Author Topic: What comes after the ACA?  (Read 310138 times)

nereo

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Re: What comes after the ACA?
« Reply #2700 on: June 14, 2017, 06:39:42 AM »
In the news:

After calling the HOuse's version of the AHCA "Great" and throwing a rose-garden ceremony DJT now calls it "mean" and says the senate must do more to cover pre-existing conditions.  There's also a big push to include billions-per-year co combat opiod addiction.

It would be nice to actually see the bill and comment on it.  Looks like it'll be voted on before it even gets scored.
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protostache

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Re: What comes after the ACA?
« Reply #2701 on: June 14, 2017, 06:46:20 AM »
In the news:

After calling the HOuse's version of the AHCA "Great" and throwing a rose-garden ceremony DJT now calls it "mean" and says the senate must do more to cover pre-existing conditions.  There's also a big push to include billions-per-year co combat opiod addiction.

It would be nice to actually see the bill and comment on it.  Looks like it'll be voted on before it even gets scored.

The Senate budget reconciliation rules require a CBO score before they can vote. That doesn't mean they have to ever release the bill prior to voting, but they have to at least get the score. That's why the vote is scheduled for the very last day before the recess, to give CBO time to score.

nereo

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Re: What comes after the ACA?
« Reply #2702 on: June 14, 2017, 07:18:23 AM »
In the news:

After calling the HOuse's version of the AHCA "Great" and throwing a rose-garden ceremony DJT now calls it "mean" and says the senate must do more to cover pre-existing conditions.  There's also a big push to include billions-per-year co combat opiod addiction.

It would be nice to actually see the bill and comment on it.  Looks like it'll be voted on before it even gets scored.

The Senate budget reconciliation rules require a CBO score before they can vote. That doesn't mean they have to ever release the bill prior to voting, but they have to at least get the score. That's why the vote is scheduled for the very last day before the recess, to give CBO time to score.

Well the CBO scoring requirement is at least good to know...
why wouldn't the House have a similar requirement?  I suppose logic and law are fairweathered friends...
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protostache

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Re: What comes after the ACA?
« Reply #2703 on: June 14, 2017, 07:53:00 AM »
In the news:

After calling the HOuse's version of the AHCA "Great" and throwing a rose-garden ceremony DJT now calls it "mean" and says the senate must do more to cover pre-existing conditions.  There's also a big push to include billions-per-year co combat opiod addiction.

It would be nice to actually see the bill and comment on it.  Looks like it'll be voted on before it even gets scored.

The Senate budget reconciliation rules require a CBO score before they can vote. That doesn't mean they have to ever release the bill prior to voting, but they have to at least get the score. That's why the vote is scheduled for the very last day before the recess, to give CBO time to score.

Well the CBO scoring requirement is at least good to know...
why wouldn't the House have a similar requirement?  I suppose logic and law are fairweathered friends...

Every bill that comes to the floor of either chamber gets a CBO score but the only time you have to wait for the score is during reconciliation, as far as I understand it. The AHCA received a score after the House passed it, but remember that Ryan held it back from the Senate until the final score arrived so he could be sure it would pass muster in the Senate.

Also, because this needs to be said at every opportunity, this is not normal. The House passing wacky bills by cover of night is not unprecedented, but the Senate attempting to pass wide sweeping changes with no committee meetings, no public hearings, no amendment opportunities, and no published drafts, is not how things are done. It's a gross abuse of the process.

JumpInTheFIRE

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Re: What comes after the ACA?
« Reply #2704 on: June 14, 2017, 08:06:20 AM »
This is just wrong.  Yes, single payer with sensible negotiating power would reduce costs, but the average profit margin of health insurance companies is nowhere near what you said.    In fact, the average is just 3.3%.  Private insurance companies also have higher administrative costs than Medicare/Medicaid, but much of that is just efficiency of scale.

The fact is, there are a bunch of ways to lower health care costs.  Single payer is one, but it's far from the only one.  And playing boogeyman with pharmaceutical companies and health insurance companies distracts from the actual source of high medical costs.

Thanks for that Beltim.  I was wrong, I believe I misremembered the statistic - I think the stat I read in the past was margin plus administrative costs which according to their industry association was 21% https://www.ahip.org/health-care-dollar/ (3% margin and 18% administrative costs).  Medicare's administrative overhead is 1.3-5% (depending on who you ask and how you calculate it).  Here's an analysis of the debate over those numbers: http://www.politifact.com/truth-o-meter/statements/2011/may/30/barbara-boxer/barbara-boxer-says-medicare-overhead-far-lower-pri/ so I think my point still stands, we stand to decrease healthcare costs by 15-20% by going to a single-payer system and since medicare costs have been growing more slowly that private insurance (http://www.kff.org/health-costs/perspective/public-vs-private-health-insurance-on-controlling-spending/) we might see greater savings than that. 


brooklynguy

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Re: What comes after the ACA?
« Reply #2705 on: June 14, 2017, 01:00:17 PM »
After calling the HOuse's version of the AHCA "Great" and throwing a rose-garden ceremony DJT now calls it "mean" and says the senate must do more to cover pre-existing conditions.

Amusingly, in addition to originally calling the House's version "great," he had also called it not just well-crafted, and not just incredibly well-crafted, and not just very incredibly well-crafted, but "very, very incredibly well-crafted."

It's difficult to handicap how Trump's reinsertion of himself into the debate will affect the outcome.  Throwing his weight in favor of the moderate faction might help get a bill passed in the Senate (where, it appears, the current strategy is to get to a majority by appeasing the moderate center at the expense of the hard right), but that would seem to make it more difficult to wind up with an end-product the House would be willing to approve.  Trump's backpedaling on his support of the House's original bill won't help in that regard, either.

nereo

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Re: What comes after the ACA?
« Reply #2706 on: June 14, 2017, 01:13:35 PM »
After calling the HOuse's version of the AHCA "Great" and throwing a rose-garden ceremony DJT now calls it "mean" and says the senate must do more to cover pre-existing conditions.

Amusingly, in addition to originally calling the House's version "great," he had also called it not just well-crafted, and not just incredibly well-crafted, and not just very incredibly well-crafted, but "very, very incredibly well-crafted."

It's difficult to handicap how Trump's reinsertion of himself into the debate will affect the outcome.  Throwing his weight in favor of the moderate faction might help get a bill passed in the Senate (where, it appears, the current strategy is to get to a majority by appeasing the moderate center at the expense of the hard right), but that would seem to make it more difficult to wind up with an end-product the House would be willing to approve.  Trump's backpedaling on his support of the House's original bill won't help in that regard, either.

Then again... throughout his career DJT has followed the strategy of doing/saying whatever helps his cause at that moment, sometimes even when it would mean contradicting himself later. This largely worked when dealing with limited attention spans and opponents who frequently changed. It's less clear how this strategy will play out long-term ont he national stage, especially with so many willing to document and dredge up this contradictions months and even years later.
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EnjoyIt

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Re: What comes after the ACA?
« Reply #2707 on: June 14, 2017, 05:53:49 PM »


The reality is:
1) Despite the massive benefits of the ACA, the law has harmed a large percentage of middle class tax payers.  The law has not only made healthcare more unaffordable to those people, it also made it very cumbersome being forced to change health plans and doctors on a yearly basis. Also just because a group of people has health insurance does not mean they can still afford the deductibles and a significant portion of the newly insured find their subsidized insurance not that helpful. These people want the ACA amended or dismantled.
2) Politics is dirty and corrupt. Both democrat and republican politicians are mostly scum who care more about being reelected and satisfying their lobbyists as opposed to doing what is right for the American people. Republicans do it in the guise of cutting taxes, cutting the deficit, and improving the American way of life. Democrats do it in the guise of social justice, environmental benefits, and improving the lives of those less fortunate.
3) Not everyone who votes republican is a racist idiot redneck. There are many intelligent hard working middle class Americans who pay taxes and are constantly squeezed by the government. They find their cost of living going up, their taxes going up, and their disposable income dwindling. They chose to vote republican last year.  It doesn't mean they are stupid or racist.  It just means they became fed up with our political system that the last 8 years has given and want change.  Maybe in 3-7 years those same people will vote democrat after seeing no benefit from the current regime.  But the reality is that they are not racist morons.

Sol, Cognitive dissonance is a normal part of human thinking.  Everyone gets this when their strong beliefs are questioned. Who knows, maybe I am the one with cognitive dissonance discussing this subject with you. Although difficult to accept, maybe with the right arguments I can see that in myself. I will try and be open to that thought.

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Hi EnjoyIt!
#1 - Not sure whether we can really tell how many are better off vs. worse off.  Many may feel that they are worse off when in fact their policy is more comprehensive and more robust...they just don't know it (no lifetime caps etc.).  I do agree, however, it should be amended/fixed/whatever.   Our setup is garbage, as we've covered over 55 pages by now.
#2 - spot on.

Unfortunately you are correct NEsailor it is very difficult to understand who the law helped and by how much vs who it harmed.  I see the following groups of people
1) The poor who couldn't get medicaid but now can due to expansion and therefor have relatively free healthcare coverage. Definitely a good thing.
2) The working poor who can now get subsidized health insurance and subsidized deductibles. Definitely an improvement from no health coverage at all.
3) Those who get some subsidies, but the deductibles are so high that they still can't afford paying for healthcare.  This group is the biggest concern for health institutions who claim that the volume of patients with health insurance has increased over the last few years, but a large portion of them don't pay their deductibles and therefor it is no better than no insurance at all.  These people may have never had any coverage at all, or had a much lower cost coverage that fit their particular needs but now forced into the ACA.  Some where harmed and some were not affected at all
4) Those who get no subsidies and have huge deductibles.  Unless these people are Mustachian or making solid 6 figure incomes, they get hit with very expensive health insurance.  These people were definitely harmed by the law.
5) The wealthier Americans who now pay much more for healthcare but are able to absorb the costs due to their income.

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#3 - Cost of living going up, squeezed by the government...puh lease! We have an entire community of people here who can clearly demonstrate that cost of living is NOT in fact going up that drastically.  The government also isn't really squeezing anyone particularly hard either.  The poor already don't pay all that much in taxes.  The middle class don't have to, if they don't want to.  And the truly wealthy (because this community right here already has many very wealthy members) can easily afford to pay what they pay...and then some.  I'm in the top few % by income for my age group.  Even if my income tax burden DOUBLED next year - I'd still be doing great...with NO impact on my quality of life. 

You need to accept that most Americans are unable to change into a Mustachian lifestyle.  If we hold those people accountable then we should also hold accountable the poor who choose not to get a higher education and better paying jobs. For multiple reasons not worth getting into, most people don't have the understanding or the motivation and therefor are in the situation they are in. We can't expect them to be mustachians just as we can't expect them to get a biotech degree. I believe we simply need to accept that a certain number of taxpayers have taken a significant hit to their healthcare costs because of the ACA.  We also need to accept that just because a family now has subsidized insurance that they are able to afford their deductibles and therefor receive any benefit from their new subsidized insurance policy.

Here is a question for you and it is a hypothetical straw man question. Is it okay to make healthcare unaffordable for 1 tax payer so that it can be affordable for 1 non tax payers? What about unaffordable healthcare to 2 taxpayers to help 1 non tax payer? What about 1 tax payer to help 2 non tax payers?  I hope you see what I am getting at. Don't get me wrong, I am not saying that the ACA is so bad that it hurts 1 person to help another.  But there is a line where maybe the harm to tax payers out ways the benefit to non tax payers.  Again, I am not fully sure where the line is because it is currently impossible to asses.

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So I don't accept any of the bitching about taxes being too high.  The argument that AHCA repeals a tax hike from 8 years ago is ridiculous.  20 years ago rates were higher, why not use 20 years ago as a baseline?  Or how about 30 years ago?  Or 40 years ago?  I know why - because somehow we've concluded that taxes are evil and we're overtaxed...when in fact we pay less and less of our incomes for an ever expanding government.  I'm fine either way.  Cut my taxes or cut spending.  But don't ask for a goddamn increase in military spending and then tell me that everyone at my level of wealth and above is suffering some undue tax burden (this is not directed at you...this is in the general direction of a plain vanilla republican politician...whose platform is just that - more military, less taxes for me).  Those who claim that are full of shit and greedy.

I do fully agree with you that we spend way too much money on so called national defense.  Personally I think our entire government is a bit overinflated and needs some mustachian style cost cutting across the board. More spending is not always the solution to fix a problem.  If we expect ourselves to be more efficient, shouldn't we strive for the same from our government?

shenlong55

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Re: What comes after the ACA?
« Reply #2708 on: June 15, 2017, 08:41:07 AM »
Unfortunately you are correct NEsailor it is very difficult to understand who the law helped and by how much vs who it harmed.  I see the following groups of people
1) The poor who couldn't get medicaid but now can due to expansion and therefor have relatively free healthcare coverage. Definitely a good thing.
2) The working poor who can now get subsidized health insurance and subsidized deductibles. Definitely an improvement from no health coverage at all.
3) Those who get some subsidies, but the deductibles are so high that they still can't afford paying for healthcare.  This group is the biggest concern for health institutions who claim that the volume of patients with health insurance has increased over the last few years, but a large portion of them don't pay their deductibles and therefor it is no better than no insurance at all.  These people may have never had any coverage at all, or had a much lower cost coverage that fit their particular needs but now forced into the ACA.  Some where harmed and some were not affected at all
4) Those who get no subsidies and have huge deductibles.  Unless these people are Mustachian or making solid 6 figure incomes, they get hit with very expensive health insurance.  These people were definitely harmed by the law.
5) The wealthier Americans who now pay much more for healthcare but are able to absorb the costs due to their income.

So...  Are you saying that those in groups 3 & 4 actually had access to plans that were cheaper (after taking subsidies into account) and also had lower deductibles before the ACA was enacted?

EnjoyIt

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Re: What comes after the ACA?
« Reply #2709 on: June 15, 2017, 10:17:38 AM »
Unfortunately you are correct NEsailor it is very difficult to understand who the law helped and by how much vs who it harmed.  I see the following groups of people
1) The poor who couldn't get medicaid but now can due to expansion and therefor have relatively free healthcare coverage. Definitely a good thing.
2) The working poor who can now get subsidized health insurance and subsidized deductibles. Definitely an improvement from no health coverage at all.
3) Those who get some subsidies, but the deductibles are so high that they still can't afford paying for healthcare.  This group is the biggest concern for health institutions who claim that the volume of patients with health insurance has increased over the last few years, but a large portion of them don't pay their deductibles and therefor it is no better than no insurance at all.  These people may have never had any coverage at all, or had a much lower cost coverage that fit their particular needs but now forced into the ACA.  Some where harmed and some were not affected at all
4) Those who get no subsidies and have huge deductibles.  Unless these people are Mustachian or making solid 6 figure incomes, they get hit with very expensive health insurance.  These people were definitely harmed by the law.
5) The wealthier Americans who now pay much more for healthcare but are able to absorb the costs due to their income.

So...  Are you saying that those in groups 3 & 4 actually had access to plans that were cheaper (after taking subsidies into account) and also had lower deductibles before the ACA was enacted?

Correct!
This is especially true for middle class American families whor are older, have multiple medical issues requiring chronic meds and physician visits but also have no dependents any more.  The crazy part comes when insurance alone is $10k/yr and their family deductibles are $12k as well but they are outside any chance for subsidies.  Subsidies come at an income of $64k/yr and increase as the income is lower.  You can easily see how a middle class American family can manage to not qualify for subsides and end up with such expensive costs.  I am sure most of these will most definitely want to dismantle or amend the ACA.

I can tell you that since the ACA has been enacted my insurance premiums have gone up almost 300% with no additional benefit to me or my family. I am glad that people with pre-existing conditions can get coverage and OK with spending a bit extra for that. Being mustachian I can comfortably absorb that difference but I am not everyone and a reasonable chunk of tax payers are significantly worse off since the law was enacted.

Personally I think the only way to fix this is to pursue cost cutting measures as opposed to cost shifting measures. Somebody will always have to foot the bill therefor we need to make the bill as small as possible without adversely affecting care provided.

Midwest

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Re: What comes after the ACA?
« Reply #2710 on: June 15, 2017, 10:32:01 AM »


Personally I think the only way to fix this is to pursue cost cutting measures as opposed to cost shifting measures. Somebody will always have to foot the bill therefor we need to make the bill as small as possible without adversely affecting care provided.

Since you bring up cost shifting - Am I correct that private pay insurance typically reimburses at a much higher rate than medicare/medicaid.  Given that, isn't anyone with private insurance indirectly supplementing lower reimbursement payor types?

EnjoyIt

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Re: What comes after the ACA?
« Reply #2711 on: June 15, 2017, 10:40:59 AM »


Personally I think the only way to fix this is to pursue cost cutting measures as opposed to cost shifting measures. Somebody will always have to foot the bill therefor we need to make the bill as small as possible without adversely affecting care provided.

Since you bring up cost shifting - Am I correct that private pay insurance typically reimburses at a much higher rate than medicare/medicaid.  Given that, isn't anyone with private insurance indirectly supplementing lower reimbursement payor types?

Yes, as well as the non insured, and those who have insurance but don't pay their deductibles.
When I mentioned cost shifting I wasn't talking about insurance companies.  I was talking about tax payers and patients. All these healthcare laws (ACA and AHCA) do is describe who will take the brunt of the cost of healthcare.  The laws should instead activity work on decreasing how much healthcare costs and thereby requiring less money and less cost shifting to pay for it. Unfortunately our crooked republican and democrat politicians have no interest in real cost cutting measures that would affect the profits of insurance providers, pharmaceutical companies and large healthcare entities.

JustGettingStarted1980

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Re: What comes after the ACA?
« Reply #2712 on: June 15, 2017, 10:45:21 AM »
I may regret joining this discussion of people basically talking past eachother because politics = religion and basically shuts off your prefrontal cortex.... but, this info may add to the overall debate.

Warning -this is a LONG READ.

https://www.theatlantic.com/theplatinumpatients/

shenlong55

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Re: What comes after the ACA?
« Reply #2713 on: June 15, 2017, 10:46:09 AM »
Unfortunately you are correct NEsailor it is very difficult to understand who the law helped and by how much vs who it harmed.  I see the following groups of people
1) The poor who couldn't get medicaid but now can due to expansion and therefor have relatively free healthcare coverage. Definitely a good thing.
2) The working poor who can now get subsidized health insurance and subsidized deductibles. Definitely an improvement from no health coverage at all.
3) Those who get some subsidies, but the deductibles are so high that they still can't afford paying for healthcare.  This group is the biggest concern for health institutions who claim that the volume of patients with health insurance has increased over the last few years, but a large portion of them don't pay their deductibles and therefor it is no better than no insurance at all.  These people may have never had any coverage at all, or had a much lower cost coverage that fit their particular needs but now forced into the ACA.  Some where harmed and some were not affected at all
4) Those who get no subsidies and have huge deductibles.  Unless these people are Mustachian or making solid 6 figure incomes, they get hit with very expensive health insurance.  These people were definitely harmed by the law.
5) The wealthier Americans who now pay much more for healthcare but are able to absorb the costs due to their income.

So...  Are you saying that those in groups 3 & 4 actually had access to plans that were cheaper (after taking subsidies into account) and also had lower deductibles before the ACA was enacted?

Correct!
This is especially true for middle class American families whor are older, have multiple medical issues requiring chronic meds and physician visits but also have no dependents any more.  The crazy part comes when insurance alone is $10k/yr and their family deductibles are $12k as well but they are outside any chance for subsidies.  Subsidies come at an income of $64k/yr and increase as the income is lower.  You can easily see how a middle class American family can manage to not qualify for subsides and end up with such expensive costs.  I am sure most of these will most definitely want to dismantle or amend the ACA.

I can tell you that since the ACA has been enacted my insurance premiums have gone up almost 300% with no additional benefit to me or my family. I am glad that people with pre-existing conditions can get coverage and OK with spending a bit extra for that. Being mustachian I can comfortably absorb that difference but I am not everyone and a reasonable chunk of tax payers are significantly worse off since the law was enacted.

Personally I think the only way to fix this is to pursue cost cutting measures as opposed to cost shifting measures. Somebody will always have to foot the bill therefor we need to make the bill as small as possible without adversely affecting care provided.

Ah, I see.  To be fair I wasn't really in the insurance market before ACA, but I think I was just confused because while $10k/year for a plan with a $12k deductible doesn't sound like good insurance it does sound like normal insurance.  In other words, I just thought it was normal for insurance to suck but I guess I just haven't seen an insurance market done well yet.

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Re: What comes after the ACA?
« Reply #2714 on: June 15, 2017, 11:17:36 AM »


Personally I think the only way to fix this is to pursue cost cutting measures as opposed to cost shifting measures. Somebody will always have to foot the bill therefor we need to make the bill as small as possible without adversely affecting care provided.

Since you bring up cost shifting - Am I correct that private pay insurance typically reimburses at a much higher rate than medicare/medicaid.  Given that, isn't anyone with private insurance indirectly supplementing lower reimbursement payor types?

Yes, as well as the non insured, and those who have insurance but don't pay their deductibles.
When I mentioned cost shifting I wasn't talking about insurance companies.  I was talking about tax payers and patients. All these healthcare laws (ACA and AHCA) do is describe who will take the brunt of the cost of healthcare.  The laws should instead activity work on decreasing how much healthcare costs and thereby requiring less money and less cost shifting to pay for it. Unfortunately our crooked republican and democrat politicians have no interest in real cost cutting measures that would affect the profits of insurance providers, pharmaceutical companies and large healthcare entities.

I understood you weren't talking about insurance companies.  However, the net effect of higher reimbursements by private pay insurance is a higher cost to the policy holder. 

With the current situation, people with private health insurance subsidize everyone else (medicare, medicaid, and uninsured) because private pay reimburses at a higher rate.  Due to this higher rate, the insureds pay higher premiums.

Your comment on cost cutting is dead on.  If that issue were addressed, maybe we could make some headway but both sides of the aisle have failed on that point.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2715 on: June 15, 2017, 11:26:25 AM »
I may regret joining this discussion of people basically talking past eachother because politics = religion and basically shuts off your prefrontal cortex.... but, this info may add to the overall debate.

Warning -this is a LONG READ.

https://www.theatlantic.com/theplatinumpatients/

Nice article.  It discusses one of the aspects of cost cutting I described in earlier posts. We need a way to tell patients and families "No" More treatment will not only be minimal affective, but will actually cause more harm than good.  For example:  Why place a feeding tube when they have no brain function and are bedridden?  Why subject them to more pain and suffering just to keep them alive a few more months or years? Why do that colon resection to improve life expectancy by 2 months? Why perform CPR and break every rib on someone who has little to no brain function and then must live on a respirator for a few more months?  I can go on and on.

End of life care is a huge financial burden.  I would love to see TV commercials that talk about hospice and decreasing pain and suffering.  It should be funded by the government since most of this care is paid for by Medicare that would be money well spent.

sol

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Re: What comes after the ACA?
« Reply #2716 on: June 15, 2017, 11:53:20 AM »

We need a way to tell patients and families "No" More treatment will not only be minimal affective, but will actually cause more harm than good. 

But, but, but DEATH PANELS (is what republicans started shouting when the democratic congress tried to institute such policies).  They said "Obama is going to kill your grandma!" and forever killed any chance at reasonable discussion about limiting end of life care for humanitarian reasons.
« Last Edit: June 15, 2017, 11:57:24 AM by sol »

NESailor

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Re: What comes after the ACA?
« Reply #2717 on: June 15, 2017, 11:56:50 AM »


I can tell you that since the ACA has been enacted my insurance premiums have gone up almost 300% with no additional benefit to me or my family. I am glad that people with pre-existing conditions can get coverage and OK with spending a bit extra for that. Being mustachian I can comfortably absorb that difference but I am not everyone and a reasonable chunk of tax payers are significantly worse off since the law was enacted.



I'm having a hard time making sense of this number.  Are you talking about your portion or the entire premium (since employers often cover a good portion (or all) of an employee's premium.  I.e.:  My family plan at work costs approximately 15K all in.  I pay 3K of this, the employer covers the other 12K.    If I said - "my premiums went up 300%" I would be signaling that my plan went from 15K to 45K/year.  I'd be pretty outraged, that's for sure. 

Or do you mean that only the part you pay is up 300%?  As in - the plan is now 21K and you pay 9K while your employer still pays 12K ?  This would still be a lot but it would actually only be a 40% increase since pre-ACA times (21/15) which is a pretty normal rate of increase when annualized (for the healthcare sector in general).

I know people are reporting ridiculous increases so I guess either scenario is possible.  Some of the increases are caused by going from a total garbage policy that wouldn't have covered a damn thing and cost 1500/year and going to a Bronze plan that has actual protections built in...but costs multiples of the 1500/year.  I'm not sorry about those - the catastrophic insurance pre-ACA was just as useless to non-mustachian people as the high deductible plans under the ACA - folks didn't plan right and still didn't have the resources to cover non-catastrophic (but high) costs of actual necessary care.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2718 on: June 15, 2017, 03:07:43 PM »

We need a way to tell patients and families "No" More treatment will not only be minimal affective, but will actually cause more harm than good. 

But, but, but DEATH PANELS (is what republicans started shouting when the democratic congress tried to institute such policies).  They said "Obama is going to kill your grandma!" and forever killed any chance at reasonable discussion about limiting end of life care for humanitarian reasons.

Sol,
I honestly do not remember democrats trying to introduce reasonable measures but would be thrilled to be pointed in the right direction. It just goes to show how self serving our politicians are. And yes, we need death panels. But maybe we should use a kinder word like death with dignity. I have a feeling that you may think I am a republican which I am not. Unfortunately our politicians will argue everything if it comes across party lines. It is a sad state of affairs.

NEsailor,
I pay my own health insurance since I am self employed.
« Last Edit: June 15, 2017, 03:19:08 PM by EnjoyIt »

protostache

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Re: What comes after the ACA?
« Reply #2719 on: June 15, 2017, 04:05:23 PM »
Origin of the term "death panels": https://en.m.wikipedia.org/wiki/America%27s_Affordable_Health_Choices_Act_of_2009#Reimbursement_for_counseling_about_living_wills

It's exactly what you described EnjoyIt. The GOP lost their shit about it when Sarah Palin interpreted it as mandatory end of life care. It was yet another obstructive move by the GOP minority.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2720 on: June 15, 2017, 07:47:15 PM »
Origin of the term "death panels": https://en.m.wikipedia.org/wiki/America%27s_Affordable_Health_Choices_Act_of_2009#Reimbursement_for_counseling_about_living_wills

It's exactly what you described EnjoyIt. The GOP lost their shit about it when Sarah Palin interpreted it as mandatory end of life care. It was yet another obstructive move by the GOP minority.

What a shame, this could have really helped curb some costs. A few months back I mentioned allowing physicians to decline providing services when those services were futile and I got a very stern chastising by a fellow mustachian. I can't remember who it was or all the details. I think most people don't realize that keeping their loved ones alive by any means necessary is not always the right thing to do.  In fact they are forcing their loved ones into more pain and suffering because they just can't let them go. I assume most people just don't understand the physiology and what such a request actually entails. There is no way to know if Sarah Palin and those that supported the term "death panels" actually believed that we should do everything possible despite the pain and suffering or they are truly just being obstructions dip shits.  As always I assume it is a little of both.  Some are simply clueless while others will be against anything that comes across party lines. It looks like this was attempted by a republican a few years back under George Bush and got shot down then as well by other republicans or better yet a health care lobbyist.
« Last Edit: June 15, 2017, 07:53:03 PM by EnjoyIt »

nereo

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Re: What comes after the ACA?
« Reply #2721 on: June 16, 2017, 06:28:34 AM »
Origin of the term "death panels": https://en.m.wikipedia.org/wiki/America%27s_Affordable_Health_Choices_Act_of_2009#Reimbursement_for_counseling_about_living_wills

It's exactly what you described EnjoyIt. The GOP lost their shit about it when Sarah Palin interpreted it as mandatory end of life care. It was yet another obstructive move by the GOP minority.

What a shame, this could have really helped curb some costs. A few months back I mentioned allowing physicians to decline providing services when those services were futile and I got a very stern chastising by a fellow mustachian. I can't remember who it was or all the details. I think most people don't realize that keeping their loved ones alive by any means necessary is not always the right thing to do.  In fact they are forcing their loved ones into more pain and suffering because they just can't let them go. I assume most people just don't understand the physiology and what such a request actually entails. There is no way to know if Sarah Palin and those that supported the term "death panels" actually believed that we should do everything possible despite the pain and suffering or they are truly just being obstructions dip shits.  As always I assume it is a little of both.  Some are simply clueless while others will be against anything that comes across party lines. It looks like this was attempted by a republican a few years back under George Bush and got shot down then as well by other republicans or better yet a health care lobbyist.
I put as much blame on our unrealistic society.  We aren't willing to discuss end-of-life care and I think most people genuinely believe that a miracle cure may be just around the corner for whatever 'terminal' disease ails a loved one. It certainly hasn't been helped by pop culture, with movies and tv shows following a familiar 'beat-the-odds, miracle cure' plot line.

I can't tell you how many times my father came home exhausted, saying "I've got a bedridden patient who's 85 and ready to die, but her children have convinced her to try one more invasive and expensive treatment which might give her a few more weeks with no real improvement in quality of life."  It got harder and harder on my dad as more of his patients reached their twilight years and so many of them had never discussed end-of-life with their spouses and children, nor had living wills.
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tyort1

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Re: What comes after the ACA?
« Reply #2722 on: June 16, 2017, 12:30:57 PM »

I can't tell you how many times my father came home exhausted, saying "I've got a bedridden patient who's 85 and ready to die, but her children have convinced her to try one more invasive and expensive treatment which might give her a few more weeks with no real improvement in quality of life."  It got harder and harder on my dad as more of his patients reached their twilight years and so many of them had never discussed end-of-life with their spouses and children, nor had living wills.

Couldn't we make this one of the forms someone has to fill out when they get insurance?
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TrudgingAlong

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Re: What comes after the ACA?
« Reply #2723 on: June 16, 2017, 01:25:23 PM »
I think assisted suicide should be considered as well. When you are terminal with something like cancer, I find it horrible your options are so limited to end the suffering. People freak out about this concept, too, but I have always wanted this to be an option if I were facing a horrible, painful end.

jim555

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Re: What comes after the ACA?
« Reply #2724 on: June 16, 2017, 01:32:04 PM »
End of life care is more of a >64 year old problem (Medicare) than a ACA problem (18-64).

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2725 on: June 16, 2017, 08:29:45 PM »
I can tell you that since the ACA has been enacted my insurance premiums have gone up almost 300% with no additional benefit to me or my family. I am glad that people with pre-existing conditions can get coverage and OK with spending a bit extra for that. Being mustachian I can comfortably absorb that difference but I am not everyone and a reasonable chunk of tax payers are significantly worse off since the law was enacted.

Before the ACA came into existence your insurance premium was going up double digits each year. I know because I also am self-employed and was buying health insurance on the private market. Moreover, the insurance you bought was no guarantee that the insurer would follow through on their obligations.

JustGettingStarted1980

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Re: What comes after the ACA?
« Reply #2726 on: June 17, 2017, 10:12:17 AM »
End of life care is more of a >64 year old problem (Medicare) than a ACA problem (18-64).

I respectfully disagree. There is only so much money in the pot. If 40% of it is used in end of life care, then that's 40% less that can be used in our society for preventative care, vaccines, emergency appendectomies, and medical research. Also, don't forget that 2/3's of Medicaid is spent on Nursing Home Care for seniors, many of which (End Stage Dementia) are being kept alive medically only because other people are paying for it.

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Re: What comes after the ACA?
« Reply #2727 on: June 18, 2017, 12:13:15 PM »
I can tell you that since the ACA has been enacted my insurance premiums have gone up almost 300% with no additional benefit to me or my family. I am glad that people with pre-existing conditions can get coverage and OK with spending a bit extra for that. Being mustachian I can comfortably absorb that difference but I am not everyone and a reasonable chunk of tax payers are significantly worse off since the law was enacted.

Before the ACA came into existence your insurance premium was going up double digits each year. I know because I also am self-employed and was buying health insurance on the private market. Moreover, the insurance you bought was no guarantee that the insurer would follow through on their obligations.

Adding more people with expensive pre-existing conditions to the pool must cause average rates to increase more than they would have, assuming no cost savings. The ACA has its winners and losers. Those of us who were buying private insurance before the ACA and don't qualify for subsidies, and couldn't keep our plan or our doctors, have been on the losing side, IMO.

We now pay $1200/mo with a $7k deductible per person for an HMO Silver plan with a shockingly narrow network. For example, we recently could not find an in network orthopedic doctor who would take a pediatric patient. That's just not right. Before the ACA we had a PPO plan with a national insurer, with a wide network. 

I think the ACA was a step in the right direction. It needs some fixes. It's not going to get fixed, obviously. I'm ready to move on. I'm concerned that if something is not done, and soon, we will not be able to buy health insurance at all. That will seriously screw up my FIRE.


Gin1984

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Re: What comes after the ACA?
« Reply #2728 on: June 18, 2017, 12:24:21 PM »
I can tell you that since the ACA has been enacted my insurance premiums have gone up almost 300% with no additional benefit to me or my family. I am glad that people with pre-existing conditions can get coverage and OK with spending a bit extra for that. Being mustachian I can comfortably absorb that difference but I am not everyone and a reasonable chunk of tax payers are significantly worse off since the law was enacted.

Before the ACA came into existence your insurance premium was going up double digits each year. I know because I also am self-employed and was buying health insurance on the private market. Moreover, the insurance you bought was no guarantee that the insurer would follow through on their obligations.

Adding more people with expensive pre-existing conditions to the pool must cause average rates to increase more than they would have, assuming no cost savings. The ACA has its winners and losers. Those of us who were buying private insurance before the ACA and don't qualify for subsidies, and couldn't keep our plan or our doctors, have been on the losing side, IMO.

We now pay $1200/mo with a $7k deductible per person for an HMO Silver plan with a shockingly narrow network. For example, we recently could not find an in network orthopedic doctor who would take a pediatric patient. That's just not right. Before the ACA we had a PPO plan with a national insurer, with a wide network. 

I think the ACA was a step in the right direction. It needs some fixes. It's not going to get fixed, obviously. I'm ready to move on. I'm concerned that if something is not done, and soon, we will not be able to buy health insurance at all. That will seriously screw up my FIRE.
But there was cost savings.  The insurance companies got caped on profit.  I remember multiple friends getting checks from their insurance companies.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2729 on: June 18, 2017, 12:28:42 PM »
I can tell you that since the ACA has been enacted my insurance premiums have gone up almost 300% with no additional benefit to me or my family. I am glad that people with pre-existing conditions can get coverage and OK with spending a bit extra for that. Being mustachian I can comfortably absorb that difference but I am not everyone and a reasonable chunk of tax payers are significantly worse off since the law was enacted.

Before the ACA came into existence your insurance premium was going up double digits each year. I know because I also am self-employed and was buying health insurance on the private market. Moreover, the insurance you bought was no guarantee that the insurer would follow through on their obligations.

Yes, 10-20% increases did occur before the ACA, but with the ACA those increases are 75% per year, every year. Ohh and the network of doctors is pathetic. I get much less for more money. Again, I can afford this increase, but many middle class Americans are having a hard time and want the ACA dismantled. At the end of the day healthcare is expensive and someone has to pay for it which is why I talk about cutting cost and not shifting the cost.

sol

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Re: What comes after the ACA?
« Reply #2730 on: June 18, 2017, 12:39:47 PM »
Yes, 10-20% increases did occur before the ACA, but with the ACA those increases are 75% per year, every year.

Why do you keep repeating this lie?  Health INSURANCE costs are way down (on the consumer side) since the ACA was passed, and health CARE costs are growing more slowly than they were before the ACA was passed.  It's at least not any worse, for the nation as a whole, and it's actually better for most people as measured by their out-of-pocket costs.

Quote
Ohh and the network of doctors is pathetic.

Why do you keep repeating this lie?  Doctor networks are dictated by the insurers, not the government.  If anything, the ACA's regulations brought more customers into each network, strengthening the insurance network in (primarily rural) places were it was previously in bad shape.

Quote
I get much less for more money.

This might be true for you personally, but it's certainly not true for the nation as a whole.  The ACA improved insurance coverage for everyone by mandating minimum coverage standards,  You can no longer buy "health insurance" that doesn't cover hospitalization or prescription drugs.  Can you believe that actually used to be a thing?

The ACA made insurance better, by mandating that it actually cover medical costs that were previously excluded.

But for you personally, especially if you are employed and very well paid, it is still possible that you are worse off.  The ACA made insurance better and cheaper for millions of people, and it accomplished that by raising taxes on few hundred thousands very wealthy individuals who already had great insurance, and who still have great insurance.  I'm okay with this trade, because it's better for the nation as a whole.

Quote
Again, I can afford this increase, but many middle class Americans are having a hard time and want the ACA dismantled.

Middle class americans are not seeing the same cost increases that rich doctors are seeing.  Middle class americans saw their coverage quality increase, their premium growth rates slow, and tens of thousands of them were saved from medical bankruptcy because the ACA mandated their insurance plans cover costs that were previously excluded, or because they were offerred insurance in a marketplace where they were previoustly not allowed to buy insurance at all.  This was good for America.  I'm okay with taxing the rich to accomplish those goals.

The "ACA dismantle" you seem to think people want is NOT what I think they want.  People do NOT want to give up their subsidized health insurance so that the government can give a huge tax break to rich people like you (and me).  What kind of person actually supports that plan?

EnjoyIt

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Re: What comes after the ACA?
« Reply #2731 on: June 18, 2017, 05:00:40 PM »

Why do you keep repeating this lie?  Health INSURANCE costs are way down (on the consumer side) since the ACA was passed, and health CARE costs are growing more slowly than they were before the ACA was passed.  It's at least not any worse, for the nation as a whole, and it's actually better for most people as measured by their out-of-pocket costs.


Why do you keep repeating the following lies? We all pay for insurance one way or another. Costs are not covered through thin air.  Someone must always pay the price. The cost of coverage has gone up substantially over the last few years despite a declining treat back in 2003 which has little to do with ACA passage.  Yes, some people have benefits and some people have suffered while many see little difference.


Quote
Why do you keep repeating this lie?  Doctor networks are dictated by the insurers, not the government.  If anything, the ACA's regulations brought more customers into each network, strengthening the insurance network in (primarily rural) places were it was previously in bad shape.

Why do you keep repeating this lie?  ACA brought customers into sporadic networks of poor coverage.  It is the reason why people did not get to keep their doctors as promised. Because the market place is so unstable people are forced into changing coverage every year and therefor changing doctors every year.

Quote
The ACA improved insurance coverage for everyone by mandating minimum coverage standards,  You can no longer buy "health insurance" that doesn't cover hospitalization or prescription drugs.  Can you believe that actually used to be a thing?

The ACA made insurance better, by mandating that it actually cover medical costs that were previously excluded.

Why do you keep repeating this lie?  Just because you have minimum coverage does not mean you can still afford it?  Just because you have insurance does not mean you can cover the $6k or $12k deductible every year.  Yes, having minimum standards has helped some, but not everyone wants prescription coverage or is willing to pay extra to have it.

Quote
Middle class americans are not seeing the same cost increases that rich doctors are seeing.  Middle class americans saw their coverage quality increase, their premium growth rates slow, and tens of thousands of them were saved from medical bankruptcy because the ACA mandated their insurance plans cover costs that were previously excluded, or because they were offerred insurance in a marketplace where they were previoustly not allowed to buy insurance at all.  This was good for America.  I'm okay with taxing the rich to accomplish those goals.

You seam to be confused a little.  I never said all middle class Americans.  Middle class America has a huge range of income.  For many with pre-existing conditions the ACA was a benefit.  For others is was a detriment. Also, having more costly provisions in your insurance does not necessarily make it better.  For example, I do not need prenatal care, nor does my 62 year old mother.  Ohh, and anyone buying health insurance from the market place has had price increases in the 100-300% range.


Quote
The "ACA dismantle" you seem to think people want is NOT what I think they want.  People do NOT want to give up their subsidized health insurance so that the government can give a huge tax break to rich people like you (and me).  What kind of person actually supports that plan?

I think you may have misread me.  I never said everyone wants the ACA dismantled, only those that have been harmed by it. I think you read what I write, but only choose to take in the pieces you disagree with and then throw out an argument to combat that piece which was taken out of context.

Sol, please read this and if you can answer my questions

I can clearly point out the benefits of the ACA and also the harms. Why can't you?  Are you so stuck in thinking it is the best thing since sliced bread that you ignore some of its detriments? I believe there is a psychological effect that comes into play here and it is called consistency. When someone openly takes a stand on a subject, they will consistently continue to take that stand without waver despite facts that may prove them wrong. In your case not wrong, but also not 100% accurate. There are without a doubt some excellent things the ACA did, but it came at a cost. Let me repeat this so that you don't ignore it. "There are without a doubt some excellent things the ACA did, but it came at a cost." For some middle class taxpayers it made healthcare which was once affordable all of a sudden unaffordable.

Try answering these questions:
1) Can you agree that just because someone has health insurance does not mean that they can still afford their deductible, and having health insurance vs having no insurance changes nothing regarding their ability to afford healthcare? No benefit or harm of ACA

2) Can you agree that some people who had no health insurance can get partial subsidies, but still can't afford their deductibles and now are mandated to pay for an insurance that provides no benefit, but still can't afford the care because their subsidies are so high? Minor detriment with potential benefit of ACA

3) Can you agree that many Americans had to change their doctors because their new mandated health plan is not taken by their physician? Minor detriment

4) Can you agree that some physicians refuse to accept healthcare.gov insurances because they are concerned they will not get paid because of the high deductible? Medium detriment

5) Can you agree that a family of 3 making $110k/yr is now paying significantly more for healthcare compared to pre ACA passage? Can you agree the cost may have increased significantly considering the increased deductibles? Very major detriment for that family.

6) Can you agree that a man or a women over 45 does not require prenatal care covered through their health insurance and having it does not make their insurance better? Very minor detriment.

7) Big question for you now which I asked earlier in this thread.  This is a hypothetical straw man question but the concept is really important.  Should we induce 1 tax payer to have unaffordable healthcare so that 1 non taxpayer can have affordable healthcare?  What about 1 tax payer suffer to benefit 10 non tax payers?  What 10 tax payers suffer to help one non tax payer?  Obviously life is not so black and white, but the concept is very important.

Sol, why is it that you simply can't come to terms that the ACA is not perfect, has harmed a percentage of taxpayers and the law needs improvement on.  The best way to help the ACA perform better is not through arguing who will pay more, but working on solutions to decrease cost. 

BTW, I can fully agree with you that expanding medicaid has helped a significant amount of people. I will agree that the pre-existing condition mandate allowed many get healthcare coverage which was once completely unaffordable or unavailable. I can also agree with you that there is a solid subset of the population that is better off thanks to the ACA. Now lets see if you can agree with me at all.  Lets see if you even respond.
« Last Edit: June 18, 2017, 05:02:29 PM by EnjoyIt »

protostache

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Re: What comes after the ACA?
« Reply #2732 on: June 18, 2017, 07:32:30 PM »
Of course ACA has problems. All of those things you list are arguably true, although lots of people qualify for CSRs that are designed to make copays and deductibles affordable.

But why do these flaws mean we have to tear the whole thing down? Why can't we work together to fix the problems and move forward? Someone earlier said they're "ready to move on" but I'm not. I want to fix ACA and make it work for more people and more providers and more markets.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2733 on: June 18, 2017, 08:44:15 PM »

ACA brought customers into sporadic networks of poor coverage.  It is the reason why people did not get to keep their doctors as promised. Because the market place is so unstable people are forced into changing coverage every year and therefor changing doctors every year.

This is totally false. The networks of coverage are not sporadic but are great in my area of Michigan.
Pre-ACA, if you actually needed medical care, then you had a pre-existing condition, and you were then going to be paying huge for health insurance, if you could even get health insurance.


Just because you have insurance does not mean you can cover the $6k or $12k deductible every year.  Yes, having minimum standards has helped some, but not everyone wants prescription coverage or is willing to pay extra to have it.

This is so self-contradictory, it doesn't make sense. How can you be concerned about people not being able to cover their deductible while at the same time you're fine with an insurance product that lacks prescription coverage?  What?  If you can't afford the deductible (which by the way is optional, get the gold plan and your deductible goes away), then how are you going to afford expensive prescriptions ? 



I do not need prenatal care, nor does my 62 year old mother. 

Well insurance is a pooling of risks. So your point is people should just pay when they get sick, which becomes the unlucky lottery that bankrupts some people because healthcare is so expensive.

Try answering these questions:
1) Can you agree that just because someone has health insurance does not mean that they can still afford their deductible?

Get the gold plan, there's no deductible.

2) Can you agree that some people who had no health insurance can get partial subsidies, but still can't afford their deductibles?

You don't understand the ACA. Not only are there subsidies, but there are cost-sharing reductions that lower deductibles and costs. If someone is poorer, they get all of that.


3) Can you agree that many Americans had to change their doctors because their new mandated health plan is not taken by their physician? Minor detriment

You can have a physician who leaves the practice that you were going to, and then therefore you don't get your same doctor. This happens regardless of health insurance plans.


5) Can you agree that a family of 3 making $110k/yr is now paying significantly more for healthcare compared to pre ACA passage?

No I don't agree. I would say the amount of income is higher than that before a family of 3 wouldn't qualify for subsidies.

The best way to help the ACA perform better is not through arguing who will pay more, but working on solutions to decrease cost. 

No I don't agree with you on that either. Revenues to pay for subsidies have to come from somewhere.

On the cost side, the ACA was yielding research on making medicine more cost-effective by
  • Changing incentives toward patient outcomes rather than merely reimbursing for procedures
  • Determining why medical procedures in one geographic region were much cheaper than in other areas

EnjoyIt

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Re: What comes after the ACA?
« Reply #2734 on: June 18, 2017, 10:09:32 PM »
Protostache,
I never said to scrap the ACA. I think there are some huge benefits to it. The ACA needs a little help.

DavidAnnArbor,
You have to realize that the ACA exists in not just Michigan but in the entire US. Some parts of the US have good insurance options while others are sporadic. You are missing my point completely. Again, there are great parts to the ACA and many people have been helped immensely. But also a good number of people have been screwed. The only thing I disagree with you is that we can not spend an infinite amount on healthcare and we need to cut cost. You want to tax more to cover more people while I want to cut costs and make it more affordable for everybody.

Regarding the deductible comment. It is my fault for not being clearer. Allow me to elaborate. Some people don't want prescription coverage though must pay for it thereby increasing their cost. A completely other subgroup of people don't get subsidies and therefor end up spending a large amount on healthcare insurance. A family of 3 for example making $115K/yr could be paying over $20k+ per year on healthcare cost. You may think they could afford it but if they lived the previous 5 years spending a fraction of that, the increased cost is outside their means. That is the middle class America I am describing. The rich can afford to pay more but a large percentage of the middle class very well may not. They are the ones who are upset and likely a subset of people who want the law scrapes.

The outcomes research and provisions have potential promise, but the way they are being administered is actually increasing the cost due to the regulatory burdens providers must jump through to comply with the outcome research. MACRA reimbursement is a behemoth mess which they still can't figure out how to track. Bundled payments for outcomes does seam to be the future and may very well decrease costs in the long run, but it is a tiny fraction of the healthcare dollar. Much of it is wasted on unnecessary treatment of the almost deceased or practically brain dead, Add in the money  wasted on regulatory compliance. There are more examples I don't want to get into again in this post.





I will reiterate one more time. the ACA has some very good aspects of the law. But is has also made healthcare unaffordable to a subset of middle class tax payers and did very little to making healthcare any more affordable for a subset of people who aren't fully subsidized.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2735 on: June 18, 2017, 10:19:04 PM »
A family of 3 for example making $115K/yr could be paying over $20k+ per year on healthcare cost. You may think they could afford it but if they lived the previous 5 years spending a fraction of that, the increased cost is outside their means. That is the middle class America I am describing.

http://www.kff.org/interactive/subsidy-calculator/

I just looked on that calculator, and the family of 3 pays $8K for a Silver plan in Ann Arbor Michigan.

MDM

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Re: What comes after the ACA?
« Reply #2736 on: June 18, 2017, 10:39:18 PM »
A family of 3 for example making $115K/yr could be paying over $20k+ per year on healthcare cost. You may think they could afford it but if they lived the previous 5 years spending a fraction of that, the increased cost is outside their means. That is the middle class America I am describing.

http://www.kff.org/interactive/subsidy-calculator/

I just looked on that calculator, and the family of 3 pays $8K for a Silver plan in Ann Arbor Michigan.
As is often the case in these discussions, you are both correct.

The insurance premiums are ~$8K.

The out-of-pocket maximum is ~$14K.

Combined, the "family of 3...making $115K/yr could be paying over $20k+ per year on healthcare cost."

former player

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Re: What comes after the ACA?
« Reply #2737 on: June 19, 2017, 01:31:33 AM »
A family of 3 for example making $115K/yr could be paying over $20k+ per year on healthcare cost. You may think they could afford it but if they lived the previous 5 years spending a fraction of that, the increased cost is outside their means. That is the middle class America I am describing.

http://www.kff.org/interactive/subsidy-calculator/

I just looked on that calculator, and the family of 3 pays $8K for a Silver plan in Ann Arbor Michigan.
As is often the case in these discussions, you are both correct.

The insurance premiums are ~$8K.

The out-of-pocket maximum is ~$14K.

Combined, the "family of 3...making $115K/yr could be paying over $20k+ per year on healthcare cost."
I believe I read somewhere (possibly on this thread) that the average health costs per American per year are $10,000.  The family of three is getting a bargain, even in their worst health years.

99.9% of the world is not going to feel sorry for a family of three earning $115k in the UKA that might have to pay $20,000 a year for access to some of the best health care in the world.
Be frugal and industrious, and you will be free (Ben Franklin)

obstinate

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Re: What comes after the ACA?
« Reply #2738 on: June 19, 2017, 04:31:47 AM »
Also, that little family could be paying arbitrarily more after the Rs remove the ban on lifetime limits.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2739 on: June 19, 2017, 06:47:57 AM »
A family of 3 for example making $115K/yr could be paying over $20k+ per year on healthcare cost. You may think they could afford it but if they lived the previous 5 years spending a fraction of that, the increased cost is outside their means. That is the middle class America I am describing.

http://www.kff.org/interactive/subsidy-calculator/

I just looked on that calculator, and the family of 3 pays $8K for a Silver plan in Ann Arbor Michigan.
As is often the case in these discussions, you are both correct.

The insurance premiums are ~$8K.

The out-of-pocket maximum is ~$14K.

Combined, the "family of 3...making $115K/yr could be paying over $20k+ per year on healthcare cost."
I believe I read somewhere (possibly on this thread) that the average health costs per American per year are $10,000.  The family of three is getting a bargain, even in their worst health years.

99.9% of the world is not going to feel sorry for a family of three earning $115k in the UKA that might have to pay $20,000 a year for access to some of the best health care in the world.


You would feel differently if it was you who had to pay $20K every year for health care. It would be different if you and your family were living a decent life in their 3x mortgage and 2 reasonably priced cars finding your health care expenses more than doubling in just a few short years making your current lifestyle unsustainable. You may even vote for any representative that wishes to abolish the ACA.

This middle class family works and pays taxpayer. Why do you think they don't deserve to have a decent life?

nereo

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Re: What comes after the ACA?
« Reply #2740 on: June 19, 2017, 07:03:18 AM »

I believe I read somewhere (possibly on this thread) that the average health costs per American per year are $10,000.  The family of three is getting a bargain, even in their worst health years.

99.9% of the world is not going to feel sorry for a family of three earning $115k in the UKA that might have to pay $20,000 a year for access to some of the best health care in the world.


You would feel differently if it was you who had to pay $20K every year for health care. It would be different if you and your family were living a decent life in their 3x mortgage and 2 reasonably priced cars finding your health care expenses more than doubling in just a few short years making your current lifestyle unsustainable. You may even vote for any representative that wishes to abolish the ACA.

This middle class family works and pays taxpayer. Why do you think they don't deserve to have a decent life?

I guess I just don't see where your outrage is coming from, EnjoyIt - perhaps this is an example of the consumers being completely disassociated from the true costs.  An $8k premium works out to $666/mo. Many (perhaps most) 'middle class' families spend at least that much on dual car payments.  Mortgages are often triple this amount. Hitting your OOP max is a rare event, but so is replacing a roof or needing major engine work.

It doesn't strike me as overly burdensome that someone would pay about as much for their healthcare as they would for their vehicles.
The problem has become that so many Americans (~2/3rds) get their health care through their employer with incredibly low monthly premiums; $200/mo for a family seems about normal.  Ergo, these 'middle class' Americans have come to believe that $200/mo is an appropriate amount to spend on health care, never realizing that their employer is chipping in 2-3x as much.
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former player

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Re: What comes after the ACA?
« Reply #2741 on: June 19, 2017, 07:04:40 AM »
A family of 3 for example making $115K/yr could be paying over $20k+ per year on healthcare cost. You may think they could afford it but if they lived the previous 5 years spending a fraction of that, the increased cost is outside their means. That is the middle class America I am describing.

http://www.kff.org/interactive/subsidy-calculator/

I just looked on that calculator, and the family of 3 pays $8K for a Silver plan in Ann Arbor Michigan.
As is often the case in these discussions, you are both correct.

The insurance premiums are ~$8K.

The out-of-pocket maximum is ~$14K.

Combined, the "family of 3...making $115K/yr could be paying over $20k+ per year on healthcare cost."
I believe I read somewhere (possibly on this thread) that the average health costs per American per year are $10,000.  The family of three is getting a bargain, even in their worst health years.

99.9% of the world is not going to feel sorry for a family of three earning $115k in the UKA that might have to pay $20,000 a year for access to some of the best health care in the world.


You would feel differently if it was you who had to pay $20K every year for health care. It would be different if you and your family were living a decent life in their 3x mortgage and 2 reasonably priced cars finding your health care expenses more than doubling in just a few short years making your current lifestyle unsustainable. You may even vote for any representative that wishes to abolish the ACA.

This middle class family works and pays taxpayer. Why do you think they don't deserve to have a decent life?
What makes you think us taxpayers in the UK who pay higher taxes in return for the NHS aren't having decent lives?  Health insurance in the USA is the equivalent of a tax payment in any country which has universal health care.

And frankly, the idea that a middle class family can't have a decent life on an income of $100,000 less $20,000 in a "bad" health year (less only $8,000 in a "good" health year) is 1) preposterous in itself, 2) an insult to the majority of USA residents, let alone the residents of other advanced economies who have "decent" lives on much less, and 3) completely in contradiction to mustachian principles.
Be frugal and industrious, and you will be free (Ben Franklin)

EnjoyIt

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Re: What comes after the ACA?
« Reply #2742 on: June 19, 2017, 07:19:33 AM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.

I also think that a family can have an excellent life in the US on $100k/yr income. This forum proves it. But, if you built your life on X and some law comes around and makes that life sudenly unsustainable, you will be pissed and vote to get it repealed.  Don't forget now that these high deductibles exist your medication costs more. Where at one time your prescriptions were covered, you are paying full price to control that blood pressure and elevated cholesterol. Someone will always have to cover the cost of healthcare and right now the middle class is being squeezed the most. The rich can afford it, the poor get subsidies and the middle class must now pay more.

Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?

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Re: What comes after the ACA?
« Reply #2743 on: June 19, 2017, 07:45:54 AM »
A family of 3 for example making $115K/yr could be paying over $20k+ per year on healthcare cost. You may think they could afford it but if they lived the previous 5 years spending a fraction of that, the increased cost is outside their means. That is the middle class America I am describing.

http://www.kff.org/interactive/subsidy-calculator/

I just looked on that calculator, and the family of 3 pays $8K for a Silver plan in Ann Arbor Michigan.
As is often the case in these discussions, you are both correct.

The insurance premiums are ~$8K.

The out-of-pocket maximum is ~$14K.

Combined, the "family of 3...making $115K/yr could be paying over $20k+ per year on healthcare cost."
I believe I read somewhere (possibly on this thread) that the average health costs per American per year are $10,000.  The family of three is getting a bargain, even in their worst health years.

99.9% of the world is not going to feel sorry for a family of three earning $115k in the UKA that might have to pay $20,000 a year for access to some of the best health care in the world.


You would feel differently if it was you who had to pay $20K every year for health care. It would be different if you and your family were living a decent life in their 3x mortgage and 2 reasonably priced cars finding your health care expenses more than doubling in just a few short years making your current lifestyle unsustainable. You may even vote for any representative that wishes to abolish the ACA.

This middle class family works and pays taxpayer. Why do you think they don't deserve to have a decent life?

This is my family. We pay $12,000 per year in premiums and have a $9,000 out of pocket max which we just met this morning. We have a 2x mortgage and 2 paid for cars. I do not feel different. I am in fact very grateful for the ACA, even with it's many flaws, even though we have to pay $21,000 out of pocket for our health care. I gladly pay higher taxes so people who can't can receive Medicaid.

nereo

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Re: What comes after the ACA?
« Reply #2744 on: June 19, 2017, 07:59:33 AM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.


Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?
Ok, it's just that your rhetoric comes off as pretty hostile.  For example: Why do you think they don't deserve to have a decent life?
To me these suggestions that someone can't have a 'decent life' is both untrue and designed to elicit a single emotional response: anger.
It just feeds the beast.

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EnjoyIt

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Re: What comes after the ACA?
« Reply #2745 on: June 19, 2017, 08:46:54 AM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.


Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?
Ok, it's just that your rhetoric comes off as pretty hostile.  For example: Why do you think they don't deserve to have a decent life?
To me these suggestions that someone can't have a 'decent life' is both untrue and designed to elicit a single emotional response: anger.
It just feeds the beast.

Nereo, you are correct, my tone can be toned down.  At first, a few years ago, I was angered about the higher premiums I now have to pay, but eventually I realize that I can afford the increase and content with it since it benefits many people.  I would still rather have the entire healthcare system cost less.  Just a 20% cut would solve all our healthcare problems today without the need to raising taxes even more. 

My biggest issue with the 100% proponents of the ACA is the one sided view saying only the good things it has done and ignoring the bad. Simply saying we have more people insured does not necessarily mean they have affordable healthcare.  A family of 3 making $60k/yr may have had very inexpensive health insurance at one time that covered what they needed.  Now they have to pay 3x as much for coverage, get subsidies that cover half and now have higher deductibles making their new insurance practically useless.  Just because you have health insurance does not mean you can still afford healthcare.  I see these people every day who are unhappy with how this bill has turned out for them.  Sure it helped a significant portion of Americans, but it harmed a significant portion as well and we can't simply ignore them.

Are we that blinded by our desire to do good that we are willing to ignore the bad?

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2746 on: June 19, 2017, 08:57:43 AM »
This is my family. We pay $12,000 per year in premiums and have a $9,000 out of pocket max which we just met this morning. We have a 2x mortgage and 2 paid for cars. I do not feel different. I am in fact very grateful for the ACA, even with it's many flaws, even though we have to pay $21,000 out of pocket for our health care. I gladly pay higher taxes so people who can't can receive Medicaid.

Explain to me why you don't get the health insurance on the marketplace that has a much lower out of pocket maximum?

Isn't that what the different metals intend to reveal, that a Gold or Platinum plan has a much lower out of pocket maximum?

A family of 3 that ends up in a negative health situation going forward would choose a plan that would have much lower deductibles.

You'll pay more for that insurance per month, but you'll probably come out ahead because you won't be paying these maximums anymore.

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Re: What comes after the ACA?
« Reply #2747 on: June 19, 2017, 09:10:40 AM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.


Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?
Ok, it's just that your rhetoric comes off as pretty hostile.  For example: Why do you think they don't deserve to have a decent life?
To me these suggestions that someone can't have a 'decent life' is both untrue and designed to elicit a single emotional response: anger.
It just feeds the beast.

Nereo, you are correct, my tone can be toned down.  At first, a few years ago, I was angered about the higher premiums I now have to pay, but eventually I realize that I can afford the increase and content with it since it benefits many people.  I would still rather have the entire healthcare system cost less.  Just a 20% cut would solve all our healthcare problems today without the need to raising taxes even more. 

My biggest issue with the 100% proponents of the ACA is the one sided view saying only the good things it has done and ignoring the bad. Simply saying we have more people insured does not necessarily mean they have affordable healthcare.  A family of 3 making $60k/yr may have had very inexpensive health insurance at one time that covered what they needed.  Now they have to pay 3x as much for coverage, get subsidies that cover half and now have higher deductibles making their new insurance practically useless.  Just because you have health insurance does not mean you can still afford healthcare.  I see these people every day who are unhappy with how this bill has turned out for them.  Sure it helped a significant portion of Americans, but it harmed a significant portion as well and we can't simply ignore them.

Are we that blinded by our desire to do good that we are willing to ignore the bad?
I think what you are not understanding is that people are not ignoring the bad.  ACA is just the best option we have now.  I know of no person who does not see improvements that can be made, but scraping it with harm many, many people and that is not worth it.  Because overall, it has improved things for those who needed it.  I'm middle class and I could NEVER retire early prior because I had medical conditions and could not get health insurance for ANY amount of money.  The small time I was going to be uninsured I COBRAed which cost me $575/month for one person.  Just premiums and that was over eight years ago.  So the numbers you keep throwing out, seem reasonable for actual insurance, if it is not subsidized by someone (employer, government).  And my husband feels safer, even though he does not have a medical condition because he saw me not be able to get anything.  And knowing that if he does get sick, the insurance won't drop him is worth a significant amount of money.   

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Re: What comes after the ACA?
« Reply #2748 on: June 19, 2017, 09:15:24 AM »
And my husband feels safer, even though he does not have a medical condition because he saw me not be able to get anything.  And knowing that if he does get sick, the insurance won't drop him is worth a significant amount of money.   

Yes this can't be underestimated. Insurance companies used to drop the insured clients when they got sick. This was well revealed in the documentary, "Sicko" by Michael Moore.

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Re: What comes after the ACA?
« Reply #2749 on: June 19, 2017, 09:19:08 AM »
But why do these flaws mean we have to tear the whole thing down? Why can't we work together to fix the problems and move forward? Someone earlier said they're "ready to move on" but I'm not. I want to fix ACA and make it work for more people and more providers and more markets.
The ACA isn't going to get fixed.