Author Topic: What comes after the ACA?  (Read 389739 times)

gerardc

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Re: What comes after the ACA?
« Reply #2950 on: June 27, 2017, 09:01:14 AM »
The biggest problem in trying to understand the mindset of people who want to do away with the ACA and replace it with something that will help fewer people is that you are approaching this from the point of view that helping people is a good thing. People like Paul Ryan don't see it that way. They see a dog-eat-dog world which rewards the strong and punishes the weak and anything that helps the weak simply reinforces their deficiencies. They don't want to help people because in their mind helping people creates dependence. Many of them will refer to it as "feeding the animals" because the poor and needy are subhuman.

That's what you need to remember while you try to make sense of what's going on with the ACA replacement bills right now.

It's fairly well established in the MMM community that giving (or worse, lending) money to family members is generally a bad idea, as they'll come to depend on it. Helping people is not always a good thing and does create dependence. How is that hard to grasp?

Liberals have this view of poor people dying of hunger, but I'd say they're closer to your irresponsible and entitled uncle that consistently makes bad financial decisions and will keep making them until you stop financing him.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2951 on: June 27, 2017, 09:08:12 AM »
The biggest problem in trying to understand the mindset of people who want to do away with the ACA and replace it with something that will help fewer people is that you are approaching this from the point of view that helping people is a good thing. People like Paul Ryan don't see it that way. They see a dog-eat-dog world which rewards the strong and punishes the weak and anything that helps the weak simply reinforces their deficiencies. They don't want to help people because in their mind helping people creates dependence. Many of them will refer to it as "feeding the animals" because the poor and needy are subhuman.

That's what you need to remember while you try to make sense of what's going on with the ACA replacement bills right now.

It's fairly well established in the MMM community that giving (or worse, lending) money to family members is generally a bad idea, as they'll come to depend on it. Helping people is not always a good thing and does create dependence. How is that hard to grasp?

Liberals have this view of poor people dying of hunger, but I'd say they're closer to your irresponsible and entitled uncle that consistently makes bad financial decisions and will keep making them until you stop financing him.

Rather, helping people with health care access makes them less sick, and more productive, better able to work, and makes the ultimate health care costs cheaper since you aren't trying to solve deep-rooted health problems that have gone untreated for too long.

"As noted by a study from the Joint Center for Political and Economic Studies, poor health and limited access to health care not only raise the cost of providing such care but also reduce productivity, eat into wages, increase absenteeism, weigh on tax revenues and generally lower the nation’s quality of life."

When Cutting Access to Health Care, There’s a Price to Pay
https://nyti.ms/2udLd8k

nereo

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Re: What comes after the ACA?
« Reply #2952 on: June 27, 2017, 09:09:48 AM »
I'm not sure how this is an improvement on the individual mandate.

It's not. It's punishingly cruel to people who get dropped if, for example, they forget to make a payment because they're in the hospital, or they're taking care of a family member, or for whatever reason.

The private insurance has been lobbying hard to prevent people from buying insurance only when they desperately need it. The talking point has been "people signing up for insurance in the back of an ambulance".  To combat this they've stuck on this 6 month waiting period and the 63 days/year of coverage lines.

To combat a very rare practice (and one where people would get emergency treatment anyway) they've stuck in some deeply onerous provisions which are designed to prevent large losses (read: Maximize profits!) of insurance companies.
It's yet another example of creating restrictions and justifying them as fraud-prevention when the real goal is both obvious and more sinister. Complex voter-registration is another example.
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protostache

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Re: What comes after the ACA?
« Reply #2953 on: June 27, 2017, 09:11:01 AM »
I'm not sure how this is an improvement on the individual mandate.

It's not. It's punishingly cruel to people who get dropped if, for example, they forget to make a payment because they're in the hospital, or they're taking care of a family member, or for whatever reason.
I mean from the perspective of trying to get more people paying into insurance. If anything this is going to chase more people away from insurance than the individual mandate did.

You're exactly right, it runs counter to the goal of stabilizing markets. Then again, market stability is not actually these lawmakers' goal. Their goal with this legislation is the complete and utter destruction of the Great Society programs. Every single bit of the stuff about the non-group market is a sideshow.

Bucksandreds

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Re: What comes after the ACA?
« Reply #2954 on: June 27, 2017, 09:12:32 AM »
Why do republicans put so much time and money into pro-life efforts and then try and kill 22 million people?

It doesn't make any logical sense.

Because in their minds, once you are an adult, you can earn enough to live or else die. They don't see health care as a right.

Luck12

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Re: What comes after the ACA?
« Reply #2955 on: June 27, 2017, 09:19:51 AM »
It's fairly well established in the MMM community that giving (or worse, lending) money to family members is generally a bad idea, as they'll come to depend on it. Helping people is not always a good thing and does create dependence. How is that hard to grasp?

Difference being that not giving a few thousand or whatever to family won't cause them to die because they can't afford cancer treatments but cutting Medicaid or backdoor evisceration of protections for pre-exisiting conditions does.  Many studies show that it's X # of deaths per Y # of uninsured.  Or is that fake news? 

Just admit that many of you right wingers just don't give a shit about people, you don't care if people die.   Fucking sociopaths. 
« Last Edit: June 27, 2017, 09:22:35 AM by Luck12 »

waltworks

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Re: What comes after the ACA?
« Reply #2956 on: June 27, 2017, 09:30:50 AM »
Sounds like *someone* has gotten too dependent on the interstate highway system, national defense (who doesn't like speaking German or Russian?), and worst of all, that pesky government-designed bastard child of DARPAnet!

There are some situations in which private enterprise doesn't work (even hardcore libertarians will admit this if pressed). I think that healthcare is probably one of them.

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Re: What comes after the ACA?
« Reply #2957 on: June 27, 2017, 09:37:51 AM »
It's fairly well established in the MMM community that giving (or worse, lending) money to family members is generally a bad idea, as they'll come to depend on it. Helping people is not always a good thing and does create dependence. How is that hard to grasp?

Liberals have this view of poor people dying of hunger, but I'd say they're closer to your irresponsible and entitled uncle that consistently makes bad financial decisions and will keep making them until you stop financing him.

IMO providing health care and/or health insurance is not furthering poor life decisions.  ACcording to Kaiser's white paper on teh subject, as may as 55MM American citizens have pre-existing conditions.  Ensuring that these people can receive affordable healthcare that includes coverage for their conditions is neither enabling bad decisions nor (as DavidAnnArbor has pointed out) wasteful spending.
No one is getting drunk off added healthcare benefits, nor are they deciding to be MORE unhealthy once they have the ability to see a doctor.  Access to healthcare makes people healthier, period.

In response to your analysis of liberals I'd remark that many conservatives consider being poor as a moral failure and the result of bad financial decisions (as you indicate above).  I don't adhear to either of these beliefs.  With the caveat that correlation isn't necessarily causation, the sinlge greatest indicator of economic success is how wealthy your parents were, and those that have recieved more governmental benefits tend to rise higher on the economic ladder than those who receive less.
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runewell

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Re: What comes after the ACA?
« Reply #2958 on: June 27, 2017, 09:57:09 AM »
I disagree with any plan that doesn't actively attempt to do something about cost making healthcare more affordable to all Americans not just those that vote for their party.

The Americans that were struggling to get healthcare had a lot of pre-existing conditions.  Why would anyone then expect that by mandating coverage for all Americans that somehow healthcare will become more affordable?  Everybody wants free benefits but nobody wants to (or is able to) pay for it.

There are big problems with health insurance.  Paul Rand correctly notes that there is a severe lack of competition, and that the customer is disconnected from financial impact. 
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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2959 on: June 27, 2017, 10:22:41 AM »
I disagree with any plan that doesn't actively attempt to do something about cost making healthcare more affordable to all Americans not just those that vote for their party.

The Americans that were struggling to get healthcare had a lot of pre-existing conditions.  Why would anyone then expect that by mandating coverage for all Americans that somehow healthcare will become more affordable?  Everybody wants free benefits but nobody wants to (or is able to) pay for it.

There are big problems with health insurance.  Paul Rand correctly notes that there is a severe lack of competition, and that the customer is disconnected from financial impact.

But what does Ayn Rand think?

The bar to starting your own health insurance company is so high, with necessary regulations to prevent fraud, that the marketplace for it is not really able to be competitive. There's too much mismatch in information between consumers and providers, etc.
This is a classic case when the free market fails. Time for government intervention.

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Re: What comes after the ACA?
« Reply #2960 on: June 27, 2017, 10:53:44 AM »
Why do republicans put so much time and money into pro-life efforts and then try and kill 22 million people?

It doesn't make any logical sense.

Because in their minds, once you are an adult, you can earn enough to live or else die. They don't see health care as a right.

"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality.  Who needs reality when you have fear.  Just an FYI, our hospital system treats about 20% of its patient who are uninsured and no pay.

If we were really serious about making healthcare affordable we would be yelling at our congress people to allow CMS to negotiate on medication purchases.  We would be pushing to decrease law suit liabilities from big pharma and minimize the regulatory burden the FDA imposes so that we can have less expensive drugs.  US has a much more stringent drug approval process as compared to European countries.  We would be pushing our congress people to demand educating the public on death with dignity. We would push to decrease the regulatory burden and unnecessary personnel involved in the delivery of healthcare. But no, we just clamor about who will pay the bill.

We all pay in some form or another except the very very poor who still qualify for medicaid.  And even they suffer because only so many providers are willing to accept the piss poor reimbursement of medicaid.  But hey, at least we can comfortably say we did not kill 22 million people.

mm1970

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Re: What comes after the ACA?
« Reply #2961 on: June 27, 2017, 10:56:45 AM »
It's fairly well established in the MMM community that giving (or worse, lending) money to family members is generally a bad idea, as they'll come to depend on it. Helping people is not always a good thing and does create dependence. How is that hard to grasp?

Difference being that not giving a few thousand or whatever to family won't cause them to die because they can't afford cancer treatments but cutting Medicaid or backdoor evisceration of protections for pre-exisiting conditions does.  Many studies show that it's X # of deaths per Y # of uninsured.  Or is that fake news? 

Just admit that many of you right wingers just don't give a shit about people, you don't care if people die.   Fucking sociopaths.
They care a lot about fetuses though!

But really, I do have a LOT of conservative family members.  A LOT.  And ... they sort of don't care if people die.  I don't mean that in a "cold-hearted" way, but more of a practical way.

You know we've touched on this in several threads, but not sure if we've really delved deeply into it.

Aside from the cost of care being high and the need to cut it, there's the practical aspect and the caring aspect
- babies born early that spend a lot of time in the NICU cost a lot of money
- many of them have life-long problems that cost a lot of money, both health-wise and education wise
- babies born with fetal alcohol syndrome, or with other birth defects like down syndrome, or genetic disorders - they cost money.  To care for medically, and to educate.
- people get cancer.  Cancer treatment is expensive.
- people get diabetes, sometimes kids get Type 1, treatment is expensive
- people get old and sick.  And end of life care is expensive, and sometimes you need it for a very long time
- people will spend an inordinate amount of money, time, effort, to keep someone alive
- we don't allow euthanasia.  What if someone would rather die peacefully than live on machines for years, or die by refusing to eat?
- young people die because they get sick and don't have insurance and aren't able to get care

So, where do you draw the line?  I've got friends in Canada and Europe and the UK where they get care.  Yes, their taxes are high.  But they don't generally go broke due to medical issues.

In the US, we are such "individuals"... honestly, a lot of my conservative family members are practical.  People die.  They get that.  My cousin died of a leg infection.  Sometimes your baby is born too early and they die.  Sometimes you get cancer, and your church has a spaghetti dinner and a pancake breakfast (or 3) because your insurance sucks, or you don't have it at all.  But then you can't afford to finish chemo, so you die.  Sometimes you get old, and you cannot afford a home.  You don't want to go in one anyway.  So a few friends and family members may help you out, come by, bring dinner.  But in the end, you are living alone, you have an aneurysm burst and you die (my dad).

It's complicated, especially when you are talking millions of dollars.  I saw a quote yesterday "by having a lifetime cap on insurance, you are telling someone that they aren't worth any more money to keep alive".  Which sounds harsh.  And it is.  A preemie can hit that in months, and that preemie can go on to grow up and get a job and pay taxes.  On the other hand, that preemie might require a lifetime of specialized care in a special home, and that can run even higher.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2962 on: June 27, 2017, 11:00:41 AM »

"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality.  Who needs reality when you have fear.  Just an FYI, our hospital system treats about 20% of its patient who are uninsured and no pay.


Ok, kill 22 million people might be quite an exaggeration.   If you make someone who is financially struggling but ineligible for medicaid wait six months to get insurance after they discover a lump in their breast, you have effectively killed them.   In a perfect world we would all be engineers with $150K+ salaries but in the real world you need someone to clean your linens in your hotel room and make sure the toilet there is not too dirty.   Sometimes those people choose slightly wrong choices instead of medical insurance.   It is a bit of a different choice than one of us choosing to fly coach instead of business class on a two week trip to Paris.

protostache

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Re: What comes after the ACA?
« Reply #2963 on: June 27, 2017, 11:08:50 AM »
Why do republicans put so much time and money into pro-life efforts and then try and kill 22 million people?

It doesn't make any logical sense.

Because in their minds, once you are an adult, you can earn enough to live or else die. They don't see health care as a right.

"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality.  Who needs reality when you have fear.  Just an FYI, our hospital system treats about 20% of its patient who are uninsured and no pay.

If we were really serious about making healthcare affordable we would be yelling at our congress people to allow CMS to negotiate on medication purchases.  We would be pushing to decrease law suit liabilities from big pharma and minimize the regulatory burden the FDA imposes so that we can have less expensive drugs.  US has a much more stringent drug approval process as compared to European countries.  We would be pushing our congress people to demand educating the public on death with dignity. We would push to decrease the regulatory burden and unnecessary personnel involved in the delivery of healthcare. But no, we just clamor about who will pay the bill.

We all pay in some form or another except the very very poor who still qualify for medicaid.  And even they suffer because only so many providers are willing to accept the piss poor reimbursement of medicaid.  But hey, at least we can comfortably say we did not kill 22 million people.

You're not wrong!

But this argument is like saying we should campaign our government representatives for a better sprinkler and alarm system while half of them are filing up the kerosene tanks on their flamethrowers. Yes, cost control is extremely important and we should fight for it, but let's make sure nobody burns the building down first.

Inaya

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Re: What comes after the ACA?
« Reply #2964 on: June 27, 2017, 11:19:15 AM »
It's fairly well established in the MMM community that giving (or worse, lending) money to family members is generally a bad idea, as they'll come to depend on it. Helping people is not always a good thing and does create dependence. How is that hard to grasp?

Difference being that not giving a few thousand or whatever to family won't cause them to die because they can't afford cancer treatments but cutting Medicaid or backdoor evisceration of protections for pre-exisiting conditions does.  Many studies show that it's X # of deaths per Y # of uninsured.  Or is that fake news? 

Just admit that many of you right wingers just don't give a shit about people, you don't care if people die.   Fucking sociopaths.
They care a lot about fetuses though!

But really, I do have a LOT of conservative family members.  A LOT.  And ... they sort of don't care if people die.  I don't mean that in a "cold-hearted" way, but more of a practical way.

You know we've touched on this in several threads, but not sure if we've really delved deeply into it.

Aside from the cost of care being high and the need to cut it, there's the practical aspect and the caring aspect
- babies born early that spend a lot of time in the NICU cost a lot of money
- many of them have life-long problems that cost a lot of money, both health-wise and education wise
- babies born with fetal alcohol syndrome, or with other birth defects like down syndrome, or genetic disorders - they cost money.  To care for medically, and to educate.
- people get cancer.  Cancer treatment is expensive.
- people get diabetes, sometimes kids get Type 1, treatment is expensive
- people get old and sick.  And end of life care is expensive, and sometimes you need it for a very long time
- people will spend an inordinate amount of money, time, effort, to keep someone alive
- we don't allow euthanasia.  What if someone would rather die peacefully than live on machines for years, or die by refusing to eat?
- young people die because they get sick and don't have insurance and aren't able to get care

So, where do you draw the line?
At birth, apparently. Since they're willing to fight so impractically hard to save the fetus--no matter the cost (physical, financial, emotional) to the mother---which will then inevitably end up being one or more of the bullets on this list.


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sol

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Re: What comes after the ACA?
« Reply #2965 on: June 27, 2017, 11:22:11 AM »
"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality. 

Okay, let me offer you some reality.

22 million people will lose access to primary care within the first ten years, and then approximately that many more after that.  Not all of those peole are going to die from lack of healthcare, but SOME of them certainly will.

Some of them will contract fatal diseases, and go undiagnosed until it is too late.  Some of them will have horrible accidents and be maimed for life because they could not afford the surgeries and rehab that they need.  Some of them will fail to get lifestyle intervention that could have saved then from diabetes or skin cancer.  Some mothers and babies will die during childbirth because they had home births with complications instead of trained hospital staff with proper equipment.

It won't be 22 million deaths, but it absolutely WILL be tens of thousands, and maybe hundreds of thousands, of needless and preventable deaths and disfigurements and the only thing that republicans have to do to save them all is... nothing.  Just do nothing.  Just don't strip healthcare access away from millions of people.  Just leave it alone.  Just don't be cruel.

Is that so hard?  Then we can talk about the good republican ideas for how to improve things.  Yes, let's do a better job controlling costs.  Yes, let's figure out how to make insurance more affordable, and fix the subsidy cliffs, and prop up the market in rural areas.  But before we start working on making it better, can we please stop trying to make it worse?

The republican healthcare bill will kill people.  That is not exaggeration. 
« Last Edit: June 27, 2017, 11:24:04 AM by sol »

chasesfish

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Re: What comes after the ACA?
« Reply #2966 on: June 27, 2017, 11:26:12 AM »
How do I unfollow a topic so its not showing up as new replies to my posts?  Y'all have gone way off the rails from the original discussion
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nereo

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Re: What comes after the ACA?
« Reply #2967 on: June 27, 2017, 12:08:00 PM »
How do I unfollow a topic so its not showing up as new replies to my posts?  Y'all have gone way off the rails from the original discussion
The only way you can do this is to delete all of the posts you have made in that thread.

Yeah... we need an 'unfollow' link but in previous discussions its apparently not a simple fix.
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protostache

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Re: What comes after the ACA?
« Reply #2968 on: June 27, 2017, 12:13:12 PM »
McConnell delayed the vote until after the 4th. Wants to make revisions and get another CBO score.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #2969 on: June 27, 2017, 12:55:59 PM »
McConnell delayed the vote until after the 4th. Wants to make revisions and get another CBO score.

Probably so Trump can fire all of the current CBO people.

nereo

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Re: What comes after the ACA?
« Reply #2970 on: June 27, 2017, 12:58:01 PM »
McConnell delayed the vote until after the 4th. Wants to make revisions and get another CBO score.

I'll chalk this up as good news.  The Senate is supposed to be a deliberative legislative body.  Everything Mitch has been doing seemed designed to try to thwart that as much as possible. Now we can collectively spend the next few days carefully examining this bill.  Everything I've read thus far suggests its horrible, and this hiatus ought to give time for more people to see its warts.

I'm curious though - how many times can they tweak the bill and wait for a new CBO score and have it actually help their cause?
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jim555

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Re: What comes after the ACA?
« Reply #2971 on: June 27, 2017, 01:00:58 PM »
Every version gets worse.  Not enough pain in this one.

protostache

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Re: What comes after the ACA?
« Reply #2972 on: June 27, 2017, 01:37:45 PM »
Probably so Trump can fire all of the current CBO people.

Congress (the collected House and Senate) fund and control the Congressional Budget Office because they're part of the Legislative branch. The Executive branch headed by Trump has zero control over the CBO.

I'll chalk this up as good news.  The Senate is supposed to be a deliberative legislative body.  Everything Mitch has been doing seemed designed to try to thwart that as much as possible. Now we can collectively spend the next few days carefully examining this bill.  Everything I've read thus far suggests its horrible, and this hiatus ought to give time for more people to see its warts.

I'm curious though - how many times can they tweak the bill and wait for a new CBO score and have it actually help their cause?

As many as they want, but remember they need to also go through the debt ceiling gauntlet again and actually do the tax changes they all ran on and pass a FY2018 budget, all before the midterm election season starts early next year. That's why this healthcare stuff has been so rushed, because the GOP has an excruciatingly short window of time to get everything done in the order they want to do it while they still have full control of the government.

nereo

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Re: What comes after the ACA?
« Reply #2973 on: June 27, 2017, 01:41:43 PM »
Probably so Trump can fire all of the current CBO people.

Congress (the collected House and Senate) fund and control the Congressional Budget Office because they're part of the Legislative branch. The Executive branch headed by Trump has zero control over the CBO.

I'll chalk this up as good news.  The Senate is supposed to be a deliberative legislative body.  Everything Mitch has been doing seemed designed to try to thwart that as much as possible. Now we can collectively spend the next few days carefully examining this bill.  Everything I've read thus far suggests its horrible, and this hiatus ought to give time for more people to see its warts.

I'm curious though - how many times can they tweak the bill and wait for a new CBO score and have it actually help their cause?

As many as they want, but remember they need to also go through the debt ceiling gauntlet again and actually do the tax changes they all ran on and pass a FY2018 budget, all before the midterm election season starts early next year. That's why this healthcare stuff has been so rushed, because the GOP has an excruciatingly short window of time to get everything done in the order they want to do it while they still have full control of the government.
Sorry I wasn't more clear - my question wasn't about how many times htey can legally do this (infinite) but rather my own musing about whether tweaking the bill over and over again will result in a harder enviornment to get it passed.
In other words - what's the political cost of tweaking and waiting for a new score.  My guess is that resistence will harden and conceptions will be formed (fairly or not) much as they did with the ACA.
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Jrr85

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Re: What comes after the ACA?
« Reply #2974 on: June 27, 2017, 02:28:36 PM »
"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality. 

Okay, let me offer you some reality.

22 million people will lose access to primary care within the first ten years, and then approximately that many more after that.  Not all of those peole are going to die from lack of healthcare, but SOME of them certainly will.

Some of them will contract fatal diseases, and go undiagnosed until it is too late.  Some of them will have horrible accidents and be maimed for life because they could not afford the surgeries and rehab that they need.  Some of them will fail to get lifestyle intervention that could have saved then from diabetes or skin cancer.  Some mothers and babies will die during childbirth because they had home births with complications instead of trained hospital staff with proper equipment.

It won't be 22 million deaths, but it absolutely WILL be tens of thousands, and maybe hundreds of thousands, of needless and preventable deaths and disfigurements and the only thing that republicans have to do to save them all is... nothing.  Just do nothing.  Just don't strip healthcare access away from millions of people.  Just leave it alone.  Just don't be cruel.

Is that so hard?  Then we can talk about the good republican ideas for how to improve things.  Yes, let's do a better job controlling costs.  Yes, let's figure out how to make insurance more affordable, and fix the subsidy cliffs, and prop up the market in rural areas.  But before we start working on making it better, can we please stop trying to make it worse?

The republican healthcare bill will kill people.  That is not exaggeration.

You realize the vast majority of the reduction in number of insured people the CBO projects are not people that are going to have their health insurance stripped away from them, but people that choose not to be insured because they are no longer subject to the individual mandate.  That may not be good policy, but it's certainly not equivalent to killing people. 

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Re: What comes after the ACA?
« Reply #2975 on: June 27, 2017, 02:33:28 PM »
"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality.  Who needs reality when you have fear.  Just an FYI, our hospital system treats about 20% of its patient who are uninsured and no pay.

If we were really serious about making healthcare affordable we would be yelling at our congress people to allow CMS to negotiate on medication purchases.  We would be pushing to decrease law suit liabilities from big pharma and minimize the regulatory burden the FDA imposes so that we can have less expensive drugs.  US has a much more stringent drug approval process as compared to European countries.  We would be pushing our congress people to demand educating the public on death with dignity. We would push to decrease the regulatory burden and unnecessary personnel involved in the delivery of healthcare. But no, we just clamor about who will pay the bill.

We all pay in some form or another except the very very poor who still qualify for medicaid.  And even they suffer because only so many providers are willing to accept the piss poor reimbursement of medicaid.  But hey, at least we can comfortably say we did not kill 22 million people.

Or maybe hospitals have to learn how to be more efficient and pay the medical doctor specialists less and learn to appreciate the Medicaid reimbursement rates which were increased thanks to Obamacare/ACA.

Doctors and staff can wash their hands more often and not spread infections inside the hospital.

Cardiologists shouldn't be doing so many stress tests to bilk Medicare.

Gin1984

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Re: What comes after the ACA?
« Reply #2976 on: June 27, 2017, 02:38:58 PM »
"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality. 

Okay, let me offer you some reality.

22 million people will lose access to primary care within the first ten years, and then approximately that many more after that.  Not all of those peole are going to die from lack of healthcare, but SOME of them certainly will.

Some of them will contract fatal diseases, and go undiagnosed until it is too late.  Some of them will have horrible accidents and be maimed for life because they could not afford the surgeries and rehab that they need.  Some of them will fail to get lifestyle intervention that could have saved then from diabetes or skin cancer.  Some mothers and babies will die during childbirth because they had home births with complications instead of trained hospital staff with proper equipment.

It won't be 22 million deaths, but it absolutely WILL be tens of thousands, and maybe hundreds of thousands, of needless and preventable deaths and disfigurements and the only thing that republicans have to do to save them all is... nothing.  Just do nothing.  Just don't strip healthcare access away from millions of people.  Just leave it alone.  Just don't be cruel.

Is that so hard?  Then we can talk about the good republican ideas for how to improve things.  Yes, let's do a better job controlling costs.  Yes, let's figure out how to make insurance more affordable, and fix the subsidy cliffs, and prop up the market in rural areas.  But before we start working on making it better, can we please stop trying to make it worse?

The republican healthcare bill will kill people.  That is not exaggeration.

You realize the vast majority of the reduction in number of insured people the CBO projects are not people that are going to have their health insurance stripped away from them, but people that choose not to be insured because they are no longer subject to the individual mandate.  That may not be good policy, but it's certainly not equivalent to killing people.
Or people who can't afford insurance or lose insurance and can't get it back because the new law will keep them from having insurance for six months.  But, yes, we should just assume those people are not the majority....

sol

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Re: What comes after the ACA?
« Reply #2977 on: June 27, 2017, 02:42:31 PM »
You realize the vast majority of the reduction in number of insured people the CBO projects are not people that are going to have their health insurance stripped away from them, but people that choose not to be insured because they are no longer subject to the individual mandate.  That may not be good policy, but it's certainly not equivalent to killing people.

You obviously haven't read the CBO report.  It says 7 million fewer people insured through the individual market, and 15 million people who would have their current Medicaid coverage stripped away by the republican health care plan (in the first 10 years, and then even more after that).

And even if you wanted to only count the 15 million who would have their health care forcibly taken away by the republicans, and not the 7 million for whom insurance would be made unaffordable by the republicans, that's still tens of thousands of totally avoidable senseless deaths.  That blood would be on the party's hands for generations to come.

And let's not forget the reasoning behind this cruelty.  They could avoid all of that misery and death by just sitting on their hands and letting the ACA continue to function as-is (nevermind fixing/improving it), but they won't.  Because billionaires need tax cuts!  Republicans are actively pursuing all of that needless death and suffering in order to fund tax cuts for the wealthiest Americans.  Tens of thousands of poor women and children would die needless deaths, but the top 0.1% of Americans would get an average of $197,350 each back from the government.  That's what the republican party is proposing with this bill.
« Last Edit: June 27, 2017, 02:55:49 PM by sol »

Cassie

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Re: What comes after the ACA?
« Reply #2978 on: June 27, 2017, 03:15:48 PM »
The whole thing makes me sick. Even if you have a ton of $ saved and insurance often you end up broke from cancer that keeps coming back, a nursing home stay, etc.  What we need is Medicare for everyone.  Everyone deserves decent health insurance. When I was young most full time jobs came  with health insurance. That ship sailed a long time ago.  I can barely stand to watch the news anymore.

Exflyboy

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Re: What comes after the ACA?
« Reply #2979 on: June 27, 2017, 03:23:14 PM »
The whole thing makes me sick. Even if you have a ton of $ saved and insurance often you end up broke from cancer that keeps coming back, a nursing home stay, etc.  What we need is Medicare for everyone.  Everyone deserves decent health insurance. When I was young most full time jobs came  with health insurance. That ship sailed a long time ago.  I can barely stand to watch the news anymore.

This does ask the Question what do you mean by a "Ton of $"?.. if you have $1m+ does this hold true?

Not trying to pick a fight here.. I come from the UK (our single payer works very well) so you can imagine I am no fan of the US HC system.

So assuming one gets the cancer treatment pre-approved by the insurance company then in theory your costs for each year are limited by the max out of pocket.

I'm sure there are a number of things on your bill that suddenly won't be covered.. so add say $10k for those items.

Is this not true???

wenchsenior

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Re: What comes after the ACA?
« Reply #2980 on: June 27, 2017, 03:25:54 PM »
"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality. 

Okay, let me offer you some reality.

22 million people will lose access to primary care within the first ten years, and then approximately that many more after that.  Not all of those peole are going to die from lack of healthcare, but SOME of them certainly will.

Some of them will contract fatal diseases, and go undiagnosed until it is too late.  Some of them will have horrible accidents and be maimed for life because they could not afford the surgeries and rehab that they need.  Some of them will fail to get lifestyle intervention that could have saved then from diabetes or skin cancer.  Some mothers and babies will die during childbirth because they had home births with complications instead of trained hospital staff with proper equipment.

It won't be 22 million deaths, but it absolutely WILL be tens of thousands, and maybe hundreds of thousands, of needless and preventable deaths and disfigurements and the only thing that republicans have to do to save them all is... nothing.  Just do nothing.  Just don't strip healthcare access away from millions of people.  Just leave it alone.  Just don't be cruel.

Is that so hard?  Then we can talk about the good republican ideas for how to improve things.  Yes, let's do a better job controlling costs.  Yes, let's figure out how to make insurance more affordable, and fix the subsidy cliffs, and prop up the market in rural areas.  But before we start working on making it better, can we please stop trying to make it worse?

The republican healthcare bill will kill people.  That is not exaggeration.

You realize the vast majority of the reduction in number of insured people the CBO projects are not people that are going to have their health insurance stripped away from them, but people that choose not to be insured because they are no longer subject to the individual mandate.  That may not be good policy, but it's certainly not equivalent to killing people.


Oh, please do tell us where you got this bit of data from?  Paul Ryan's bs talking points?

the_fixer

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Re: What comes after the ACA?
« Reply #2981 on: June 27, 2017, 03:46:01 PM »
Can we stop with all of the theatrics already?

I really would like to hear about what is happening but this BS is getting an it over the top with the everyone on the right wants everyone to die except except rich people and fetuses.

Keep fighting along party lines, that is what they want you to do because as long as you are focused on that you will not be focused on them.


wenchsenior

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Re: What comes after the ACA?
« Reply #2982 on: June 27, 2017, 04:11:41 PM »
Can we stop with all of the theatrics already?

I really would like to hear about what is happening but this BS is getting an it over the top with the everyone on the right wants everyone to die except except rich people and fetuses.

Keep fighting along party lines, that is what they want you to do because as long as you are focused on that you will not be focused on them.

Heh. I can multitask.  I'm on top of what Congress is up to nearly all the time, even when they are doing boring stuff.

wenchsenior

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Re: What comes after the ACA?
« Reply #2983 on: June 27, 2017, 04:19:04 PM »
The whole thing makes me sick. Even if you have a ton of $ saved and insurance often you end up broke from cancer that keeps coming back, a nursing home stay, etc.  What we need is Medicare for everyone.  Everyone deserves decent health insurance. When I was young most full time jobs came  with health insurance. That ship sailed a long time ago.  I can barely stand to watch the news anymore.

This does ask the Question what do you mean by a "Ton of $"?.. if you have $1m+ does this hold true?

Not trying to pick a fight here.. I come from the UK (our single payer works very well) so you can imagine I am no fan of the US HC system.

So assuming one gets the cancer treatment pre-approved by the insurance company then in theory your costs for each year are limited by the max out of pocket.

I'm sure there are a number of things on your bill that suddenly won't be covered.. so add say $10k for those items.

Is this not true???

This is true currently, under the ACA, which does not allow caps to spending by the health insurance companies. So as long as you pay your premiums and meet your deductible (which can be very substantial...a legit problem with the ACA in some markets), your cancer treatment would be covered with no cap.  However, under the proposed GOP bill, premiums and deductibles will go up (at least for the first few years, after  which the GOP believes competition would drive rates down) and the quality of the plan will drop. So people will have to pay more for worse insurance.

In addition, this legislation proposes that states can opt out of current restrictions on plans that are offered. So they could theoretically start offering plans with lifetime caps (could be blown through by cancer) or maximum annual caps, etc. Also, this could allow backdoor methods of dropping coverage for preexisting conditions. So insurance companies would be required to offer SOME sort of insurance to a cancer sufferer, but not necessarily insurance that covered chemo.


sol

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Re: What comes after the ACA?
« Reply #2984 on: June 27, 2017, 04:21:54 PM »
Can we stop with all of the theatrics already?

I really would like to hear about what is happening but this BS is getting an it over the top with the everyone on the right wants everyone to die except except rich people and fetuses.

Keep fighting along party lines, that is what they want you to do because as long as you are focused on that you will not be focused on them.

This really shouldn't be a party issue.  It's a bad bill, in virtually every respect.  It makes insurance more expensive, it covers fewer people, and it makes that coverage less useful, all without actually repealing Obamacare.  It breaks every campaign promise Trump made about healthcare.

What it does do is reduce federal spending on healthcare.  Unfortunately, it just replaces it with federal spending on tax refunds for rich people.

Cassie

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Re: What comes after the ACA?
« Reply #2985 on: June 27, 2017, 04:30:09 PM »
Exfly: some good friends of mine had health insurance but his wife got cancer 8 times through 12 years and he got it twice. They had a paid for house, money saved and jobs. Eventually she could no longer work so had to go on SSDI.  They both died last year in early 60's without a penny to their names and she was in a nursing home on Medicaid. They had so many medical bills that eventually took equity out of their home to pay them and finally sold it and rented a tiny place. In the end they sold everything they had when he was dying and she went into a home because he was too sick to care for her and she by then had developed dementia.

Exflyboy

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Re: What comes after the ACA?
« Reply #2986 on: June 27, 2017, 04:41:32 PM »
Cassie.. I wonder if they had treatments that were pre-approved by the insurance company? I too have friends in a similar situation but it turns out they agreed to care for her breast cancer suggested by her Dr without getting pre-approval.. Guess what?.. It wasn't covered and cost them $100k.

So I'm wondering if your friends were in a similar situation? Also, prior to the ACA you could be kicked off your insurance and then no one would touch you because of the pre-existing condition clause. But currently they can't do that.

So I'm at a loss as to (under current law) how you can be charged much more than the max OOP number listed on your plan?

As for us if we got stung with a $100k bill then I'm on the first flight back to the UK!

wenchsenior

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Re: What comes after the ACA?
« Reply #2987 on: June 27, 2017, 04:48:25 PM »
It's fairly well established in the MMM community that giving (or worse, lending) money to family members is generally a bad idea, as they'll come to depend on it. Helping people is not always a good thing and does create dependence. How is that hard to grasp?

Difference being that not giving a few thousand or whatever to family won't cause them to die because they can't afford cancer treatments but cutting Medicaid or backdoor evisceration of protections for pre-exisiting conditions does.  Many studies show that it's X # of deaths per Y # of uninsured.  Or is that fake news? 

Just admit that many of you right wingers just don't give a shit about people, you don't care if people die.   Fucking sociopaths.
They care a lot about fetuses though!

But really, I do have a LOT of conservative family members.  A LOT.  And ... they sort of don't care if people die.  I don't mean that in a "cold-hearted" way, but more of a practical way.

You know we've touched on this in several threads, but not sure if we've really delved deeply into it.

Aside from the cost of care being high and the need to cut it, there's the practical aspect and the caring aspect
- babies born early that spend a lot of time in the NICU cost a lot of money
- many of them have life-long problems that cost a lot of money, both health-wise and education wise
- babies born with fetal alcohol syndrome, or with other birth defects like down syndrome, or genetic disorders - they cost money.  To care for medically, and to educate.
- people get cancer.  Cancer treatment is expensive.
- people get diabetes, sometimes kids get Type 1, treatment is expensive
- people get old and sick.  And end of life care is expensive, and sometimes you need it for a very long time
- people will spend an inordinate amount of money, time, effort, to keep someone alive
- we don't allow euthanasia.  What if someone would rather die peacefully than live on machines for years, or die by refusing to eat?
- young people die because they get sick and don't have insurance and aren't able to get care

So, where do you draw the line?  I've got friends in Canada and Europe and the UK where they get care.  Yes, their taxes are high.  But they don't generally go broke due to medical issues.

In the US, we are such "individuals"... honestly, a lot of my conservative family members are practical.  People die.  They get that.  My cousin died of a leg infection.  Sometimes your baby is born too early and they die.  Sometimes you get cancer, and your church has a spaghetti dinner and a pancake breakfast (or 3) because your insurance sucks, or you don't have it at all.  But then you can't afford to finish chemo, so you die.  Sometimes you get old, and you cannot afford a home.  You don't want to go in one anyway.  So a few friends and family members may help you out, come by, bring dinner.  But in the end, you are living alone, you have an aneurysm burst and you die (my dad).

It's complicated, especially when you are talking millions of dollars.  I saw a quote yesterday "by having a lifetime cap on insurance, you are telling someone that they aren't worth any more money to keep alive".  Which sounds harsh.  And it is.  A preemie can hit that in months, and that preemie can go on to grow up and get a job and pay taxes.  On the other hand, that preemie might require a lifetime of specialized care in a special home, and that can run even higher.

Oooo, oooo, so the post above where I was wrestling with the oddness of my father and  his family and their super conservative mindest that views poor people as too stupid to earn proper livings and too irresponsible to make smart choices like buy health insurance?  So...guess who never bothered to buy health insurance in his twenties, when his wife was pregnant with their first child (me)? And guess who ended up being an emergency c-section preemie who required intensive care for 2 weeks? Me!  And guess who got away with not having hundreds of thousands of dollars in bills that he couldn't possibly pay on his salary by the skin of his teeth? My dad. But HOW, you ask? By buying full coverage health insurance AFTER the emergency delivery...from his own father...because one of the two businesses  my dad's family owned was INSURANCE!!!  So handy... Extreme nepotism for the win!

Now, this did teach my father a lesson about never going without health insurance. But it NEVER made him more compassionate or understanding toward any OTHER person who went without insurance out of carelessness, thoughtlessness, or poverty and suffered financially or physically because of it. Those people just deserved whatever they got.   

Cassie

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Re: What comes after the ACA?
« Reply #2988 on: June 27, 2017, 04:53:10 PM »
All their treatments were approved. She had 8 different surgeries and 8 different rounds of chemo. This happened from 1998 and they just died last year. Also most of those years she was too sick to work and then developed dementia from all the metal that is in chemo. He worked until a year before he died. They were never kicked off their insurance. I think one thing that hurt so much financially ws that they lost her income and she got SSDI that was about 1700/month. Then as he got older he got laid-off and at one point had to work as a security guard. But in the past 5 years before he died worked his way up in the company and had a good job.  They actually were not bitter and valued their lives more then $ but I think it is super sad the way it turned out.  AFter he died I was her guardian and when her care level went up the home charge double their rent. I ran out of her $ fast then and she qualified for Medicaid.

wenchsenior

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Re: What comes after the ACA?
« Reply #2989 on: June 27, 2017, 04:55:16 PM »
Cassie.. I wonder if they had treatments that were pre-approved by the insurance company? I too have friends in a similar situation but it turns out they agreed to care for her breast cancer suggested by her Dr without getting pre-approval.. Guess what?.. It wasn't covered and cost them $100k.

So I'm wondering if your friends were in a similar situation? Also, prior to the ACA you could be kicked off your insurance and then no one would touch you because of the pre-existing condition clause. But currently they can't do that.

So I'm at a loss as to (under current law) how you can be charged much more than the max OOP number listed on your plan?

As for us if we got stung with a $100k bill then I'm on the first flight back to the UK!

I am not sure you can be under current law, though there might be weird loopholes somewhere. The point was, pre ACA, as you note, there were hardly any rules about this.  You could easily be bankrupted by medical bills.  And if the GOP passes something similar to their current bill, things will be very similar to how they were pre ACA except with the additional cuts to Medicaid, even fewer poor people will be covered than pre-ACA.

Cassie

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Re: What comes after the ACA?
« Reply #2990 on: June 27, 2017, 04:58:30 PM »
Also when she got dementia and her cancer came back we did not treat it because doing so would be cruel.

Exflyboy

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Re: What comes after the ACA?
« Reply #2991 on: June 27, 2017, 06:12:38 PM »
I am very sorry for you're loss, but glad you were there to help them Cassie.

mm1970

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Re: What comes after the ACA?
« Reply #2992 on: June 27, 2017, 06:14:04 PM »
Also when she got dementia and her cancer came back we did not treat it because doing so would be cruel.
My FIL opted to do that with his mother in her 90s when her cancer came back.  But man, she suffered for a couple of years after that.  I think he partially regrets his decision.  If he'd known she was going to live, and be in that much pain, for that long - he might have opted to treat her.  It's so tricky.

GuitarStv

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Re: What comes after the ACA?
« Reply #2993 on: June 28, 2017, 05:48:40 AM »
Why do republicans put so much time and money into pro-life efforts and then try and kill 22 million people?

It doesn't make any logical sense.

It does when you realize that pro-life is a misnomer.  Republicans are pro-punishment, and view children as punishment for sexual indiscretions.

nereo

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Re: What comes after the ACA?
« Reply #2994 on: June 28, 2017, 05:50:53 AM »
Whether through luck or skill, Sol's prediction that GOP Senators would leave only in mass seems to be correct - immediately after the vote was postponed 5 more senators expressed unwillingness to support the bill without further debate and analysis.   WaPo counts 5 opposed and 5 'leaning-no'

Looks like we'll spend the 4th with campaign-style blitz from both sides. More details are starting to emerge as people get past the initial talking points and into the weeds.
 ALterations of the current Senate bill seem almost certain. I'm counting on some blatant mis-representation of the next CBO score - if the next one says only 19MM will lose health insurance the talking point will be "three million more will gain insurance" (not mentioning that number is compared to a bill which could not pass).
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ReadySetMillionaire

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Re: What comes after the ACA?
« Reply #2995 on: June 28, 2017, 07:29:54 AM »
I haven't dipped my toe into this thread because it's painfully clear to me that a lot of people posting in this thread know far more about healthcare than I do.

Yet I have one single question, which I'm hoping can start an informative dialogue: what do you guys think of banning employers offering healthcare as a benefit?

To my simple mind, the employment-based model of healthcare is the single biggest problem with our healthcare system. It removes the true cost from the consumer, it does not make any sense (employers don't pay for other insurance), it creates gaps in coverage if people get laid off (which then contributes to the pre-existing conditions issue), and it actually discourages entrepreneurship. I myself have thought long and hard about starting my own solo practice, but healthcare costs are a golden handcuff that I can't seem to shake.

Put simply, I think getting rid of the employment-based healthcare system would be the single best first step we can take, because it would create a true private versus public competition.

Thoughts?
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Roland of Gilead

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Re: What comes after the ACA?
« Reply #2996 on: June 28, 2017, 07:37:37 AM »
It doesn't have to be a straight ban, just start taxing employer provided healthcare as compensation.

If my employer paid my home owner or car insurance I would expect to be taxed on that.

brooklynguy

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Re: What comes after the ACA?
« Reply #2997 on: June 28, 2017, 07:43:05 AM »
McConnell's backing down from his bluff to force a vote this week come hell or high water means the repeal efforts remain alive and strong.  The speculation that he would have moved forward with a vote destined to fail in order to "show the electorate a body" and move on to other issues on the agenda turns out to have been smoke and mirrors.  Successfully threading the need across all GOP factions might appear to be getting more difficult, but the effort is still underway.  I wouldn't be surprised if we see a repeat of the House process, where a little delay and some incremental changes to make the bill even worse ultimately result in passage (but I also wouldn't be surprised if GOP infighting ultimately proves insurmountable).  One thing is clear:  the longer this uncertainty lasts, the worse off our current health insurance system will become.

nereo

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Re: What comes after the ACA?
« Reply #2998 on: June 28, 2017, 07:44:57 AM »
Yet I have one single question, which I'm hoping can start an informative dialogue: what do you guys think of banning employers offering healthcare as a benefit?

To my simple mind, the employment-based model of healthcare is the single biggest problem with our healthcare system (snip)

I would wholeheartedly support such a plan.  Problem is, particularly under the current climate it would be politically impractical, if not impossible. it would involve not just revamping our health care, but our entire tax code simultaneously (and we can't seem to do either in isolation, so together it seems like fantasy).  You're absoltuely right that it shields consumers from the true cost of hteir insurance, plus it makes employees beholden to their jobs.  About 20+ pages ago I mentioned how in ~2010 the enormous CalPERS (California State Employees) shifted their networks and premiums a bunch of my friends were irate that their family healthcare costs went from $80/mo to about $140 ("a 50% increase!! Thanks Obama!!").  Few realized that CalPERS continued to cover >90% of their health insurance, and that even $140/mo was dirt cheap for a family of 4.

I've heard pundits from both sides comment that if we were to really start over from scratch we'd never choose a model where the employer supplied ~2/3 of our health insurance. If we started taxing employer-provided healthcare as Roland suggests, employers would drop their healh plans like a flaming bag of poo - the only reason large corporations do this is because they can 'save' ~35¢ per dollar on corporate taxes.
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Inaya

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Re: What comes after the ACA?
« Reply #2999 on: June 28, 2017, 07:51:07 AM »
Yet I have one single question, which I'm hoping can start an informative dialogue: what do you guys think of banning employers offering healthcare as a benefit?

To my simple mind, the employment-based model of healthcare is the single biggest problem with our healthcare system (snip)

I would wholeheartedly support such a plan.  Problem is, particularly under the current climate it would be politically impractical, if not impossible.
More impractical/impossible than single-payer?
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