Author Topic: What comes after the ACA?  (Read 311253 times)

Lance Burkhart

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Re: What comes after the ACA?
« Reply #3150 on: July 16, 2017, 02:13:15 PM »
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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.


I'm actually open to single payer under certain conditions which it has not met in a very long time: a balanced budget, secure borders, much more of the deficit paid-off where we're no longer on the hockey stick of public debt growth.  The European and Asian countries you mentioned differ from the US in so many ways we could debate all day.  What works there will not necessarily work in a large, multiethnic empire (really) like the US with huge regional differences in the way people are, how much they pay into the system, costs, etc. 

I am not at all opposed to taxation.  I am opposed to misuse of public funds.  I was not shifting the goalposts but merely arguing that public spending does not result in a more efficient system if public funds are misused.  The unstated assumption in your/sol's argument is that the government will tax us more for single-payer AND they will spend the the tax money wisely.  There is so far no proof that OUR government will handle single payer well.  If we could import Singapore's government, the story might be different.

So, I am arguing from what IS, you are arguing what OUGHT based on what MIGHT.

I am further arguing that a federal government coercing every state into the same system is bad policy.  Leadership must rely on much more than coercion.  Different states can try different solutions.  This is the best way to experiment with a new system.
« Last Edit: July 16, 2017, 02:16:06 PM by Lance Burkhart »

JLee

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Re: What comes after the ACA?
« Reply #3151 on: July 16, 2017, 02:20:33 PM »
Quote
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.


I'm actually open to single payer under certain conditions which it has not met in a very long time: a balanced budget, secure borders, much more of the deficit paid-off where we're no longer on the hockey stick of public debt growth.  The European and Asian countries you mentioned differ from the US in so many ways we could debate all day.  What works there will not necessarily work in a large, multiethnic empire (really) like the US with huge regional differences in the way people are, how much they pay into the system, costs, etc. 

I am not at all opposed to taxation.  I am opposed to misuse of public funds.  I was not shifting the goalposts but merely arguing that public spending does not result in a more efficient system if public funds are misused.  The unstated assumption in your/sol's argument is that the government will tax us more for single-payer AND they will spend the the tax money wisely.  There is so far no proof that OUR government will handle single payer well.  If we could import Singapore's government, the story might be different.

So, I am arguing from what IS, you are arguing what OUGHT based on what MIGHT.

I am further arguing that a federal government coercing every state into the same system is bad policy.  Leadership must rely on much more than coercion.  Different states can try different solutions.  This is the best way to experiment with a new system.

Does this mean that the 39% of federal tax money that New Jersey pays out and doesn't get benefits from can go back to New Jersey, instead of to subsidize other states? We'd have a pretty good start on a health care system here if we got all that money back!

Lance Burkhart

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Re: What comes after the ACA?
« Reply #3152 on: July 16, 2017, 02:32:12 PM »
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?
 
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Are you a bureaucrat?

No, I'm a scientist.  What are you?

I'm the same.  The big problem with scientists and engineers is that they live in a closed world with smart people.  They have trouble seeing how poorer and dumber people think and behave and how their ideas won't scale out amongst a diverse population full of people with massive differences in ability. 

I am not at all opposed to socializing the costs of things or taxation.  I am opposed to Socialism as a system and a philosophy which involves wealth re-distribution at the whim of a large, intrusive Hobbesian bureaucracy.  Most of your examples of successful socializing of public costs were from the era before the bureaucracy grew to this size and became this indebted.  In principle I have no problems paying for roads or the common defense.  I served in the military.  That doesn't mean I think we need 12-14 carrier battle groups and a huge standing military.  I think we need roads and public schools; that doesn't mean I think the public sector should be as large as it currently is.  In California, the public sector unions maintain a stranglehold on our fiscal policy through the ballot box and lobbying. 

I want better, more responsible, less coercive government before I sign up for the single-payer idea. 

You should read "The Rise and Decline of the State" by Martin Van Creveld.  There are free .pdfs of it. 

former player

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Re: What comes after the ACA?
« Reply #3153 on: July 16, 2017, 03:52:41 PM »
I'm actually open to single payer under certain conditions which it has not met in a very long time: a balanced budget, secure borders, much more of the deficit paid-off where we're no longer on the hockey stick of public debt growth.  The European and Asian countries you mentioned differ from the US in so many ways we could debate all day.  What works there will not necessarily work in a large, multiethnic empire (really) like the US with huge regional differences in the way people are, how much they pay into the system, costs, etc.

The European Union has reciprocal agreements across the whole EU: any EU citizen is entitled to health treatment in any EU country on production of the appropriate form (there is a system of reimbursement).  I don't understand how the size of the USA (smaller than the EU), the multiethnicity of the USA (we have plenty of that throughout the EU), the regional differences of the USA (we have those in the EU too) or differences in the way people pay into the system (guess what) mean that a USA-wide system would not work.

A good analogy for making health care available to everyone is the fire service.  It used to be the case that fire services were paid for privately and individually: the fire service turned up and saved your house if you had paid your dues.  But the deleterious effects on society of having houses which were left to burn makes a system of fire services available to all in return for taxes a good idea.  Keeping the population healthy is also sufficiently beneficial for health services for all to be a similarly good idea.
Be frugal and industrious, and you will be free (Ben Franklin)

wenchsenior

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Re: What comes after the ACA?
« Reply #3154 on: July 16, 2017, 04:33:54 PM »
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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.


I'm actually open to single payer under certain conditions which it has not met in a very long time: a balanced budget, secure borders, much more of the deficit paid-off where we're no longer on the hockey stick of public debt growth.  The European and Asian countries you mentioned differ from the US in so many ways we could debate all day.  What works there will not necessarily work in a large, multiethnic empire (really) like the US with huge regional differences in the way people are, how much they pay into the system, costs, etc. 

I am not at all opposed to taxation.  I am opposed to misuse of public funds.  I was not shifting the goalposts but merely arguing that public spending does not result in a more efficient system if public funds are misused.  The unstated assumption in your/sol's argument is that the government will tax us more for single-payer AND they will spend the the tax money wisely.  There is so far no proof that OUR government will handle single payer well.  If we could import Singapore's government, the story might be different.

So, I am arguing from what IS, you are arguing what OUGHT based on what MIGHT.

I am further arguing that a federal government coercing every state into the same system is bad policy.  Leadership must rely on much more than coercion.  Different states can try different solutions.  This is the best way to experiment with a new system.

No, I am not assuming that.  Pretty much everyone in the country is opposed to "misuse of public funds", so that is a meaningless phrase.  What matters is what you define as "misuse".  What I was arguing is that our current system is highly inefficient and wasteful and expensive, but other countries have successfully implemented better systems by nearly every metric.  Said other countries do not have perfect efficiency and no waste or misuse of public funds (which is impossible to achieve in the public or private sector, anyway); however, they ARE more efficient and less wasteful with their public monies in regard to health care outcomes than the U.S. is.  Some do this through socialized health care, some do it via hybrid systems, etc.  It stands to reason that the U.S. should at least attempt to implement some of the systems that have been demonstrated to work in lots of other countries, instead of bungling along the way we bullheadedly keep doing.  Maybe it won't work here and we will end up with an even worse system.  But I doubt it. Anyway, I'm arguing for 'better', not 'perfect'.

Exflyboy

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Re: What comes after the ACA?
« Reply #3155 on: July 16, 2017, 04:39:20 PM »
Well the US system is perfect for healthcare providers and drug companies.. As they collectively own the Government there is very little momentum for things to change.

Besides which it seems enough of the voting base is swayed by the "At least it not socialism" mantra that there is almost zero chance of us getting anything better in the short term.

The best you can do is insulate yourself with a large bucket of moolah and wait for the system to collapse... Sad as that is.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3156 on: July 16, 2017, 05:06:39 PM »
  There is so far no proof that OUR government will handle single payer well. 

Just not accurate.

Private health insurers have huge overhead
  • Ridiculously high executive pay
  • Marketing costs
  • Attempts to cherry-pick clients


On the other hand the government program of Medicare is extremely efficient.
Private insurers, with their extra overhead, have never been able to compete on a level playing field with conventional Medicare.

jim555

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Re: What comes after the ACA?
« Reply #3157 on: July 16, 2017, 06:11:01 PM »
The whole layer that makes up insurance simply is not needed.  It just adds a cost. 

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3158 on: July 16, 2017, 06:18:42 PM »
Politically not feasible to get rid of the health insurance industry
We're better off highly regulating it and capping the profit taking, which is what Obamacare/ACA does.

BTDretire

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Re: What comes after the ACA?
« Reply #3159 on: July 16, 2017, 07:53:04 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.
Yes very sorry, it is spelled Mecklenburg. I'm not from there and was not familiar with the town of Matthews.
 I can't tell if you are confusing my hypothetical family the with root of good family.
 Please go back to #3148 and put in the data I presented, which is basically my family, if I lived in Mecklenburg. I used Mecklenburg because someone on MMM said their healthcare policy in Charlotte NC, was very expensive and I wanted to verify that moving 450 miles more than doubled the cost of a healthcare policy. I found it does. 
Why does that make you angry at me?

BTDretire

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Re: What comes after the ACA?
« Reply #3160 on: July 16, 2017, 07:55:59 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.
That's not so easy if you are still employed, if you are living of your money, much easier.

tyort1

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Re: What comes after the ACA?
« Reply #3161 on: July 16, 2017, 08:05:24 PM »
Lower your MAGI down and you get health insurance covered. Sounds perfectly valid to me.
That's not so easy if you are still employed, if you are living of your money, much easier.

Another reason to have your house paid off before FIRE - once the mortgage is gone, it's pretty easy to live off $40k per year and not really feel deprived.  If you have a mortgage after FIRE, you have to withdraw a lot more, which disqualifies you for subsidies and lower tax rates.
Frugalite in training.

Lance Burkhart

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Re: What comes after the ACA?
« Reply #3162 on: July 16, 2017, 08:28:57 PM »
  There is so far no proof that OUR government will handle single payer well. 

Just not accurate.

Private health insurers have huge overhead
  • Ridiculously high executive pay
  • Marketing costs
  • Attempts to cherry-pick clients


On the other hand the government program of Medicare is extremely efficient.
Private insurers, with their extra overhead, have never been able to compete on a level playing field with conventional Medicare.

You see only two options: health insurance or single-payer.  On my other thread, I have some ideas for eliminating the need for health insurance. 

In 2015, Medicare was a $644 billion entitlement with 55.3 million beneficiaries for a total cost per person of roughly ~$11k.  This is roughly the same or slightly more efficient than the average cost of premiums + deductibles for those buying private insurance in that year.  Medicare DOES cover the aged who are expensive to insure.  It does this, however, by taxing everyone who works and employers to pay for those who are no longer working.  You're talking about a lot more taxes on employees and employers to pay for everyone who's working and the aged and disabled.  Will this also cover the non-working?  There are - what? - 100 million people in the workforce out of a country of 320 million.  There are 100 million people not in the workforce. 

In summary, Medicare is a $600 billion entitlement that covers only 17% of the population.  Multiplying $600 billion by 5 gives you the back-of-the-envelope cost of insuring everyone ($3 trillion).  The IRS took in only $3 trillion last year, didn't it? The cost of providing single payer to just California was estimated to be $400 billion (our legislature is trying to figure out how to pay for this).  We have roughly 40 million people or 12.5 % of the population. 

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Re: What comes after the ACA?
« Reply #3163 on: July 16, 2017, 08:54:35 PM »
Lower your MAGI down and you get health insurance covered. Sounds perfectly valid to me.
That's not so easy if you are still employed, if you are living of your money, much easier.

Another reason to have your house paid off before FIRE - once the mortgage is gone, it's pretty easy to live off $40k per year and not really feel deprived.  If you have a mortgage after FIRE, you have to withdraw a lot more, which disqualifies you for subsidies and lower tax rates.

That's a good point. As it now stands with the ACA, the lower the income the more the subsidy you get. In essence it's like a tax rate that you add on.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3164 on: July 16, 2017, 08:56:32 PM »

Lower your MAGI down and you get health insurance covered. Sounds perfectly valid to me.
That's not so easy if you are still employed, if you are living of your money, much easier.

I am self-employed so I know it's not easy. A lot of money is dumped into the solo 401k, both as employee and employer, as well as HSA, tIRA.

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Re: What comes after the ACA?
« Reply #3165 on: July 16, 2017, 09:02:56 PM »
  There is so far no proof that OUR government will handle single payer well. 

Just not accurate.

Private health insurers have huge overhead
  • Ridiculously high executive pay
  • Marketing costs
  • Attempts to cherry-pick clients


On the other hand the government program of Medicare is extremely efficient.
Private insurers, with their extra overhead, have never been able to compete on a level playing field with conventional Medicare.

You see only two options: health insurance or single-payer.  On my other thread, I have some ideas for eliminating the need for health insurance. 

In 2015, Medicare was a $644 billion entitlement with 55.3 million beneficiaries for a total cost per person of roughly ~$11k.  This is roughly the same or slightly more efficient than the average cost of premiums + deductibles for those buying private insurance in that year.  Medicare DOES cover the aged who are expensive to insure.  It does this, however, by taxing everyone who works and employers to pay for those who are no longer working.  You're talking about a lot more taxes on employees and employers to pay for everyone who's working and the aged and disabled.  Will this also cover the non-working?  There are - what? - 100 million people in the workforce out of a country of 320 million.  There are 100 million people not in the workforce. 

In summary, Medicare is a $600 billion entitlement that covers only 17% of the population.  Multiplying $600 billion by 5 gives you the back-of-the-envelope cost of insuring everyone ($3 trillion).  The IRS took in only $3 trillion last year, didn't it? The cost of providing single payer to just California was estimated to be $400 billion (our legislature is trying to figure out how to pay for this).  We have roughly 40 million people or 12.5 % of the population.

I agree the cost of health care has to come down. I also don't think you can extrapolate the cost of 65 and older population to what the healthcare costs are going to be for those younger than that. Younger are going to have considerably lower health care costs on average. Many younger won't have any health care needs for years or decades. In fact you could probably just double the current cost of Medicare to cover the other 75% of people.

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Re: What comes after the ACA?
« Reply #3166 on: July 16, 2017, 09:18:28 PM »
I am self-employed so I know it's not easy. A lot of money is dumped into the solo 401k, both as employee and employer, as well as HSA, tIRA.

Doesn't MAGI ignore the tIRA deduction?

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Re: What comes after the ACA?
« Reply #3167 on: July 17, 2017, 11:02:37 AM »
I am self-employed so I know it's not easy. A lot of money is dumped into the solo 401k, both as employee and employer, as well as HSA, tIRA.

Doesn't MAGI ignore the tIRA deduction?
No.  tIRA deductions reduce MAGI.

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Re: What comes after the ACA?
« Reply #3168 on: July 17, 2017, 11:07:31 AM »
In summary, Medicare is a $600 billion entitlement that covers only 17% of the population.  Multiplying $600 billion by 5 gives you the back-of-the-envelope cost of insuring everyone ($3 trillion).  The IRS took in only $3 trillion last year, didn't it? The cost of providing single payer to just California was estimated to be $400 billion (our legislature is trying to figure out how to pay for this).  We have roughly 40 million people or 12.5 % of the population.

I agree the cost of health care has to come down. I also don't think you can extrapolate the cost of 65 and older population to what the healthcare costs are going to be for those younger than that. Younger are going to have considerably lower health care costs on average. Many younger won't have any health care needs for years or decades. In fact you could probably just double the current cost of Medicare to cover the other 75% of people.

That's actually pretty good considering that we spend $3.2 trillion a year on giving most (but not everyone) healthcare right now. And as DAA points out, taking care of folks on Medicare is going to be significantly more expensive per head than younger healthier people.
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Re: What comes after the ACA?
« Reply #3169 on: July 17, 2017, 11:12:11 AM »
I am self-employed so I know it's not easy. A lot of money is dumped into the solo 401k, both as employee and employer, as well as HSA, tIRA.
Doesn't MAGI ignore the tIRA deduction?
No.  tIRA deductions reduce MAGI.
Yes, tIRA deductions reduce the MAGI for ACA purposes.  See https://www.healthcare.gov/income-and-household-information/income/

What's confusing is there are multiple MAGIs, with each "Modified" in slightly different ways.  E.g., in the MAGI for tIRA deductibility the tIRA itself does not affect that MAGI.

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Re: What comes after the ACA?
« Reply #3170 on: July 17, 2017, 11:32:48 AM »
Lower your MAGI down and you get health insurance covered. Sounds perfectly valid to me.
That's not so easy if you are still employed, if you are living of your money, much easier.

Another reason to have your house paid off before FIRE - once the mortgage is gone, it's pretty easy to live off $40k per year and not really feel deprived.  If you have a mortgage after FIRE, you have to withdraw a lot more, which disqualifies you for subsidies and lower tax rates.

I'll take this post as my cue to insert another reminder that the extra withdrawals needed to service a mortgage loan do not necessarily translate into extra income on a dollar-for-dollar basis, a point which is often overlooked, leading folks to overstate the adverse tax/subsidy impact of retaining a mortgage loan in retirement (feel free to follow the rabbit hole of links embedded within the linked post for more detail and discussion on this point).

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Re: What comes after the ACA?
« Reply #3171 on: July 17, 2017, 11:44:15 AM »
I am self-employed so I know it's not easy. A lot of money is dumped into the solo 401k, both as employee and employer, as well as HSA, tIRA.
Doesn't MAGI ignore the tIRA deduction?
No.  tIRA deductions reduce MAGI.
Yes, tIRA deductions reduce the MAGI for ACA purposes.  See https://www.healthcare.gov/income-and-household-information/income/

What's confusing is there are multiple MAGIs, with each "Modified" in slightly different ways.  E.g., in the MAGI for tIRA deductibility the tIRA itself does not affect that MAGI.

Thank you for the link.  When I read the UC Berkeley summary for MAGI, I thought "deduct the IRA deduction" meant we had to add the deduction back in.  I'll need to purchase insurance through healthcare.gov starting next year, so it's good to know a tIRA will help reduce my MAGI.

Exflyboy

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Re: What comes after the ACA?
« Reply #3172 on: July 17, 2017, 11:52:56 AM »
Also if you select a plan with an HSA you can make a further MAGI deduction for that year.

JLee

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Re: What comes after the ACA?
« Reply #3173 on: July 17, 2017, 03:46:18 PM »
http://www.abc.net.au/news/2017-07-17/australian-healthcare-ranked-second-best-in-developed-world/8716326

This seems somewhat relevant to the overall discussion.  The US spends a lot of money on health care and really does a poor job overall.

Exflyboy

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Re: What comes after the ACA?
« Reply #3174 on: July 17, 2017, 04:14:49 PM »
http://www.abc.net.au/news/2017-07-17/australian-healthcare-ranked-second-best-in-developed-world/8716326

This seems somewhat relevant to the overall discussion.  The US spends a lot of money on health care and really does a poor job overall.

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Re: What comes after the ACA?
« Reply #3175 on: July 17, 2017, 06:43:43 PM »
Lower your MAGI down and you get health insurance covered. Sounds perfectly valid to me.
That's not so easy if you are still employed, if you are living of your money, much easier.

Another reason to have your house paid off before FIRE - once the mortgage is gone, it's pretty easy to live off $40k per year and not really feel deprived.  If you have a mortgage after FIRE, you have to withdraw a lot more, which disqualifies you for subsidies and lower tax rates.

I'll take this post as my cue to insert another reminder that the extra withdrawals needed to service a mortgage loan do not necessarily translate into extra income on a dollar-for-dollar basis, a point which is often overlooked, leading folks to overstate the adverse tax/subsidy impact of retaining a mortgage loan in retirement (feel free to follow the rabbit hole of links embedded within the linked post for more detail and discussion on this point).

That was a fun little Easter egg hunt.

If one sells taxable stock accounts to pay for the mortgage, then that's true that all of that money will not be taxable as some of it is the cost basis of buying the stock that gets returned to you.



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Re: What comes after the ACA?
« Reply #3176 on: July 17, 2017, 08:10:25 PM »
Quote
Younger are going to have considerably lower health care costs on average. Many younger won't have any health care needs for years or decades. In fact you could probably just double the current cost of Medicare to cover the other 75% of people.

I have 3 kids - all healthy - and they've been anything but cheap.  They were expensive to deliver and they injure themselves often.  It costs a fortune to have a baby in this country.

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Re: What comes after the ACA?
« Reply #3177 on: July 17, 2017, 08:43:51 PM »
Looks like the current Senate bill is dead, once again. I can't help but wonder how long this process is going to linger.

http://www.msn.com/en-us/news/politics/2-more-gop-senators-oppose-health-bill-killing-it-for-now/ar-BBECpPW?li=BBnb7Kz
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Exflyboy

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Re: What comes after the ACA?
« Reply #3178 on: July 17, 2017, 09:35:54 PM »
Looks like the current Senate bill is dead, once again. I can't help but wonder how long this process is going to linger.

http://www.msn.com/en-us/news/politics/2-more-gop-senators-oppose-health-bill-killing-it-for-now/ar-BBECpPW?li=BBnb7Kz

Who knows maybe they will work on something that will actually reduce costs rather than push the existing enourmous cost around to different players.

Naah, that will never happen!

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Re: What comes after the ACA?
« Reply #3179 on: July 17, 2017, 11:55:40 PM »
Turtle threw in the towel.  It dies yet another time!  How long until ZombiTrumpCare 4.0 is re-animated?

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Re: What comes after the ACA?
« Reply #3180 on: July 18, 2017, 04:35:46 AM »
Turtle threw in the towel.  It dies yet another time!  How long until ZombiTrumpCare 4.0 is re-animated?

He's already talking about resurrecting the first option that failed: "clean" repeal with a delayed replacement.  Supposedly this will force Democrats to vote for the replacement out of fear that they will get blamed for "obstructing" something that will only increase the uninsured by 22 million instead of the 30-something gajillion more that repeal-only would leave in the cold.  So we've come full circle back to what we were talking about in January.  The pundits are already predicting that this tactic will fail again.

Personally, I think the circus will continue until the repubs lose control of one of the two houses of Congress, or the presidency, or until they gain a 60-vote supermajority in the Senate.
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protostache

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Re: What comes after the ACA?
« Reply #3181 on: July 18, 2017, 06:19:27 AM »
Turtle threw in the towel.  It dies yet another time!  How long until ZombiTrumpCare 4.0 is re-animated?

He's already talking about resurrecting the first option that failed: "clean" repeal with a delayed replacement.  Supposedly this will force Democrats to vote for the replacement out of fear that they will get blamed for "obstructing" something that will only increase the uninsured by 22 million instead of the 30-something gajillion more that repeal-only would leave in the cold.  So we've come full circle back to what we were talking about in January.  The pundits are already predicting that this tactic will fail again.

Personally, I think the circus will continue until the repubs lose control of one of the two houses of Congress, or the presidency, or until they gain a 60-vote supermajority in the Senate.

Or McConnell continues his campaign of destruction and nukes the filibuster for legislation and then he can try to whatever old thing he wants without threat of obstruction from the minority.

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Re: What comes after the ACA?
« Reply #3182 on: July 18, 2017, 06:30:31 AM »
.. or maybe he'll try to work with democrats, as he has 'threatened' to do...
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Re: What comes after the ACA?
« Reply #3183 on: July 18, 2017, 07:33:52 AM »
The entire GOP platform for the last 7 year was "Repeal & Replace Obamacare"...and they can't do it with control of both houses of Congress.  Amazing.
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Re: What comes after the ACA?
« Reply #3184 on: July 18, 2017, 08:02:11 AM »
The entire GOP platform for the last 7 year was "Repeal & Replace Obamacare"...and they can't do it with control of both houses of Congress.  Amazing.
It is amazing.  I'm wondering how this will get spun.  No doubt there will be lots of talk about it being Dems fault.  Shocker, they don't want to repeal their signature legislation of the last decade...
Here's where a rational person might say: where can we find common ground to get at least some support from the opposing party?  Sadly, compromise has become akin to traitorism in this day and age...
"Do not confuse complexity with superiority"

Exflyboy

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Re: What comes after the ACA?
« Reply #3185 on: July 18, 2017, 08:13:23 AM »
The entire GOP platform for the last 7 year was "Repeal & Replace Obamacare"...and they can't do it with control of both houses of Congress.  Amazing.
It is amazing.  I'm wondering how this will get spun.  No doubt there will be lots of talk about it being Dems fault.  Shocker, they don't want to repeal their signature legislation of the last decade...
Here's where a rational person might say: where can we find common ground to get at least some support from the opposing party?  Sadly, compromise has become akin to traitorism in this day and age...


And.. How about solving the real problem of "Healthcare is just too damned expensive", rather than rearranging the deck chairs on the Titanic again.

nereo

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Re: What comes after the ACA?
« Reply #3186 on: July 18, 2017, 08:32:10 AM »
The entire GOP platform for the last 7 year was "Repeal & Replace Obamacare"...and they can't do it with control of both houses of Congress.  Amazing.
It is amazing.  I'm wondering how this will get spun.  No doubt there will be lots of talk about it being Dems fault.  Shocker, they don't want to repeal their signature legislation of the last decade...
Here's where a rational person might say: where can we find common ground to get at least some support from the opposing party?  Sadly, compromise has become akin to traitorism in this day and age...


And.. How about solving the real problem of "Healthcare is just too damned expensive", rather than rearranging the deck chairs on the Titanic again.

I agree that the ACA (and the AHCA) don't do a very good job of this, BUT I think this ought to be done with two seperate pieces of legislation.  One (the ACA - ideally tweaked for improvements) which increases health care coverage, and an entirely different bill that would address why the system is so damn expensive.  Heck, here's where the GOP could really make their mark (if they had the clout and balls, which I don't think they do right now). The "Medical Affordability Act".  Here they can pass long ballyhooed legislation about limiting liability and 'needless' beautification projects in hospitals, but also stuff like corporate profits (they won't touch this with a 100' pole), preventative medicine (again, good prevention limits profits down the road), medical school cost (not likely), doctor compensation (also not likely), allowing more foreign-born & trained doctors to fill staffing needs, particularly in rural areas (unlikely with this WH and congress afraid of immigration), drug costs (see profits, above), etc.

tl/dr: we need an entirely seperate piece of legislation to further reduce medical costs in the US.  It seems unlikely to happen.
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Exflyboy

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Re: What comes after the ACA?
« Reply #3187 on: July 18, 2017, 08:44:15 AM »
The entire GOP platform for the last 7 year was "Repeal & Replace Obamacare"...and they can't do it with control of both houses of Congress.  Amazing.
It is amazing.  I'm wondering how this will get spun.  No doubt there will be lots of talk about it being Dems fault.  Shocker, they don't want to repeal their signature legislation of the last decade...
Here's where a rational person might say: where can we find common ground to get at least some support from the opposing party?  Sadly, compromise has become akin to traitorism in this day and age...


And.. How about solving the real problem of "Healthcare is just too damned expensive", rather than rearranging the deck chairs on the Titanic again.

I agree that the ACA (and the AHCA) don't do a very good job of this, BUT I think this ought to be done with two seperate pieces of legislation.  One (the ACA - ideally tweaked for improvements) which increases health care coverage, and an entirely different bill that would address why the system is so damn expensive.  Heck, here's where the GOP could really make their mark (if they had the clout and balls, which I don't think they do right now). The "Medical Affordability Act".  Here they can pass long ballyhooed legislation about limiting liability and 'needless' beautification projects in hospitals, but also stuff like corporate profits (they won't touch this with a 100' pole), preventative medicine (again, good prevention limits profits down the road), medical school cost (not likely), doctor compensation (also not likely), allowing more foreign-born & trained doctors to fill staffing needs, particularly in rural areas (unlikely with this WH and congress afraid of immigration), drug costs (see profits, above), etc.

tl/dr: we need an entirely seperate piece of legislation to further reduce medical costs in the US.  It seems unlikely to happen.

Bingo!

jim555

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Re: What comes after the ACA?
« Reply #3188 on: July 18, 2017, 09:29:39 AM »
Sounds like commie price controls = unfreedom!  Nothing is going to be done, these guys are well greased.

TrudgingAlong

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Re: What comes after the ACA?
« Reply #3189 on: July 18, 2017, 10:07:46 AM »
Never have I been more grateful we decided to stay the course to military retirement, as miserable as that choice can be at times.

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Re: What comes after the ACA?
« Reply #3190 on: July 18, 2017, 10:12:30 AM »
Well here's what DJT had to say about it on Twitter a few hours ago (emphasis added):
Quote from: Trump
We were let down by all of the Democrats and a few Republicans. Most Republicans were loyal, terrific & worked really hard. We will return!

So: it's all Dems fault that they didn't want to destroy their own signature healthcare law. ::eyeroll::
Note the stress on loyalty.  Substance doesn't enter into it, just whether you were loyal and worked hard.

This was followed up by him urging to "let Obamacare Fail".  Am I the only one disgusted at the thought of routing for failure of the healthcare people depend on just because your own bill was so unpopular?
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Re: What comes after the ACA?
« Reply #3191 on: July 18, 2017, 12:34:06 PM »
Well here's what DJT had to say about it on Twitter a few hours ago (emphasis added):
Quote from: Trump
We were let down by all of the Democrats and a few Republicans. Most Republicans were loyal, terrific & worked really hard. We will return!

So: it's all Dems fault that they didn't want to destroy their own signature healthcare law. ::eyeroll::
Note the stress on loyalty.  Substance doesn't enter into it, just whether you were loyal and worked hard.

This was followed up by him urging to "let Obamacare Fail".  Am I the only one disgusted at the thought of routing for failure of the healthcare people depend on just because your own bill was so unpopular?
In order to be "let down" the expectation of cooperation has to exist first. Since that was never there in the first place, being let down is a misnomer.
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Re: What comes after the ACA?
« Reply #3192 on: July 18, 2017, 12:50:35 PM »

You really need to treat him like he is your crazy grandpa.  At some point, old people get cranky and say random things that don't make any sense.  You just smile and nod at their racist, sexist comments.  Because they are really old and don't know what they are saying and are going to die before you do.

AFAIK, my grandpa does not have any nuclear weapons, nor can he alter the lives of millions just by signing his name.
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Mr. Green

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Re: What comes after the ACA?
« Reply #3193 on: July 18, 2017, 01:38:04 PM »
FIRE, Take Two.

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Re: What comes after the ACA?
« Reply #3194 on: July 18, 2017, 01:40:46 PM »

ZiziPB

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Re: What comes after the ACA?
« Reply #3195 on: July 18, 2017, 02:10:11 PM »
It looks like a simple repeal vote is going to fail too.

https://www.usatoday.com/story/news/politics/2017/07/18/senate-plan-repeal-obamacare-already-jeopardy/487671001/
That lasted all of 5 hours.
Yup, now our "president" is tweeting that he's just going to let Obamacare fail (read: the Republicans are going to sabotage it so that they can make sure it fails)...



Mr. Green

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Re: What comes after the ACA?
« Reply #3196 on: July 18, 2017, 02:34:27 PM »
It looks like a simple repeal vote is going to fail too.

https://www.usatoday.com/story/news/politics/2017/07/18/senate-plan-repeal-obamacare-already-jeopardy/487671001/
That lasted all of 5 hours.
Yup, now our "president" is tweeting that he's just going to let Obamacare fail (read: the Republicans are going to sabotage it so that they can make sure it fails)...
Now that they've basically exhausted all their other options it seems like allowing it to fail would be political suicide. They already have multiple insurance companies on record stating the situation is tenuous in some states because of the non-committal attitude coming from Washington, not because of the actual insurance process itself. I don't know how you spin that into something that doesn't lose votes next year, especially as people start to become affected by destabilized markets.
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dividendman

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Re: What comes after the ACA?
« Reply #3197 on: July 18, 2017, 04:26:46 PM »
It looks like a simple repeal vote is going to fail too.

https://www.usatoday.com/story/news/politics/2017/07/18/senate-plan-repeal-obamacare-already-jeopardy/487671001/
That lasted all of 5 hours.
Yup, now our "president" is tweeting that he's just going to let Obamacare fail (read: the Republicans are going to sabotage it so that they can make sure it fails)...
Now that they've basically exhausted all their other options it seems like allowing it to fail would be political suicide. They already have multiple insurance companies on record stating the situation is tenuous in some states because of the non-committal attitude coming from Washington, not because of the actual insurance process itself. I don't know how you spin that into something that doesn't lose votes next year, especially as people start to become affected by destabilized markets.

Well, most of the areas that are at risk of losing all insurers in the ACA markets are in areas that voted for Trump.... so they are getting what they want I guess.

Exflyboy

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Re: What comes after the ACA?
« Reply #3198 on: July 18, 2017, 06:16:31 PM »
Apparently the right wing media (Rush Limbagh is the one I heard) is accusing the GOP Republicans of basically sabotaging Trump's grand plan.

Oh and the ACA is evil and we're all going to Hell etc.

I could almost see the guy foaming at the mouth. If it wasn't so serious it would be quite funny.

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Re: What comes after the ACA?
« Reply #3199 on: July 18, 2017, 06:37:43 PM »
 All this discussion about the ACA and the actual ACA only covers about 7 million of the
320 million people in the US. (0.3%) a few million of those had insurance before the ACA and either it no longer qualified or with the subsidy the ACA was cheaper so they switched.
 There are another 10 million that were put onto Medicaid, because they were below the income threshold to qualify for the ACA.
 Seems like a massive social eruption for such a small part of the population.
 Could it be because the ACA legislation cause a huge increase in the cost of health insurance?