Author Topic: What comes after the ACA?  (Read 386823 times)

MrMoneySaver

  • 5 O'Clock Shadow
  • *
  • Posts: 99
Re: What comes after the ACA?
« Reply #1800 on: March 31, 2017, 05:30:09 PM »

Bateaux

  • Pencil Stache
  • ****
  • Posts: 807
  • Location: Port Vincent
Re: What comes after the ACA?
« Reply #1801 on: March 31, 2017, 10:26:20 PM »
That's the delima I'm currently facing.   Want to FIRE but can't trust our health care system.
“Perfection is achieved, not when there is nothing more to add, but when there is nothing left to take away.”
 ― Antoine de Saint Exupery-

Class of 2019

DavidAnnArbor

  • Handlebar Stache
  • *****
  • Posts: 1333
  • Age: 52
  • Location: Ann Arbor, Michigan
Re: What comes after the ACA?
« Reply #1802 on: April 01, 2017, 06:37:16 AM »
"Here’s a big roadblock for your dreams of early retirement"
http://www.marketwatch.com/story/how-washington-just-upended-your-dreams-of-early-retirement-2017-03-29

The article even cites MrMoneyMustache ideas of early retirement

EnjoyIt

  • Pencil Stache
  • ****
  • Posts: 787
Re: What comes after the ACA?
« Reply #1803 on: April 01, 2017, 11:15:42 PM »

It amazes me how much of the "debate" is about who pays what, rather than how much y'all pay and what you get for it.

You are so point on.  The healthcare industry would rather us fight over who pays as opposed to having real transparency, and decreasing the cost of medical care.  Healthcare has no ceiling in cost when it comes free once deductibles are met.  It is no different in the cost of higher education.  Since it is subsidized by unlimited loans, the cost just keeps rising.  In medicine there will always be more research, more medicine, more tech that will cost more and more and more.  Like fools we keep yelling at each other "who will pay for it all?"  We are having the wrong discussion here people. It shouldn't be who will pay, but how much we pay and what we get for it.

Mr Mark

  • Handlebar Stache
  • *****
  • Posts: 1043
  • Location: Detroit, MI
  • Achieved Financial Independence summer 2014. RE'18
Re: What comes after the ACA?
« Reply #1804 on: April 02, 2017, 12:23:05 AM »
I hope the collapse of the GOP's crazy tax cut health bill will enable a more considered law that is underpinned by some kind of public option, based on medicaid I guess. But I presume the industry  - insurance, hospitals, doctors - will squeal like crazy at that.
Mr. Mark

Monkey Uncle

  • Handlebar Stache
  • *****
  • Posts: 1039
  • Location: West-by-god-Virginia
Re: What comes after the ACA?
« Reply #1805 on: April 02, 2017, 04:29:35 AM »
I hope the collapse of the GOP's crazy tax cut health bill will enable a more considered law that is underpinned by some kind of public option, based on medicaid I guess. But I presume the industry  - insurance, hospitals, doctors - will squeal like crazy at that.

Ain't gonna happen until the Democrats control the presidency, House, and at least 60 votes in the Senate.  To do that, they'll have to take back all the state legislatures and governorships they've lost so they can undo all the gerrymandering that the republicans did when the 2010 census coincided with the Tea Party wave.  Next opportunity for major re-districting is 2021.  So they need to win a lot of state races in 2018 and 2020, fix the gerrymandering in 2021, then they might be able to take Congress during the 2022 mid-terms.  If they happen to also win the presidency in 2020, then we might be looking at real health care reform in 2023.  Sigh.
"Take this job and shove it" - David Allan Coe

EnjoyIt

  • Pencil Stache
  • ****
  • Posts: 787
Re: What comes after the ACA?
« Reply #1806 on: April 02, 2017, 08:37:14 AM »
I hope the collapse of the GOP's crazy tax cut health bill will enable a more considered law that is underpinned by some kind of public option, based on medicaid I guess. But I presume the industry  - insurance, hospitals, doctors - will squeal like crazy at that.

Ain't gonna happen until the Democrats control the presidency, House, and at least 60 votes in the Senate.  To do that, they'll have to take back all the state legislatures and governorships they've lost so they can undo all the gerrymandering that the republicans did when the 2010 census coincided with the Tea Party wave.  Next opportunity for major re-districting is 2021.  So they need to win a lot of state races in 2018 and 2020, fix the gerrymandering in 2021, then they might be able to take Congress during the 2022 mid-terms.  If they happen to also win the presidency in 2020, then we might be looking at real health care reform in 2023.  Sigh.

Don't you get it, there is no healthcare reform from democrats or republicans.  Its a bunch of bullshit.  Real reform will happen only when the prices are so outlandish that no one can afford it.  Until then it will be the same old same old.  Let the people argue about who will pay for it in the meantime.  It really makes no difference if it is a republican or democrat.  If the Rich pay more or the old pay more or the middle class pay more, someone has to pay while the price keeps going up.  And it will continue to rise until we stop this stupid battle about who will pay and switch to real transparency in cost cutting measures.

As I see it, the only cost cutting measures I see create more hoops to jump though in the medical industry which actually increases cost to the hospitals and physicians with the threat of decreasing reimbursement.  But the cost just keeps rising in the meantime.

You can keep increasing premiums for some group of people, the rich for example, but it will not contain the actual price, prices will go up until premiums need to go up again and again and again.  Our hunger for the latest and greatest medicine, technology, research, etc is never ending and therefor price has only one way to go especially when so many get it for "free," or "free" after deductible.

DavidAnnArbor

  • Handlebar Stache
  • *****
  • Posts: 1333
  • Age: 52
  • Location: Ann Arbor, Michigan
Re: What comes after the ACA?
« Reply #1807 on: April 02, 2017, 09:15:33 AM »
I hope the collapse of the GOP's crazy tax cut health bill will enable a more considered law that is underpinned by some kind of public option, based on medicaid I guess. But I presume the industry  - insurance, hospitals, doctors - will squeal like crazy at that.

Ain't gonna happen until the Democrats control the presidency, House, and at least 60 votes in the Senate.  To do that, they'll have to take back all the state legislatures and governorships they've lost so they can undo all the gerrymandering that the republicans did when the 2010 census coincided with the Tea Party wave.  Next opportunity for major re-districting is 2021.  So they need to win a lot of state races in 2018 and 2020, fix the gerrymandering in 2021, then they might be able to take Congress during the 2022 mid-terms.  If they happen to also win the presidency in 2020, then we might be looking at real health care reform in 2023.  Sigh.

Don't you get it, there is no healthcare reform from democrats or republicans.  Its a bunch of bullshit.  Real reform will happen only when the prices are so outlandish that no one can afford it.  Until then it will be the same old same old.  Let the people argue about who will pay for it in the meantime.  It really makes no difference if it is a republican or democrat.  If the Rich pay more or the old pay more or the middle class pay more, someone has to pay while the price keeps going up.  And it will continue to rise until we stop this stupid battle about who will pay and switch to real transparency in cost cutting measures.

As I see it, the only cost cutting measures I see create more hoops to jump though in the medical industry which actually increases cost to the hospitals and physicians with the threat of decreasing reimbursement.  But the cost just keeps rising in the meantime.

You can keep increasing premiums for some group of people, the rich for example, but it will not contain the actual price, prices will go up until premiums need to go up again and again and again.  Our hunger for the latest and greatest medicine, technology, research, etc is never ending and therefor price has only one way to go especially when so many get it for "free," or "free" after deductible.

The public option if it were allowed to happen in the ACA is real reform that the Democrats tried to create and it was almost accomplished save 1 or 2 Senate votes. So let's try to get that through.

I do agree that the costs need to stabilize, and it will have to come down to rationing of health care - using health care technology in a more smart, sensible, and useful way.
And the ACA included significant reforms to slow the growth of Medicare spending.
ACA reform is trying to change the model of reimbursement based on outcomes rather than the number of medical procedures performed.

https://www.americanprogress.org/issues/economy/news/2017/03/30/429602/new-data-deliver-good-news-health-care-bad-news-speaker-ryans-tax-reform-plan/

Monkey Uncle

  • Handlebar Stache
  • *****
  • Posts: 1039
  • Location: West-by-god-Virginia
Re: What comes after the ACA?
« Reply #1808 on: April 02, 2017, 02:27:11 PM »
I hope the collapse of the GOP's crazy tax cut health bill will enable a more considered law that is underpinned by some kind of public option, based on medicaid I guess. But I presume the industry  - insurance, hospitals, doctors - will squeal like crazy at that.

Ain't gonna happen until the Democrats control the presidency, House, and at least 60 votes in the Senate.  To do that, they'll have to take back all the state legislatures and governorships they've lost so they can undo all the gerrymandering that the republicans did when the 2010 census coincided with the Tea Party wave.  Next opportunity for major re-districting is 2021.  So they need to win a lot of state races in 2018 and 2020, fix the gerrymandering in 2021, then they might be able to take Congress during the 2022 mid-terms.  If they happen to also win the presidency in 2020, then we might be looking at real health care reform in 2023.  Sigh.

Don't you get it, there is no healthcare reform from democrats or republicans.  Its a bunch of bullshit.  Real reform will happen only when the prices are so outlandish that no one can afford it.  Until then it will be the same old same old.  Let the people argue about who will pay for it in the meantime.  It really makes no difference if it is a republican or democrat.  If the Rich pay more or the old pay more or the middle class pay more, someone has to pay while the price keeps going up.  And it will continue to rise until we stop this stupid battle about who will pay and switch to real transparency in cost cutting measures.

As I see it, the only cost cutting measures I see create more hoops to jump though in the medical industry which actually increases cost to the hospitals and physicians with the threat of decreasing reimbursement.  But the cost just keeps rising in the meantime.

You can keep increasing premiums for some group of people, the rich for example, but it will not contain the actual price, prices will go up until premiums need to go up again and again and again.  Our hunger for the latest and greatest medicine, technology, research, etc is never ending and therefor price has only one way to go especially when so many get it for "free," or "free" after deductible.

The public option if it were allowed to happen in the ACA is real reform that the Democrats tried to create and it was almost accomplished save 1 or 2 Senate votes. So let's try to get that through.

I do agree that the costs need to stabilize, and it will have to come down to rationing of health care - using health care technology in a more smart, sensible, and useful way.
And the ACA included significant reforms to slow the growth of Medicare spending.
ACA reform is trying to change the model of reimbursement based on outcomes rather than the number of medical procedures performed.

https://www.americanprogress.org/issues/economy/news/2017/03/30/429602/new-data-deliver-good-news-health-care-bad-news-speaker-ryans-tax-reform-plan/

Single payer has the power to (1) ration care, and (2) set prices.  That's how the rest of the civilized world gets better health outcomes at half the cost.
"Take this job and shove it" - David Allan Coe

gerardc

  • Bristles
  • ***
  • Posts: 420
  • Age: 33
  • Location: SF bay area
Re: What comes after the ACA?
« Reply #1809 on: April 02, 2017, 02:55:12 PM »
Single payer has the power to (1) ration care, and (2) set prices.  That's how the rest of the civilized world gets better health outcomes at half the cost.

Say we get a single payer with rationed care and set prices. The vast majority will benefit, but who will suffer the consequences?
1- Patients get less care and suffer from it
2- Patients get less care but are equally well off because some of it was useless
3- Doctors/nurses/etc. get paid less
4- Insurance companies have lower profits
5- Middle-men become obsolete, and transfer to more useful occupations in the long term

I genuinely don't know. Anybody care to guess?
« Last Edit: April 02, 2017, 02:57:31 PM by gerardc »

stoaX

  • Bristles
  • ***
  • Posts: 377
  • Location: SoCal
  • 'tis nothing good nor bad but thinking makes it so
Re: What comes after the ACA?
« Reply #1810 on: April 02, 2017, 03:02:51 PM »
Single payer has the power to (1) ration care, and (2) set prices.  That's how the rest of the civilized world gets better health outcomes at half the cost.

Say we get a single payer with rationed care and set prices. The vast majority will benefit, but who will suffer the consequences?
1- Patients get less care and suffer from it
2- Patients get less care but are equally well off because some of it was useless
3- Doctors/nurses/etc. get paid less
4- Insurance companies have lower profits
5- Middle-men become obsolete, and transfer to more useful occupations in the long term

I genuinely don't know. Anybody care to guess?

I guess all 5 with the possible exception of #4 - don't underestimate the ability of the health insurance carriers to adapt, particularly the ones that are well connected politically.

Glenstache

  • Handlebar Stache
  • *****
  • Posts: 1474
  • Age: 185
  • Location: Seattle!
  • Target FI date 2027 (maybe?)
Re: What comes after the ACA?
« Reply #1811 on: April 02, 2017, 03:07:07 PM »
Single payer has the power to (1) ration care, and (2) set prices.  That's how the rest of the civilized world gets better health outcomes at half the cost.

Say we get a single payer with rationed care and set prices. The vast majority will benefit, but who will suffer the consequences?
1- Patients get less care and suffer from it
2- Patients get less care but are equally well off because some of it was useless
3- Doctors/nurses/etc. get paid less
4- Insurance companies have lower profits
5- Middle-men become obsolete, and transfer to more useful occupations in the long term

I genuinely don't know. Anybody care to guess?

I would suggest that 4 and 5 would be the biggest necessary impacts to reduce costs. While recognizing that it could have big local economic imapcts where the insurance companies are big employers, I would not be disappointed to see them go away entriely under a single payer system (though they may remain for some sort of parallel secondary health care market). If we assume that the 10 to 20% profit for insurance companies and brokers (note that this is above and beyond the actual administrative costs) would go away with single payer, that gets us a big chunk of the way to more cost effective care without decreasing the actual doctor-patient care. It is a reasonable assumption that a single payer system could result in less paperwork and administrative overhead for doctors (i.e., only one bureaucratic system to interface with), which could also reduce costs.


NoStacheOhio

  • Handlebar Stache
  • *****
  • Posts: 1648
  • Location: Cleveland
Re: What comes after the ACA?
« Reply #1812 on: April 02, 2017, 03:15:30 PM »
Single payer has the power to (1) ration care, and (2) set prices.  That's how the rest of the civilized world gets better health outcomes at half the cost.

Say we get a single payer with rationed care and set prices. The vast majority will benefit, but who will suffer the consequences?
1- Patients get less care and suffer from it
2- Patients get less care but are equally well off because some of it was useless
3- Doctors/nurses/etc. get paid less
4- Insurance companies have lower profits
5- Middle-men become obsolete, and transfer to more useful occupations in the long term

I genuinely don't know. Anybody care to guess?

I think 2 is more likely than 1 at the population level. We have plenty of capacity, and making it more difficult for super-utilizers to super-utilize would free up resources for people who are, y'know, actually sick.

WRT #3, if med school didn't saddle docs with so much debt, getting paid less wouldn't be as big of a deal.
The first step is acknowledging you have a problem, right?

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

Classical_Liberal

  • Pencil Stache
  • ****
  • Posts: 750
  • Age: 41
Re: What comes after the ACA?
« Reply #1813 on: April 02, 2017, 03:18:40 PM »
I'm a nurse.  If I got paid any less I'd switch careers or retire.  Hopefully trump doesn't keep up with the anti-immigration movement, because I'm not alone in this sentiment and there's already a shortage in large swaths of the country.   

DavidAnnArbor

  • Handlebar Stache
  • *****
  • Posts: 1333
  • Age: 52
  • Location: Ann Arbor, Michigan
Re: What comes after the ACA?
« Reply #1814 on: April 02, 2017, 03:22:10 PM »
Economist Brad De Long rips into his conservative colleague John Cochrane of the Hoover Institution. Cochrane pronounced that the Obamacare Exchanges would collapse in Spring 2014, and now Cochranes makes the same claim but this time it is for April 2017.

http://www.bradford-delong.com/2017/04/i-see-john-cochrane-has-tried-to-make-an-april-fools-day-joke-of-sorts-about-obamacare.html

Interesting points that Brad De Long makes include:

"There are problems in the Neo-Confederacy. If you (a) have a poor population, (b) have an unhealthy population, and (c) by not expanding Medicaid overload the Exchanges with more poor people desperate for coverage because they know they are likely to get sick, then you can damage the ObamaCare Exchanges: you can raise adverse selection problems in the ObamaCare Exchanges to a level in which only a single monopoly insurance seller can make money."

Here is a webpage link for which states did/did not expand Medicaid

http://familiesusa.org/product/50-state-look-medicaid-expansion

stoaX

  • Bristles
  • ***
  • Posts: 377
  • Location: SoCal
  • 'tis nothing good nor bad but thinking makes it so
Re: What comes after the ACA?
« Reply #1815 on: April 02, 2017, 03:30:17 PM »
Single payer has the power to (1) ration care, and (2) set prices.  That's how the rest of the civilized world gets better health outcomes at half the cost.

Say we get a single payer with rationed care and set prices. The vast majority will benefit, but who will suffer the consequences?
1- Patients get less care and suffer from it
2- Patients get less care but are equally well off because some of it was useless
3- Doctors/nurses/etc. get paid less
4- Insurance companies have lower profits
5- Middle-men become obsolete, and transfer to more useful occupations in the long term

I genuinely don't know. Anybody care to guess?

I would suggest that 4 and 5 would be the biggest necessary impacts to reduce costs. While recognizing that it could have big local economic imapcts where the insurance companies are big employers, I would not be disappointed to see them go away entriely under a single payer system (though they may remain for some sort of parallel secondary health care market). If we assume that the 10 to 20% profit for insurance companies and brokers (note that this is above and beyond the actual administrative costs) would go away with single payer, that gets us a big chunk of the way to more cost effective care without decreasing the actual doctor-patient care. It is a reasonable assumption that a single payer system could result in less paperwork and administrative overhead for doctors (i.e., only one bureaucratic system to interface with), which could also reduce costs.

I don't think the insurance companies would go away because of single payer.  The insurance carriers are still involved with Medicare, ranging from administration of claims to assuming the risk (and reward) with full Medicare Advantage plans.

jim555

  • Handlebar Stache
  • *****
  • Posts: 1338
Re: What comes after the ACA?
« Reply #1816 on: April 02, 2017, 07:22:58 PM »
Recent Donald J. Trump tweets...
"Talks on Repealing and Replacing ObamaCare are, and have been, going on, and will continue until such time as a deal is hopefully struck."
"Anybody (especially  Fake News media) who thinks that Repeal & Replace of ObamaCare is dead does not know the love and strength in R Party!"

"love and strength in R Party" = send tens of thousands to early death due to unaffordable health coverage.  These guys are such a bunch of compulsive liars.

EnjoyIt

  • Pencil Stache
  • ****
  • Posts: 787
Re: What comes after the ACA?
« Reply #1817 on: April 03, 2017, 01:31:52 AM »
I would suggest that 4 and 5 would be the biggest necessary impacts to reduce costs. While recognizing that it could have big local economic imapcts where the insurance companies are big employers, I would not be disappointed to see them go away entriely under a single payer system (though they may remain for some sort of parallel secondary health care market). If we assume that the 10 to 20% profit for insurance companies and brokers (note that this is above and beyond the actual administrative costs) would go away with single payer, that gets us a big chunk of the way to more cost effective care without decreasing the actual doctor-patient care. It is a reasonable assumption that a single payer system could result in less paperwork and administrative overhead for doctors (i.e., only one bureaucratic system to interface with), which could also reduce costs.

Where have you seen 10-20% profit margins for health insurers? The number I've seen for industry average is 3.3%.

One of the biggest contributors to high medical costs is the incentive structure for fee-for-service providers. For example, surgeons recommend invasive back surgery instead of PT for certain issues that would be helped just as much by PT, with less risk. One of those makes surgeons a lot of money. One doesn't.

Nobody wants to even hint at criticizing doctors. Some of you may be offended at my suggestion that money considerations would affect the recommended treatment. But a hospital full of salaried doctors is going to operate differently than one with doctors compensated per procedure.

Sure, pay me a flat rate and I'll clock out at 5pm and have time for an early dinner and a good nights sleep. I'm not staying late and working hard anymore.

I guess you get what you pay for.

BTW, the way Medicare is cutting cost is through beautocratic hoops we now must jump though. Don't worry costs will continue to go up despite these hoops. We just learn to play the new billing and coding game they are offering while patients continue to demand everything all at once without regard to actual cost.

former player

  • Magnum Stache
  • ******
  • Posts: 2610
  • Location: Avalon
Re: What comes after the ACA?
« Reply #1818 on: April 03, 2017, 01:46:03 AM »

Sure, pay me a flat rate and I'll clock out at 5pm and have time for an early dinner and a good nights sleep. I'm not staying late and working hard anymore.

UK's National Health Service pays its doctors a flat rate, and whatever is wrong with it has very little to do with the doctors.  Your attitude is your own, not a general position to build a policy case on.

Reducing the USA's health spend by 3.3% plus the cost of the insurer's and other people's bureaucracy in dealing with the insurance companies could be a good start to reform.  That would pay for a lot of extra health care.
Be frugal and industrious, and you will be free (Ben Franklin)

Classical_Liberal

  • Pencil Stache
  • ****
  • Posts: 750
  • Age: 41
Re: What comes after the ACA?
« Reply #1819 on: April 03, 2017, 04:26:22 AM »
[quote author=EnjoyIt link=topic=66557.msg1499738#msg1499738 date=1491204712
Sure, pay me a flat rate and I'll clock out at 5pm and have time for an early dinner and a good nights sleep. I'm not staying late and working hard anymore.

I guess you get what you pay for.
[/quote]

Its always a great idea to cut pay, vilify providers and health care workers because they make too much or recommend best practice treatment options... That is until its 5:05 (or 2AM)... and the patient's are no longer getting what they want, are in pain, have life threatening conditions and complications, etc.  Then, suddenly and amazingly, it seems we are worth our weight in gold. 

Monkey Uncle

  • Handlebar Stache
  • *****
  • Posts: 1039
  • Location: West-by-god-Virginia
Re: What comes after the ACA?
« Reply #1820 on: April 03, 2017, 04:30:26 AM »
[quote author=EnjoyIt link=topic=66557.msg1499738#msg1499738 date=1491204712
Sure, pay me a flat rate and I'll clock out at 5pm and have time for an early dinner and a good nights sleep. I'm not staying late and working hard anymore.

I guess you get what you pay for.

Its always a great idea to cut pay, vilify providers and health care workers because they make too much or recommend best practice treatment options... That is until its 5:05 (or 2AM)... and the patient's are no longer getting what they want, are in pain, have life threatening conditions and complications, etc.  Then, suddenly and amazingly, it seems we are worth our weight in gold.
[/quote]

Death Panels!  DEATH PANELS!!  SCREAM IT LOUDER AND MAYBE IT WILL BECOME TRUE!!!
"Take this job and shove it" - David Allan Coe

EnjoyIt

  • Pencil Stache
  • ****
  • Posts: 787
Re: What comes after the ACA?
« Reply #1821 on: April 03, 2017, 08:25:31 AM »
Death Panels is a comment people say to scare away from a conversation.  Stop using it as it is useless.

We don't need to spend more on healthcare, we need to cut costs.  We cut costs through efficiency, decreased bureaucracy, removing the middle man from everyday or low cost healthcare spending.  BTW, I am all for a 1 payer system for the poor. 

Just remember our demand for healthcare is always rising.  People want to be seen immediately, treated immediately, use the latest and newest drugs, use the latest and greatest tech, demanding everything done for their braindead, bed ridden family members, etc.  All of that costs money and there is no ceiling to how much it can and will cost.  Until we combat the above, there is no healthcare plan that will fix the issue.  ACA will fail just like AHCA or whatever bullshit congress passes.

The ACA did nothing to combat actual cost of care, they just built more bureaucracy into the system so that hospitals and providers need to jump through more hoops to get paid.  It cuts cost for the first year or two until we/they learn how to play the new game and we are back on the rise again.

The ACA is talking about capitation models for reimbursement.  This was tried in the 90s and failed.  They talk about value based reimbursement. This is a good thing since it tends to improve outcomes.  Unfortunately these values or outcomes appear to be picked by people who don't understand medicine.  Some are excellent while others just create more work with no benefit and actual harm to the patient.

It is so easy to talk about healthcare when all the facts one gets come from the internet and are regurgitated such as the word "death panels." it is another to be physically involved, caring for real live people at 3pm or 3am.  It is completely different when regulations are shoved down your throat that do nothing but take you away from the patient to document or comply with those regulation. 

Us greedy doctors want to take care of people, make them understand their bodies and how to live longer and healthier.  It is in most of our nature and training.  We give up 12 years of our lives for this pursuit and then some dip shit with no medical knowledge comes around and thinks they know what is best for our patients and shoves useless bureaucracy down our throat.  Physicians are on the top of the list for suicide rates http://www.newhealthguide.org/Highest-Suicide-Rate-By-Profession.html.  All these new laws just make it worse, just make it harder, just make us want to get out.

We are being duped by our insurance industry to discuss who will pay for healthcare.  Like pawns we just keep squabbling about the wrong thing while they keep profiting.

sol

  • Walrus Stache
  • *******
  • Posts: 5567
  • Age: 40
  • Location: Pacific Northwest
Re: What comes after the ACA?
« Reply #1822 on: April 03, 2017, 08:44:34 AM »
Death Panels is a comment people say to scare away from a conversation.  Stop using it as it is useless.

In this case, it was used sarcastically to highlight that you (and Classical_Liberal) were the one trying to use the threat of rationed care as an argument against ACA reforms.  Maybe that wasn't your intent, but it sure did sound like you were saying that the ACA will fail because rationed care is a terrible thing.  This is exactly what Republicans means when they used to shout "Death Panels!" on TV every night.

Quote
there is no ceiling to how much it can and will cost.  Until we combat the above, there is no healthcare plan that will fix the issue.  ACA will fail just like AHCA or whatever bullshit congress passes.

How do you feel about the Medicaid/Medicare model, where they use a fixed price list?  The most efficient way that the ACA reduced healthcare spending in the US was to move more people onto the Medicaid model.

Quote
The ACA did nothing to combat actual cost of care,

Except move millions of people onto expanded Medicaid?  And mandate preventative screening services, which reduce long term costs.  And cap insurance company profits.  And mandate individuals to have coverage, to cut EMTALA losses.  And ACOs and the IPAB.  And set up new fraud prevention programs. 

Wait, that's a whole bunch of things that the ACA did to combat the actual cost of care!  It's almost like you were deliberately lying!

I agree the ACA could have done more, on this front.  But it's clearly not "nothing".

Quote
We give up 12 years of our lives for this pursuit

Are you counting college?  And part of high school?

Well shit, by that logic I gave up 23 years of my life to getting the required education for my PhD.  Except not a single one of those years felt like a loss, because for each and every one of them I was exactly where I wanted to be.  You were too.  Don't get all dramatic about it.  No one forced you to go to school.

Quote
Physicians are on the top of the list for suicide rates

That has very little to do with their quality of life, and much to do with their access to easy and painless ways to die.  It's not like there are 35 year old doctors shooting themselves in the face in quiet moments of despair.  But there sure are a lot of retired ex-doctors who recognize that their time has come, and don't want to be a burden on their families and finances, and quietly excuse themselves from life.

Quote
We are being duped by our insurance industry to discuss who will pay for healthcare.  Like pawns we just keep squabbling about the wrong thing while they keep profiting.

I think we're being duped by doctors (and the health care industry in general) into discussing who will pay.  Doctors have just as much to lose as do insurance companies, in the switch to single payer.  They are personally invested in maintaining those artificially high prices, because that's how they afford all of those fancy cars and golf memberships.  You may be the rare exception who wants to make less money as a doctor, but that's certainly not the position of most docs.

Classical_Liberal

  • Pencil Stache
  • ****
  • Posts: 750
  • Age: 41
Re: What comes after the ACA?
« Reply #1823 on: April 03, 2017, 12:59:49 PM »
In this case, it was used sarcastically to highlight that you (and Classical_Liberal) were the one trying to use the threat of rationed care as an argument against ACA reforms.  Maybe that wasn't your intent, but it sure did sound like you were saying that the ACA will fail because rationed care is a terrible thing.  This is exactly what Republicans means when they used to shout "Death Panels!" on TV every night.

Yeah, my personal position, I am pro rationing care.  It has to happen.  Like anything healthcare is a limited resource and we, as a society, have to start making tough decisions about where to allocate those resources most effectively.  "Death Panels" is a way to scare people away from a conversation that needs to be had. Attack rising costs at the root. I'm also a libertarian AND I'm pro-government single payer.  The current health care environment makes any private free market system impossible, even a libertarian admits the need for government in such a situation.  I'd be happy to detail why I think private health care untenable, but don't have the time a this particular moment.

To clarify, the point I was trying to make is that doctors, nurses, rad techs, lab specialist, etc. work long and hard in educational programs; they work weekends, holidays, 16 hours shifts, overnight shift, etc regularly.  To imply that cutting pay to these literal life saving professionals as an effective way to reduce costs is not realistic.  There are many burnt-out professionals already and any such "plan"will likely create a situation in which we suffer a shortage in which healthcare will not be available to all no matter what system we have. 

Monkey Uncle

  • Handlebar Stache
  • *****
  • Posts: 1039
  • Location: West-by-god-Virginia
Re: What comes after the ACA?
« Reply #1824 on: April 03, 2017, 07:05:00 PM »
Death Panels is a comment people say to scare away from a conversation.  Stop using it as it is useless.

In this case, it was used sarcastically to highlight that you (and Classical_Liberal) were the one trying to use the threat of rationed care as an argument against ACA reforms.  Maybe that wasn't your intent, but it sure did sound like you were saying that the ACA will fail because rationed care is a terrible thing.  This is exactly what Republicans means when they used to shout "Death Panels!" on TV every night.

Thanks for 'splainin' my sarcasm, Sol.
"Take this job and shove it" - David Allan Coe

goatmom

  • Bristles
  • ***
  • Posts: 262
Re: What comes after the ACA?
« Reply #1825 on: April 03, 2017, 08:17:00 PM »

Quote
We give up 12 years of our lives for this pursuit

Are you counting college?  And part of high school?

Well shit, by that logic I gave up 23 years of my life to getting the required education for my PhD.  Except not a single one of those years felt like a loss, because for each and every one of them I was exactly where I wanted to be.  You were too.  Don't get all dramatic about it.  No one forced you to go to school.


Most doctors spent 4 years in college, 4 years in med school, then four years in residency.  Many also tack on a year or two for fellowship.


I

EnjoyIt

  • Pencil Stache
  • ****
  • Posts: 787
Re: What comes after the ACA?
« Reply #1826 on: April 03, 2017, 10:36:41 PM »
Thanks for responding, I will try answering these as best I could.

Death Panels is a comment people say to scare away from a conversation.  Stop using it as it is useless.

In this case, it was used sarcastically to highlight that you (and Classical_Liberal) were the one trying to use the threat of rationed care as an argument against ACA reforms.  Maybe that wasn't your intent, but it sure did sound like you were saying that the ACA will fail because rationed care is a terrible thing.  This is exactly what Republicans means when they used to shout "Death Panels!" on TV every night.

No, ACA and AHCA and any other CA will fail until we address the demand and cost of healthcare.  The only way to contain cost with government subsidized health care is to ration it and I fully agree with that.  Unfortunately I do not see that happening.  There is talk about trying to contain utilization, but no talk in containing some of the regulations that incentivize utilization as well as talk about decreasing the risk of litigation.  I also see no discussion in using older tried and true therapies over novel more expensive options. I see no discussion over and of life care.  I see no discussion about removing the insurance middle man from low cost therapies, interventions and diagnostics.

Quote
Quote
there is no ceiling to how much it can and will cost.  Until we combat the above, there is no healthcare plan that will fix the issue.  ACA will fail just like AHCA or whatever bullshit congress passes.

How do you feel about the Medicaid/Medicare model, where they use a fixed price list?  The most efficient way that the ACA reduced healthcare spending in the US was to move more people onto the Medicaid model.

You are correct taking someone who pays cash or has health insurance and moving them to Medicaid which is a payment system that reimburses less will decrease cost overall, but increase cost to the government.  Also prior to the medicaid expansion those who were self pay who did not pay for care are now being subsidized by government as well. These measures increase the cost of healthcare to the government which goes back to the argument regarding who pays for care as opposed to the actual cost of care. Lastly, medicaid reimburses less than what it costs to take care of the patient which is the reason why so many private doctors take a limited number of medicaid patients some take none at all.  At the very least reimbursement should provide some profit to the entities providing care, but to do that the cost of providing care must decrease which would provide the necessary profit to make the proposition enticing.

Quote
Quote
The ACA did nothing to combat actual cost of care,

Except move millions of people onto expanded Medicaid?  And mandate preventative screening services, which reduce long term costs.  And cap insurance company profits.  And mandate individuals to have coverage, to cut EMTALA losses.  And ACOs and the IPAB.  And set up new fraud prevention programs. 

Wait, that's a whole bunch of things that the ACA did to combat the actual cost of care!  It's almost like you were deliberately lying!

I agree the ACA could have done more, on this front.  But it's clearly not "nothing".

Great response,
1) Moving millions off from self pay did indeed decrease the cost of healthcare to the individual but increased the cost of care overall by the US citizens through taxation. Not a horrible thing, but again this does not decrease to cost of care. 
2) Mandating preventative screening is an awesome law which I fully agree with and in the long term ideally should decrease the cost of care.
3) Caping insurance profits looks good, but profits can be divided out in other ways hiding actual profit.  Actually take a look at the profits of insurance companies over the last 4 years.  They are increasing, not decreasing.
4) Mandating healthy people to get coverage increases cost of care for them to help subsidize the cost to the individuals.  It does not actually decrease how much it costs to treat each individual.
5) Fraud prevention is terrific and in all honesty I have not evaluated their success or failure.  Actually I have heard nothing from this.
6) ACOs are a great idea incentivizing decreased cost through better outcomes.  I am part of an ACO and think it has some potential.  We have decreased cost on a few disease processes via our ACO and indeed I believe it did decrease the cost of care for those patients.  What ACOs do is take financial risk away from the insurance companies and direct it towards the providers. It may be one of the reasons insurance company profits have gone up.

Some of the above have helped curb cost a little, others increase cost.  Either way it is not enough.  Insurance companies are still the middle man in the process, there is absolutely no transparency in cost, regulations still exist and even more added that actually increase the cost of administering care.  Physicians are still expected to provide the latest most expensive therapies in a more than timely manor or get poor satisfaction scores which leads to less reimbursement. Or worse, risk litigation. Until we can say no to care, ration it to those who can not afford it, as well as make the cost transparent to those who could, prices will continue to rise just like they do in our higher education industry.

Quote
Quote
We give up 12 years of our lives for this pursuit

Are you counting college?  And part of high school?

Well shit, by that logic I gave up 23 years of my life to getting the required education for my PhD.  Except not a single one of those years felt like a loss, because for each and every one of them I was exactly where I wanted to be.  You were too.  Don't get all dramatic about it.  No one forced you to go to school.

4 years college, 4 years med school and 4 years residency. A PhD is very time consuming but most  PhDs do not consume 70-90 hours a week like during medical school and residency for 8 years of their life.  Unless you live it, you just won't accept it or understand it.  Some are good at having a life during med school and residency while most just live in a book or at the hospital for those 8 years.  As for college physicians are competing among the very top of the US and to do so requires being better than most of your class.  Some are naturally smart and get good grades while most only know living in books with minimal fun in their lives.  Let us just agree to disagree that we do not understand each other and just not bother to discuss this topic.

Quote
Quote
Physicians are on the top of the list for suicide rates

That has very little to do with their quality of life, and much to do with their access to easy and painless ways to die.  It's not like there are 35 year old doctors shooting themselves in the face in quiet moments of despair.  But there sure are a lot of retired ex-doctors who recognize that their time has come, and don't want to be a burden on their families and finances, and quietly excuse themselves from life.


There are several studies on this, physicians are on the top of the list because the life is very difficult and not everyone could hack it. How they commit suicide makes no difference with the rate which is much higher than most other professions.  Again, unless you see it and live it, you just won't get it.  It's okay, but the facts are real and I prefer you do not belittle them. 

Quote
Quote
We are being duped by our insurance industry to discuss who will pay for healthcare.  Like pawns we just keep squabbling about the wrong thing while they keep profiting.

I think we're being duped by doctors (and the health care industry in general) into discussing who will pay.  Doctors have just as much to lose as do insurance companies, in the switch to single payer.  They are personally invested in maintaining those artificially high prices, because that's how they afford all of those fancy cars and golf memberships.  You may be the rare exception who wants to make less money as a doctor, but that's certainly not the position of most docs.

It is not the physicians. Physicians used to make a lot more money 20-30 years ago before all this healthcare bullshit that we see today. They still talk about it as the "golden age of medicine."  I do not know a single doctor who would love to get rid of the bureaucracy and add transparency to what they do.  Take away all the bullshit I do no a daily basis and I can double the amount of patients I see which would make me more money even if reimbursement is less.  I really believe it is the insurance industry with the deepest pockets that controls our congress, not the disorganized physicians.

Single payer:  We do have a single payer system for the poor and the old.  It exists and it is currently broken because little is done to address cost as I described above.  I am all for a single payer system for the poor since we need some safety net, but this system needs to be less expensive, not by decreasing reimbursement, but decreasing how much it costs to provide that care.  You cut the cost of care by having transparency in price, eliminate the insurance middle man from low cost events such as monthly meds, doctors visits, imaging, and so forth.  Eliminate reimbursement hoops we need to jump though as well as cut useless regulations and lastly allow insurance be insurance for catastrophic events.  The poor get their safety net, the middle class gets lower cost care, and the rich can afford whatever the hell they want.  Everybody wins except the insurance companies and all their employees.

jim555

  • Handlebar Stache
  • *****
  • Posts: 1338
Re: What comes after the ACA?
« Reply #1827 on: April 04, 2017, 03:35:06 PM »
Trumpcare 2.0, now with pre-existing conditions considered in health policies is being negotiated.  Looks like a rush job is again being attempted. 

DavidAnnArbor

  • Handlebar Stache
  • *****
  • Posts: 1333
  • Age: 52
  • Location: Ann Arbor, Michigan
Re: What comes after the ACA?
« Reply #1828 on: April 04, 2017, 03:42:52 PM »
Well ACA is the best system we've got at the moment. AHCA would result in millions of people going uninsured.
You can complain that ACA isn't a perfect system, but it does address a lot of the problems of getting everyone covered for health insurance, because right now that's what's needed to get access to healthcare. Yes a single payer system would be better, but it's going to be a cold day in Hell before Republicans and insurance companies and pharmaceutical companies would ever allow that. If single payer were attempted by Congress we'd get commercials about how you're going to lose your doctor, death panels, and how such a system is going to help "those" people. Now that corporations are people with respect to speech thanks to the Republican tilted Supreme Court,  they will spend unlimited amounts of cash to fight against a single payer system.

Monkey Uncle

  • Handlebar Stache
  • *****
  • Posts: 1039
  • Location: West-by-god-Virginia
Re: What comes after the ACA?
« Reply #1829 on: April 04, 2017, 06:48:15 PM »
Well ACA is the best system we've got at the moment. AHCA would result in millions of people going uninsured.
You can complain that ACA isn't a perfect system, but it does address a lot of the problems of getting everyone covered for health insurance, because right now that's what's needed to get access to healthcare. Yes a single payer system would be better, but it's going to be a cold day in Hell before Republicans and insurance companies and pharmaceutical companies would ever allow that. If single payer were attempted by Congress we'd get commercials about how you're going to lose your doctor, death panels, and how such a system is going to help "those" people. Now that corporations are people with respect to speech thanks to the Republican tilted Supreme Court,  they will spend unlimited amounts of cash to fight against a single payer system.

Some corporations will fight against single payer.  Mostly those that are involved in the health care industry, because they are using their monopoly power to get rich at everyone else's expense.  But it seems like most corporations would stand to gain from single payer, because then they could get out of paying ever-increasing premiums for their employees' health insurance.  How do we enlist those companies in the fight for single payer?
"Take this job and shove it" - David Allan Coe

gerardc

  • Bristles
  • ***
  • Posts: 420
  • Age: 33
  • Location: SF bay area
Re: What comes after the ACA?
« Reply #1830 on: April 04, 2017, 08:50:03 PM »
Some corporations will fight against single payer.  Mostly those that are involved in the health care industry, because they are using their monopoly power to get rich at everyone else's expense.  But it seems like most corporations would stand to gain from single payer, because then they could get out of paying ever-increasing premiums for their employees' health insurance.  How do we enlist those companies in the fight for single payer?

This is the classic concentrated benefits and diffuse costs problem, where benefits affect a small subpopulation who will naturally be more vocal in lobbying, and costs are smaller for the rest of the population who becomes complacent.

jim555

  • Handlebar Stache
  • *****
  • Posts: 1338
Re: What comes after the ACA?
« Reply #1831 on: April 05, 2017, 12:24:54 PM »
Trumpcare 2.0 is DOA for now, nothing to be done before the recess.

brooklynguy

  • Handlebar Stache
  • *****
  • Posts: 2111
  • Age: 37
Re: What comes after the ACA?
« Reply #1832 on: April 05, 2017, 01:01:09 PM »
Trumpcare 2.0 is DOA for now, nothing to be done before the recess.

I keep harping on this, but even if these repeal/replace efforts ultimately go nowhere, the very fact that they are still ongoing will itself contribute to the destabilization of the insurance markets.  Insurance companies have less than three months to submit their plans for participating in the exchanges next year.  How are they supposed to do that in the face of all this uncertainty?

sol

  • Walrus Stache
  • *******
  • Posts: 5567
  • Age: 40
  • Location: Pacific Northwest
Re: What comes after the ACA?
« Reply #1833 on: April 05, 2017, 01:28:48 PM »
Trumpcare 2.0 is DOA for now, nothing to be done before the recess.

I keep harping on this, but even if these repeal/replace efforts ultimately go nowhere, the very fact that they are still ongoing will itself contribute to the destabilization of the insurance markets.  Insurance companies have less than three months to submit their plans for participating in the exchanges next year.  How are they supposed to do that in the face of all this uncertainty?

I'm just assuming that the destabilizing effect you've described is the very point of maintaining the illusion of ongoing discussions.  They can't actually kill Obamacare outright, but these kinds of theatrics can undermine it enough to make a more compelling case for repeal in the future.

The republican plan still confuses me.  Why do they want to make health care worse for millions of Americans?  When they started this discussion, I was trying to give them the benefit of the doubt by assuming they genuinely thought they could improve things, but instead every single version of every plan has only made it worse.  Higher costs, fewer people with insurance, and less care provided to those who are still covered.  At some point they need to drop the charade and just come out and say "the republican party doesn't think you should have access to good healthcare."

That's a perfectly acceptable conservative position, if you believe in individualism and boot straps and free markets.  Just admit that they think only rich people should have doctors and poor people should suffer and die.  It would be more consistent with the rest of the party platform than this current lie of "everybody is going to have the best healthcare, it's going to be great."  Every single republican plan thus far has been in direct conflict with that assertion.
« Last Edit: April 05, 2017, 03:10:29 PM by sol »

waltworks

  • Handlebar Stache
  • *****
  • Posts: 2478
Re: What comes after the ACA?
« Reply #1834 on: April 05, 2017, 01:39:11 PM »
Yeah, if the GOP position is really that the free market should be handling this, FFS do it already. At least we'd get a chance to see the results of that experiment in the real world. Kill Medicare, kill the VA, kill Medicaid, kill EMTALA. Refund all the money spent on those programs to the population at large making, say, <500% of median income. Let's see what happens.

My personal guess is that nobody would like the results much, but at least we'd never have to hear about how much better our healthcare system would be if only it was unregulated.

-W

Paul der Krake

  • Magnum Stache
  • ******
  • Posts: 3594
  • Age: 9
  • Location: WA
Re: What comes after the ACA?
« Reply #1835 on: April 05, 2017, 02:08:17 PM »
My psychopathic tendencies may be showing their true colors, but anyone else rooting for a repeal and some deaths?

If 100 people die but we get single payer, is that an acceptable casualty rate?
What about 1,000?
10,000?
100,000?

Luck12

  • Bristles
  • ***
  • Posts: 283
Re: What comes after the ACA?
« Reply #1836 on: April 05, 2017, 02:09:38 PM »
Why do they want to make health care worse for millions of Americans?  When they started this discussion, I was trying to give them the benefit of the doubt by assuming they genuinely thought they could improve things, but instead every single version of every plan has only made it worse.

You made the common mistake of thinking that Republicans actually care.  Tom Perez was right on when he said "Republicans don't give a shit about people".   


PiobStache

  • 5 O'Clock Shadow
  • *
  • Posts: 85
Re: What comes after the ACA?
« Reply #1837 on: April 05, 2017, 02:24:28 PM »
Single payer has the power to (1) ration care, and (2) set prices.  That's how the rest of the civilized world gets better health outcomes at half the cost.

That's simply not true as "the rest of the civilized world" does not uniformly have single payer systems.  This is a highly common piece of misinformation.  Germany and France, to name two large economies with world class systems, do not have single payer systems. 

ETA:  France was voted #1 in the world by the first and only WHO ranking.  And again, it's distinctly NOT single payer.  This piece of misinformation needs to be stopped.
« Last Edit: April 05, 2017, 02:27:03 PM by PiobStache »

bacchi

  • Handlebar Stache
  • *****
  • Posts: 2184
Re: What comes after the ACA?
« Reply #1838 on: April 05, 2017, 02:31:11 PM »
Its always a great idea to cut pay, vilify providers and health care workers because they make too much or recommend best practice treatment options... That is until its 5:05 (or 2AM)... and the patient's are no longer getting what they want, are in pain, have life threatening conditions and complications, etc.  Then, suddenly and amazingly, it seems we are worth our weight in gold.

Good point. When someone gets sick in Japan and Germany after hours, they're shit-outta-luck. That's why tourists to those countries always bring along their own doctor.

PiobStache

  • 5 O'Clock Shadow
  • *
  • Posts: 85
Re: What comes after the ACA?
« Reply #1839 on: April 05, 2017, 02:33:30 PM »
Japan is another country that does not have single payer.

pbkmaine

  • Walrus Stache
  • *******
  • Posts: 6833
  • Age: 61
  • Location: The Villages, Florida
Re: What comes after the ACA?
« Reply #1840 on: April 05, 2017, 03:36:07 PM »
Germany's healthcare system is, however, a "universal" system:

https://en.m.wikipedia.org/wiki/Healthcare_in_Germany

PiobStache

  • 5 O'Clock Shadow
  • *
  • Posts: 85
Re: What comes after the ACA?
« Reply #1841 on: April 05, 2017, 03:38:43 PM »
Germany's healthcare system is, however, a "universal" system:

https://en.m.wikipedia.org/wiki/Healthcare_in_Germany

I never said it wasn't, now did I?  And do you really think the guy that knows it's a Bismarck system, and not a single payer, needs a Wiki link to verify it's universal?  ;)

dividendman

  • Pencil Stache
  • ****
  • Posts: 998
  • Age: 35
Re: What comes after the ACA?
« Reply #1842 on: April 05, 2017, 03:41:05 PM »
My psychopathic tendencies may be showing their true colors, but anyone else rooting for a repeal and some deaths?

If 100 people die but we get single payer, is that an acceptable casualty rate?
What about 1,000?
10,000?
100,000?

I think anything under 1,079,000 is acceptable (that's the total number deaths from smoking, medical errors, obesity and alcohol).

https://en.wikipedia.org/wiki/Preventable_causes_of_death#Accidental_death

stoaX

  • Bristles
  • ***
  • Posts: 377
  • Location: SoCal
  • 'tis nothing good nor bad but thinking makes it so
Re: What comes after the ACA?
« Reply #1843 on: April 05, 2017, 03:41:27 PM »
Germany's healthcare system is, however, a "universal" system:

https://en.m.wikipedia.org/wiki/Healthcare_in_Germany

I never said it wasn't, now did I?  And do you really think the guy that knows it's a Bismarck system, and not a single payer, needs a Wiki link to verify it's universal?  ;)

I think the point was to add some nuance for the benefit of all the rest of us...

PiobStache

  • 5 O'Clock Shadow
  • *
  • Posts: 85
Re: What comes after the ACA?
« Reply #1844 on: April 05, 2017, 03:44:32 PM »
I think the point was to add some nuance for the benefit of all the rest of us...

Could be.  The important thing was to clear up the erroneous thought "the rest of the civilized world" functions under single payer.  Mustache-land seems to be all about people creating choices for themselves so understanding that choice in healthcare delivery models is greater than just "US status quo" and "single payer" is crucial.

pbkmaine

  • Walrus Stache
  • *******
  • Posts: 6833
  • Age: 61
  • Location: The Villages, Florida
Re: What comes after the ACA?
« Reply #1845 on: April 05, 2017, 04:40:34 PM »
I think there is a lot of confusion in the US about health care delivery systems and the terminology attached to them.

sol

  • Walrus Stache
  • *******
  • Posts: 5567
  • Age: 40
  • Location: Pacific Northwest
Re: What comes after the ACA?
« Reply #1846 on: April 05, 2017, 04:43:44 PM »
I think there is a lot of confusion in the US about health care delivery systems and the terminology attached to them.

Maybe if some more republicans go on TV and shout about DEATH PANELS often enough, that will clear things up for everybody.

RedmondStash

  • Pencil Stache
  • ****
  • Posts: 598
Re: What comes after the ACA?
« Reply #1847 on: April 05, 2017, 05:25:48 PM »
Are there any efforts at the state level to create an ACA substitute if the ACA is repealed federally? Like Romneycare in Massachusetts, which the ACA was partly based on?

Seems to me that if the worst comes to the worst, maybe we can lobby locally for a solution, at least in some states.

It just kills me that universal healthcare was originally a Republican idea, right up until it got Democratic stank on it, at which point it became the worst moral scourge of the land. We're living in Bizarro land.

BGordon

  • 5 O'Clock Shadow
  • *
  • Posts: 68
  • Age: 49
  • Location: Tennessee
Re: What comes after the ACA?
« Reply #1848 on: April 05, 2017, 06:14:54 PM »
I live in an area where a large percentage of the McMansions are built on profits from the Health Care Industry.  As someone who worked in the public accounting industry on both the audit and tax sides, I can tell you that the Health Care companies in town are  some of the most profitable.  At the accounting firms, you wanted Health Care Clients because they were the easier routes to partner and if you decided to leave public accounting they were the places that paid the best salaries, had the best offices, best benefits, etc.  I think as a society we have to make the decision that profits, or at least large profits, in this arena are unethical.  I am not talking about the salaries of Doctors, Nurses, or other Health Care workers.  I am talking about corporate profits.


PiobStache

  • 5 O'Clock Shadow
  • *
  • Posts: 85
Re: What comes after the ACA?
« Reply #1849 on: April 05, 2017, 07:18:42 PM »
I think there is a lot of confusion in the US about health care delivery systems and the terminology attached to them.

Maybe if some more republicans go on TV and shout about DEATH PANELS often enough, that will clear things up for everybody.

Or if more Dems keep chanting, "Single payer!  Single payer!"

Neither side is presenting a cogent, contextualized, rational position.  There's no "right side" in the US political system regarding healthcare at this moment.