply #1532 on: March 14, 2017, 05:43:23 AM »
Our representative in congress, Warren Davidson, member of the Freedom Caucus, in response to my email to his office:

I have significant concerns with the current proposal making its way through the House. While the bill repeals nearly all of Obamacare's taxes and spending, it replaces much of its spending with refundable tax credits that in many ways look similar to those in Obamacare. I also believe the bill's rollback of Obamacare's Medicaid expansion does not go far enough or start soon enough.
No enough dead people soon enough.

Schaefer Light

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Re: What comes after the ACA?
« Reply #1533 on: March 14, 2017, 05:57:24 AM »
"... voters don’t want genuine insurance, by which I mean a pool that provides financial assistance for genuinely unforeseeable and unmanageable expenses. Voters want comprehensive coverage that kicks in at close to the first dollar of spending, no restrictions on treatments or their ability to see a doctor, nice American-style facilities, and so forth. They are also fond of their health-care professionals and do not wish to see provider incomes slashed and hospitals closed, nor do they want their taxes to go up, or to pay 10 percent of their annual income in premiums. This conflicting set of deeply held views is one major reason that Obamacare -- and American health-care policy more generally -- has the problems it does."

That's exactly what I want.  Well, that plus access to an HSA.  But I have no idea what it would cost.

AdrianC

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Re: What comes after the ACA?
« Reply #1534 on: March 14, 2017, 05:58:01 AM »
Our representative in congress, Warren Davidson, member of the Freedom Caucus, in response to my email to his office:

I have significant concerns with the current proposal making its way through the House. While the bill repeals nearly all of Obamacare's taxes and spending, it replaces much of its spending with refundable tax credits that in many ways look similar to those in Obamacare. I also believe the bill's rollback of Obamacare's Medicaid expansion does not go far enough or start soon enough.
No enough dead people soon enough.
Apparently.

MrMoneySaver

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Re: What comes after the ACA?
« Reply #1535 on: March 14, 2017, 06:30:17 AM »
This plan is really a piece of garbage.

No Magic in How G.O.P. Plan Lowers Premiums: It Penalizes Older People
https://www.nytimes.com/2017/03/14/upshot/no-magic-in-how-gop-plan-lowers-premiums-it-penalizes-older-people.html?_r=0

radram

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Re: What comes after the ACA?
« Reply #1536 on: March 14, 2017, 07:18:21 AM »

Do we really think that this will pass? I  guess I see too much obstruction from the Democrats and too much division in the Republican party for this to slide though. I've got a terrible track record with reading this stuff though; and consistently wrong goddamn always since last November.
What do you mean by obstruction from the democrats? This plan needs exactly 0 democratic votes to pass via reconciliation.

The only division I see in the Republicans is that this bill does not do enough. Seriously, does anyone have ANY link that shows any republican with a vote in the senate or house that has come out against this plan because it goes too far? I am not talking about being "concerned", I am talking publicly stating they will vote NO. It looks as though their only options are to pass it as is and complain about it not going far enough, or provide even less in the plan to get the freedom caucus on board. Are political figures eligible for acting awards(tony's, Oscar's, Emmy's ). If they get nationwide support for this pile, they deserve one :)

Politically, there is 0 chance they don't de-fund ACA. It is what they said they would do, and they have the votes to do it.

In my opinion, people that still believe nothing will change just have not been paying attention. This last comment is NOT directed at MM, just a general comment.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #1537 on: March 14, 2017, 07:59:10 AM »

Do we really think that this will pass? I  guess I see too much obstruction from the Democrats and too much division in the Republican party for this to slide though. I've got a terrible track record with reading this stuff though; and consistently wrong goddamn always since last November.
What do you mean by obstruction from the democrats? This plan needs exactly 0 democratic votes to pass via reconciliation.

The only division I see in the Republicans is that this bill does not do enough. Seriously, does anyone have ANY link that shows any republican with a vote in the senate or house that has come out against this plan because it goes too far? I am not talking about being "concerned", I am talking publicly stating they will vote NO. It looks as though their only options are to pass it as is and complain about it not going far enough, or provide even less in the plan to get the freedom caucus on board. Are political figures eligible for acting awards(tony's, Oscar's, Emmy's ). If they get nationwide support for this pile, they deserve one :)

Politically, there is 0 chance they don't de-fund ACA. It is what they said they would do, and they have the votes to do it.

In my opinion, people that still believe nothing will change just have not been paying attention. This last comment is NOT directed at MM, just a general comment.

I'm not sure if Collins has come out and explicitly said that, but she has a counter-proposal: https://www.collins.senate.gov/newsroom/us-senator-collins%E2%80%99-statement-release-cbo-score-house-aca-replacement-bill
The first step is acknowledging you have a problem, right?

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

thenextguy

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Re: What comes after the ACA?
« Reply #1538 on: March 14, 2017, 08:15:18 AM »

Do we really think that this will pass? I  guess I see too much obstruction from the Democrats and too much division in the Republican party for this to slide though. I've got a terrible track record with reading this stuff though; and consistently wrong goddamn always since last November.
What do you mean by obstruction from the democrats? This plan needs exactly 0 democratic votes to pass via reconciliation.

The only division I see in the Republicans is that this bill does not do enough. Seriously, does anyone have ANY link that shows any republican with a vote in the senate or house that has come out against this plan because it goes too far? I am not talking about being "concerned", I am talking publicly stating they will vote NO. It looks as though their only options are to pass it as is and complain about it not going far enough, or provide even less in the plan to get the freedom caucus on board. Are political figures eligible for acting awards(tony's, Oscar's, Emmy's ). If they get nationwide support for this pile, they deserve one :)

Politically, there is 0 chance they don't de-fund ACA. It is what they said they would do, and they have the votes to do it.


I don't agree with this. At least not with this iteration of their plan. Tom Cotton, an extremely conservative Senator from Arkansas is urging House members NOT to vote for it because he says it can't pass the Senate.

http://www.huffingtonpost.com/entry/tom-cotton-obamacare-bill-majority_us_58c558e0e4b0ed71826d31bd

Also: 12 GOP senators have criticized Paul Ryan’s health care bill. 3 defections kill it.
« Last Edit: March 14, 2017, 08:19:41 AM by thenextguy »

radram

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Re: What comes after the ACA?
« Reply #1539 on: March 14, 2017, 08:30:35 AM »

I'm not sure if Collins has come out and explicitly said that, but she has a counter-proposal: https://www.collins.senate.gov/newsroom/us-senator-collins%E2%80%99-statement-release-cbo-score-house-aca-replacement-bill
Thanks for the link. Here is the only quote I can see from her.

"But Sen. Susan Collins (R-Maine) said the CBO's findings should be a "cause for alarm" for lawmakers. "It should prompt the House to slow down and reconsider certain provisions of the bill," she said in a statement. "We need to spend the time necessary to get this right."

While not an endorsement, it certainly is not a committed "NO" because it goes too far. Her counter proposal was announced months BEFORE this latest republican plan.

This is exactly my point. Many seem to believe this new plan is the beginning of negotiations and with anything they decide, this new proposal is the worst it could be with regard to cuts. I still contend that this is the BEST it could be. The real bill needs to be much more drastic in order to garner the freedom caucus votes, unless they are vying for those acting awards I mentioned earlier.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #1540 on: March 14, 2017, 08:36:29 AM »

I'm not sure if Collins has come out and explicitly said that, but she has a counter-proposal: https://www.collins.senate.gov/newsroom/us-senator-collins%E2%80%99-statement-release-cbo-score-house-aca-replacement-bill
Thanks for the link. Here is the only quote I can see from her.

"But Sen. Susan Collins (R-Maine) said the CBO's findings should be a "cause for alarm" for lawmakers. "It should prompt the House to slow down and reconsider certain provisions of the bill," she said in a statement. "We need to spend the time necessary to get this right."

While not an endorsement, it certainly is not a committed "NO" because it goes too far. Her counter proposal was announced months BEFORE this latest republican plan.

This is exactly my point. Many seem to believe this new plan is the beginning of negotiations and with anything they decide, this new proposal is the worst it could be with regard to cuts. I still contend that this is the BEST it could be. The real bill needs to be much more drastic in order to garner the freedom caucus votes, unless they are vying for those acting awards I mentioned earlier.

Murkowski, McCain and a few others are also on record saying negative things about the plan.
The first step is acknowledging you have a problem, right?

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

radram

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Re: What comes after the ACA?
« Reply #1541 on: March 14, 2017, 08:48:06 AM »

I don't agree with this. At least not with this iteration of their plan. Tom Cotton, an extremely conservative Senator from Arkansas is urging House members NOT to vote for it because he says it can't pass the Senate.

http://www.huffingtonpost.com/entry/tom-cotton-obamacare-bill-majority_us_58c558e0e4b0ed71826d31bd

Also: 12 GOP senators have criticized Paul Ryan’s health care bill. 3 defections kill it.
I read every word of both links you provided. I stand by my statement that there are still 0 republicans that have committed to vote NO because the bill goes too far. "having concerns" is not at all a committed NO.

The strongest words are the following from the Vox article:
"And Sen. Susan Collins (R-ME), who crosses the aisle more frequently with her votes than most, has said she won’t support a bill that contains the provisions to strip Planned Parenthood of its federal funding. "

Interestingly enough, the link they provided that concluded she "would not support", did not actually attribute those words to her. Here is the only mention of her in that article:
"Meanwhile, Sen. Susan Collins (R-ME) and Sen. Murkowski say the House health bill should be stripped of its provisions to defund Planned Parenthood."

Again, this is not a committed NO because it goes too far.

thenextguy

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Re: What comes after the ACA?
« Reply #1542 on: March 14, 2017, 09:00:40 AM »

I don't agree with this. At least not with this iteration of their plan. Tom Cotton, an extremely conservative Senator from Arkansas is urging House members NOT to vote for it because he says it can't pass the Senate.

http://www.huffingtonpost.com/entry/tom-cotton-obamacare-bill-majority_us_58c558e0e4b0ed71826d31bd

Also: 12 GOP senators have criticized Paul Ryan’s health care bill. 3 defections kill it.
I read every word of both links you provided. I stand by my statement that there are still 0 republicans that have committed to vote NO because the bill goes too far. "having concerns" is not at all a committed NO.

The strongest words are the following from the Vox article:
"And Sen. Susan Collins (R-ME), who crosses the aisle more frequently with her votes than most, has said she won’t support a bill that contains the provisions to strip Planned Parenthood of its federal funding. "

Interestingly enough, the link they provided that concluded she "would not support", did not actually attribute those words to her. Here is the only mention of her in that article:
"Meanwhile, Sen. Susan Collins (R-ME) and Sen. Murkowski say the House health bill should be stripped of its provisions to defund Planned Parenthood."

Again, this is not a committed NO because it goes too far.

I think you need to consider the politics involved. This is how party members oppose things their leadership wants. They generally don't come out and say they're against something until push comes to shove. As of right now there are many Republicans sending the message, "Hey, this isn't going to work for me. We need to revise this."

Like I said, Tom Cotton is actively whipping against House members from voting for this! And yes, he's doing so because it's going to far.

But if you insistent on relying on public statements at face value then this claim falls apart:

Quote
Politically, there is 0 chance they don't de-fund ACA. It is what they said they would do, and they have the votes to do it.

They have the votes to do it? Show me the quotes of 50 Senators that have vowed to support it.

Edit: Hell, show me the quotes of 10 Senators that have committed to support it.
« Last Edit: March 14, 2017, 09:04:14 AM by thenextguy »

radram

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Re: What comes after the ACA?
« Reply #1543 on: March 14, 2017, 09:07:55 AM »
Murkowski, McCain and a few others are also on record saying negative things about the plan.
People vote all the time for bills that have stuff in them they do not agree with. It used to be called compromise and was a sign of strength, not weakness. Times have changed.

Do you have a quote from ANY of them that they plan to vote NO?

When push comes to shove, their only 2 choices are to do NOTHING, or do SOMETHING. I contend that doing nothing would be political suicide since many ran on kill ACA and nothing else. It was effective. They won. They absolutely can not do NOTHING. Everyone is waiting for someone to blink. Will it be the freedom caucus, or the moderate Republicans? What does history tell us?





thenextguy

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Re: What comes after the ACA?
« Reply #1544 on: March 14, 2017, 09:18:38 AM »
Murkowski, McCain and a few others are also on record saying negative things about the plan.
People vote all the time for bills that have stuff in them they do not agree with. It used to be called compromise and was a sign of strength, not weakness. Times have changed.

Do you have a quote from ANY of them that they plan to vote NO?

When push comes to shove, their only 2 choices are to do NOTHING, or do SOMETHING. I contend that doing nothing would be political suicide since many ran on kill ACA and nothing else. It was effective. They won. They absolutely can not do NOTHING. Everyone is waiting for someone to blink. Will it be the freedom caucus, or the moderate Republicans? What does history tell us?

Not that I think it's so important for a Republican to publicly oppose the AHCA right now, but since you seem so insistent on it having meaning here you go:

http://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-issa-s-not-prepared-to-support-gop-1489427228-htmlstory.html

Darrell Issa is a 'No.'


the_gastropod

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Re: What comes after the ACA?
« Reply #1545 on: March 14, 2017, 09:24:02 AM »
I contend that doing nothing would be political suicide since many ran on kill ACA and nothing else. It was effective. They won.

1. Most of them ran on killing "Obamacare", not the ACA. Something like 45% of Americans don't know they're the same thing. The unpopularity of the ACA can largely be attributed to the knee jerk reaction of some disliking anything to do with Obama.

2. Republicans lost the popular vote in the presidential election, and continue to win congressional seats thanks to the wonders of gerrymandering. Acreage is more important than people in the U.S.

thenextguy

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Re: What comes after the ACA?
« Reply #1546 on: March 14, 2017, 09:31:38 AM »
I contend that doing nothing would be political suicide since many ran on kill ACA and nothing else. It was effective. They won.

1. Most of them ran on killing "Obamacare", not the ACA. Something like 45% of Americans don't know they're the same thing. The unpopularity of the ACA can largely be attributed to the knee jerk reaction of some disliking anything to do with Obama.

2. Republicans lost the popular vote in the presidential election, and continue to win congressional seats thanks to the wonders of gerrymandering. Acreage is more important than people in the U.S.

Also, if we're relying on campaign promises to predict future action, Trump ran on not cutting Medicaid and promising coverage for everyone. So much for that.

radram

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Re: What comes after the ACA?
« Reply #1547 on: March 14, 2017, 09:34:19 AM »
I think you need to consider the politics involved. This is how party members oppose things their leadership wants. They generally don't come out and say they're against something until push comes to shove. As of right now there are many Republicans sending the message, "Hey, this isn't going to work for me. We need to revise this."

Like I said, Tom Cotton is actively whipping against House members from voting for this! And yes, he's doing so because it's going to far.

But if you insistent on relying on public statements at face value then this claim falls apart:

Quote
Politically, there is 0 chance they don't de-fund ACA. It is what they said they would do, and they have the votes to do it.

They have the votes to do it? Show me the quotes of 50 Senators that have vowed to support it.

Edit: Hell, show me the quotes of 10 Senators that have committed to support it.

I agree with you with regard to the committed YES votes. In its current form, it is being reported that it has enough support of the house, but since 2 (R) senators can kill it, it has not yet garnered that support. It is interesting that it appears that at this point, there might be enough to kill it because it goes too far, and there might also be enough to kill it because it does not go far enough. Reminds my how fair you are when everyone hates the compromise (looking only at republicans, of course). Who is more likely to compromise, moderate R's, or the freedom caucus? This is why my position is that the present proposal is the minimum cuts that will pass, not the maximum.

I should have clarified my "votes to do it" comment. I meant that they can do any financial maneuvering they want with 0 support from the democrats using budget reconciliation. I still contend they are in agreement that they must do SOMETHING. Do you agree with this assessment?


jim555

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Re: What comes after the ACA?
« Reply #1548 on: March 14, 2017, 09:41:58 AM »
The Trump BS spin is the ACA is unstable, however the CBO disagrees:
"In CBO and JCT’s assessment, however, the nongroup market would probably be stable in most areas under either current law or the legislation."

So has Trump declared the CBO the enemy of the people yet?

thenextguy

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Re: What comes after the ACA?
« Reply #1549 on: March 14, 2017, 09:44:51 AM »
I think you need to consider the politics involved. This is how party members oppose things their leadership wants. They generally don't come out and say they're against something until push comes to shove. As of right now there are many Republicans sending the message, "Hey, this isn't going to work for me. We need to revise this."

Like I said, Tom Cotton is actively whipping against House members from voting for this! And yes, he's doing so because it's going to far.

But if you insistent on relying on public statements at face value then this claim falls apart:

Quote
Politically, there is 0 chance they don't de-fund ACA. It is what they said they would do, and they have the votes to do it.

They have the votes to do it? Show me the quotes of 50 Senators that have vowed to support it.

Edit: Hell, show me the quotes of 10 Senators that have committed to support it.

I agree with you with regard to the committed YES votes. In its current form, it is being reported that it has enough support of the house, but since 2 (R) senators can kill it, it has not yet garnered that support. It is interesting that it appears that at this point, there might be enough to kill it because it goes too far, and there might also be enough to kill it because it does not go far enough. Reminds my how fair you are when everyone hates the compromise (looking only at republicans, of course). Who is more likely to compromise, moderate R's, or the freedom caucus? This is why my position is that the present proposal is the minimum cuts that will pass, not the maximum.

I should have clarified my "votes to do it" comment. I meant that they can do any financial maneuvering they want with 0 support from the democrats using budget reconciliation. I still contend they are in agreement that they must do SOMETHING. Do you agree with this assessment?

I agree that many Republicans will pay a political price if they don't do something. But I don't think that means they can/will be able to do something. They ran against the ACA for 6 years, but they never thought ahead to what they would do if they actually had to do something. Now that we're here, they're discovering that they will also pay a political price if they actually do do something. The problem is that the political price to be paid is not uniform. Dean Heller, Senator of Nevada, might pay a political price for repealing the ACA. A Republican House member in a deep red gerrymandered district might pay a political price if they don't repeal the ACA. So which of the forces will win out? Well, given how incredibly thin the room for error is, especially in the Senate, I think it's going to be extremely difficult to find a plan that a majority of Republicans in the House and Senate can support.