Author Topic: What comes after the ACA?  (Read 387516 times)

fuzzy math

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Re: What comes after the ACA?
« Reply #3100 on: July 11, 2017, 08:52:50 PM »
And they delayed the next summer recess. Ted Cruz submitted some of the latest amendments. They'll probably just left him speak nonstop until every member of the senate is crying and agrees to vote yes just to make him shut up.

I have a bad feeling its going to go through this time.
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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3101 on: July 11, 2017, 10:27:17 PM »
They don't have Susan Collins.

"Senator Susan Collins, Republican of Maine, said, “Minor changes and tweaks will not be sufficient to win my support for the bill.”"

I'm pretty sure there are 2 more Republican Senators that are worried about Medicaid cuts, Dean Heller of Nevada, Bill Cassidy of Louisiana, Shelley Capito of West Virginia, and a couple of others.

sol

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Re: What comes after the ACA?
« Reply #3102 on: July 12, 2017, 10:18:41 AM »
I gotta give them a sick sort of credit. I was sure they would give up the Medicaid cuts before giving up their beloved tax cuts.

Turns out their hatred of poor people is stronger than their love for rich people?

When you put it like that, it does actually seem less surprising.

The Post speculates this morning that the Republicans are agreeing to keep the investment income tax because...

a)  it is the single largest revenue raiser in the ACA, making it easier for them to balance the books as required by reconciliation and pass with 50 votes.
b)  it helps reframe the bill so it doesn't look quite so much like reverse-robin-hooding.
c)  unlike the medical devices industry and the pharma industry, investors don't have a lobbying group pushing to repeal this tax.

So the GOP bill still repeals the ACA taxes on medical devices, drug companies, health insurance companies, tanning salons, medicare part A, and executive compensation.  Those groups apparently have good lobbyists the GOP wants to keep happy, and their tax breaks are individually small.  Since no one is complaining about the 3.8% tax on investment income over $250k, that one will probably stay in place.

Of course all of this negotiation is merely a sideshow, because they're only trying to save some of the 7 million people who will lose coverage under the GOP plan's individual marketplace, but they're still holding fast to the plan to take Medicaid away from 15 million people (at first, then more after that by capping the growth).  I'm not sure how many moderate GOP senators will be appeased by a smaller amount of coverage losses on the marketplace, but still the full amount of coverage losses under Medicaid.

Hey, remember when Trump said "Everybody's going to be covered" and "There will be no cuts to Medicaid"?  Those were good times.

dividendman

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Re: What comes after the ACA?
« Reply #3103 on: July 12, 2017, 10:32:08 AM »
I gotta give them a sick sort of credit. I was sure they would give up the Medicaid cuts before giving up their beloved tax cuts.

Turns out their hatred of poor people is stronger than their love for rich people?

When you put it like that, it does actually seem less surprising.

The Post speculates this morning that the Republicans are agreeing to keep the investment income tax because...

a)  it is the single largest revenue raiser in the ACA, making it easier for them to balance the books as required by reconciliation and pass with 50 votes.
b)  it helps reframe the bill so it doesn't look quite so much like reverse-robin-hooding.
c)  unlike the medical devices industry and the pharma industry, investors don't have a lobbying group pushing to repeal this tax.

So the GOP bill still repeals the ACA taxes on medical devices, drug companies, health insurance companies, tanning salons, medicare part A, and executive compensation.  Those groups apparently have good lobbyists the GOP wants to keep happy, and their tax breaks are individually small.  Since no one is complaining about the 3.8% tax on investment income over $250k, that one will probably stay in place.

Of course all of this negotiation is merely a sideshow, because they're only trying to save some of the 7 million people who will lose coverage under the GOP plan's individual marketplace, but they're still holding fast to the plan to take Medicaid away from 15 million people (at first, then more after that by capping the growth).  I'm not sure how many moderate GOP senators will be appeased by a smaller amount of coverage losses on the marketplace, but still the full amount of coverage losses under Medicaid.

Hey, remember when Trump said "Everybody's going to be covered" and "There will be no cuts to Medicaid"?  Those were good times.

Hrm... nothing about the medicare surtax? If they do pass something I hope they retroactively get rid of the medicare surtax, this is the only year I could save some dough with it due to FIRE.

Ideally, of course, they would do nothing (which is most probable).

talltexan

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Re: What comes after the ACA?
« Reply #3104 on: July 12, 2017, 02:29:40 PM »
I gotta give them a sick sort of credit. I was sure they would give up the Medicaid cuts before giving up their beloved tax cuts.

Turns out their hatred of poor people is stronger than their love for rich people?

But it's half measure on both sides.  They left in some of the tax cuts, and they can always get the rest when they move on to tax "reform", after passing their ACA "repeal".  And they're going all the way on Medicaid but only scaling back the ACA's premium subsidies, so they're still shitting on poor people but not as much as their original bill.

Frankly, I'm shocked Mitch thinks any of this is a good idea.  Whatever Republicans pass on their own will be widely hated, and he knows that.  Much better to pass a bipartisan plan (maybe even one that actually helps improve the situation, but that's just a detail) and be able to share the blame on all sides when the inevitable public backlash comes.  That's how Republicans passed Medicare reform in the 80s, right?  They got buy-in from some Democrats and all sides made painful concessions to get a compromise plan that everyone hated, but both sides took the heat for it from the public.  Cutting entitlements is hard.

I think that there are substantial primary consequences for republicans if they cannot pass a bill. Those are exactly the opposite of the general election consequences you're describing here. McConnel is hoping we're early enough in the cycle that there will be tax reform and infrastructure successes that they can use to keep the House.

jim555

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Re: What comes after the ACA?
« Reply #3105 on: July 13, 2017, 10:24:37 AM »
Mitch McTurtle just pinched out the latest bill.  As expected, even worse than the last version.

https://www.scribd.com/document/353689897/BetterCareJuly13-2017#from_embed

Exflyboy

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Re: What comes after the ACA?
« Reply #3106 on: July 13, 2017, 10:46:03 AM »
Mitch McTurtle just pinched out the latest bill.  As expected, even worse than the last version.

https://www.scribd.com/document/353689897/BetterCareJuly13-2017#from_embed

Well that was a fun read.. And probably a waste of time as I doubt they will get the votes for this one either.

dividendman

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Re: What comes after the ACA?
« Reply #3107 on: July 13, 2017, 11:14:44 AM »
I think that there are substantial primary consequences for republicans if they cannot pass a bill. Those are exactly the opposite of the general election consequences you're describing here. McConnel is hoping we're early enough in the cycle that there will be tax reform and infrastructure successes that they can use to keep the House.

I think, strategy wise, it's better for Republicans to do something on health care right *before* the mid-terms. This allows them to say they did what they said on healthcare, but nobody is getting fucked by the consequences yet so it won't cost them.

If they pass it this early, by next year election time many people will have already been fucked by it and might vote against them due to that.

sol

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Re: What comes after the ACA?
« Reply #3108 on: July 13, 2017, 11:40:54 AM »
Mitch McTurtle just pinched out the latest bill.  As expected, even worse than the last version.

The way this process has been going thus far, I wouldn't be surprised if the new version mandates colonoscopies starting at age 18 and requires every American kill a kitten to qualify for insurance. 

I'm baffled at the Republican approach to healthcare reform.  They spent all these years complaining about specific problems with the ACA, and now that they have the chance to fix them they are instead making every single of those same problems much, much worse. 

On the bright side, it's beginnign to look less and less likely they will be able to do anything at all.  The country passed the ACA by voting for a sweeping Democratic majority in both houses, including a filibuster proof 60 senators.  The Republicans just didn't get that many votes this time around, so it looks like they only have the power to break healthcare, not actually fix it. 

it's unfair so say the tax on insurance companies and medical devices goes to rich people - in theory reducing taxes on them should reduce premiums and/or out of pocket costs for all. 

Did I say that?  I didn't mean to say that.

But it's a slippery slope you're on.  The Republican philosophical basis for tax cuts has always been closely tied to advancing the interests of rich people, by advancing the interests of businesses that are owned by rich people, at the expense of poor people who work for those businesses.  They call it a "pro-business" agenda and claim they are trying to grow the economy, and that businesses are merely pass-through entities that connect poor people to goods and services, but it's closer to the truth to say modern wealth-inequality is perpetuated by businesses which concentrate wealth in the hands of the minority of wealthy business owners, by extracting wealth from the majority of consumers.

Yes, businesses respond to market forces like tax increases by raising prices, but don't fall for the supply-side economics trap of believing that anything you make will get bought.  Economies are driven by demand from buyers, not by supply from sellers.  Businesses profit when people want their services, which is the reason why it is consumers, not business owners, who determine the health of our economy.  This is the reason why taxes on businesses are less harmful to the economy than taxes on consumers.  If you tax consumers and take away their ability to buy goods, the business gets nothing.  If you tax businesses and they raise prices (instead of reducing profits for the owner), the business still makes money by selling because consumers are still buying.

Republicans usually think that entire paragraph is bologna.  They are so invested in the "job-creator" mythos that they they don't see any role at all for consumers in our economy.  They think that the rich white men who own businesses are the backbone of the American economy, they decide what gets made and sold, and consumers will inevitably show up to buy whatever crap the owners decide on.  This is the supply side myth, the Joe The Plumber myth, the trickle down myth, the Reaganomics myth, the "tax cuts generate government revenue" myth, the Republican myth.  We keep disproving it again, decade after decade, but Ben Stein is just convinced it's inarguably true.  It just HAS to be, he can feel it in his bones.

One of these days, maybe even in my lifetime, the Republican party will start looking at data as evidence, instead of as a grand liberal plot to undermine their core beliefs.

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Re: What comes after the ACA?
« Reply #3109 on: July 13, 2017, 01:04:24 PM »
One of the only viewpoints on the bill that I agree with on Republicans is that it's unfair so say the tax on insurance companies and medical devices goes to rich people - in theory reducing taxes on them should reduce premiums and/or out of pocket costs for all.

It's absolutely fair to say that when those taxes are used to fund tax cuts to the wealthy. I believe this was the case in the first two (?) versions if not this one.
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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3110 on: July 13, 2017, 04:16:22 PM »
Mitch McTurtle just pinched out the latest bill.  As expected, even worse than the last version.

The way this process has been going thus far, I wouldn't be surprised if the new version mandates colonoscopies starting at age 18 and requires every American kill a kitten to qualify for insurance. 

I'm baffled at the Republican approach to healthcare reform.  They spent all these years complaining about specific problems with the ACA, and now that they have the chance to fix them they are instead making every single of those same problems much, much worse. 

On the bright side, it's beginnign to look less and less likely they will be able to do anything at all.  The country passed the ACA by voting for a sweeping Democratic majority in both houses, including a filibuster proof 60 senators.  The Republicans just didn't get that many votes this time around, so it looks like they only have the power to break healthcare, not actually fix it. 

it's unfair so say the tax on insurance companies and medical devices goes to rich people - in theory reducing taxes on them should reduce premiums and/or out of pocket costs for all. 

Did I say that?  I didn't mean to say that.

But it's a slippery slope you're on.  The Republican philosophical basis for tax cuts has always been closely tied to advancing the interests of rich people, by advancing the interests of businesses that are owned by rich people, at the expense of poor people who work for those businesses.  They call it a "pro-business" agenda and claim they are trying to grow the economy, and that businesses are merely pass-through entities that connect poor people to goods and services, but it's closer to the truth to say modern wealth-inequality is perpetuated by businesses which concentrate wealth in the hands of the minority of wealthy business owners, by extracting wealth from the majority of consumers.

Yes, businesses respond to market forces like tax increases by raising prices, but don't fall for the supply-side economics trap of believing that anything you make will get bought.  Economies are driven by demand from buyers, not by supply from sellers.  Businesses profit when people want their services, which is the reason why it is consumers, not business owners, who determine the health of our economy.  This is the reason why taxes on businesses are less harmful to the economy than taxes on consumers.  If you tax consumers and take away their ability to buy goods, the business gets nothing.  If you tax businesses and they raise prices (instead of reducing profits for the owner), the business still makes money by selling because consumers are still buying.

Republicans usually think that entire paragraph is bologna.  They are so invested in the "job-creator" mythos that they they don't see any role at all for consumers in our economy.  They think that the rich white men who own businesses are the backbone of the American economy, they decide what gets made and sold, and consumers will inevitably show up to buy whatever crap the owners decide on.  This is the supply side myth, the Joe The Plumber myth, the trickle down myth, the Reaganomics myth, the "tax cuts generate government revenue" myth, the Republican myth.  We keep disproving it again, decade after decade, but Ben Stein is just convinced it's inarguably true.  It just HAS to be, he can feel it in his bones.

One of these days, maybe even in my lifetime, the Republican party will start looking at data as evidence, instead of as a grand liberal plot to undermine their core beliefs.

Econ 101 states that when you put a tax on a business, it increases the cost of goods sold, causing a shift in the supply curve.  This will indirectly cause them to raise prices and reduce supply, but the profits go down from the optimal supply and demand price point as they have less supply units sold.  So the producer and consumer lose but the government wins.  When you take away the tax, the producer and consumer both win.  So it's misleading to state that removing the tax from health insurers will result in benefits to only the producer.

One complicating factor with this is that in the status quo the tax comes back to the consumer in the form of subsidies.  So in effect, the producer loses and the consumer breaks even.

Bottom line is I'd rather that Obamacare be funded through taxes on the top 1% of income than on health insurers and medical device companies, solely out of self interest as I'm not in the top 1%.

The slope of that curve really matters. If you keep these taxes then it might be that the supply curve, even if it shifts, doesn't really change the demand.

sol

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Re: What comes after the ACA?
« Reply #3111 on: July 14, 2017, 02:24:51 PM »
The new draft legislation includes the Cruz amendment that allows insurers to sell plans that don't cover the minimum essential health benefits, but here's the great part, republicans in congress exempted themselves from that rule so their own insurance would not be affected.

Classic.  Let them eat cake!

nereo

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Re: What comes after the ACA?
« Reply #3112 on: July 14, 2017, 08:45:03 PM »
To me there seems to be one obvious way forward that no one in the GOP leadership is willing to take.

Step 1 - they stop calling for either "repeal" or "replace". 

Step 2 - throw the Dems a bone and say "there are some very popular parts of the ACA, which we're going to keep."  Call it the ACA Improvement Act or some similar BS that allows Dems to come to the table. They can even toot their own horn here nad talk about how the ACA was actually modeled after previously republican ideas

Step 3 - Actually draft legislation that isn't draconian in scope, covers pre-existing conditions and shores up marketplaces. Yeah, they'll lose a lot of the Freedom Caucus/Ted Cruz votes, but a few dozen Dems might actually vote yes to preserve the protections they really want.  Obama gets to keep his legacy and DJT (never one to shy away from taking credit) can claim he "saved" the system and created "the greatest" health care.  Average Americans can sleep at night and Rand Paul can suck it.

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JLee

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Re: What comes after the ACA?
« Reply #3113 on: July 14, 2017, 08:53:29 PM »
To me there seems to be one obvious way forward that no one in the GOP leadership is willing to take.

Step 1 - they stop calling for either "repeal" or "replace". 

Step 2 - throw the Dems a bone and say "there are some very popular parts of the ACA, which we're going to keep."  Call it the ACA Improvement Act or some similar BS that allows Dems to come to the table. They can even toot their own horn here nad talk about how the ACA was actually modeled after previously republican ideas

Step 3 - Actually draft legislation that isn't draconian in scope, covers pre-existing conditions and shores up marketplaces. Yeah, they'll lose a lot of the Freedom Caucus/Ted Cruz votes, but a few dozen Dems might actually vote yes to preserve the protections they really want.  Obama gets to keep his legacy and DJT (never one to shy away from taking credit) can claim he "saved" the system and created "the greatest" health care.  Average Americans can sleep at night and Rand Paul can suck it.

Trump would piss off his primary supporter base, though.

Exflyboy

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Re: What comes after the ACA?
« Reply #3114 on: July 14, 2017, 11:09:32 PM »
To me there seems to be one obvious way forward that no one in the GOP leadership is willing to take.

Step 1 - they stop calling for either "repeal" or "replace". 

Step 2 - throw the Dems a bone and say "there are some very popular parts of the ACA, which we're going to keep."  Call it the ACA Improvement Act or some similar BS that allows Dems to come to the table. They can even toot their own horn here nad talk about how the ACA was actually modeled after previously republican ideas

Step 3 - Actually draft legislation that isn't draconian in scope, covers pre-existing conditions and shores up marketplaces. Yeah, they'll lose a lot of the Freedom Caucus/Ted Cruz votes, but a few dozen Dems might actually vote yes to preserve the protections they really want.  Obama gets to keep his legacy and DJT (never one to shy away from taking credit) can claim he "saved" the system and created "the greatest" health care.  Average Americans can sleep at night and Rand Paul can suck it.

Trump would piss off his primary supporter base, though.

What you mean those poor starving West Virginian coal miners (except the are not coal miners anymore of course)?

simmias

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Re: What comes after the ACA?
« Reply #3115 on: July 15, 2017, 06:17:09 AM »
Trump would piss off his primary supporter base, though.
I'm starting to think that's just not possible.

nereo

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Re: What comes after the ACA?
« Reply #3116 on: July 15, 2017, 08:20:27 AM »
To me there seems to be one obvious way forward that no one in the GOP leadership is willing to take.

Step 1 - they stop calling for either "repeal" or "replace". 

Step 2 - throw the Dems a bone and say "there are some very popular parts of the ACA, which we're going to keep."  Call it the ACA Improvement Act or some similar BS that allows Dems to come to the table. They can even toot their own horn here nad talk about how the ACA was actually modeled after previously republican ideas

Step 3 - Actually draft legislation that isn't draconian in scope, covers pre-existing conditions and shores up marketplaces. Yeah, they'll lose a lot of the Freedom Caucus/Ted Cruz votes, but a few dozen Dems might actually vote yes to preserve the protections they really want.  Obama gets to keep his legacy and DJT (never one to shy away from taking credit) can claim he "saved" the system and created "the greatest" health care.  Average Americans can sleep at night and Rand Paul can suck it.

Trump would piss off his primary supporter base, though.

Yeah, I find the likelihood of this happening extremely unlikely.  DJT won't allow Obama to keep any credit, even if he could then claim that he "fixed" a broken ACA. The GOP have also campaigned too long and too hard on "repeal and replace" for most of them to make the pivot.
I honestly think dozens of Dems might join a bill that keeps teh ACA name and many of its provisions, as they could sleep at night and go home saying they've saved what their constutients loved about Obamacare.

Like i said, it's probably a fantasy for this congress and WH. Too bad - I think that's really, deep down, what most everyone wants...
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tyort1

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Re: What comes after the ACA?
« Reply #3117 on: July 15, 2017, 01:27:53 PM »
To me there seems to be one obvious way forward that no one in the GOP leadership is willing to take.

Step 1 - they stop calling for either "repeal" or "replace". 

Step 2 - throw the Dems a bone and say "there are some very popular parts of the ACA, which we're going to keep."  Call it the ACA Improvement Act or some similar BS that allows Dems to come to the table. They can even toot their own horn here nad talk about how the ACA was actually modeled after previously republican ideas

Step 3 - Actually draft legislation that isn't draconian in scope, covers pre-existing conditions and shores up marketplaces. Yeah, they'll lose a lot of the Freedom Caucus/Ted Cruz votes, but a few dozen Dems might actually vote yes to preserve the protections they really want.  Obama gets to keep his legacy and DJT (never one to shy away from taking credit) can claim he "saved" the system and created "the greatest" health care.  Average Americans can sleep at night and Rand Paul can suck it.

Trump would piss off his primary supporter base, though.

Yeah, I find the likelihood of this happening extremely unlikely.  DJT won't allow Obama to keep any credit, even if he could then claim that he "fixed" a broken ACA. The GOP have also campaigned too long and too hard on "repeal and replace" for most of them to make the pivot.
I honestly think dozens of Dems might join a bill that keeps teh ACA name and many of its provisions, as they could sleep at night and go home saying they've saved what their constutients loved about Obamacare.

Like i said, it's probably a fantasy for this congress and WH. Too bad - I think that's really, deep down, what most everyone wants...

And this is the tragedy of radicalizing your base - you are unable to pass reasonable legislation. 
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Miss Piggy

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Re: What comes after the ACA?
« Reply #3118 on: July 15, 2017, 03:02:02 PM »
Well, here's a scary proposition: EPO, or Exclusive Provider Organization. Zero coverage outside of the network. Zero.


I just came across this article about these types of plans. If an employer I was working for switched to a plan like this, I'd be forced to look for employment elsewhere. That said, I suppose it could be the perfect inexpensive plan for young, healthy people. Just not for employers, unless I'm missing something. What am I missing?

http://www.stltoday.com/business/local/price-sensitive-health-plans-with-no-out-of-network-benefits/article_11548b14-eb75-5cda-b588-bfa6ad0ee939.html

ketchup

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Re: What comes after the ACA?
« Reply #3119 on: July 15, 2017, 03:17:53 PM »
Well, here's a scary proposition: EPO, or Exclusive Provider Organization. Zero coverage outside of the network. Zero.


I just came across this article about these types of plans. If an employer I was working for switched to a plan like this, I'd be forced to look for employment elsewhere. That said, I suppose it could be the perfect inexpensive plan for young, healthy people. Just not for employers, unless I'm missing something. What am I missing?

http://www.stltoday.com/business/local/price-sensitive-health-plans-with-no-out-of-network-benefits/article_11548b14-eb75-5cda-b588-bfa6ad0ee939.html
My employer just switched insurance providers a few months back (to UnitedHealthCare), and those were some of our options.  No thanks.  They were the cheapest plans (though not by a huge margin), but that's just not something that would allow me to sleep at night.

Lance Burkhart

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Re: What comes after the ACA?
« Reply #3120 on: July 15, 2017, 03:35:41 PM »
Sorry if this is a repost,  I didn't want to read through the crying about DJT and Republicans:
https://resources.ehealthinsurance.com/affordable-care-act/much-obamacare-cost-2017


protostache

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Re: What comes after the ACA?
« Reply #3121 on: July 15, 2017, 05:34:57 PM »
Sorry if this is a repost,  I didn't want to read through the crying about DJT and Republicans:
https://resources.ehealthinsurance.com/affordable-care-act/much-obamacare-cost-2017

This data is misleading because it only includes people buying from eHealthInsurance and not on the exchanges. The report is based on "thousands" of applications submitted through eHealth, whereas there are 6.4 million people signed up through the Federal exchange. Furthermore, price changes in the individual market from years before 2014 are not comparable to those after because the plans are significantly different.

These fact sheets from Kaiser Family Foundation are more interesting because they talk about the exchanges, where the vast majority of people in the individual market get their insurance:


Again, KFF's data might be a little misleading because it doesn't include off-exchange, but that's a small slice of the market (~5-10%). Taken together, premiums are up a little over 36% 2014-2017.

2016-2017 was indeed an extremely large jump, but earlier this year insurers were giving indications that they were actually turning a profit, despite the expiration of the Federal reinsurance program, and that the market in most places in the country is finally stable. Areas that aren't stable are those that are inherently difficult to properly service by a non-governmental organization because the population is both spread out and poor.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3122 on: July 15, 2017, 07:02:35 PM »
The skimpy health insurance plans that will arise from the new Senate version are a con.

Here's a comment from a NY Times article on these skimpy plans

"Buyer Beware!
There's another con going on with this junk insurance.

The Republican plan requires that you have continuous coverage to avoid people signing up when they become ill or injured.

However, this junk insurance does not count as continuous coverage.

Michael Hiltzik writes about in this article in the LA Times - he writes about several of the problems but this one really caught my eye because Republicans are touting it like some wonderful thing:

Here are the hidden horrors in the Senate GOP's new Obamacare repeal bill

Buyers of cheap Cruz plans would be locked out of the insurance market if they get sick. A little-noticed aspect of the Cruz proposal is that the cheap plans it allows would not qualify as legitimate insurance coverage under the GOP’s “continuous coverage” rules.

Those rules, embodied in both the House and Senate GOP repeal bills, guarantee coverage for preexisting conditions as long as the buyer maintains insurance coverage without a break of longer than two months. Under the Senate bill, anyone with such a lapse would face a six-month waiting period for new insurance before the preexisting condition guarantee would be effective.

It's a con."

"In Clash Over Health Bill, a Growing Fear of ‘Junk Insurance’  "
https://nyti.ms/2voE1Hj

Lance Burkhart

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Re: What comes after the ACA?
« Reply #3123 on: July 15, 2017, 08:00:17 PM »
Sorry if this is a repost,  I didn't want to read through the crying about DJT and Republicans:
https://resources.ehealthinsurance.com/affordable-care-act/much-obamacare-cost-2017

This data is misleading because it only includes people buying from eHealthInsurance and not on the exchanges. The report is based on "thousands" of applications submitted through eHealth, whereas there are 6.4 million people signed up through the Federal exchange. Furthermore, price changes in the individual market from years before 2014 are not comparable to those after because the plans are significantly different.

These fact sheets from Kaiser Family Foundation are more interesting because they talk about the exchanges, where the vast majority of people in the individual market get their insurance:


Again, KFF's data might be a little misleading because it doesn't include off-exchange, but that's a small slice of the market (~5-10%). Taken together, premiums are up a little over 36% 2014-2017.

2016-2017 was indeed an extremely large jump, but earlier this year insurers were giving indications that they were actually turning a profit, despite the expiration of the Federal reinsurance program, and that the market in most places in the country is finally stable. Areas that aren't stable are those that are inherently difficult to properly service by a non-governmental organization because the population is both spread out and poor.

Premiums are only part of the problem.  Accepting that the KFF data is a good representation a 36% jump over 4 years is a large jump when wages have been stagnant.  Also, what about deductibles?  How much more are employers paying to cover their employees? Don't most people get coverage through their employers? I care about the overall effect on the cost of health insurance, not just the premiums for plans bought through the exchanges.   

It seems like the Left only likes this because it's a stepping-stone to single payer. 

sol

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Re: What comes after the ACA?
« Reply #3124 on: July 15, 2017, 08:54:53 PM »
Premiums are only part of the problem.

I agree that premiums are only part of the problem.  But they're the part of the problem that prevents people from having health insurance, if they are too high, so I think they're an important part.  It's also worth noting that while Republicans like to point to premium growth as evidence of the ACA's failure, they conveniently leave out the fact that people under 400% of the FPL have their premiums subsidizes to keep them affordable.  This only transfers the problem from the individual to the taxpayer, but it's worth nothing that the ACA made sure that a 36% increase in premiums does NOT mean your insurance will cost you 36% more than it used to.  If your income is the same (and under 400% of the FPL), then your premiums didn't budge at all no matter what growth rates are reported.

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Accepting that the KFF data is a good representation a 36% jump over 4 years is a large jump when wages have been stagnant.

It IS a large jump!  Almost as large as the four years before the ACA was enacted!

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Also, what about deductibles?

Generally speaking, conservatives have lobbied for raising deductibles, as a part of their plan to reduce premiums.  The ACA capped deductibles (and the OOP max) at a maximum level in attempt to keep them affordable, but the Republicans want to repeal this part of the law so that deductible can rise again.  It's all part of the GOP plan to take all of their supposed complaints about the ACA, and then make them worse instead of better.

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How much more are employers paying to cover their employees?

I'm not sure, but it's an interesting question and I'm open to data suggestions.  At least for all of my insurance plans (I'm a fed), the percentage of the premiums the employer pays is a fixed percentage of the premium amount, so the employer contribution scales exactly with the premium changes.

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I care about the overall effect on the cost of health insurance, not just the premiums for plans bought through the exchanges.   

In that case, you must be REALLY pissed off about the Republican plan to shrink Medicaid to cover 22 million fewer people over the next ten years.  If you care about everyone's health insurance, and not just the plans bought through the exchanges, then the 7 million people the CBO projected would lose coverage in the exchanges under the Senate bill is probably more worrisome than the 4 million people projected to lose employee coverage (because the Senate bill repeals the employer mandate), but less worrisome than those 22 million medicaid people;. 

Once again, the Republican's proposed draft legislation makes this problem worse, instead of better.  I agree the ACA has problems and I agree that we have seen some good ideas on how to fix them.  Republicans seem to be trying to make those problems worse instead of fixing them, which is why I'm so baffled by their attempts.  You spent all those years complaining about this stuff, here's your chance to fix it!  Please fix it!

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It seems like the Left only likes this because it's a stepping-stone to single payer.

I think it's more accurate to say that the ACA was a deliberate step AWAY from single payer.  Single payer was a viable option for healthcare reform, a decade ago, and instead of pursing that path (which has lowered costs and improved outcomes in every single country that has tried it, btw) Democrats adopted the conservative Heritage Foundation's plan for a hybrid public-private system in which federal tax dollars would prop up private insurers.  The ACA is a Republican idea.  A Republican governor pioneered it in MA.  Democrats just expanded the idea, and I think we all agree they've had mixed results.  It's better than what we had before, but still far from perfect.

At this point, I think single payer in America makes a lot more sense now than it ever has before.  We tried the unregulated free market, and it failed us by leaving tens of millions of people uninsured, precluding sick people from getting insurance, and setting premiums on an incredible upward trend.  We tried the conservative's public-private hybrid approach, which improved things somewhat but still has some flaws.  All of those flaws could be addressed by a single payer system.

Single payer is cheaper.  It will cost us all less money.  It provides better care.  It covers more people.  It doesn't exclude sick people.  It ends medical bankruptcy, it controls rising costs, and it doesn't have to harm the private insurance market.   Frankly I don't see the down side anymore, now that we've exhausted the alternatives.

edited to add: okay I do see one problem a single payer system, but I think it's a silly one:  most conservatives are just philosophically opposed to the idea of the government helping people.  They don't want poor people to have insurance, and single payer would help everyone to have insurance, including poor people. 
« Last Edit: July 15, 2017, 09:37:43 PM by sol »

radram

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Re: What comes after the ACA?
« Reply #3125 on: July 15, 2017, 09:35:47 PM »
Bill is dead for at least a week.

McCain had eye surgery for a blood clot and will not vote this week.

Does anyone else find it ironic that a medical procedure is what stalled a healthcare bill?

Lance Burkhart

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Re: What comes after the ACA?
« Reply #3126 on: July 15, 2017, 09:43:00 PM »
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The ACA capped deductibles (and the OOP max) at a maximum level in attempt to keep them affordable

This number appears to be $14,300, regardless of the premiums.  I just plugged different salaries into the KFF calculator (on my other thread) and the deductible was $14,300 for a silver plan regardless of whether or not the premiums were subsidized.  I can't see what value insurance even provides with deductibles this large.  As I said on the other thread, no wonder only 18% of the population is paying its bills in full.  My son just broke his arm and I'd be paying a lot more under a silver care plan.  Fortunately, my employer-provided high deductible plan has a deductible about half of an Obamacare silver plan.

Which 'conservatives' have lobbied for higher deductibles? 

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In that case, you must be REALLY pissed off about the Republican plan to shrink Medicaid to cover 22 million fewer people over the next ten years.  If you care about everyone's health insurance, and not just the plans bought through the exchanges, then the 7 million people the CBO projected would lose coverage in the exchanges under the Senate bill is probably more worrisome than the 4 million people projected to lose employee coverage (because the Senate bill repeals the employer mandate), but less worrisome than those 22 million medicaid people;. 

Many people lost their previous plans when the ACA was enacted and HAD to go onto the exchanges and buy a new one. If 7 million people lose insurance from the exchanges, they might regain it some other way.  Shrinking or expanding Medicaid will not necessarily shrink or expand the cost of care - it all depends on where the costs are shifted and who's paying them.  Generally, Medicare and Medicaid have expanded to a $1 trillion entitlement since they were enacted and no one is arguing that costs, premiums or deductibles are lower now.

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I think it's more accurate to say that the ACA was a deliberate step AWAY from single payer.  Single payer was a viable option for healthcare reform, a decade ago, and instead of pursing that path (which has lowered costs and improved outcomes in every single country that has tried it, btw) Democrats adopted the conservative Heritage Foundation's plan for a hybrid public-private system in which federal tax dollars would prop up private insurers.  The ACA is a Republican idea.  A Republican governor pioneered it in MA.  Democrats just expanded the idea, and I think we all agree they've had mixed results.  It's better than what we had before, but still far from perfect.

How is it better than what we had before?  Because more people in raw numbers are covered?  This isn't the only metric of success or failure.  The premiums have continued to rise though you noted a minor decrease in the second derivative of the curve.  Deductibles are now astronomical.  People can't pay their bills. 

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Single payer is cheaper.  It will cost us all less money.  It provides better care.  It covers more people.  It doesn't exclude sick people.  It ends medical bankruptcy, it controls rising costs, and it doesn't have to harm the private insurance market.   Frankly I don't see the down side anymore, now that we've exhausted the alternatives.

Single payer is going to result in higher taxes for everyone.  Significantly higher.  Look at the rates of taxation in the UK and the Nordic countries which are always praised for their single-payer systems.  Costs are controlled through price fixing and rationing of care.  Those may be things you want.  Again, I point to the growth of the Medicare and Medicaid entitlements since their inception.  Both combine for 23% of the Federal budget right now.  The burden on the taxpayer is close to a trillion and would obviously be much larger under a single payer system and would require cuts in other areas (defense, social security) or more taxation. 
http://www.kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/
 

« Last Edit: July 15, 2017, 09:46:09 PM by Lance Burkhart »

sol

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Re: What comes after the ACA?
« Reply #3127 on: July 15, 2017, 09:48:07 PM »
Single payer is going to result in higher taxes for everyone. 

Yes it is!  But you would end up paying less, not more, because you wouldn't have to pay for health insurance.

The United States pays more per capita for healthcare than any other westernized country, because we pay for it with private insurance.  The whole point of single payer is to stop paying those ridiculous private insurer prices, and instead pay for it with taxes.  Taxes will go up, but your health insurance bills go away, and we collectively spend less on healthcare.  See how easy that is?

But in general, congressional republicans usually ignore the whole "costs less" aspect and instead focus on the "raises taxes" aspect.  It's almost like they don't really care about lowering costs or expanding coverage, and instead only care about shrinking the role of the federal government.

JLee

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Re: What comes after the ACA?
« Reply #3128 on: July 15, 2017, 09:56:41 PM »
Single payer is going to result in higher taxes for everyone. 

Yes it is!  But you would end up paying less, not more, because you wouldn't have to pay for health insurance.

The United States pays more per capita for healthcare than any other westernized country, because we pay for it with private insurance.  The whole point of single payer is to stop paying those ridiculous private insurer prices, and instead pay for it with taxes.  Taxes will go up, but your health insurance bills go away, and we collectively spend less on healthcare.  See how easy that is?

But in general, congressional republicans usually ignore the whole "costs less" aspect and instead focus on the "raises taxes" aspect.  It's almost like they don't really care about lowering costs or expanding coverage, and instead only care about shrinking the role of the federal government. maintaining or increasing profit in the health care industry.

fixed ;)

Joking aside, I do think there's some element of truth to that - pharma CEOs in particular are the highest paid executives of any industry.  They don't want their cash firehose to stop.

Lance Burkhart

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Re: What comes after the ACA?
« Reply #3129 on: July 15, 2017, 10:57:48 PM »
Single payer is going to result in higher taxes for everyone. 

Yes it is!  But you would end up paying less, not more, because you wouldn't have to pay for health insurance.

The United States pays more per capita for healthcare than any other westernized country, because we pay for it with private insurance.  The whole point of single payer is to stop paying those ridiculous private insurer prices, and instead pay for it with taxes.  Taxes will go up, but your health insurance bills go away, and we collectively spend less on healthcare.  See how easy that is?


  You have not proved that the collective cost would be less, you have asserted it.  In general, I think my tax dollars are already poorly spent and 'public' is a word now associated with shoddiness.  For example, I don't think defense spending is cheaper because we all have to pay into it.  It's simply a large planned economy focused on war.  Nothing about it is efficient.  I don't think Medicare or Medicaid are cheaper or have controlled medical costs for me.  They've controlled costs for those receiving the benefits but not for the people who are taxed to pay for the benefit but don't get it.  You want socialized medicine, I don't.  I want to be able to ask the prices for care before I receive it and shop around.  I want the same price for everyone, not a bill  that is a cost-shifting of nonpayers onto me.  I don't want insurance at all.  I think the whole thing is a scam that raises costs.  I think the same thing about Medicare and Medicaid.   

We can go back and forth on this forever.  The ideological divide cannot be bridged.  Since it cannot, maybe the best thing is for each state to vote-on and fund a single payer system if that's what the voters choose.  California politicians are agitating for such a thing now.  Californians who don't want it can move out-of-state.  Those that wanted it can pay for it.  There's no reason to impose the same thing on every state.

sol

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Re: What comes after the ACA?
« Reply #3130 on: July 15, 2017, 11:11:09 PM »
You have not proved that the collective cost would be less, you have asserted it.

Are you really so clueless that this is a point of contention?  Do you not know that the United States spends more money on healthcare per capita than any other westernized nation (all of which have some form of tax-payer supported universal coverage), and yet still has worse outcomes than most of them?  If I proved that to you, would you believe me that single payer would be cheaper?

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In general, I think my tax dollars are already poorly spent and 'public' is a word now associated with shoddiness.  For example, I don't think defense spending is cheaper because we all have to pay into it.  It's simply a large planned economy focused on war.  Nothing about it is efficient.

If you think our current public/private healthcare system, with its myriad variety of coverages and billing codes and networks of providers, is in any way efficient, I think you might not have been reading along in this thread with the rest of us.

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I don't think Medicare or Medicaid are cheaper or have controlled medical costs for me.

Are you on one or both of those?  Because they have absolutely controlled the costs for the people who are on them.  This is like basic American healthcare 101, I'm shocked to hear you contest these points.  Medicaid and Medicare have controlled these costs, both for the beneficiaries and the taxpayers, because they reimburse less than does private insurance. 

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You want socialized medicine, I don't. 

Health insurance is by definition socialized.  That's how risk pools work.  The old American system failed, in part, by failing to recognize this fact and attempting to segregate people into subpopulations of people.  The ACA was an attempt to recombine those pools, for example by guaranteeing coverage to people with pre-existing conditions instead of charging them separate (higher) premiums.

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I want to be able to ask the prices for care before I receive it and shop around.  I want the same price for everyone, not a bill  that is a cost-shifting of nonpayers onto me.  I don't want insurance at all.

Back to healthcare 101, the problem with this idea (commonly known as "fee for service") is that the costs for catastrophic health emergencies are astronomically high, and nobody can afford them.  If you are hit by a car, you can reasonably expect over $100k in medical bills and very few people can afford that.  If you get cancer or your child is born with disabilities, the bill can run into the millions.  Fee for service leaves these people to die, which is not the American way.

If you have a solution to this problem, I'd love to hear it.  What I want is a healthcare system that doesn't punish people for being unlucky, and so far the only good way I've found to provide that coverage to everyone is to ask everyone to pay for it, just like we all pay for national defense and highways and public schools.  These are things that benefit everyone, whether or not we personally utilize them, and I think it makes sense for everyone to contribute to paying for them.  We can (and should) argue about who should pay how much, but first we have to agree that good healthcare is something that benefits all Americans and can thus be provided by and for all Americans.
« Last Edit: July 15, 2017, 11:42:54 PM by sol »

Lance Burkhart

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Re: What comes after the ACA?
« Reply #3131 on: July 16, 2017, 09:04:00 AM »
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If you have a solution to this problem, I'd love to hear it.  What I want is a healthcare system that doesn't punish people for being unlucky, and so far the only good way I've found to provide that coverage to everyone is to ask everyone to pay for it, just like we all pay for national defense and highways and public schools.  These are things that benefit everyone, whether or not we personally utilize them, and I think it makes sense for everyone to contribute to paying for them

Right, you are a socialist.  Half the country is not.  You want the government to coerce the other half of the country into paying into what you believe is right. You could've reached for better examples of "My Tax Dollars At Work" because defense since WWII has grown into an expensive and dangerous military industrial complex, our roads and infrastructure are crumbling, and our public schools are failing in many places.  The solution I always hear to these problems from people like you is to throw more tax money at the problems, which is what you're advocating for health.  The idea behind socialism sounds nice but the reality is the government takes a lot of money and returns very little benefit to those it has taxed. Sooner or later, you run out of Other People's Money.  Since US taxpayers owe $20 trillion, we may be very close to running out of other people's money.  Again, we were coerced into the ACA and Left and Right are now more pissed off at each other than they were before.  To avoid a worse situation with single-payer, each state should implement its own system.  You can move to California, Illinois, or Massachussetts where people like big socialist governments.  Other states can have their own systems. 

I think health insurance should be done away with. Hospitals would not be able to charge a fortune for services if there weren't insurance companies in between the patient and the provider since, as you point out, no one has that kind of money.  Hospitals would have to reduce costs by shedding bureaucrats and other administrators. 

Are you a bureaucrat? 

tyort1

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Re: What comes after the ACA?
« Reply #3132 on: July 16, 2017, 09:34:25 AM »
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If you have a solution to this problem, I'd love to hear it.  What I want is a healthcare system that doesn't punish people for being unlucky, and so far the only good way I've found to provide that coverage to everyone is to ask everyone to pay for it, just like we all pay for national defense and highways and public schools.  These are things that benefit everyone, whether or not we personally utilize them, and I think it makes sense for everyone to contribute to paying for them

Right, you are a socialist.  Half the country is not.

You are correct.  Which is why I am glad we live in a democracy, and glad that we (the progressives) already outnumber you and demographics are trending strongly in our favor over the next couple of decades.  Pretty soon we'll just be able to simply outvote you.
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wenchsenior

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Re: What comes after the ACA?
« Reply #3133 on: July 16, 2017, 10:01:02 AM »
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If you have a solution to this problem, I'd love to hear it.  What I want is a healthcare system that doesn't punish people for being unlucky, and so far the only good way I've found to provide that coverage to everyone is to ask everyone to pay for it, just like we all pay for national defense and highways and public schools.  These are things that benefit everyone, whether or not we personally utilize them, and I think it makes sense for everyone to contribute to paying for them

Right, you are a socialist.  Half the country is not.  You want the government to coerce the other half of the country into paying into what you believe is right. You could've reached for better examples of "My Tax Dollars At Work" because defense since WWII has grown into an expensive and dangerous military industrial complex, our roads and infrastructure are crumbling, and our public schools are failing in many places.  The solution I always hear to these problems from people like you is to throw more tax money at the problems, which is what you're advocating for health.  The idea behind socialism sounds nice but the reality is the government takes a lot of money and returns very little benefit to those it has taxed. Sooner or later, you run out of Other People's Money.  Since US taxpayers owe $20 trillion, we may be very close to running out of other people's money.  Again, we were coerced into the ACA and Left and Right are now more pissed off at each other than they were before.  To avoid a worse situation with single-payer, each state should implement its own system.  You can move to California, Illinois, or Massachussetts where people like big socialist governments.  Other states can have their own systems. 

I think health insurance should be done away with. Hospitals would not be able to charge a fortune for services if there weren't insurance companies in between the patient and the provider since, as you point out, no one has that kind of money.  Hospitals would have to reduce costs by shedding bureaucrats and other administrators. 

Are you a bureaucrat?

You sound like a grad student that I had to listen to at a dinner table full of people from Great Britain, China, Israel, Denmark, and Italy, as well as the U.S. She ranted and ranted about socialized health care and how terrible it was, and how much it sucked in all the countries that tried it.  Finally I interrupted her and asked if she, who had never lived out of the United States, might want to hear the opinions of all the people at the table who HAD lived in countries with such terrible systems.  That shut her up in a hurry.

For the record, you are moving the goal posts of your argument.  If you are philosophically opposed to 1) taxation; or 2) the government being involved in providing either healthcare access or healthcare itself, then logically it doesn't matter to you what the data show (which is that single payer is far more cost efficient and better in care delivery by most metrics). 

You can deny the data, which makes you irrational or willfully uninformed.  Or you can just argue from a philosophical standpoint (points 1 and 2), which is totally a legitimate argument.  Albeit, one that I don't agree with. 

ETA: for the record, I'm personally not a big supporter of single payer, though it would certainly be better than what we currently have.  Personally, I'd like to see a public option tried first, or alternatively I'd like to try a system similar to the original conservative Heritage Foundation plan (before it was watered down into the ACA), where private insurance is still the norm so that there is some free market competition, but the types of plans are heavily regulated and people absolutely MUST purchase health insurance or they face wage garnishment or actual jail. Switzerland has a plan like this, and it works fine.

But  I'm open to single payer as well. It just wouldn't be my first choice.



 
« Last Edit: July 16, 2017, 10:05:10 AM by wenchsenior »

maizeman

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Re: What comes after the ACA?
« Reply #3134 on: July 16, 2017, 10:16:12 AM »
I think health insurance should be done away with. Hospitals would not be able to charge a fortune for services if there weren't insurance companies in between the patient and the provider since, as you point out, no one has that kind of money.  Hospitals would have to reduce costs by shedding bureaucrats and other administrators. 

Or they could reduce costs by reducing services they offer, particularly for the most expensive to treat conditions as these are the ones people are least likely to be able to pay for in the absence of insurance (either private insurance or government supported).

The vast majority of people who have heart attacks cannot afford to pay for the cost treatment out of pocket.* That making maintaining a cath lab and having cardiologists on staff a big money loser. So they'd have to go.

Chemo therapy on the other hand is probably okay because the infrastructure costs aren't as high and cancer gives you enough time to run a credit check and/or wire payment over before you start treatment.

Emergency rooms are also expensive to run and probably are not economically viable in the absence of insurance (high cost of care combined with high urgency of care meaning you cannot negotiate payment up front before you slice into the patient).

Urgent care facilities (cuts and pneumonia and broken bones and basically anything where the patient can walk in themselves or be taken by friends instead of an ambulance) are much cheaper to operate and tend to make a lot more money. They don't take folks involved in major car accidents though, and generally aren't open if you need a doctor in the middle of the night.

The world you propose would certainly spend a lot less on healthcare than the world we live in today. It would also have much higher death rates from treatable conditions like heart attacks and car crashes even among those with plenty of money to pay for the care.

*And a bunch of heart attack victims die on the table, and what are you going to do then, try to collect six figure medical debt from their bankrupt estate?
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scottish

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Re: What comes after the ACA?
« Reply #3135 on: July 16, 2017, 10:50:32 AM »

ETA: for the record, I'm personally not a big supporter of single payer, though it would certainly be better than what we currently have.  Personally, I'd like to see a public option tried first, or alternatively I'd like to try a system similar to the original conservative Heritage Foundation plan (before it was watered down into the ACA), where private insurance is still the norm so that there is some free market competition, but the types of plans are heavily regulated and people absolutely MUST purchase health insurance or they face wage garnishment or actual jail. Switzerland has a plan like this, and it works fine.

But  I'm open to single payer as well. It just wouldn't be my first choice.

That's really the crux of the problem with single payer, isn't it.   Lack of competition makes it hard to improve the health care system.   Instead of letting market forces duke it out, we have to rely on public servants to try and make the system work better.    We see that in Canada quite a bit.   

I've seen a couple of cases where the public system wasn't working well and privatized options sprung up.    The government doesn't let these go very far though because they take funding away from the public system, which makes the problem with the public system worse.

We need some way of identifying best practices from the privatized alternatives, compensating the people who did the innovation and incorporating the innovations into the public system.     Huh, that sounds very idealistic when I read it back.

sol

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Re: What comes after the ACA?
« Reply #3136 on: July 16, 2017, 11:26:19 AM »
Right, you are a socialist.

So are you!  We're all socialists!  Civilization is a socialist enterprise.  The nature of our social contract is that we rely on each other to ensure certain basic services, and also certain basic freedoms.  Socialism is what makes murder illegal, because by ensuring your freedom to not be murdered, we have all agreed to forfeit our freedom to murder other people.  This freedom is made possible by the services we provide to each other (like police and a court system).

Every libertarian and anarchist I've ever met will admit, if pushed, to recognizing the benefits of socialism.  Socialism is what allows capitalism to thrive.  Socialism is what allows technological progress.  Socialism is what protects us and has made America great.  Conservatives like to use the word as a perjorative, without really understanding what it means.  It means we all work together to make our society better for everyone, in areas where that work is better done collectively than individually.  Like with murder.

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You want the government to coerce the other half of the country into paying into what you believe is right.

No, I want the entire country to pay for the services it is going to receive, because I believe in personal responsibility and people who don't pay while enjoying the benefits the rest of us provide are freeloaders.  I hate freeloaders.

You, on the other hand, seem to be wanting to disassemble our great country by tearing apart the very things that have made us great.  Why do you hate America so much?

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You could've reached for better examples of "My Tax Dollars At Work" because defense since WWII has grown

Do you at least recognize the basic need for national military?  The conservative "fee for service" approach lets every individual pay for their own defense against foreign threats.  And just like with healthcare, that is something that is virtually impossible for an individual to provide but relatively straightforward for a nation to provide.  It's too expensive for every person to duplicate the full effort required, but easy when we each pitch in a little bit to protect each other.

Once you've recognized that America does need a military, of some sort, then we can move on to the worthwhile discussion of what type, and how big, and for what purpose.  But those are all details to be worked out, after we've first agreed on the socialist premise of us having a military for common defense.

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our roads and infrastructure are crumbling

Our roads and infrastructure need repair specifically because conservatives have consistently voted to defund their maintenance and upkeep costs.  I was shocked and amazed when Trump picked up the socialist talking point of pushing for a massive infrastructure spending bill.  I fully support him in that area, because it's a good idea.

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and our public schools are failing in many places.

That has always been the case, but also note that our public schools are consistently better than our private schools.  Check the test scores and see for yourself.  Private schools do a tiny bit better, but not nearly enough better to account for their demographic differences.  Public schools just do a better job of educating students, in part because there are more gains to be had by educating students at the bottom of the ladder.

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To avoid a worse situation with single-payer, each state should implement its own system.  You can move to California, Illinois, or Massachussetts where people like big socialist governments.  Other states can have their own systems.

This is an idea worth discussing further, because I think it has merit.  The risk is that blue states will implement (and pay for) universal healthcare while red states will not, and then every sick person from a red state will just move to a blue state to get covered.  This is the classic "adverse selection problem", the same one that Ted Cruz is now pushing for in the Senate, which concentrates sick people into one risk pool (which thus gets very expensive) while concentrating healthy people into another risk pool (which thus gets cheaper by providing no health care).  If people are free to jump between the pools whenever they want to, there is nothing stopping a person from paying nothing until they get sick, and then moving to a blue state and paying nothing to get healthcare.   Now we're back to the freeloader problem, see?
 
Quote
Are you a bureaucrat?

No, I'm a scientist.  What are you?
« Last Edit: July 16, 2017, 11:30:05 AM by sol »

wenchsenior

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Re: What comes after the ACA?
« Reply #3137 on: July 16, 2017, 11:33:30 AM »

ETA: for the record, I'm personally not a big supporter of single payer, though it would certainly be better than what we currently have.  Personally, I'd like to see a public option tried first, or alternatively I'd like to try a system similar to the original conservative Heritage Foundation plan (before it was watered down into the ACA), where private insurance is still the norm so that there is some free market competition, but the types of plans are heavily regulated and people absolutely MUST purchase health insurance or they face wage garnishment or actual jail. Switzerland has a plan like this, and it works fine.

But  I'm open to single payer as well. It just wouldn't be my first choice.

That's really the crux of the problem with single payer, isn't it.   Lack of competition makes it hard to improve the health care system.   Instead of letting market forces duke it out, we have to rely on public servants to try and make the system work better.    We see that in Canada quite a bit.   

I've seen a couple of cases where the public system wasn't working well and privatized options sprung up.    The government doesn't let these go very far though because they take funding away from the public system, which makes the problem with the public system worse.

We need some way of identifying best practices from the privatized alternatives, compensating the people who did the innovation and incorporating the innovations into the public system.     Huh, that sounds very idealistic when I read it back.


This is why I lean to public option as a better alternative given where our current system is.  It would be incredibly disruptive to take 1/6th of our economy and totally restructure it away from the private sector. I'm not saying it couldn't be done or that it would not in the long run be a better way to do things.  But the private system is just tentacled into place with our employers here in the U.S. We aren't starting from close to scratch, e.g., post WW2. 

I've been really depressed over the whole thing lately.  We have good coverage, which is very reasonable in terms of our out of pocket premiums of about 6300$ plus copays and percentages of labs...last few years our out of pocket costs for 2 people have run around 10K/year.  So far, we've never faced a denial of coverage.  But several of my friends face chronic lifelong conditions that will run to the millions very quickly.

One friend is the picture of healthy living (exercise, diet, etc) and Mustachian frugality (off grid, raises own food, etc). At around 50 he was diagnosed out of the blue with a disease somewhat similar to some of the big autoimmune diseases.  It's rather rare, and usually flares only occasionally.  But in even rarer cases, it remains permanently active and eventually kills you (usually via lung fibrosis) if not suppressed.  After several years on high dose steroids, he had to come off them for his safety and his remission immediately stopped.  Now he's on a combo of chemo and immune suppressant drugs that are the 'secondary, emergency' treatment for this disease. He is likely to have to remain on them more or less continuously for life.

He's been on them for a couple months at this point, and so far his insurance (a big insurer) has refused to cover them. 

Guess how much they cost?

FOURTEEN THOUSAND dollars. Per MONTH. 

He makes about 60K gross per year. So his drugs cost almost 3x his gross income.

What the FUCK kind of world IS this? 

And in a free market, would individual patients with life threatening illnesses like cancer or my friend's disease, or debilitating chronic conditions like a lot of the autoimmune illnesses, have ANY bargaining power to bring these costs down to something my friend could ever hope to cover?

No, because people threatened with death have no leverage.  The super rich ones pay.  Everyone else, like my friend, would die.  If I ran an insurance company for profit, I wouldn't want to cover these drugs either.  I really think only an entity the size of the federal government has the kind of leverage it takes, in a market that can never truly be free.

BTDretire

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Re: What comes after the ACA?
« Reply #3138 on: July 16, 2017, 11:35:27 AM »
I don't know what comes after the ACA, but this needs to be fixed.
 A family of 4 in Merklenberg NC zipcode 28105, consisting of
Male 62, female 57. Female 25 and male 23. The family earns
$100,000 and their MAGI is $68,000. (Subsidy is based on MAGI)
Please put these numbers in the ACA website here,
https://www.healthcare.gov/see-plans/  and verify what I wrote.
 I did skip the low, medium, high usage area and went straight to plans.
You are welcome to experiment there.
There are 10 ACA policies available.
 This family will get a subsidy of $33,069.12 to pay their ACA policy.
The ACA has 2 policies that cost less than $33,069.12, for those
the family pays $0 for the their health insurance. The lowest cost
policy costs the taxpayers $32,466.08 family $0. The third policy
costs the family $420 a year, taxpayers, $33,069.
 The highest cost ACA policy available for this family is $49,733.88. WTF!
 How can it be realistic for the cheapest policy to cost $32,466.08.
 (I contend, because government got involved.)
 That is the cheapest ACA policy available to that family and then
for the taxpayers to subsidize that full amount is wrong.
 Meanwhile, my older non group, non ACA policy costs *$11,220 a year,
and it is every bit as good if not a little better than the ACA policies.

* it would be cheaper if not for some ACA mandates.
Like lifetime unlimited benefits, I was satisfied with $5,000,000.
At that point I'm to much burden to society.

Edit to change there to their, because it confused an MMM reader enough that
it was pointed out to me. :-)
« Last Edit: July 16, 2017, 07:43:49 PM by BTDretire »

wenchsenior

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Re: What comes after the ACA?
« Reply #3139 on: July 16, 2017, 11:41:26 AM »


* it would be cheaper if not for some ACA mandates.
Like lifetime unlimited benefits, I was satisfied with $5,000,000.
At that point I'm to much burden to society.

Glad to see you can make that judgement call about the value of my friend's life.

Padonak

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Re: What comes after the ACA?
« Reply #3140 on: July 16, 2017, 11:51:01 AM »
I don't know what comes after the ACA, but this needs to be fixed.
 A family of 4 in Merklenberg NC zipcode 28105, consisting of
Male 62, female 57. Female 25 and male 23. The family earns
$100,000 and there MAGI is $68,000. (Subsidy is based on MAGI)
Please put these numbers in the ACA website here,
https://www.healthcare.gov/see-plans/  and verify what I wrote.
 I did skip the low, medium, high usage area and went straight to plans.
You are welcome to experiment there.
There are 10 ACA policies available.
 This family will get a subsidy of $33,069.12 to pay their ACA policy.
The ACA has 2 policies that cost less than $33,069.12, for those
the family pays $0 for the their health insurance. The lowest cost
policy costs the taxpayers $32,466.08 family $0. The third policy
costs the family $420 a year, taxpayers, $33,069.
 The highest cost ACA policy available for this family is $49,733.88. WTF!
 How can it be realistic for the cheapest policy to cost $32,466.08.
 (I contend, because government got involved.)
 That is the cheapest ACA policy available to that family and then
for the taxpayers to subsidize that full amount is wrong.
 Meanwhile, my older non group, non ACA policy costs *$11,220 a year,
and it is every bit as good if not a little better than the ACA policies.

* it would be cheaper if not for some ACA mandates.
Like lifetime unlimited benefits, I was satisfied with $5,000,000.
At that point I'm to much burden to society.

Another example: there is a personal finance blogger The Root of Good http://rootofgood.com/

He retired in his 30s with a wife and three kids in Raleigh, NC. His NW is about 1.8M according to his blog. As he explains in his income reports, he gets Obamacare with very generous subsidies and pays almost nothing for healthcare. Also, being FI/RE makes it easier to manipulate income to qualify for subsidies.




simmias

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Re: What comes after the ACA?
« Reply #3141 on: July 16, 2017, 12:07:32 PM »
Another example: there is a personal finance blogger The Root of Good http://rootofgood.com/

He retired in his 30s with a wife and three kids in Raleigh, NC. His NW is about 1.8M according to his blog. As he explains in his income reports, he gets Obamacare with very generous subsidies and pays almost nothing for healthcare. Also, being FI/RE makes it easier to manipulate income to qualify for subsidies.
But he has a MAGI of $40k or so for a family of 5.  I'm not sure how Matthews guy is seeing subsidies of $30k on $100k income, unless I read his wall of text incorrectly (which is entirely possible).
« Last Edit: July 16, 2017, 12:09:11 PM by simmias »

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3142 on: July 16, 2017, 12:11:43 PM »
I don't know what comes after the ACA, but this needs to be fixed.
 A family of 4 in Merklenberg NC zipcode 28105, consisting of
Male 62, female 57. Female 25 and male 23. The family earns
$100,000 and there MAGI is $68,000. (Subsidy is based on MAGI)
Please put these numbers in the ACA website here,
https://www.healthcare.gov/see-plans/  and verify what I wrote.
 I did skip the low, medium, high usage area and went straight to plans.
You are welcome to experiment there.
There are 10 ACA policies available.
 This family will get a subsidy of $33,069.12 to pay their ACA policy.
The ACA has 2 policies that cost less than $33,069.12, for those
the family pays $0 for the their health insurance. The lowest cost
policy costs the taxpayers $32,466.08 family $0. The third policy
costs the family $420 a year, taxpayers, $33,069.
 The highest cost ACA policy available for this family is $49,733.88. WTF!
 How can it be realistic for the cheapest policy to cost $32,466.08.
 (I contend, because government got involved.)
 That is the cheapest ACA policy available to that family and then
for the taxpayers to subsidize that full amount is wrong.
 Meanwhile, my older non group, non ACA policy costs *$11,220 a year,
and it is every bit as good if not a little better than the ACA policies.

* it would be cheaper if not for some ACA mandates.
Like lifetime unlimited benefits, I was satisfied with $5,000,000.
At that point I'm to much burden to society.

Yes the essential care benefits makes health insurance more expensive but it's worth it.

You don't like it right now because you don't need any care, and it's expensive.

But if you get cancer and you're on one of your "skimpy" plans, you'll soon discover what expensive means.

sol

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Re: What comes after the ACA?
« Reply #3143 on: July 16, 2017, 12:12:36 PM »
This is why I lean to public option as a better alternative given where our current system is.  It would be incredibly disruptive to take 1/6th of our economy and totally restructure it away from the private sector.

Earlier in this thread someone suggested enacting a public option ONLY in areas in which private insurers have pulled out of the market.  I think this is a great idea.  Those people need healthcare, and the private market has totally failed them, so I think the government should step in.

These are typically rural areas with low average incomes, which means they have very few care facilities, very few customers, and their customers don't have much ability to pay.  This is the classic worst case example for a private for-profit insurance company, and I totally understand why they have pulled out of such places.  They can't make money there.

So let the government offer those people health insurance!  Pool their risks with the rest of the country.  It doesn't threaten the private market at all, and it helps people in red states who feel abandoned by the ACA.

We did the same thing with electrification, a century ago.  Cities were electrified first, because it was profitable for private companies to build the required infrastructure.  Rural areas with low population density came later, and only because the government subsidized expansion of the power grid into those places.  The free market failed, so the government stepped into help people, and now we find it ludicrous that anyone in America would live without electricity.  Socialism worked.

Quote
FOURTEEN THOUSAND dollars. Per MONTH. 
...
What the FUCK kind of world IS this? 

This is the free market at work.  When you have a product that a very small number of people absolutely have to have, you can charge astronomical rates.  All luxury goods are priced this way, but it's a different story when it's handbags instead of lifesaving drugs.  With healthcare, what is otherwise acceptable normal market forces is suddenly unfettered capitalism at its worst.

The highest cost ACA policy available for this family is $49,733.88. WTF!

For starters, we don't generally compare the highest price you can pay for something as a useful benchmark.

But your underlying point is still valid; healthcare costs way too much in rural areas.  They don't have enough buyers or enough sellers to have a well functioning marketplace where competition could theoretically drive down prices, not that car crash victims are comparison shopping for ambulance rides.

The ACA tried to fix the problem of insufficient rural hospitals by allocating additional specific funding to these types of facilities, to help expand the network of providers in the hopes of propping up the market.  Even the Republicans are making overtures in this direction, in their new proposals.  It's a definite problem, but it's one that could be instantly fixed with a single nationwide universal coverage basic healthcare plan.
« Last Edit: July 16, 2017, 01:27:40 PM by sol »

BTDretire

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Re: What comes after the ACA?
« Reply #3144 on: July 16, 2017, 12:47:43 PM »
Another example: there is a personal finance blogger The Root of Good http://rootofgood.com/

He retired in his 30s with a wife and three kids in Raleigh, NC. His NW is about 1.8M according to his blog. As he explains in his income reports, he gets Obamacare with very generous subsidies and pays almost nothing for healthcare. Also, being FI/RE makes it easier to manipulate income to qualify for subsidies.
But he has a MAGI of $40k or so for a family of 5.  I'm not sure how Matthews guy is seeing subsidies of $30k on $100k income, unless I read his wall of text incorrectly (which is entirely possible).
I'm not finding a post by the Mathews guy, but that is what I recently posted (Post #3148). A family earning $100,000 after adjustments they have a MAGI, (Modified Adjusted Gross Income) $68,000. They live in the 28105 zipcode area and get a $33,069.12 subsidy on their ACA policy.
 See post #3148 to get the info to look it up yourself.

simmias

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Re: What comes after the ACA?
« Reply #3145 on: July 16, 2017, 01:12:32 PM »
Another example: there is a personal finance blogger The Root of Good http://rootofgood.com/

He retired in his 30s with a wife and three kids in Raleigh, NC. His NW is about 1.8M according to his blog. As he explains in his income reports, he gets Obamacare with very generous subsidies and pays almost nothing for healthcare. Also, being FI/RE makes it easier to manipulate income to qualify for subsidies.
But he has a MAGI of $40k or so for a family of 5.  I'm not sure how Matthews guy is seeing subsidies of $30k on $100k income, unless I read his wall of text incorrectly (which is entirely possible).
I'm not finding a post by the Mathews guy, but that is what I recently posted (Post #3148). A family earning $100,000 after adjustments they have a MAGI, (Modified Adjusted Gross Income) $68,000. They live in the 28105 zipcode area and get a $33,069.12 subsidy on their ACA policy.
 See post #3148 to get the info to look it up yourself.
You don't live in Matthews?  Then why use 28105?  But I guess since you can't spell "Matthews" or "Mecklenburg" you probably don't live around these parts.

I got confused by your use of "there" when you meant to write "their."  Carry on.
« Last Edit: July 16, 2017, 01:16:25 PM by simmias »

simmias

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Re: What comes after the ACA?
« Reply #3146 on: July 16, 2017, 01:24:50 PM »
But your underlying point is still valid; healthcare costs way too much in rural areas.
That's not a rural area.  It's essentially Charlotte.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3147 on: July 16, 2017, 01:36:04 PM »
I don't know what comes after the ACA, but this needs to be fixed.
 A family of 4 in Merklenberg NC zipcode 28105, consisting of
Male 62, female 57. Female 25 and male 23. The family earns
$100,000 and there MAGI is $68,000. (Subsidy is based on MAGI)
Please put these numbers in the ACA website here,
https://www.healthcare.gov/see-plans/  and verify what I wrote.
 I did skip the low, medium, high usage area and went straight to plans.
You are welcome to experiment there.
There are 10 ACA policies available.
 This family will get a subsidy of $33,069.12 to pay their ACA policy.
The ACA has 2 policies that cost less than $33,069.12, for those
the family pays $0 for the their health insurance. The lowest cost
policy costs the taxpayers $32,466.08 family $0. The third policy
costs the family $420 a year, taxpayers, $33,069.
 The highest cost ACA policy available for this family is $49,733.88. WTF!
 How can it be realistic for the cheapest policy to cost $32,466.08.
 (I contend, because government got involved.)
 That is the cheapest ACA policy available to that family and then
for the taxpayers to subsidize that full amount is wrong.
 Meanwhile, my older non group, non ACA policy costs *$11,220 a year,
and it is every bit as good if not a little better than the ACA policies.

* it would be cheaper if not for some ACA mandates.
Like lifetime unlimited benefits, I was satisfied with $5,000,000.
At that point I'm to much burden to society.

Another example: there is a personal finance blogger The Root of Good http://rootofgood.com/

He retired in his 30s with a wife and three kids in Raleigh, NC. His NW is about 1.8M according to his blog. As he explains in his income reports, he gets Obamacare with very generous subsidies and pays almost nothing for healthcare. Also, being FI/RE makes it easier to manipulate income to qualify for subsidies.

Lower your MAGI down and you get health insurance covered. Sounds perfectly valid to me.

Exflyboy

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Re: What comes after the ACA?
« Reply #3148 on: July 16, 2017, 01:50:06 PM »
I was trying to explain how this all works to my Dad who lives under the UK's national Healthcare system when he said "But didn't Obamacare fix all the healthcare problems?"

OK take our situation.. Nearly $1million in after tax savings, no house payment, but we can set our income to be around $35k. Our max OOP plus uncovered drugs will be about $15k on an ACA bronze plan and $35/month consequently in premium out of pocket.

So if we both get sick (or a couple of broken bones in a car wreck).. we write a check from our after tax savings.. Rinse lather repeat for future years and continue on as normal with our retired lives.

But Mr and Mrs "poor" who get $35k from a job, have $zero savings, and spend $15k on renting their apartment would be financially devastated if they got sick just one time. Plus of course, if you are sick you're probably not working and are homeless.

When the giant orangutan showed up in West Virginia it was these (working or not) poor people he was talking too.. See the ACA doesn't work for you.. We have to scrap and replace.. Great they said!

Except that what they will be slashing will be Medicaid and these poor folks will be screwed basically. Black lung with the prospect of no access to healthcare would be very scary indeed.
« Last Edit: July 16, 2017, 02:04:09 PM by Exflyboy »

JLee

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Re: What comes after the ACA?
« Reply #3149 on: July 16, 2017, 02:06:58 PM »
This is an idea worth discussing further, because I think it has merit.  The risk is that blue states will implement (and pay for) universal healthcare while red states will not, and then every sick person from a red state will just move to a blue state to get covered.  This is the classic "adverse selection problem", the same one that Ted Cruz is now pushing for in the Senate, which concentrates sick people into one risk pool (which thus gets very expensive) while concentrating healthy people into another risk pool (which thus gets cheaper by providing no health care).  If people are free to jump between the pools whenever they want to, there is nothing stopping a person from paying nothing until they get sick, and then moving to a blue state and paying nothing to get healthcare.   Now we're back to the freeloader problem, see?

On top of this, the blue states are already subsidizing the red states (ironic, as the red states are typically the ones crying about their tax dollars going to support the "others").