Author Topic: What comes after the ACA?  (Read 243278 times)

nereo

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Re: What comes after the ACA?
« Reply #2500 on: May 31, 2017, 10:49:05 AM »

Do you really think anything will come with this Russia thing or is this just a huge scandal which will either last his entire presidency or be discarded for another scandal in the future. Mark my words, no one is getting impeached over this. As for news, there are many ways to interpret the information.  ...
[snip]
When Obama was president he did things that I liked and some that I did not like. The same is currently going for Trump.

Odd that you started this with a question about whether anything will come from "this Russia thing".  I'd argue that a lot has already come from it.  Example 1: Michael Flynn.  Example 2: Director Comey. You could also connect the dots and say that Mike Dubke left due to the president's ire with the whole focus. I'm guessing a few more will follow in the weeks to come. I'd also say the Russia scandals have taken all momentum from what normally should be a newly elected POTUS's most productive period - four congressional committees investigating "this Russia thing" plus the FBI's special prosecutor.

Will DJT specifically get impeached by this?  I have no idea, but I doubt it would happen before the midterms. (yet another example - House members are having to spend an inordinate amount of time talking/defending/deflecting "this Russia thing").

So yes, I'd say they've already had a large effect.  I predict it will keep going - more people will be sacked, more shoes will drop, more legislative-hours will be spent on Russia instead of passing laws (interpret that as a good or bad thing depending on your philosophy).

Finally, there's a difference between arguing about policy and facts. I've agreed with some policies of every past president and disagreed with them on others. People on both sides are free to compare whomever they like to Hitler, Jesus or John Henry but its understood those are opinions and comparisons. Deliberately trying to pass fiction as fact (e.g. Birthers) or declare facts are fiction leads us away from opinion and into the territory of outright lies.
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Mr. Green

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Re: What comes after the ACA?
« Reply #2501 on: May 31, 2017, 10:59:00 AM »
Seems like the gravity of just how far Washington is from an actual law on the AHCA is finally sinking in. I will not be surprised at all if they inevitably end up having to abandon the AHCA and work to improve the existing framework of the ACA.

That would almost be funny, given that, in the meantime, they're doing such an excellent job of sabotaging the existing framework.
I just have a feeling that this is where we're going to end up, which wouldn't necessarily be a bad thing if there wasn't all the sabotage in the middle. I would love to see how they'll explain that away without losing votes.
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nereo

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Re: What comes after the ACA?
« Reply #2502 on: May 31, 2017, 11:19:52 AM »

Gorsuch was a slam dunk that should be loved by conservatives and people on the left that still want the little guy protected from government.  Not sure how much of that credit should go to Trump,
...
But at the same time, not much is being harmed either.  We got a appropriations deal that was basically a continuation of the status quo.  A lot of relatively meaningless symbolism going on (the courts blocking legal but probably ineffectual immigration orders; the paris accord which is just a symbolic deal anyway that won't actually slow global warming even according to the people who believe in a huge multiplier...

 Doing a little better on foreign relations in that at least we are treating allies like allies and actually pursuing our interests, but not really any more comfortable with this administrations competence than Obama's.
Geez, I'd almost forgotten about Gorsuch b/c, as you said, once the GOP blocked Garland a confirmation of their choice was pretty much guaranteed.  I chalk that up to McConnell though.

Stongly disagree with some of oyur other points.  The courts interpret legality, and so far several have indicated that the EO was NOT legal. Maybe the supreme court will interpret things differently but not much grounds to stand on saying "well, it's legal but the courts are blocking it..."

Also disagree that the Paris accord is just symbolic and that experts say it will be ineffective. The scientific community (which I consider myself a member) is pretty clear that its a good step.  No, it probably won't keep us below the +2ºC threshold on its own but it will slow it down. The broadscale hope is that the Paris accord holds and then more ambitious targets emerge in another 5-10 years.  Saying its ineffective just because it isn't a complete solution is akin to saying "well, I'm 40 with no savings and despite my resolution to fund my IRA every year I've learned that this will not be enough, so I won't even do that."

Can't see how we are treating our allies like allies - DJT seems intent to piss of the germans now after antagonizing Canada while turning a blind eye to human rights violations of Russia and Saudi Arabia (but not, at least on one occation, to Syria.  Odd).

Do agre that the appropration bill is essentially continuation of the status quo (but we'll see what the next budget congress drafts actually does)
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EnjoyIt

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Re: What comes after the ACA?
« Reply #2503 on: May 31, 2017, 11:22:29 AM »
When Obama was president he did things that I liked and some that I did not like. The same is currently going for Trump.

What has trump done, on healthcare or otherwise, that you have liked?

I'm not being sarcastic, I'm genuinely looking for any meager bright spot in what appears to be just a storm of incompetence and lies.
Thanks for asking Sol, You and I have disagreements though there is plenty that we see eye to eye on. I enjoy our discourse.

1) Through all his bitching and moaning regarding immigration, he created fear and now we have a very large reduction in illegal immigration. I'm all for immigration but it should be done legally.  I'm am also for deporting criminals. No need to pay for illegals in our prison system if we don't have to.

2) Working on getting China to take more responsibility of North Korea.

3) Cutting 2 regulations for every 1 regulation that is implemented. To me this is a huge pro.

4) Looks like we may be seeing a decreasing in financial support to foreign countries.

5) His inspiration to the business community has given more stamina to the stock market and has improved all of our staches. Some have even retired earlier than expected. I am fully aware that presidents have little control over the economy as a whole.  But equities going up and then us rebalancing into bonds is a big win for many here.

6) Incentivized a few extra manufacturing jobs to stay in the US and hopefully created a precedent.

There may be more I did not think of in the few minutes I typed this response. There are also plenty of things I am completely neutral about that has received lots of media attention.  Equally there are plenty of things I disagree with as well. It has been less than half a year so I am curious what the future will bring.  I suspect some good and some bad. I highly doubt we will be in Mad Max territory by the end of 2020.


Overall it's a meh . . .   

couldn't agree more.
« Last Edit: May 31, 2017, 11:25:42 AM by EnjoyIt »

EnjoyIt

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Re: What comes after the ACA?
« Reply #2504 on: May 31, 2017, 11:35:51 AM »
dabnasty,
There is really only one considered "credible" news source that portrays republicans in a good light and that is Fox.  The others are minor representations. Contrary most of the media is liberal and therefor many more "credible" sources out there. There are plenty of ridiculous liberal news organizations out there  that spew out garbage just as the ridiculous conservative media you alluded to.  I honestly don't think any of it really matters.

Nereo,
So some people got fired...so what?  It is just more controversy in a very controversial presidency.

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Re: What comes after the ACA?
« Reply #2505 on: May 31, 2017, 12:08:35 PM »
Geez, I'd almost forgotten about Gorsuch b/c, as you said, once the GOP blocked Garland a confirmation of their choice was pretty much guaranteed.  I chalk that up to McConnell though.

Stongly disagree with some of oyur other points.  The courts interpret legality, and so far several have indicated that the EO was NOT legal. Maybe the supreme court will interpret things differently but not much grounds to stand on saying "well, it's legal but the courts are blocking it..."

Courts interpret legality, but they don't get to legitimately make new law.  The arguments have basically been, yes, the order is facially valid, but remarks made while campaigning mean that DJT can't issue it, even though any other president could.  That's not exactly in line with other caselaw on pretexts, which wouldn't apply to orders on immigration anyway. 

Also disagree that the Paris accord is just symbolic and that experts say it will be ineffective. The scientific community (which I consider myself a member) is pretty clear that its a good step.  No, it probably won't keep us below the +2ºC threshold on its own but it will slow it down. The broadscale hope is that the Paris accord holds and then more ambitious targets emerge in another 5-10 years.  Saying its ineffective just because it isn't a complete solution is akin to saying "well, I'm 40 with no savings and despite my resolution to fund my IRA every year I've learned that this will not be enough, so I won't even do that."
  This is not saving 10% of income after 40 and hoping to do better later.  This is more like stopping drinking coffee as a symbolic commitment to funding retirement, except if stopping drinking coffee actually caused you to make less money going forward. 

Can't see how we are treating our allies like allies - DJT seems intent to piss of the germans now after antagonizing Canada while turning a blind eye to human rights violations of Russia and Saudi Arabia (but not, at least on one occation, to Syria.  Odd).
  He is treating Russia like a political adversary with whom we have aligned interest on certain issues (Syria), which is at least better than the Obama's "flexibility" to let Russia do what they want.  He's treating Israel like an ally.  He's treating NATO countries as allies who are not complying with commitments they have made (which, coincidentally, they are).  Saudi Arabia has always been a least ugly girl at the dance and he's maintaining the status quo there of pretending they are not as horrible as they are.  Not sure that's the right approach, but it's the status quo and it makes sense when you look at what kind of disaster there can be when you assume that whatever comes next will be better (e.g., Iran).

Not a fan of his antitrade stuff, but compared with clearing the way for Iran to go nuclear, I guess the antitrade stuff could be worse.     

Do agre that the appropration bill is essentially continuation of the status quo (but we'll see what the next budget congress drafts actually does)
  It will be interesting.  Trump had tons of leverage for this cycle and got absolutely steam rolled.  He's going to have even less next time, so it will be interesting to see if democrats actually make legislative gains beyond maintaining the status quo as the minority party in both the House and Senate with a Republican (I guess) President.  That would both be the logical expectation based on the last appropriation bill but also would be a bass ackwards crazy result. 

Dabnasty

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Re: What comes after the ACA?
« Reply #2506 on: May 31, 2017, 12:55:03 PM »
dabnasty,
There is really only one considered "credible" news source that portrays republicans in a good light and that is Fox.  The others are minor representations. Contrary most of the media is liberal and therefor many more "credible" sources out there. There are plenty of ridiculous liberal news organizations out there  that spew out garbage just as the ridiculous conservative media you alluded to.  I honestly don't think any of it really matters.
I said exactly that. There are and always will be crazy's on both sides. But your claim was that the accusations against Trump are equivalent to the accusations against Obama. Are you suggesting that the investigation into Russian ties is just as baseless as the suggestion that Obama was a Muslim born in Kenya?

As for Fox being a credible source, both Fox reporters and the current president have cited Infowars and others as a legitimate source of information. They're tied together and promoting similar storylines everyday. Also, Sean Hannity.

I don't want to get too far away from healthcare, the only question I'm trying to ask: do you believe that the outrage over Trump is equivalent to the outrage over Obama?

“If you could learn to cater to the king you wouldn’t have to live on rice and beans”…”If you could learn to live on rice and beans you wouldn’t have to cater to the king”

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Re: What comes after the ACA?
« Reply #2507 on: May 31, 2017, 01:00:23 PM »
Also disagree that the Paris accord is just symbolic and that experts say it will be ineffective. The scientific community (which I consider myself a member) is pretty clear that its a good step.  No, it probably won't keep us below the +2ºC threshold on its own but it will slow it down. The broadscale hope is that the Paris accord holds and then more ambitious targets emerge in another 5-10 years.  Saying its ineffective just because it isn't a complete solution is akin to saying "well, I'm 40 with no savings and despite my resolution to fund my IRA every year I've learned that this will not be enough, so I won't even do that."
 
This is not saving 10% of income after 40 and hoping to do better later.  This is more like stopping drinking coffee as a symbolic commitment to funding retirement, except if stopping drinking coffee actually caused you to make less money going forward. 
I don't get this analogy. Are you suggesting that limiting carbon emissions will increase the temperature of the planet?
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nereo

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Re: What comes after the ACA?
« Reply #2508 on: May 31, 2017, 01:54:45 PM »
Nereo,
So some people got fired...so what?  It is just more controversy in a very controversial presidency.

You asked the question: "Do you really think anything will come with this Russia thing?"
My point was merely that we've already had some major things 'come out of this Russia thing'.  We don't have to wait.  It's already happened.
Maybe more and bigger things will come - only time will.
Agreed that it's just more controversy in a very controversial presidency. 
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EnjoyIt

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Re: What comes after the ACA?
« Reply #2509 on: May 31, 2017, 02:00:32 PM »
dabnasty,
There is really only one considered "credible" news source that portrays republicans in a good light and that is Fox.  The others are minor representations. Contrary most of the media is liberal and therefor many more "credible" sources out there. There are plenty of ridiculous liberal news organizations out there  that spew out garbage just as the ridiculous conservative media you alluded to.  I honestly don't think any of it really matters.
I said exactly that. There are and always will be crazy's on both sides. But your claim was that the accusations against Trump are equivalent to the accusations against Obama. Are you suggesting that the investigation into Russian ties is just as baseless as the suggestion that Obama was a Muslim born in Kenya?

As for Fox being a credible source, both Fox reporters and the current president have cited Infowars and others as a legitimate source of information. They're tied together and promoting similar storylines everyday. Also, Sean Hannity.

I don't want to get too far away from healthcare, the only question I'm trying to ask: do you believe that the outrage over Trump is equivalent to the outrage over Obama?

Yes they are similar in that they are meaningless to what will actually be the outcome to this country and its well being.

No, they are different in that you picked some really crazy item the conservatives were blubbering about which is definitely less crazy than Trump having some ties with Russia.  How about we instead talk about Obama and the deal the US made with Iran.  Conservative news beat the crap out of him on that going as far as saying he is muslim and has muslim ties.  Obama being a muslim is just as preposterous as saying that Trump is Putin's puppet.

Either way nothing will come of this.

Dabnasty

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Re: What comes after the ACA?
« Reply #2510 on: May 31, 2017, 02:33:13 PM »
Yes they are similar in that they are meaningless to what will actually be the outcome to this country and its well being.

No, they are different in that you picked some really crazy item the conservatives were blubbering about which is definitely less crazy than Trump having some ties with Russia.  How about we instead talk about Obama and the deal the US made with Iran.  Conservative news beat the crap out of him on that going as far as saying he is muslim and has muslim ties.  Obama being a muslim is just as preposterous as saying that Trump is Putin's puppet.

Either way nothing will come of this.
But there is evidence of ties between his campaign and Russia. Something has come of it, an individual at a high level in our government has been fired for lying. I don't care that someone got fired, I care because this damages public trust in government and is indicative that others in his administration may be involved.

Are you suggesting that there's nothing we can do so we might as well give up?

Or are you saying it will all work out in the end so don't worry about it?
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EnjoyIt

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Re: What comes after the ACA?
« Reply #2511 on: May 31, 2017, 03:02:47 PM »
I'm saying that I don't care if there was some ties between Russia and the Trump campaign.  The only reason why people are upset is because "Russia is evil."  Politicians have ties with people from foreign countries all the time.  I would care if we saw Trump creating policy that somehow gives Russia a significant upper had.  I would prefer that politicians can't be bought regardless of it being foreign countries or rich corporations.  All of it is bad, but, it seams to me like standard practice in today's political environment.

Again, it makes no difference to the US or its people. Its just one more scandal that everyone is talking about. Personally I believe he likes scandal.  He once said in an interview regarding a hotel he was building in NYC that he liked the publicity and did not want to squash it when some scandalous event occurred regarding its construction. I believe he has even created scandal just for the sake of getting news coverage. Personally I think he thrives on it, but that is just an opinion. I bet if we go for a few weeks without some new tirade about him, Trump will lay out some tweets or do an interview just to bring attention back on him.

nereo

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Re: What comes after the ACA?
« Reply #2512 on: May 31, 2017, 03:46:55 PM »
I'm saying that I don't care if there was some ties between Russia and the Trump campaign.  The only reason why people are upset is because "Russia is evil."  Politicians have ties with people from foreign countries all the time.  I would care if we saw Trump creating policy that somehow gives Russia a significant upper had.  I would prefer that politicians can't be bought regardless of it being foreign countries or rich corporations.  All of it is bad, but, it seams to me like standard practice in today's political environment.


I would disagree with your premises  that 1) the only reason people are upset is because "Russia is evil" & 2) this involvement with foreign countries is standard practice.

1) Distrust of Russia is certainly one aspect, but what also is deeply disturbing is the lack of transparency, promises that there is nothing going on and (later) realizations that this was utter crap and a great deal has been going on. Flynn lied about his contacts regarding Russia and payment recieved. Manafort was paid to lobby for the Russians (and payments weren't disclosed). Sessions said, under oath, that he did not have contact with Russian government officials during the campaign (and later recanted). Kushner sought to set up a private channel while he was a private citizen.
It goes on and on... multiple upper-echilon members have said they have had no dealings with Russia, yet that's repeatedly turned out to be untrue. Maybe this is a case where there's a coverup or no crime - but why the steady denial of contacts.

2) it simply isn't standard practice to have back-door channels set up as a private citizen (ie..g before DJT took office). I could go on but it's getting late and I need to go to the store - perhaps I'll finish this later.
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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2513 on: May 31, 2017, 04:36:41 PM »
Moreover Russia hacked emails from both the Trump and Hillary campaigns and tried to influence the election in favor of Trump by releasing Hillary campaign's emails.

There are policy changes, there's a promise by Trump campaign to get rid of sanctions imposed by Obama on Russian officials and Russian banks for tampering with the election.
In fact have those sanctions now been removed?

Trump won't release his tax returns and there may very well be Russian bank lending to Trump's various businesses.

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Re: What comes after the ACA?
« Reply #2514 on: May 31, 2017, 05:44:54 PM »
Is this a thread about healthcare? I can't really tell anymore.
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nereo

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Re: What comes after the ACA?
« Reply #2515 on: May 31, 2017, 06:08:56 PM »
Is this a thread about healthcare? I can't really tell anymore.
Healthcare occasionally comes up...
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Dabnasty

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Re: What comes after the ACA?
« Reply #2516 on: May 31, 2017, 08:45:17 PM »
Sorry, It's the "Godwin's Law" of Trump.

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Re: What comes after the ACA?
« Reply #2517 on: May 31, 2017, 09:09:15 PM »
Sorry, It's the "Godwin's Law" of Trump.

And, I daresay, if Trump somehow accidentally gives Russia (or any other Super-Power) the location of one US nuclear submarine (he's already apparently indicated to the Philippine PM that two are in proximity of North Korea) then healthcare should be the least of our worries.  I have a feeling Trump doesn't understand the concept of 'deterrents' and diplomacy, life is very black and white to that Billionaire 70 y.o..  So, in this case at least, I'd actually say the internet is getting it right and has evolved vs. calling out Godwin's Law - but maybe this is just me using my MMM optimism gun.
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EnjoyIt

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Re: What comes after the ACA?
« Reply #2518 on: May 31, 2017, 09:15:01 PM »
I'm saying that I don't care if there was some ties between Russia and the Trump campaign.  The only reason why people are upset is because "Russia is evil."  Politicians have ties with people from foreign countries all the time.  I would care if we saw Trump creating policy that somehow gives Russia a significant upper had.  I would prefer that politicians can't be bought regardless of it being foreign countries or rich corporations.  All of it is bad, but, it seams to me like standard practice in today's political environment.


I would disagree with your premises  that 1) the only reason people are upset is because "Russia is evil" & 2) this involvement with foreign countries is standard practice.

1) Distrust of Russia is certainly one aspect, but what also is deeply disturbing is the lack of transparency, promises that there is nothing going on and (later) realizations that this was utter crap and a great deal has been going on. Flynn lied about his contacts regarding Russia and payment recieved. Manafort was paid to lobby for the Russians (and payments weren't disclosed). Sessions said, under oath, that he did not have contact with Russian government officials during the campaign (and later recanted). Kushner sought to set up a private channel while he was a private citizen.
It goes on and on... multiple upper-echilon members have said they have had no dealings with Russia, yet that's repeatedly turned out to be untrue. Maybe this is a case where there's a coverup or no crime - but why the steady denial of contacts.

2) it simply isn't standard practice to have back-door channels set up as a private citizen (ie..g before DJT took office). I could go on but it's getting late and I need to go to the store - perhaps I'll finish this later.

All this stuff happened, sure, I'm not sure what it all means, and maybe we will find out in the future.  Either way I still don't think anything will come of this. None of it will affect our lives in any way.

Ohh and to keep on topic.  I hope no one repeals the pre-existing condition clause.


Sorry, It's the "Godwin's Law" of Trump.


I had to google that.  Funny.

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Re: What comes after the ACA?
« Reply #2519 on: June 01, 2017, 06:09:12 AM »

All this stuff happened, sure, I'm not sure what it all means, and maybe we will find out in the future.  Either way I still don't think anything will come of this. None of it will affect our lives in any way.


I just can't understand your conclusion, EnjoyIt. With all that has already happened it seems far too late to say nothing will come of this. Perhaps the fire will be tamped out and the structure will be saved but the scorch-marks will remain. As for whether htis 'affects our lives in any way' depends partly on an unknowable (what would life be like if there were no "Russia thing"), but I'm still deeply skeptical of the notion. We're talking about it for one, and I think this rip-current has kept a new president from moving on many things that he otherwise should be able to champion with ease with GOP control of both houses. Instead, most of the energy of both houses are being spent on hearings, investigations, subpoenas and 'lawyering up'. That's got to be an immense drag.

Quote

Ohh and to keep on topic.  I hope no one repeals the pre-existing condition clause.

Yes, back onto topic.  I, too, hope no one repeals the pre-existing condition clause (Kaiser's white paper says that as many as 52MM people can be considered to have
pre-existing conditions).  I'll go one furhter and say that I hope people with pre-existing conditions can get easily affordable health care which covers their condition.  This will certainly mean that the rest of us will help subsidize it (unless we can get Mexico to pay for it), but that seems preferable to the alternatives.
I have two close family members with costly pre-existing conditions who would be unable to afford non-subsidized health insurance.
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Re: What comes after the ACA?
« Reply #2520 on: June 01, 2017, 06:54:32 AM »
Also disagree that the Paris accord is just symbolic and that experts say it will be ineffective. The scientific community (which I consider myself a member) is pretty clear that its a good step.  No, it probably won't keep us below the +2ºC threshold on its own but it will slow it down. The broadscale hope is that the Paris accord holds and then more ambitious targets emerge in another 5-10 years.  Saying its ineffective just because it isn't a complete solution is akin to saying "well, I'm 40 with no savings and despite my resolution to fund my IRA every year I've learned that this will not be enough, so I won't even do that."
 
This is not saving 10% of income after 40 and hoping to do better later.  This is more like stopping drinking coffee as a symbolic commitment to funding retirement, except if stopping drinking coffee actually caused you to make less money going forward. 
I don't get this analogy. Are you suggesting that limiting carbon emissions will increase the temperature of the planet?

Or that you could not TRIPLE the average retirement savings of a 50 year old by doing NOTHING ELSE other than simply saving the cost of a daily cup of coffee at Starbucks? You would have $130,000 in 30 years ($3.25 average cost of coffee at Starbucks daily, 3% inflation, 7% growth,EDIT: start at 18)
« Last Edit: June 01, 2017, 07:04:08 AM by radram »

EnjoyIt

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Re: What comes after the ACA?
« Reply #2521 on: June 01, 2017, 11:24:09 AM »

Yes, back onto topic.  I, too, hope no one repeals the pre-existing condition clause (Kaiser's white paper says that as many as 52MM people can be considered to have
pre-existing conditions).  I'll go one furhter and say that I hope people with pre-existing conditions can get easily affordable health care which covers their condition.  This will certainly mean that the rest of us will help subsidize it (unless we can get Mexico to pay for it), but that seems preferable to the alternatives.
I have two close family members with costly pre-existing conditions who would be unable to afford non-subsidized health insurance.

There it goes again talking about who will pay for healthcare instead of how to fix the problem :)
If we cut the cost of healthcare by 25% that would solve many of the issues we are talking about right now. And believe me 25% is very doable if we as a country are willing to agree on somethings.

We keep confusing health insurance as healthcare.  Health insurance is just a middle man that pays for goods and services. Health care is provided by health care professionals in a setting such as an office or a hospital. The friction between providing the care and getting paid for it is extremely costly.  The friction alone is worth over 25%

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Re: What comes after the ACA?
« Reply #2522 on: June 01, 2017, 12:18:06 PM »


There it goes again talking about who will pay for healthcare instead of how to fix the problem :)
If we cut the cost of healthcare by 25% that would solve many of the issues we are talking about right now. And believe me 25% is very doable if we as a country are willing to agree on somethings.

We keep confusing health insurance as healthcare.  Health insurance is just a middle man that pays for goods and services. Health care is provided by health care professionals in a setting such as an office or a hospital. The friction between providing the care and getting paid for it is extremely costly.  The friction alone is worth over 25%

If we were to start the whole system from scratch then you're right we wouldn't have health insurance middlemen. But politically the Republican party will never allow a single payer government run system of health care - it goes against their ideology that the market is always perfect and right.
So now we have a potential system that accommodates health insurance companies, limits their profits, provides them with more customers who receive premium subsidies to afford the health insurance.

You can still cut the cost of health care, there's a million in one ways to do it, that everyone would get on board with.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2523 on: June 01, 2017, 06:53:55 PM »


There it goes again talking about who will pay for healthcare instead of how to fix the problem :)
If we cut the cost of healthcare by 25% that would solve many of the issues we are talking about right now. And believe me 25% is very doable if we as a country are willing to agree on somethings.

We keep confusing health insurance as healthcare.  Health insurance is just a middle man that pays for goods and services. Health care is provided by health care professionals in a setting such as an office or a hospital. The friction between providing the care and getting paid for it is extremely costly.  The friction alone is worth over 25%

If we were to start the whole system from scratch then you're right we wouldn't have health insurance middlemen. But politically the Republican party will never allow a single payer government run system of health care - it goes against their ideology that the market is always perfect and right.
So now we have a potential system that accommodates health insurance companies, limits their profits, provides them with more customers who receive premium subsidies to afford the health insurance.

You can still cut the cost of health care, there's a million in one ways to do it, that everyone would get on board with.

I'm not fully for or against a single payer system but it should only cover catastrophic health care. There is absolutely no need for even a single payer middle man for simple healthcare related transactions.  You should not have to pay $400 for a month's insurance premiums and then a $30 copay to see your GP. It should cost a flat fee with no one else involved. Same for simple imaging or lab tests.  On the other hand if someone ends up with cancer or some other expensive medical condition insurance should be able to step in and take over. Just making that change would cut the friction on much of our healthcare expenditure, and buy having transparency in prices, costs will go down for all simple outpatient care.  Emergencies are a whole other story where catastrophic insurance can come in.  I would also go so far as to say there is no need to have a prescription from your doctor for refills on your medications. Very expensive chronic conditions should also be covered by some form of insurance.  Those who can not afford it based on income or disability should get subsidies or vouchers to help pay for their care.  Subsidies/vouchers are given out on a sliding scale based on income as opposed to an all or nothing distribution ideally incentivizing employment. 

protostache

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Re: What comes after the ACA?
« Reply #2524 on: June 01, 2017, 07:38:43 PM »
The California Senate passed SB 562 today which would enact single payer healthcare for all California residents. A study released yesterday finds that single payer in California would cut overall spending by 18% and would cost an additional $106 billion to implement on top of the current $225 billion that taxpayers currently contribute to healthcare in the state via Medicare, Medicaid, and the ACA premium and cost sharing reduction subsidies. Notably this legislation would cover every resident of California regardless of their immigration status.

The Senate version of the bill does not contain any actual funding provisions, other than stipulating that California would seek all waivers necessary for all Federal health care money to be paid into a state trust fund. The study referred to above proposes two alternatives for generating the $106 bill in additional revenue: a 2.3% gross receipts tax on businesses (with an exemption for the first $2 mil in revenue) plus a 2.3% sales tax (with a broad swath of exemptions) OR a 6.6% payroll tax plus the 2.3% sales tax.

The bill now passes to the Assembly, who can either pass it and kick the funding can down the road, or they can work up a funding plan and send it back to the Senate where it would require a 2/3 majority (I think? I'm don't know much about CA legislative workings.) Today's bill passed 23-14.
« Last Edit: June 01, 2017, 07:47:24 PM by protostache »

Lagom

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Re: What comes after the ACA?
« Reply #2525 on: June 01, 2017, 08:07:42 PM »
The California Senate passed SB 562 today which would enact single payer healthcare for all California residents. A study released yesterday finds that single payer in California would cut overall spending by 18% and would cost an additional $106 billion to implement on top of the current $225 billion that taxpayers currently contribute to healthcare in the state via Medicare, Medicaid, and the ACA premium and cost sharing reduction subsidies. Notably this legislation would cover every resident of California regardless of their immigration status.

The Senate version of the bill does not contain any actual funding provisions, other than stipulating that California would seek all waivers necessary for all Federal health care money to be paid into a state trust fund. The study referred to above proposes two alternatives for generating the $106 bill in additional revenue: a 2.3% gross receipts tax on businesses (with an exemption for the first $2 mil in revenue) plus a 2.3% sales tax (with a broad swath of exemptions) OR a 6.6% payroll tax plus the 2.3% sales tax.

The bill now passes to the Assembly, who can either pass it and kick the funding can down the road, or they can work up a funding plan and send it back to the Senate where it would require a 2/3 majority (I think? I'm don't know much about CA legislative workings.) Today's bill passed 23-14.

Huh, I'm actually surprised it passed given what I had read on it earlier, but I have not been closely following the subsequent debate. I would love to see some analysis beyond handwavy supposition on how much reduced healthcare costs would offset a tax increase for the average Californian.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2526 on: June 01, 2017, 08:20:05 PM »
The California Senate passed SB 562 today which would enact single payer healthcare for all California residents. A study released yesterday finds that single payer in California would cut overall spending by 18% and would cost an additional $106 billion to implement on top of the current $225 billion that taxpayers currently contribute to healthcare in the state via Medicare, Medicaid, and the ACA premium and cost sharing reduction subsidies.

The Senate version of the bill does not contain any actual funding provisions, other than stipulating that California would seek all waivers necessary for all Federal health care money to be paid into a state trust fund. The bill now passes to the Assembly, who can either pass it and kick the funding can down the road, or they can work up a funding plan and send it back to the Senate where it would require a 2/3 majority (I think? I'm don't know much about CA legislative workings.) Today's bill passed 23-14.

I hope this goes through. This would be a great experiment to see if the government can have a single payer system.  California will need to provide reasonable healthcare without running out of money, while not overtaxing their population into moving out, and still keep the doctors around. We have a few docs here from California who fled for better pay and a better lifestyle and that is under the current system. I'm not sure how spending an extra 45% on healthcare will save 18% in the long run unless hat 45% one time fee will cut spending by 18% in the long run. Again, I am very curious to see this experiment in action.  This should put to rest the controversy if we can have a single payer system in the United States. I'm also currently glad I don't live or work in California because I would hate to be a part of that experiment. More reason to get myself FI cause who knows what will come next.

protostache

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Re: What comes after the ACA?
« Reply #2527 on: June 01, 2017, 08:25:39 PM »
The California Senate passed SB 562 today which would enact single payer healthcare for all California residents. A study released yesterday finds that single payer in California would cut overall spending by 18% and would cost an additional $106 billion to implement on top of the current $225 billion that taxpayers currently contribute to healthcare in the state via Medicare, Medicaid, and the ACA premium and cost sharing reduction subsidies.

The Senate version of the bill does not contain any actual funding provisions, other than stipulating that California would seek all waivers necessary for all Federal health care money to be paid into a state trust fund. The bill now passes to the Assembly, who can either pass it and kick the funding can down the road, or they can work up a funding plan and send it back to the Senate where it would require a 2/3 majority (I think? I'm don't know much about CA legislative workings.) Today's bill passed 23-14.

I hope this goes through. This would be a great experiment to see if the government can have a single payer system.  California will need to provide reasonable healthcare without running out of money, while not overtaxing their population into moving out, and still keep the doctors around. We have a few docs here from California who fled for better pay and a better lifestyle and that is under the current system. I'm not sure how spending an extra 45% on healthcare will save 18% in the long run unless hat 45% one time fee will cut spending by 18% in the long run. Again, I am very curious to see this experiment in action.  This should put to rest the controversy if we can have a single payer system in the United States. I'm also currently glad I don't live or work in California because I would hate to be a part of that experiment. More reason to get myself FI cause who knows what will come next.

The estimate is $106 billion per year on top of the current payments from the Federal government of all types. The study has a breakdown of where that money comes from. Remember that nobody will be paying premiums or copays for health or dental care. It will all be paid for with Federal money and the addition of a sales tax and either a gross receipts tax or a payroll tax (assuming the final legislation hews close to the study).  The 18% overall savings comes from a broad swath of friction reduction, as you put it earlier, plus price controls in the same vein as the Medicare price list. For purposes of the study they assume Healthy California would adopt the Medicare price list exactly, but that's probably not how it would shake out in the end.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2528 on: June 01, 2017, 08:46:03 PM »
The California Senate passed SB 562 today which would enact single payer healthcare for all California residents. A study released yesterday finds that single payer in California would cut overall spending by 18% and would cost an additional $106 billion to implement on top of the current $225 billion that taxpayers currently contribute to healthcare in the state via Medicare, Medicaid, and the ACA premium and cost sharing reduction subsidies.

The Senate version of the bill does not contain any actual funding provisions, other than stipulating that California would seek all waivers necessary for all Federal health care money to be paid into a state trust fund. The bill now passes to the Assembly, who can either pass it and kick the funding can down the road, or they can work up a funding plan and send it back to the Senate where it would require a 2/3 majority (I think? I'm don't know much about CA legislative workings.) Today's bill passed 23-14.

I hope this goes through. This would be a great experiment to see if the government can have a single payer system.  California will need to provide reasonable healthcare without running out of money, while not overtaxing their population into moving out, and still keep the doctors around. We have a few docs here from California who fled for better pay and a better lifestyle and that is under the current system. I'm not sure how spending an extra 45% on healthcare will save 18% in the long run unless hat 45% one time fee will cut spending by 18% in the long run. Again, I am very curious to see this experiment in action.  This should put to rest the controversy if we can have a single payer system in the United States. I'm also currently glad I don't live or work in California because I would hate to be a part of that experiment. More reason to get myself FI cause who knows what will come next.

The estimate is $106 billion per year on top of the current payments from the Federal government of all types. The study has a breakdown of where that money comes from. Remember that nobody will be paying premiums or copays for health or dental care. It will all be paid for with Federal money and the addition of a sales tax and either a gross receipts tax or a payroll tax (assuming the final legislation hews close to the study).  The 18% overall savings comes from a broad swath of friction reduction, as you put it earlier, plus price controls in the same vein as the Medicare price list. For purposes of the study they assume Healthy California would adopt the Medicare price list exactly, but that's probably not how it would shake out in the end.

Currently Medicare/Medicaid is a major source of friction and cost. They are the ones who have created much of the expensive regulations providers and doctors must now follow.  They also have some rules regarding documentation and billing making the process much more costly as compared to some private insurance companies. At least they are not looking for a profit like private insurance.  Maybe there is a possibility at cost cutting though I think the 18% is overzealous.

California has 12.2% of the US population.  We currently spend $ 3.4 trillion dollars in the US on healthcare every year. Based on population alone California therefor spends $414 Billion and apparently looking to add another $106 billion and increase spending by 25% in the hopes of saving 18%.  I probably am still not quite getting it which is fine. I have always been skeptical of a single payer system in the US because of how expensive the cost of care is. I am truly eager to see if this can be accomplished in California without detrimental consequences. I would be completely content to be proven wrong because we really need some big changes in our healthcare industry.
« Last Edit: June 01, 2017, 08:54:21 PM by EnjoyIt »

protostache

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Re: What comes after the ACA?
« Reply #2529 on: June 02, 2017, 03:54:26 AM »
At least read the first page or two of the study. It explains how the math works in the summary.

nereo

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Re: What comes after the ACA?
« Reply #2530 on: June 02, 2017, 05:32:16 AM »
-EnjoyIt: I (mostly) follow your numbers but I do not understand your conclusion regarding single-payer. If we are already spending this amount on health-care in the US in all our various forms (e.g. Individual, employer, out-of-pocket, Medicare/caid etc) why would *cost* be the reason single-payer cannot work here?  Are you suggesting that a single-payer system would cause costs to increase further (seems?to be your argument regarding Medicare and its "friction and cost")?
"Do not confuse complexity with superiority"

jim555

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Re: What comes after the ACA?
« Reply #2531 on: June 02, 2017, 07:09:46 AM »
Medicare fee for service is very efficient.  No insurance company slice between payer and provider.  Insurance companies should be closed down they just add a layer of expense for no reason.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2532 on: June 02, 2017, 09:16:17 AM »
This is why we can't have cheap drug prices:

https://finance.yahoo.com/m/4f84226f-c898-3c1a-b4e9-ffcd1406a194/endocyte-stock-plummets-30%25.html

A billion dollars of investor money down the drain.

OurTown

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Re: What comes after the ACA?
« Reply #2533 on: June 02, 2017, 11:04:01 AM »
Okay, this should be popular:  https://www.wsj.com/articles/gop-senators-weigh-taxing-employer-health-plans-1496350662

I thought the Rs were going to cut my taxes!  Instead, they are talking about taxing health premiums for employer plans and Roth-ifying the 401(k). 


jim555

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Re: What comes after the ACA?
« Reply #2534 on: June 02, 2017, 11:18:05 AM »
And large employers would no longer have a mandate to provide coverage at all. 

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2535 on: June 02, 2017, 01:12:53 PM »
Okay, this should be popular:  https://www.wsj.com/articles/gop-senators-weigh-taxing-employer-health-plans-1496350662

I thought the Rs were going to cut my taxes!  Instead, they are talking about taxing health premiums for employer plans and Roth-ifying the 401(k).

Actually taxing compensation that is used to buy your health insurance is completely fair.

Why should a person get to use pre-tax dollars to get health insurance if an unemployed person has to buy the same insurance with post-tax dollars?

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2536 on: June 02, 2017, 01:43:45 PM »
I guess this thread is just a free for all discussing anything Trump related.

How about that Kathy Griffen thing?   Publicity stunt to try and stay relevant or just an idiot with poor impulse control?

sol

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Re: What comes after the ACA?
« Reply #2537 on: June 02, 2017, 01:56:15 PM »
I guess this thread is just a free for all discussing anything Trump related.

How about that Kathy Griffen thing?   Publicity stunt to try and stay relevant or just an idiot with poor impulse control?

Why not both?

Lagom

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Re: What comes after the ACA?
« Reply #2538 on: June 02, 2017, 01:58:25 PM »
I guess this thread is just a free for all discussing anything Trump related.

How about that Kathy Griffen thing?   Publicity stunt to try and stay relevant or just an idiot with poor impulse control?

Inconsequential political commentary made in poor taste that has been thoroughly punished worse than what happened to Ted Nugent, for example. Not worth discussing tbh, but if you care to, I would recommend the Political Current Events thread.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2539 on: June 02, 2017, 02:05:08 PM »

sol

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Re: What comes after the ACA?
« Reply #2540 on: June 02, 2017, 02:12:21 PM »
Parliamentarian MacDonough is going to decide which parts of the AHCA need 50 votes versus 60 votes in the Senate to pass.

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/05/30/the-health-202-meet-the-referee-in-the-gop-effort-to-replace-obamacare/592cad88e9b69b2fb981dbe1/?utm_term=.52e29c57d0cc

Any bets on just how strongly worded Trumps conversation with her was, when he "really hoped she could see the right thing to do, because if not someone else will"?  Having watched the way the administration works, I'd lay 10:1 odds they've already tried to strongarm her.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2541 on: June 02, 2017, 02:17:43 PM »
Parliamentarian MacDonough is going to decide which parts of the AHCA need 50 votes versus 60 votes in the Senate to pass.

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/05/30/the-health-202-meet-the-referee-in-the-gop-effort-to-replace-obamacare/592cad88e9b69b2fb981dbe1/?utm_term=.52e29c57d0cc

Any bets on just how strongly worded Trumps conversation with her was, when he "really hoped she could see the right thing to do, because if not someone else will"?  Having watched the way the administration works, I'd lay 10:1 odds they've already tried to strongarm her.

Trump's immorality will likely happen here too abetted by the Republican Senate Majority Leader McConnell

protostache

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Re: What comes after the ACA?
« Reply #2542 on: June 02, 2017, 02:25:57 PM »
Parliamentarian MacDonough is going to decide which parts of the AHCA need 50 votes versus 60 votes in the Senate to pass.

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/05/30/the-health-202-meet-the-referee-in-the-gop-effort-to-replace-obamacare/592cad88e9b69b2fb981dbe1/?utm_term=.52e29c57d0cc

Any bets on just how strongly worded Trumps conversation with her was, when he "really hoped she could see the right thing to do, because if not someone else will"?  Having watched the way the administration works, I'd lay 10:1 odds they've already tried to strongarm her.

Trump's immorality will likely happen here too abetted by the Republican Senate Majority Leader McConnell

McConnell doesn't have anything to do with it, but Mike Pence as President of the Senate can overrule the Parliamentarian for purposes of the Byrd rule.

jim555

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Re: What comes after the ACA?
« Reply #2543 on: June 02, 2017, 02:32:54 PM »
If the Republicans had the will they could blow up the Senate rules and pass a full repeal, sending everything back to 2009.  This is what they ran on. 
I don't know why they aren't doing this.  Could it be that the "free market" just doesn't work?

Mr. Green

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Re: What comes after the ACA?
« Reply #2544 on: June 02, 2017, 04:49:10 PM »
If the Republicans had the will they could blow up the Senate rules and pass a full repeal, sending everything back to 2009.  This is what they ran on. 
I don't know why they aren't doing this.  Could it be that the "free market" just doesn't work?
I don't think anyone would survive the fallout of this, despite it being what they ran on. Ironically, politicians always seem more interested in preserving their own position than fulfilling their fiduciary duties as a representative of the people.
FIRE, Take Two.

stoaX

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Re: What comes after the ACA?
« Reply #2545 on: June 02, 2017, 05:52:21 PM »

[/quote]
politicians always seem more interested in preserving their own position than fulfilling their fiduciary duties as a representative of the people.
[/quote]

Shocking!   And as a footnote, "their own position" includes health insurance.   


EnjoyIt

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Re: What comes after the ACA?
« Reply #2546 on: June 04, 2017, 07:35:47 AM »
-EnjoyIt: I (mostly) follow your numbers but I do not understand your conclusion regarding single-payer. If we are already spending this amount on health-care in the US in all our various forms (e.g. Individual, employer, out-of-pocket, Medicare/caid etc) why would *cost* be the reason single-payer cannot work here?  Are you suggesting that a single-payer system would cause costs to increase further (seems?to be your argument regarding Medicare and its "friction and cost")?

Great question.
1) Medicaid pays less than what it costs to treat the patient. If the reimbursement rates are all Medicaid rates then this is unsustainable. This is the reason why so many providers just don't take on Medicaid patients. Medicare pays better but also very poorly to providers although it does allow for a small profit.

2) Many single payer systems in the world outsource to insurance companies to manage payments. These infact do take a profit. BTW, this practice also occurs in the US as well.

3) CMS, the guys who run Medicare/Medicaid are the ones who have created some of the rediculous regulations that are putting small practices out of business. CMS is also the reason why costs are so high in the hospital settings as well.

4) I can promise you that if tomorrow my pay got cut to just Medicaid reimbursement, I would probably just quit. Just not worth going into work. The reason why physicians take Medicare/Medicaid patients is that they hope it will also bring insured patients as well. Without the insured there just isn't a point to keeping the doors open.

5) Think about it from the physician standpoint. They graduate at about 30 years old with about $350K in debt. Very very few docs are mustachiane and buy their first home right out of residency at 3x income.  Now all of a sudden their pay is cut by 25%. For many that equals bankruptcy. Sad but true.

6) Why have insurance private or public of any kind interfere with low cost health expenditures. It is an added step, and a waste of time and money.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2547 on: June 04, 2017, 07:14:17 PM »
Regarding the bloated costs of medical care in this country, it sounds like the specialty physicians are a major factor here.

Every specialist wants to run a bunch of tests on you, most not needed, and a primary care doctor could have prevented this waste.


"The Specialists' Stranglehold on Medicine", by Jamie Koufman, Otolaryngologist (you have to get really good grades in Med school in order to get an Otolaryngology residency program)

https://nyti.ms/2rDTDI1


NESailor

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Re: What comes after the ACA?
« Reply #2548 on: June 05, 2017, 08:04:26 AM »
-EnjoyIt: I (mostly) follow your numbers but I do not understand your conclusion regarding single-payer. If we are already spending this amount on health-care in the US in all our various forms (e.g. Individual, employer, out-of-pocket, Medicare/caid etc) why would *cost* be the reason single-payer cannot work here?  Are you suggesting that a single-payer system would cause costs to increase further (seems?to be your argument regarding Medicare and its "friction and cost")?

Great question.
1) Medicaid pays less than what it costs to treat the patient. If the reimbursement rates are all Medicaid rates then this is unsustainable. This is the reason why so many providers just don't take on Medicaid patients. Medicare pays better but also very poorly to providers although it does allow for a small profit.

2) Many single payer systems in the world outsource to insurance companies to manage payments. These infact do take a profit. BTW, this practice also occurs in the US as well.

3) CMS, the guys who run Medicare/Medicaid are the ones who have created some of the rediculous regulations that are putting small practices out of business. CMS is also the reason why costs are so high in the hospital settings as well.

4) I can promise you that if tomorrow my pay got cut to just Medicaid reimbursement, I would probably just quit. Just not worth going into work. The reason why physicians take Medicare/Medicaid patients is that they hope it will also bring insured patients as well. Without the insured there just isn't a point to keeping the doors open.

5) Think about it from the physician standpoint. They graduate at about 30 years old with about $350K in debt. Very very few docs are mustachiane and buy their first home right out of residency at 3x income.  Now all of a sudden their pay is cut by 25%. For many that equals bankruptcy. Sad but true.

6) Why have insurance private or public of any kind interfere with low cost health expenditures. It is an added step, and a waste of time and money.

The first bolded part - I'm going to go with no, it's not that simple.  It's part of it, but not nearly all or even the largest part of the problem.  The second bolded part illustrates why.  The entire system - literally from the pre-Med program up through the company that does the laundry for the hospital is bloated because we've managed to obfuscate what things cost and who pays them.   If Colleges didn't think they can enrich themselves (admins, professors, subcontractors, etc etc.), you wouldn't graduate with 350K in debt.  Then you wouldn't expect to make 250K out of the gate.  So on and so forth.  This setup does motivate some of the best and brightest to pursue medical care careers - that's good.  But it comes at a cost, obviously. 

Somehow, very bright students all around the world choose to become doctors without the expectation of a 500K salary ...ever.  You know how I know? My ex is an MD in Prague.  Probably makes a fraction of what I make in the US as a CPA.   As does her now hubby.  Both are brilliant.  Neither paid any tuition at a great med school in Prague.

Same story with pharma, equipment manufacturers and so on.  Everyone knows that price is secondary in the US.  Someone will foot the bill and as long as the bill keeps getting footed we are seeing rates of cost increases outpace inflation. 

You are right, Medicaid does reimburse at rates below cost...but it's not a Medicaid problem - you've identified it pages ago as a cost problem.   Medicare, as I've also noted a few pages back, is actually a pretty good payer.  If even a small hospital didn't need an army to deal with coding and insurance reimbursement issues (i.e.: they only dealt with a few players and 1 common price list), costs would surely be saved.  As a first step. 

I could ramble on...which is what I'm already doing...but I've gotta get some work done :)


nereo

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Re: What comes after the ACA?
« Reply #2549 on: June 05, 2017, 08:08:45 AM »
-EnjoyIt: I (mostly) follow your numbers but I do not understand your conclusion regarding single-payer. If we are already spending this amount on health-care in the US in all our various forms (e.g. Individual, employer, out-of-pocket, Medicare/caid etc) why would *cost* be the reason single-payer cannot work here?  Are you suggesting that a single-payer system would cause costs to increase further (seems?to be your argument regarding Medicare and its "friction and cost")?

Great question.
1) Medicaid pays less than what it costs to treat the patient. If the reimbursement rates are all Medicaid rates then this is unsustainable. This is the reason why so many providers just don't take on Medicaid patients. Medicare pays better but also very poorly to providers although it does allow for a small profit.

2) Many single payer systems in the world outsource to insurance companies to manage payments. These infact do take a profit. BTW, this practice also occurs in the US as well.

3) CMS, the guys who run Medicare/Medicaid are the ones who have created some of the rediculous regulations that are putting small practices out of business. CMS is also the reason why costs are so high in the hospital settings as well.

4) I can promise you that if tomorrow my pay got cut to just Medicaid reimbursement, I would probably just quit. Just not worth going into work. The reason why physicians take Medicare/Medicaid patients is that they hope it will also bring insured patients as well. Without the insured there just isn't a point to keeping the doors open.

5) Think about it from the physician standpoint. They graduate at about 30 years old with about $350K in debt. Very very few docs are mustachiane and buy their first home right out of residency at 3x income.  Now all of a sudden their pay is cut by 25%. For many that equals bankruptcy. Sad but true.

6) Why have insurance private or public of any kind interfere with low cost health expenditures. It is an added step, and a waste of time and money.
This is a long list of problems with our medical system, but none of it really addressed the question about why a single-payer system would not work.  The closest it comes is talking about how medicaid pays less for treatment than what doctors bill.
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