Author Topic: What comes after the ACA?  (Read 689345 times)

Roadrunner53

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Re: What comes after the ACA?
« Reply #4450 on: June 30, 2018, 08:35:39 AM »
Medicare for all...good luck with that and the costs.

Medicare Part A (Hospital) Costs zero if you have worked 10 years. But you have to pay a yearly deductible $1,340 for each benefit period if you need hospitalization. Benefit periods could be more than once per year.

Medicare Part B Costs $134 a month. Covers doctor visits, tests but still requires copays. Deductible is $183 a year.

Medicare Plan D (Prescriptions) cost vary from maybe $34-$78 a month the lower you pay per month you will pay something like $405 yearly deductible.

Then there are supplements to Medicare. Medicare pays only 80% so you have to pay the 20% out of your pocket or buy a supplement to partially cover or completely cover the expenses. The less you pay for a supplement, the more you pay out of pocket. Same the more you pay for the supplement, the less you pay.

These costs are PER PERSON!

So tell me how a couple with three children could afford this Medicare for all? They make it sound like Medicare is a free program but it is far from it.

My Hub and I have Medicare Supplement Plan F and it costs $241.50 a month for each of us. So between all the parts and plans we pay $907 per month for the two of us. Yes, we chose the most expensive Plan F but it pays for all the deductibles and copays so for the most part we pay nothing more. We go to the doctor and pay nothing, have tests or treatments and pay nothing. However, everything has to be approved by Medicare.

« Last Edit: June 30, 2018, 10:32:39 AM by Roadrunner53 »

DreamFIRE

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Re: What comes after the ACA?
« Reply #4451 on: June 30, 2018, 10:09:40 AM »
Roadrunner, you mentioned subsidy several times, but looks like you meant "supplement".

Healthcare total out of pocket under Medicare can get very expensive, for sure.

Roadrunner53

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Re: What comes after the ACA?
« Reply #4452 on: June 30, 2018, 10:21:57 AM »
Roadrunner, you mentioned subsidy several times, but looks like you meant "supplement".

Healthcare total out of pocket under Medicare can get very expensive, for sure.

Thanks DreamFIRE! DUH, I made the corrections!

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Re: What comes after the ACA?
« Reply #4453 on: June 30, 2018, 12:44:24 PM »
You guys are so negative.. Trump is going to "dismantle the lie that is Obama care and replace it with something MUCH better"

I'm sure its just around the corner!  right?

GuitarStv

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Re: What comes after the ACA?
« Reply #4454 on: June 30, 2018, 06:47:31 PM »
You guys are so negative.. Trump is going to "dismantle the lie that is Obama care and replace it with something MUCH better"

I'm sure its just around the corner!  right?

It must be.  Trump has never lied before, has he?
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chasesfish

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Re: What comes after the ACA?
« Reply #4455 on: July 01, 2018, 05:53:00 AM »
You guys are so negative.. Trump is going to "dismantle the lie that is Obama care and replace it with something MUCH better"

I'm sure its just around the corner!  right?

Republicans claiming to dismantle the ACA will have about the same track records as the other side has on immigration and gun control.  Campaign and raise a lot of money on it, but don't do anything with it.   Each side has its "third rail" of politics, the ACA has become one of those.  Anyone who touches this risks loosing their seat in the primary.   
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DreamFIRE

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Re: What comes after the ACA?
« Reply #4456 on: July 01, 2018, 08:47:05 AM »

They're not just trying to dismantle, which they've already had some success at, they're trying to overturn the whole thing.

https://www.vox.com/the-big-idea/2018/6/8/17442238/trump-aca-obamacare-texas-department-of-justice-rule-of-law

pecunia

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Re: What comes after the ACA?
« Reply #4457 on: July 01, 2018, 10:23:36 AM »
Dream of FIRE:
Quote
They're not just trying to dismantle, which they've already had some success at, they're trying to overturn the whole thing.

Why?

I could sort of understand the principle of getting rid of the requirement to buy insurance.  I can also understand that this provided needed revenue to pay for the whole thing.

However, given they've just passed a big tax law where the government will have to borrow money, it now becomes obvious that it isn't a money thing.  They also have no qualms about borrowing money to pay for the wars.  It gives their customers, the insurance companies, more business and it is somewhat humanitarian.  So, I don't get it.  Why are they so against it?

I mean, it has come to the time where these guys need a humanitarian feather or three in their caps or many will be voted out.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4458 on: July 01, 2018, 11:51:30 AM »
Dream of FIRE:
Quote
They're not just trying to dismantle, which they've already had some success at, they're trying to overturn the whole thing.

Why?

I could sort of understand the principle of getting rid of the requirement to buy insurance.  I can also understand that this provided needed revenue to pay for the whole thing.

However, given they've just passed a big tax law where the government will have to borrow money, it now becomes obvious that it isn't a money thing.  They also have no qualms about borrowing money to pay for the wars.  It gives their customers, the insurance companies, more business and it is somewhat humanitarian.  So, I don't get it.  Why are they so against it?

I mean, it has come to the time where these guys need a humanitarian feather or three in their caps or many will be voted out.

Check out the previous page of this thread - same thing was questioned there.  The irony of tax cuts for the rich increasing the deficit while trying to cut programs like ACA and Medicare to reduce the deficit wasn't lost on me.

pecunia

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Re: What comes after the ACA?
« Reply #4459 on: July 01, 2018, 12:12:16 PM »
Dreamfire:
Quote
Check out the previous page of this thread - same thing was questioned there.

Toganet almost phrased it exactly like I did.  I didn't like the answers though.  Not saying they aren't right.  I just don't understand them.  Today's Republicans are not like Nixon, Eisenhower, Teddy Roosevelt or even McCain.  I can't figure those guys out.  They are there as public servants, but seem to only serve "their" public.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4460 on: July 01, 2018, 02:04:00 PM »
Dreamfire:
Quote
Check out the previous page of this thread - same thing was questioned there.

Toganet almost phrased it exactly like I did.  I didn't like the answers though.  Not saying they aren't right.  I just don't understand them.  Today's Republicans are not like Nixon, Eisenhower, Teddy Roosevelt or even McCain.  I can't figure those guys out.  They are there as public servants, but seem to only serve "their" public.

Yep, there are no good answers for 20M people losing health coverage.  The republicans just barely missed getting their own healthcare bill through, which would have been a big step back, despite not completely eliminating ACA.

wenchsenior

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Re: What comes after the ACA?
« Reply #4461 on: July 01, 2018, 02:11:21 PM »
Dreamfire:
Quote
Check out the previous page of this thread - same thing was questioned there.

Toganet almost phrased it exactly like I did.  I didn't like the answers though.  Not saying they aren't right.  I just don't understand them.  Today's Republicans are not like Nixon, Eisenhower, Teddy Roosevelt or even McCain.  I can't figure those guys out.  They are there as public servants, but seem to only serve "their" public.

There is truly a faction of the conservatives and libertarians (e.g., much of my father's family and my father) were/are in this group, that come from some privilege (if not actual wealth, very comfortable money with a large financial safety net) that truly are repulsed by poor people b/c they think they are morally inferior and completely responsible for every bad thing that happens to them.  This includes the fact that they cannot afford insurance under the pre ACA system.  It's their own fault and a sign that they are inferior.  If they were 'worthy', they would be working at jobs that offered insurance, or would sacrifice whatever it took to pay for private insurance.

They also object to the entire concept of Social Security/Medicare/Medicaid for the same reasons.  People who can't pay for all those things are 'parasites on hard working people'.  I've actually heard my father say this sort of thing lots of times, and he has trouble understanding how big an advantage he had coming from an upper middle class professional family that paid for his first car, paid for his college, and could bail him out financially early in his life when he nearly flunked out and also made a couple of other very dumb decisions.  One of  his younger sisters was born developmentally disabled AND has epilepsy, and he regards her as 'gross and lazy' even though she did work a state-subsidized job for developmentally disabled for many years. But she's overweight (which he views as a total flaw of character) and has an affect in talking etc that just repulses him.

What's interesting is my father is not a sociopath, but there is this complete barrier to feeling empathy toward anyone or anything that causes him to feel consistently negative emotions. My working theory about this is that he was conditioned to these beliefs by his father, and also that he's so afraid of poverty, obesity, failing at business (he was a very successful business owner), ill health, what have you in himself that he can't process it except by believing all those things are 99% under his own control and that b/c they haven't happened to him, it's evidence that he is 'superior' to most other people.  However, he isn't a sociopath or anything.  He's extremely loving and can be very generous toward people that he deems 'worthy'.  But he just has very narrow categories of what kind of person is 'worthy'.   

Interestingly, he himself was without insurance (through laziness/lack of attention) when I was born under emergency circumstances that resulted in a week of intensive care afterward for me and surgery for my mom. This event would have destroyed his financial life had his own father (who has the same world view but who handily owned an insurance company) not stepped in and rescued him by retroactively providing him with insurance.

I've seen similar reasoning in a lot of the conservatives on that side of the family.

Interestingly, my father's opinion about the evils of SS and Medicare changed a lot when his super healthy, youthful, super fit second wife got cancer at a time in the 1990s when they had to self insure b/c of early retirement.  They had money, but it was a huge drain on their finances to self insure then and afterward with cancer as a preexisting condition.  All of a sudden, he began to not be so conservative about health care issues.  And now that he's relying heavily on SS and Medicare and definitely needs it (not being nearly as financially well off as he always assumed he would be), he supports keeping those policies.  But again, he views himself as a good person who paid into those and is worthy of using of them, unlike all those he deems as freeloaders.

As hard as it is to grasp, I really think there's a subset of people that have this weirdly warped world view.  They think of themselves as good, moral, and compassionate.  Some of them post on this board.  Paul Ryan would be a great example of this, as well.  I really think that this subgroup would be pretty much fine with poor people dying of curable illnesses if they couldn't afford care. 


pecunia

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Re: What comes after the ACA?
« Reply #4462 on: July 01, 2018, 04:28:54 PM »
wenchsenior:
Quote
As hard as it is to grasp, I really think there's a subset of people that have this weirdly warped world view. 

Thanks for the fine explanation.  It may take another depression or World War to uproot these non enlightened views.  And, I'll bet there still is a lot of goodness in these people despite their parochial viewpoints.

protostache

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Re: What comes after the ACA?
« Reply #4463 on: July 01, 2018, 06:01:15 PM »
Dreamfire:
Quote
Check out the previous page of this thread - same thing was questioned there.

Toganet almost phrased it exactly like I did.  I didn't like the answers though.  Not saying they aren't right.  I just don't understand them.  Today's Republicans are not like Nixon, Eisenhower, Teddy Roosevelt or even McCain.  I can't figure those guys out.  They are there as public servants, but seem to only serve "their" public.

There is truly a faction of the conservatives and libertarians (e.g., much of my father's family and my father) were/are in this group, that come from some privilege (if not actual wealth, very comfortable money with a large financial safety net) that truly are repulsed by poor people b/c they think they are morally inferior and completely responsible for every bad thing that happens to them.  This includes the fact that they cannot afford insurance under the pre ACA system.  It's their own fault and a sign that they are inferior.  If they were 'worthy', they would be working at jobs that offered insurance, or would sacrifice whatever it took to pay for private insurance.

They also object to the entire concept of Social Security/Medicare/Medicaid for the same reasons.  People who can't pay for all those things are 'parasites on hard working people'.  I've actually heard my father say this sort of thing lots of times, and he has trouble understanding how big an advantage he had coming from an upper middle class professional family that paid for his first car, paid for his college, and could bail him out financially early in his life when he nearly flunked out and also made a couple of other very dumb decisions.  One of  his younger sisters was born developmentally disabled AND has epilepsy, and he regards her as 'gross and lazy' even though she did work a state-subsidized job for developmentally disabled for many years. But she's overweight (which he views as a total flaw of character) and has an affect in talking etc that just repulses him.

What's interesting is my father is not a sociopath, but there is this complete barrier to feeling empathy toward anyone or anything that causes him to feel consistently negative emotions. My working theory about this is that he was conditioned to these beliefs by his father, and also that he's so afraid of poverty, obesity, failing at business (he was a very successful business owner), ill health, what have you in himself that he can't process it except by believing all those things are 99% under his own control and that b/c they haven't happened to him, it's evidence that he is 'superior' to most other people.  However, he isn't a sociopath or anything.  He's extremely loving and can be very generous toward people that he deems 'worthy'.  But he just has very narrow categories of what kind of person is 'worthy'.   

Interestingly, he himself was without insurance (through laziness/lack of attention) when I was born under emergency circumstances that resulted in a week of intensive care afterward for me and surgery for my mom. This event would have destroyed his financial life had his own father (who has the same world view but who handily owned an insurance company) not stepped in and rescued him by retroactively providing him with insurance.

I've seen similar reasoning in a lot of the conservatives on that side of the family.

Interestingly, my father's opinion about the evils of SS and Medicare changed a lot when his super healthy, youthful, super fit second wife got cancer at a time in the 1990s when they had to self insure b/c of early retirement.  They had money, but it was a huge drain on their finances to self insure then and afterward with cancer as a preexisting condition.  All of a sudden, he began to not be so conservative about health care issues.  And now that he's relying heavily on SS and Medicare and definitely needs it (not being nearly as financially well off as he always assumed he would be), he supports keeping those policies.  But again, he views himself as a good person who paid into those and is worthy of using of them, unlike all those he deems as freeloaders.

As hard as it is to grasp, I really think there's a subset of people that have this weirdly warped world view.  They think of themselves as good, moral, and compassionate.  Some of them post on this board.  Paul Ryan would be a great example of this, as well.  I really think that this subgroup would be pretty much fine with poor people dying of curable illnesses if they couldn't afford care.

Screw them. I mean it. We as a society have to push these people to the margins where they belong and implement policies that actually help most of the people most of the time.

toganet

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Re: What comes after the ACA?
« Reply #4464 on: July 02, 2018, 02:01:35 PM »
wenchsenior:
Quote
As hard as it is to grasp, I really think there's a subset of people that have this weirdly warped world view. 

Thanks for the fine explanation.  It may take another depression or World War to uproot these non enlightened views.  And, I'll bet there still is a lot of goodness in these people despite their parochial viewpoints.

There are some interesting theories around psychological differences between right- and left-leaning folks, specifically around empathy and worldview.

The empathy angle posits that "liberals" feel empathy for the wider world, while "conservatives" feel empathy for family & friends, but not further.  Likewise, those on the right are driven by fear and disgust, while the left is more open and optimistic.

"Pop" articles re these ideas; take with a grain of salt:

https://www.psychologytoday.com/us/blog/the-human-beast/201210/why-liberal-hearts-bleed-and-conservatives-dont
http://www.businessinsider.com/liberals-and-conservatives-process-disgust-and-empathy-differently-2018-1

wenchsenior

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Re: What comes after the ACA?
« Reply #4465 on: July 02, 2018, 02:37:14 PM »
Dreamfire:
Quote
Check out the previous page of this thread - same thing was questioned there.

Toganet almost phrased it exactly like I did.  I didn't like the answers though.  Not saying they aren't right.  I just don't understand them.  Today's Republicans are not like Nixon, Eisenhower, Teddy Roosevelt or even McCain.  I can't figure those guys out.  They are there as public servants, but seem to only serve "their" public.

There is truly a faction of the conservatives and libertarians (e.g., much of my father's family and my father) were/are in this group, that come from some privilege (if not actual wealth, very comfortable money with a large financial safety net) that truly are repulsed by poor people b/c they think they are morally inferior and completely responsible for every bad thing that happens to them.  This includes the fact that they cannot afford insurance under the pre ACA system.  It's their own fault and a sign that they are inferior.  If they were 'worthy', they would be working at jobs that offered insurance, or would sacrifice whatever it took to pay for private insurance.

They also object to the entire concept of Social Security/Medicare/Medicaid for the same reasons.  People who can't pay for all those things are 'parasites on hard working people'.  I've actually heard my father say this sort of thing lots of times, and he has trouble understanding how big an advantage he had coming from an upper middle class professional family that paid for his first car, paid for his college, and could bail him out financially early in his life when he nearly flunked out and also made a couple of other very dumb decisions.  One of  his younger sisters was born developmentally disabled AND has epilepsy, and he regards her as 'gross and lazy' even though she did work a state-subsidized job for developmentally disabled for many years. But she's overweight (which he views as a total flaw of character) and has an affect in talking etc that just repulses him.

What's interesting is my father is not a sociopath, but there is this complete barrier to feeling empathy toward anyone or anything that causes him to feel consistently negative emotions. My working theory about this is that he was conditioned to these beliefs by his father, and also that he's so afraid of poverty, obesity, failing at business (he was a very successful business owner), ill health, what have you in himself that he can't process it except by believing all those things are 99% under his own control and that b/c they haven't happened to him, it's evidence that he is 'superior' to most other people.  However, he isn't a sociopath or anything.  He's extremely loving and can be very generous toward people that he deems 'worthy'.  But he just has very narrow categories of what kind of person is 'worthy'.   

Interestingly, he himself was without insurance (through laziness/lack of attention) when I was born under emergency circumstances that resulted in a week of intensive care afterward for me and surgery for my mom. This event would have destroyed his financial life had his own father (who has the same world view but who handily owned an insurance company) not stepped in and rescued him by retroactively providing him with insurance.

I've seen similar reasoning in a lot of the conservatives on that side of the family.

Interestingly, my father's opinion about the evils of SS and Medicare changed a lot when his super healthy, youthful, super fit second wife got cancer at a time in the 1990s when they had to self insure b/c of early retirement.  They had money, but it was a huge drain on their finances to self insure then and afterward with cancer as a preexisting condition.  All of a sudden, he began to not be so conservative about health care issues.  And now that he's relying heavily on SS and Medicare and definitely needs it (not being nearly as financially well off as he always assumed he would be), he supports keeping those policies.  But again, he views himself as a good person who paid into those and is worthy of using of them, unlike all those he deems as freeloaders.

As hard as it is to grasp, I really think there's a subset of people that have this weirdly warped world view.  They think of themselves as good, moral, and compassionate.  Some of them post on this board.  Paul Ryan would be a great example of this, as well.  I really think that this subgroup would be pretty much fine with poor people dying of curable illnesses if they couldn't afford care.

Screw them. I mean it. We as a society have to push these people to the margins where they belong and implement policies that actually help most of the people most of the time.

I think if toganet's info is accurate (and my experience jives with it), then we can't really 'push them to the margins' b/c it's a relatively common way for people to be 'wired' and that isn't very easy to change.  Again, based only on my own anecdotal info, e.g., my father is extremely anxiety-driven in his world view.  He views anything new or uncontrollable as threatening and I think that plays heavily into how his political views were shaped.  That's fairly hard-wired, though in later years as he's been forced to confront more situations that he could not control, he's benefited from CBT-type therapy that has helped him modify some of his thought patterns.  But he actively rejected this therapy and would never have done it had circumstances not essentially forced him to it. And despite the fact that he has become slightly less judgmental and rigid in his ideas about people and society as a result of years of therapy, that still all collapses when he gets anxious or angry, which is often. 

We can't change peoples' genetic predisposition to some viewpoints.  I guess we could set up society to completely marginalize them, but I think that is part of the cause of the current poisonous political environment...every subgroup is convinced they are being marginalized, which just makes them (us) more tribal.  Tribalism also appears to be hardwired into most humans, along with emotionally driven 'reasoning', which makes me very pessimistic about our future as a functioning democracy.

jim555

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Re: What comes after the ACA?
« Reply #4466 on: July 02, 2018, 06:01:49 PM »
« Last Edit: July 02, 2018, 06:10:41 PM by jim555 »

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #4467 on: July 03, 2018, 11:58:56 AM »
https://www.bostonglobe.com/metro/2018/07/02/woman-got-her-leg-caught-gap-orange-line-train-and-then-begged-for-ambulance-because-cost/q6gBPV8ujcfH0qLrQ6HjEJ/story.html?s_campaign=breakingnews:newsletter

Quote
When a 45-year-old woman’s leg became caught in the gap between an Orange Line train and the platform Friday afternoon, she was in agony. The cut on her leg went down to the bone.

Beyond her pain, she had another fear. Shaking and crying, she begged people not to call an ambulance. “Do you know how much an ambulance costs?” she wept.
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Mr. Green

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Re: What comes after the ACA?
« Reply #4468 on: July 03, 2018, 12:47:49 PM »
https://www.bostonglobe.com/metro/2018/07/02/woman-got-her-leg-caught-gap-orange-line-train-and-then-begged-for-ambulance-because-cost/q6gBPV8ujcfH0qLrQ6HjEJ/story.html?s_campaign=breakingnews:newsletter

Quote
When a 45-year-old woman’s leg became caught in the gap between an Orange Line train and the platform Friday afternoon, she was in agony. The cut on her leg went down to the bone.

Beyond her pain, she had another fear. Shaking and crying, she begged people not to call an ambulance. “Do you know how much an ambulance costs?” she wept.
That that was the first thing going through someone's head immediately after a serious injury ought to disgust everyone living in the US, whether they're feeling comfortable with their own healthcare or not.

It also illustrates how HDHPs create a mentality in people to defer care until something small becomes a much bigger problem.
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Exflyboy

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Re: What comes after the ACA?
« Reply #4469 on: July 03, 2018, 01:07:12 PM »
https://www.bostonglobe.com/metro/2018/07/02/woman-got-her-leg-caught-gap-orange-line-train-and-then-begged-for-ambulance-because-cost/q6gBPV8ujcfH0qLrQ6HjEJ/story.html?s_campaign=breakingnews:newsletter

Quote
When a 45-year-old woman’s leg became caught in the gap between an Orange Line train and the platform Friday afternoon, she was in agony. The cut on her leg went down to the bone.

Beyond her pain, she had another fear. Shaking and crying, she begged people not to call an ambulance. “Do you know how much an ambulance costs?” she wept.

Or she could pay for a lawyer and try to prove negligence.. Good luck with that.

The surgery will cost many thousands as well so I hope she has some insurance.

chasesfish

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Re: What comes after the ACA?
« Reply #4470 on: July 03, 2018, 06:20:01 PM »
https://www.bostonglobe.com/metro/2018/07/02/woman-got-her-leg-caught-gap-orange-line-train-and-then-begged-for-ambulance-because-cost/q6gBPV8ujcfH0qLrQ6HjEJ/story.html?s_campaign=breakingnews:newsletter

Quote
When a 45-year-old woman’s leg became caught in the gap between an Orange Line train and the platform Friday afternoon, she was in agony. The cut on her leg went down to the bone.

Beyond her pain, she had another fear. Shaking and crying, she begged people not to call an ambulance. “Do you know how much an ambulance costs?” she wept.

Or she could pay for a lawyer and try to prove negligence.. Good luck with that.

The surgery will cost many thousands as well so I hope she has some insurance.

I hope she asked for Uber instead.  We got a $1500 bill from our local municipality for a 2.5 mile ambulance ride with no supportive care
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LAGuy

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Re: What comes after the ACA?
« Reply #4471 on: July 04, 2018, 09:30:42 AM »
I think if toganet's info is accurate (and my experience jives with it), then we can't really 'push them to the margins' b/c it's a relatively common way for people to be 'wired' and that isn't very easy to change.  Again, based only on my own anecdotal info, e.g., my father is extremely anxiety-driven in his world view.  He views anything new or uncontrollable as threatening and I think that plays heavily into how his political views were shaped.  That's fairly hard-wired, though in later years as he's been forced to confront more situations that he could not control, he's benefited from CBT-type therapy that has helped him modify some of his thought patterns.  But he actively rejected this therapy and would never have done it had circumstances not essentially forced him to it. And despite the fact that he has become slightly less judgmental and rigid in his ideas about people and society as a result of years of therapy, that still all collapses when he gets anxious or angry, which is often. 

We can't change peoples' genetic predisposition to some viewpoints.  I guess we could set up society to completely marginalize them, but I think that is part of the cause of the current poisonous political environment...every subgroup is convinced they are being marginalized, which just makes them (us) more tribal.  Tribalism also appears to be hardwired into most humans, along with emotionally driven 'reasoning', which makes me very pessimistic about our future as a functioning democracy.

Yeah, my mother sounds just like your father except with a lot more saccharine added. The line about "parasites" though is what jumps out at me the most. She says the same thing all the time, yet she happily collects her city pension (inflation adjusted to boot!), SS, and Medicare. One of my two brothers is also of the same mold. But how do we marginalize our own mothers and brothers? My other brother, very liberal school teacher, has basically disowned the conservative brother and verbally berates our mother to the point of tears. So, she just shuts herself away and festers on Sean Hannity while waiting to vote for the next most outrageous douche bag the right can dream up.
« Last Edit: July 04, 2018, 09:35:09 AM by LAGuy »

wenchsenior

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Re: What comes after the ACA?
« Reply #4472 on: July 04, 2018, 12:40:41 PM »
I think if toganet's info is accurate (and my experience jives with it), then we can't really 'push them to the margins' b/c it's a relatively common way for people to be 'wired' and that isn't very easy to change.  Again, based only on my own anecdotal info, e.g., my father is extremely anxiety-driven in his world view.  He views anything new or uncontrollable as threatening and I think that plays heavily into how his political views were shaped.  That's fairly hard-wired, though in later years as he's been forced to confront more situations that he could not control, he's benefited from CBT-type therapy that has helped him modify some of his thought patterns.  But he actively rejected this therapy and would never have done it had circumstances not essentially forced him to it. And despite the fact that he has become slightly less judgmental and rigid in his ideas about people and society as a result of years of therapy, that still all collapses when he gets anxious or angry, which is often. 

We can't change peoples' genetic predisposition to some viewpoints.  I guess we could set up society to completely marginalize them, but I think that is part of the cause of the current poisonous political environment...every subgroup is convinced they are being marginalized, which just makes them (us) more tribal.  Tribalism also appears to be hardwired into most humans, along with emotionally driven 'reasoning', which makes me very pessimistic about our future as a functioning democracy.

Yeah, my mother sounds just like your father except with a lot more saccharine added. The line about "parasites" though is what jumps out at me the most. She says the same thing all the time, yet she happily collects her city pension (inflation adjusted to boot!), SS, and Medicare. One of my two brothers is also of the same mold. But how do we marginalize our own mothers and brothers? My other brother, very liberal school teacher, has basically disowned the conservative brother and verbally berates our mother to the point of tears. So, she just shuts herself away and festers on Sean Hannity while waiting to vote for the next most outrageous douche bag the right can dream up.

Another interesting book looking at this topic (psychology of political viewpoint) is The Righteous Mind, by Johnathan Haidt.  Definitely worth a read.

I'm always interested in how 'plastic' one's political leanings are, given that some of them seem to be hard-wired.

I seem to be able to trace my own political leanings (center or center-left) to a very particular compromise between my instinctive 'wiring' and my life experiences, and this seems to fit also with the links provided by toganet's post above.  My instinct is to view people in general as, if not actively dangerous, at least essentially self-serving and somewhat disturbing or inexplicable in their behavior until I am proven otherwise/get to know them.  Generally speaking, I'm wired for mild pessimism about the future (in the last 15 years has turned into raging pessimism), and was prone to anxiety over unpredictable or uncontrollable situations (though perversely, as my pessimism has grown, my ability to defuse my anxiety has dramatically improved). 

These traits seem to have been present from birth and probably mostly inherited from my father, but they were probably reinforced by my social difficulties up through the middle of  high school.  Also, my wariness seems almost entirely centered on people, especially their behavior when in groups.  I have no such instinctive distrust of the broader non-human-related world, which I find endlessly fascinating and compelling. 

However, I have some traits and experiences that seem to have strongly counter-weighted what was likely an inborn tendency to conservatism. I'm not religious (got highly suspicious of it around age 12, though I had nothing but positive personal experience with religion/religious people as a kid).  I moved away from the small, thoroughly white town I grew up in and lived in multiple locations all over the country (including a border city with tons of legal and illegal immigrants), traveled a fair amount, made a lot of friends from other countries, and got a bs and ms in science.  Whereas most of the conservatives I knew only left their towns or states of origin for college, did not travel as much, got degrees in business or similar, and then immediately returned to their home town, home state, or a nearly culturally identical neighboring state to live. 

These experiences I think pushed me to be more empathetic to a much larger and more diverse 'social circle', to understand human social behavior through the lens of science (so that it was at least explicable, if not always relatable).  My adult world view matches many of the characteristics listed as liberal in the link below.  I assume the reason I identify as center left is b/c I don't share ALL of those characteristics.  On the other hand, I share almost none of the conservative characteristics, other than viewing the 'human' world as generally dysfunctional and threatening.  https://www.psychologytoday.com/us/blog/the-human-beast/201210/why-liberal-hearts-bleed-and-conservatives-dont
« Last Edit: July 04, 2018, 12:48:41 PM by wenchsenior »

swampwiz

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Re: What comes after the ACA?
« Reply #4473 on: July 05, 2018, 12:31:15 PM »
Dreamfire:
Quote
Check out the previous page of this thread - same thing was questioned there.

Toganet almost phrased it exactly like I did.  I didn't like the answers though.  Not saying they aren't right.  I just don't understand them.  Today's Republicans are not like Nixon, Eisenhower, Teddy Roosevelt or even McCain.  I can't figure those guys out.  They are there as public servants, but seem to only serve "their" public.

There is truly a faction of the conservatives and libertarians (e.g., much of my father's family and my father) were/are in this group, that come from some privilege (if not actual wealth, very comfortable money with a large financial safety net) that truly are repulsed by poor people b/c they think they are morally inferior and completely responsible for every bad thing that happens to them.  This includes the fact that they cannot afford insurance under the pre ACA system.  It's their own fault and a sign that they are inferior.  If they were 'worthy', they would be working at jobs that offered insurance, or would sacrifice whatever it took to pay for private insurance.

They also object to the entire concept of Social Security/Medicare/Medicaid for the same reasons.  People who can't pay for all those things are 'parasites on hard working people'.  I've actually heard my father say this sort of thing lots of times, and he has trouble understanding how big an advantage he had coming from an upper middle class professional family that paid for his first car, paid for his college, and could bail him out financially early in his life when he nearly flunked out and also made a couple of other very dumb decisions.  One of  his younger sisters was born developmentally disabled AND has epilepsy, and he regards her as 'gross and lazy' even though she did work a state-subsidized job for developmentally disabled for many years. But she's overweight (which he views as a total flaw of character) and has an affect in talking etc that just repulses him.

What's interesting is my father is not a sociopath, but there is this complete barrier to feeling empathy toward anyone or anything that causes him to feel consistently negative emotions. My working theory about this is that he was conditioned to these beliefs by his father, and also that he's so afraid of poverty, obesity, failing at business (he was a very successful business owner), ill health, what have you in himself that he can't process it except by believing all those things are 99% under his own control and that b/c they haven't happened to him, it's evidence that he is 'superior' to most other people.  However, he isn't a sociopath or anything.  He's extremely loving and can be very generous toward people that he deems 'worthy'.  But he just has very narrow categories of what kind of person is 'worthy'.   

Interestingly, he himself was without insurance (through laziness/lack of attention) when I was born under emergency circumstances that resulted in a week of intensive care afterward for me and surgery for my mom. This event would have destroyed his financial life had his own father (who has the same world view but who handily owned an insurance company) not stepped in and rescued him by retroactively providing him with insurance.

I've seen similar reasoning in a lot of the conservatives on that side of the family.

Interestingly, my father's opinion about the evils of SS and Medicare changed a lot when his super healthy, youthful, super fit second wife got cancer at a time in the 1990s when they had to self insure b/c of early retirement.  They had money, but it was a huge drain on their finances to self insure then and afterward with cancer as a preexisting condition.  All of a sudden, he began to not be so conservative about health care issues.  And now that he's relying heavily on SS and Medicare and definitely needs it (not being nearly as financially well off as he always assumed he would be), he supports keeping those policies.  But again, he views himself as a good person who paid into those and is worthy of using of them, unlike all those he deems as freeloaders.

As hard as it is to grasp, I really think there's a subset of people that have this weirdly warped world view.  They think of themselves as good, moral, and compassionate.  Some of them post on this board.  Paul Ryan would be a great example of this, as well.  I really think that this subgroup would be pretty much fine with poor people dying of curable illnesses if they couldn't afford care.

Screw them. I mean it. We as a society have to push these people to the margins where they belong and implement policies that actually help most of the people most of the time.

*** THIS ***

EnjoyIt

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Re: What comes after the ACA?
« Reply #4474 on: July 05, 2018, 01:32:07 PM »
Dreamfire:
Quote
Check out the previous page of this thread - same thing was questioned there.

Toganet almost phrased it exactly like I did.  I didn't like the answers though.  Not saying they aren't right.  I just don't understand them.  Today's Republicans are not like Nixon, Eisenhower, Teddy Roosevelt or even McCain.  I can't figure those guys out.  They are there as public servants, but seem to only serve "their" public.

There is truly a faction of the conservatives and libertarians (e.g., much of my father's family and my father) were/are in this group, that come from some privilege (if not actual wealth, very comfortable money with a large financial safety net) that truly are repulsed by poor people b/c they think they are morally inferior and completely responsible for every bad thing that happens to them.  This includes the fact that they cannot afford insurance under the pre ACA system.  It's their own fault and a sign that they are inferior.  If they were 'worthy', they would be working at jobs that offered insurance, or would sacrifice whatever it took to pay for private insurance.

They also object to the entire concept of Social Security/Medicare/Medicaid for the same reasons.  People who can't pay for all those things are 'parasites on hard working people'.  I've actually heard my father say this sort of thing lots of times, and he has trouble understanding how big an advantage he had coming from an upper middle class professional family that paid for his first car, paid for his college, and could bail him out financially early in his life when he nearly flunked out and also made a couple of other very dumb decisions.  One of  his younger sisters was born developmentally disabled AND has epilepsy, and he regards her as 'gross and lazy' even though she did work a state-subsidized job for developmentally disabled for many years. But she's overweight (which he views as a total flaw of character) and has an affect in talking etc that just repulses him.

What's interesting is my father is not a sociopath, but there is this complete barrier to feeling empathy toward anyone or anything that causes him to feel consistently negative emotions. My working theory about this is that he was conditioned to these beliefs by his father, and also that he's so afraid of poverty, obesity, failing at business (he was a very successful business owner), ill health, what have you in himself that he can't process it except by believing all those things are 99% under his own control and that b/c they haven't happened to him, it's evidence that he is 'superior' to most other people.  However, he isn't a sociopath or anything.  He's extremely loving and can be very generous toward people that he deems 'worthy'.  But he just has very narrow categories of what kind of person is 'worthy'.   

Interestingly, he himself was without insurance (through laziness/lack of attention) when I was born under emergency circumstances that resulted in a week of intensive care afterward for me and surgery for my mom. This event would have destroyed his financial life had his own father (who has the same world view but who handily owned an insurance company) not stepped in and rescued him by retroactively providing him with insurance.

I've seen similar reasoning in a lot of the conservatives on that side of the family.

Interestingly, my father's opinion about the evils of SS and Medicare changed a lot when his super healthy, youthful, super fit second wife got cancer at a time in the 1990s when they had to self insure b/c of early retirement.  They had money, but it was a huge drain on their finances to self insure then and afterward with cancer as a preexisting condition.  All of a sudden, he began to not be so conservative about health care issues.  And now that he's relying heavily on SS and Medicare and definitely needs it (not being nearly as financially well off as he always assumed he would be), he supports keeping those policies.  But again, he views himself as a good person who paid into those and is worthy of using of them, unlike all those he deems as freeloaders.

As hard as it is to grasp, I really think there's a subset of people that have this weirdly warped world view.  They think of themselves as good, moral, and compassionate.  Some of them post on this board.  Paul Ryan would be a great example of this, as well.  I really think that this subgroup would be pretty much fine with poor people dying of curable illnesses if they couldn't afford care.

Screw them. I mean it. We as a society have to push these people to the margins where they belong and implement policies that actually help most of the people most of the time.

*** THIS ***

I generally try and stay away from this thread but am curious on some opinions.  Just to make things clear about me, I am socially liberal but lean fiscally conservative which at times pits my views and beliefs against each other.  So here is my question in several parts:

Which people get help such as free stuff to make their lives better? Do we help just the citizens in our country or do we help immigrants legal and illegal alike?  What about neighboring countries?  What about the 3 billion poor people in the whole world? How much help do we give them?  Basic nutrition/shelter/medicine or do we provide fresh meats, fruits and veggies, large apartments, concierge health care?  Do we give them free smart phones and internet? what about free cars?  And lastly who will pay for all this stuff? Is it just the top 1% of the world or the top 10% (which would include every American BTW.) Also how much should each person pay? 

You see I think those questions are very very difficult to answer because we can't provide the good life for every person on this planet.  there just isn't enough money to go around.  Therefor we need to have some fiscal responsibility in how we spend and where we spend it.  Me personally I have created my line which gets a little blurry at times.

BTW, people are dying of easily curable diseases in the world every day.  It sucks but the people and resources that are needed to help them all is astronomical.  I would be happy if we can take care of Americans to start with and I am not including or excluding immigrants in that comment so as to not create a needless alternate discussion.

protostache

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Re: What comes after the ACA?
« Reply #4475 on: July 05, 2018, 02:02:19 PM »
I generally try and stay away from this thread but am curious on some opinions.  Just to make things clear about me, I am socially liberal but lean fiscally conservative which at times pits my views and beliefs against each other.  So here is my question in several parts:

Which people get help such as free stuff to make their lives better? Do we help just the citizens in our country or do we help immigrants legal and illegal alike?  What about neighboring countries?  What about the 3 billion poor people in the whole world? How much help do we give them?  Basic nutrition/shelter/medicine or do we provide fresh meats, fruits and veggies, large apartments, concierge health care?  Do we give them free smart phones and internet? what about free cars?  And lastly who will pay for all this stuff? Is it just the top 1% of the world or the top 10% (which would include every American BTW.) Also how much should each person pay? 

You see I think those questions are very very difficult to answer because we can't provide the good life for every person on this planet.  there just isn't enough money to go around.  Therefor we need to have some fiscal responsibility in how we spend and where we spend it.  Me personally I have created my line which gets a little blurry at times.

BTW, people are dying of easily curable diseases in the world every day.  It sucks but the people and resources that are needed to help them all is astronomical.  I would be happy if we can take care of Americans to start with and I am not including or excluding immigrants in that comment so as to not create a needless alternate discussion.

This is a strawman argument and I'm not going to get dragged back into it in this 90 page thread.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4476 on: July 05, 2018, 03:51:28 PM »
I generally try and stay away from this thread but am curious on some opinions.  Just to make things clear about me, I am socially liberal but lean fiscally conservative which at times pits my views and beliefs against each other.  So here is my question in several parts:

Which people get help such as free stuff to make their lives better? Do we help just the citizens in our country or do we help immigrants legal and illegal alike?  What about neighboring countries?  What about the 3 billion poor people in the whole world? How much help do we give them?  Basic nutrition/shelter/medicine or do we provide fresh meats, fruits and veggies, large apartments, concierge health care?  Do we give them free smart phones and internet? what about free cars?  And lastly who will pay for all this stuff? Is it just the top 1% of the world or the top 10% (which would include every American BTW.) Also how much should each person pay? 

You see I think those questions are very very difficult to answer because we can't provide the good life for every person on this planet.  there just isn't enough money to go around.  Therefor we need to have some fiscal responsibility in how we spend and where we spend it.  Me personally I have created my line which gets a little blurry at times.

BTW, people are dying of easily curable diseases in the world every day.  It sucks but the people and resources that are needed to help them all is astronomical.  I would be happy if we can take care of Americans to start with and I am not including or excluding immigrants in that comment so as to not create a needless alternate discussion.

This is a strawman argument and I'm not going to get dragged back into it in this 90 page thread.

You are probably right but I am not trying to make a strawman.  Just saying we need to decide where the line is which is extremely hard to do because we all have differing views on the subject including those with similar political views. Some are willing to spend everything they have while others don't give a damn about anyone but themselves and their immediate circle. 

pecunia

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Re: What comes after the ACA?
« Reply #4477 on: July 05, 2018, 09:02:10 PM »
Enjoyit:
Quote
BTW, people are dying of easily curable diseases in the world every day.  It sucks but the people and resources that are needed to help them all is astronomical.  I would be happy if we can take care of Americans to start with and I am not including or excluding immigrants in that comment so as to not create a needless alternate discussion.

Yes - because you can't fix everything do nothing.  You are right that is not the subject at hand?  What comes after the ACA is the subject that has been raised?

I guess you make the world a better place by one act at a time.  Fixing the ACA is one act that can make the United States a much better place.

Have non medical businesses been lobbying to fix the ACA?  Along with the rest of us, they have to battle rising premiums and this extra cost affects their ability to compete.  Perhaps this has been discussed previously in the many responses.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4478 on: July 05, 2018, 09:41:47 PM »
Enjoyit:
Quote
BTW, people are dying of easily curable diseases in the world every day.  It sucks but the people and resources that are needed to help them all is astronomical.  I would be happy if we can take care of Americans to start with and I am not including or excluding immigrants in that comment so as to not create a needless alternate discussion.

Yes - because you can't fix everything do nothing.  You are right that is not the subject at hand?  What comes after the ACA is the subject that has been raised?

I guess you make the world a better place by one act at a time.  Fixing the ACA is one act that can make the United States a much better place.

Have non medical businesses been lobbying to fix the ACA?  Along with the rest of us, they have to battle rising premiums and this extra cost affects their ability to compete.  Perhaps this has been discussed previously in the many responses.

I like the comment about making the world a better place one act at a time.

The ACA is drowning from high premiums and now defunding via elimination of the mandate. It would be nice to see some positive changes in the law that can provide low cost healthcare to as many people as possible. Hopefully we can enact some changes that help cut regulations and help lower the cost of delivery.

toganet

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Re: What comes after the ACA?
« Reply #4479 on: July 06, 2018, 09:36:34 AM »
Enjoyit:
Quote
BTW, people are dying of easily curable diseases in the world every day.  It sucks but the people and resources that are needed to help them all is astronomical.  I would be happy if we can take care of Americans to start with and I am not including or excluding immigrants in that comment so as to not create a needless alternate discussion.

Yes - because you can't fix everything do nothing.  You are right that is not the subject at hand?  What comes after the ACA is the subject that has been raised?

I guess you make the world a better place by one act at a time.  Fixing the ACA is one act that can make the United States a much better place.

Have non medical businesses been lobbying to fix the ACA?  Along with the rest of us, they have to battle rising premiums and this extra cost affects their ability to compete.  Perhaps this has been discussed previously in the many responses.

I like the comment about making the world a better place one act at a time.

The ACA is drowning from high premiums and now defunding via elimination of the mandate. It would be nice to see some positive changes in the law that can provide low cost healthcare to as many people as possible. Hopefully we can enact some changes that help cut regulations and help lower the cost of delivery.

This is why I think that whatever comes next needs to include universal coverage for US citizens and legal, tax-paying immigrants.  One of the biggest mistakes this country made was framing SS, Medicare, etc. as a "social safety net" -- pitting those who pay into the system against those taking advantage of the services.  Countries like Sweden took care to avoid this by emphasizing the universality of the programs -- they benefit everyone in the country, not just those in need.  This defuses the us v. them, which is great -- but the wealthy in the US don't want to defuse that, they leverage it to maintain power.

Wexler

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Re: What comes after the ACA?
« Reply #4480 on: July 06, 2018, 10:13:39 AM »
Enjoyit:
Quote
BTW, people are dying of easily curable diseases in the world every day.  It sucks but the people and resources that are needed to help them all is astronomical.  I would be happy if we can take care of Americans to start with and I am not including or excluding immigrants in that comment so as to not create a needless alternate discussion.

Yes - because you can't fix everything do nothing.  You are right that is not the subject at hand?  What comes after the ACA is the subject that has been raised?

I guess you make the world a better place by one act at a time.  Fixing the ACA is one act that can make the United States a much better place.

Have non medical businesses been lobbying to fix the ACA?  Along with the rest of us, they have to battle rising premiums and this extra cost affects their ability to compete.  Perhaps this has been discussed previously in the many responses.

I like the comment about making the world a better place one act at a time.

The ACA is drowning from high premiums and now defunding via elimination of the mandate. It would be nice to see some positive changes in the law that can provide low cost healthcare to as many people as possible. Hopefully we can enact some changes that help cut regulations and help lower the cost of delivery.

EnjoyIt-I agree with you from the other side of the political spectrum.  The cost of health care is the third rail of public and private health care policy solutions.  It will have to be addressed at some point, and people in all fields of healthcare, from doctors to administrators to drug company employees who are now making a lot of money are going start making less money at some time in the future.   

If there are no technology disruptions that drive prices down, we will either revert to pre-ACA days where only some Americans get access to quality insurance as a matter of mostly luck with employment/marriage or we will see policy solutions that control prices. I fear we are headed towards the pre-ACA model, which is terrible for early retirement and for those with pre-existing conditions.


Paul der Krake

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Re: What comes after the ACA?
« Reply #4481 on: July 06, 2018, 10:21:11 AM »
This is why I think that whatever comes next needs to include universal coverage for US citizens and legal, tax-paying immigrants.  One of the biggest mistakes this country made was framing SS, Medicare, etc. as a "social safety net" -- pitting those who pay into the system against those taking advantage of the services.  Countries like Sweden took care to avoid this by emphasizing the universality of the programs -- they benefit everyone in the country, not just those in need.  This defuses the us v. them, which is great -- but the wealthy in the US don't want to defuse that, they leverage it to maintain power.
That sounds a lot like the ACA... guaranteed issue, financial assistance, available to everyone legally in the country.

bilmar

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Re: What comes after the ACA?
« Reply #4482 on: July 06, 2018, 10:41:05 AM »
Getting back to the original question, I suspect that our mediocre self-serving politicians of both parties will be unable to :

Learn from the rest of the world
Formulate a reasoned plan
Execute that plan


Further, I think it is a mistake to call this mess Health "insurance"  because this system is nothing like anything else we call insurance.

But, I do see some simple-to-execute changes that could really make a difference if the will is there:

1. Allow me to buy prescriptions from any approved pharmacy worldwide ( start with Canada) - this will cause drug prices to tumble.
2. Allow US Gov to negotiate drug prices - REQUIRING U.S. to pay full price is insane.
3. Require all medical service providers to publish a rate sheet and cap Insurance company discounts from the rate sheet to x% ( 20% ??) . MRI's don't cost $10K and a 5 min annual checkup with my dermatologist does not cost $400 so don't let them charge unreasonable prices that are passed around the system.

The comprehensive approach is the best way to fix this but doomed in my opinion due to the idiots in congress - more practical to tackle the cost generators first and only then go after the system.

Bill

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Re: What comes after the ACA?
« Reply #4483 on: July 06, 2018, 11:27:05 AM »
This is why I think that whatever comes next needs to include universal coverage for US citizens and legal, tax-paying immigrants.  One of the biggest mistakes this country made was framing SS, Medicare, etc. as a "social safety net" -- pitting those who pay into the system against those taking advantage of the services.  Countries like Sweden took care to avoid this by emphasizing the universality of the programs -- they benefit everyone in the country, not just those in need.  This defuses the us v. them, which is great -- but the wealthy in the US don't want to defuse that, they leverage it to maintain power.
That sounds a lot like the ACA... guaranteed issue, financial assistance, available to everyone legally in the country.

Exactly.  I would like to see the ACA stabilized before trying to implement anything that is supposedly better, that could take years, and won't happen in the current political climate.

jim555

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Re: What comes after the ACA?
« Reply #4484 on: July 06, 2018, 12:36:48 PM »
Republicans are saying if they hold the House they will make another attempt at whacking the ACA.  They will model it after the Graham-Cassidy crapola proposal that failed last time.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4485 on: July 06, 2018, 05:39:26 PM »
Republicans are saying if they hold the House they will make another attempt at whacking the ACA.  They will model it after the Graham-Cassidy crapola proposal that failed last time.
The dems and anyone who cares about people having healthcare need to get out and vote to make sure that doesn't happen.  There's already a lawsuit attempting to overturn ACA as unconstitutional now that the penalty for not complying with the mandate has been eliminated.  And the justice dept. will not defend the ACA in the lawsuit.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4486 on: July 06, 2018, 10:39:02 PM »
Getting back to the original question, I suspect that our mediocre self-serving politicians of both parties will be unable to :

Learn from the rest of the world
Formulate a reasoned plan
Execute that plan


Further, I think it is a mistake to call this mess Health "insurance"  because this system is nothing like anything else we call insurance.

But, I do see some simple-to-execute changes that could really make a difference if the will is there:

1. Allow me to buy prescriptions from any approved pharmacy worldwide ( start with Canada) - this will cause drug prices to tumble.
2. Allow US Gov to negotiate drug prices - REQUIRING U.S. to pay full price is insane.
3. Require all medical service providers to publish a rate sheet and cap Insurance company discounts from the rate sheet to x% ( 20% ??) . MRI's don't cost $10K and a 5 min annual checkup with my dermatologist does not cost $400 so don't let them charge unreasonable prices that are passed around the system.

The comprehensive approach is the best way to fix this but doomed in my opinion due to the idiots in congress - more practical to tackle the cost generators first and only then go after the system.

Bill

Great ideas up there.  Until we deal with the cost it makes no difference what proposal is out there.  Someone will have to pay the exorbitant price.  Outside of the pre-existing condition clause I believe the ACA is pretty much dead.

TrudgingAlong

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Re: What comes after the ACA?
« Reply #4487 on: July 07, 2018, 12:00:32 AM »
While much if the criticism of politicians in this healthcare debacle is well deserved, I’m ceaselessly amazed at the resistance of regular Americans being fucked over with this to still insist our “private” system is so much better than any public system anyone else has. I have amazing government healthcare. From the US government. The military system is pretty much the closest thing we have to a government-run healthcare system. I love it. Every time I express my support of some sort of single payer system DUE TO MY OWN EXPERIENCE, people scofff and insist there’s no way it can be done.

 At this point, the only reason I pay attention is because we have kids who will age out of our coverage. I can only hope the will of the people to not be willingly fucked over changes by then...

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #4488 on: July 07, 2018, 12:03:03 AM »
Getting back to the original question, I suspect that our mediocre self-serving politicians of both parties will be unable to :

Learn from the rest of the world
Formulate a reasoned plan
Execute that plan


Further, I think it is a mistake to call this mess Health "insurance"  because this system is nothing like anything else we call insurance.

But, I do see some simple-to-execute changes that could really make a difference if the will is there:

1. Allow me to buy prescriptions from any approved pharmacy worldwide ( start with Canada) - this will cause drug prices to tumble.
2. Allow US Gov to negotiate drug prices - REQUIRING U.S. to pay full price is insane.
3. Require all medical service providers to publish a rate sheet and cap Insurance company discounts from the rate sheet to x% ( 20% ??) . MRI's don't cost $10K and a 5 min annual checkup with my dermatologist does not cost $400 so don't let them charge unreasonable prices that are passed around the system.

The comprehensive approach is the best way to fix this but doomed in my opinion due to the idiots in congress - more practical to tackle the cost generators first and only then go after the system.

Bill

Great ideas up there.  Until we deal with the cost it makes no difference what proposal is out there.  Someone will have to pay the exorbitant price.  Outside of the pre-existing condition clause I believe the ACA is pretty much dead.

So then what comes after the ACA?  People actually not being stabilized in the public hospital?  The cost is just so high, we have to start dealing with folks that can't pay just die in the waiting room?  Seriously, what are your great ideas or what do you hope replaces the ACA?
Transitioning to FIRE'd albeit somewhat cautiously...

EnjoyIt

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Re: What comes after the ACA?
« Reply #4489 on: July 07, 2018, 12:54:09 AM »
Getting back to the original question, I suspect that our mediocre self-serving politicians of both parties will be unable to :

Learn from the rest of the world
Formulate a reasoned plan
Execute that plan


Further, I think it is a mistake to call this mess Health "insurance"  because this system is nothing like anything else we call insurance.

But, I do see some simple-to-execute changes that could really make a difference if the will is there:

1. Allow me to buy prescriptions from any approved pharmacy worldwide ( start with Canada) - this will cause drug prices to tumble.
2. Allow US Gov to negotiate drug prices - REQUIRING U.S. to pay full price is insane.
3. Require all medical service providers to publish a rate sheet and cap Insurance company discounts from the rate sheet to x% ( 20% ??) . MRI's don't cost $10K and a 5 min annual checkup with my dermatologist does not cost $400 so don't let them charge unreasonable prices that are passed around the system.

The comprehensive approach is the best way to fix this but doomed in my opinion due to the idiots in congress - more practical to tackle the cost generators first and only then go after the system.

Bill

Great ideas up there.  Until we deal with the cost it makes no difference what proposal is out there.  Someone will have to pay the exorbitant price.  Outside of the pre-existing condition clause I believe the ACA is pretty much dead.

So then what comes after the ACA?  People actually not being stabilized in the public hospital?  The cost is just so high, we have to start dealing with folks that can't pay just die in the waiting room?  Seriously, what are your great ideas or what do you hope replaces the ACA?

What I think is the answer and what I think will happen are two very different things and I will address them both.

In the US I think the best solution is that the country provides cheap, rationed healthcare to all citizens, immigrants, and Visa holders.  The healthcare must not be fancy using the latest most expensive drugs or cutting edge technology but proven generic medication and more standard lower cost therapies.  No private rooms in hospitals but 2-4 person shared rooms. Lines for seeing the physician and having a procedure done that is not an emergency.  No heroic or expensive procedures to keep those with minimal to no brain function alive for as long as possible.  Decreased regulations and bureaucracy to help cut costs.  Tort reform to mitigate the risk of law suites for bad outcomes despite following reasonable standard of care practices. Negotiated prices with pharmaceutical and tech companies. Basically good effective low cost healthcare to all.  On top of this system people can pay out of pocket for amenities or more expensive cutting edge procedures. Since this will be out of pocket there will be market pressures to make those amenities affordable so that those who can afford it will choose to do so. Basically this is a healthcare safety net for everyone.  Until we address the cost, no insurance based law will ever fix the problem. 

Personally I think healthcare in the US is very bleak.  What I think will actually happen is that the ACA will fail in the next few years leaving behind the clause regarding pre-existing conditions.  In its place will be the insurance model we saw prior to the ACA only more expensive because it must now cover those pre-existing conditions.  Over the years insurance premiums and healthcare costs will continue to rise until a very large portion of the population will be unable to afford to pay for it. At that point our politicians will be forced to deal with the issue or get voted out.  This timeframe can be hastened by another large recession. Recessions are a time of crisis and a good time for politicians to try and push ideas both good and bad.  People in financial straights will vote for change as they usually do.

BTW, the way you write your question is based on fear mongering of people dying in the streets or not stabilizing people's medical conditions which is ridiculous.  EMTALA has been around way longer than the ACA and I highly doubt it is going anywhere.  But, since you brought it up the definition of stabilizing is changing. As the law currently stands, someone shows up to the hospital with complaint but does not need immediate testing and therapy is actually stable and insurance companies are threatening to not pay for any testing or medication given in the ER. If this continues, these patients are going to be turned away to receive healthcare elsewhere. The days of "just go to the ER" are numbered.

sol

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Re: What comes after the ACA?
« Reply #4490 on: July 07, 2018, 09:05:11 AM »
I believe the ACA is pretty much dead.

Why do you think it's dead? 

It's still the law.  The party that has been trying to deconstruct it failed multiple times, and now looks poised to lose power.  The exchanges are adding insurers, coverage is at an all time high, and subsidies are still being paid.  Why all the doom and gloom?  Just because some pol on the campaign trail used an applause line about repeal and replace?

News coverage about healthcare exchanges adding insurers this year:
 https://www.cnn.com/2018/07/06/politics/obamacare-insurers/index.html

chasesfish

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Re: What comes after the ACA?
« Reply #4491 on: July 07, 2018, 10:53:06 AM »
Sol - My only "doom and gloom" is having only one captive insurer with a very small network where I want to domicile my address.  The penalty needs to be real and enforced (a both party problem)
Check out our journal, counting down the days until I Stop Ironing Shirts

We hit $1mil by 33 and will retire at 36!  Stop by over at my site Stop Ironing Shirts

wenchsenior

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Re: What comes after the ACA?
« Reply #4492 on: July 07, 2018, 11:29:47 AM »
The future of the ACA or (probably) any single payer option will likely hinge on whether RGB or Breyer die during Trump's tenure.   The court is already going to be more conservative than in ~1 century with this next pick.  If Trump gets one more conservative on the Court, most of the landmark liberal legislation of the past 100 years is going to go in the dumpster. 

Also, for any youngish people on this board who can't believe the health care 'problem' of spiraling costs won't be solved in the next few years, keep in mind that costs began spiraling in the early 1980s, but it took close to 30 years of misery before any legislation was passed that tried to address the issue.  I suspect that simply expanding Medicare as a public option for everyone will be the eventual fix, but I also wouldn't be shocked if it took another 10-15 years to make that happen.

bacchi

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Re: What comes after the ACA?
« Reply #4493 on: July 07, 2018, 03:07:26 PM »
Quote
The Trump administration announced Saturday that it will temporarily halt billions of dollars in payments under the Affordable Care Act's risk adjustment program, a move that could shake up insurance markets.

https://www.cnn.com/2018/07/07/politics/wsj-aca-risk-adjustment/index.html

It'll be "temporary" until another lawsuit forces the money loose. That is, it'll take years and, meanwhile, premiums will rise.

BuildingFrugalHabits

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Re: What comes after the ACA?
« Reply #4494 on: July 07, 2018, 04:18:43 PM »
The future of the ACA or (probably) any single payer option will likely hinge on whether RGB or Breyer die during Trump's tenure.   The court is already going to be more conservative than in ~1 century with this next pick.  If Trump gets one more conservative on the Court, most of the landmark liberal legislation of the past 100 years is going to go in the dumpster. 

Also, for any youngish people on this board who can't believe the health care 'problem' of spiraling costs won't be solved in the next few years, keep in mind that costs began spiraling in the early 1980s, but it took close to 30 years of misery before any legislation was passed that tried to address the issue.  I suspect that simply expanding Medicare as a public option for everyone will be the eventual fix, but I also wouldn't be shocked if it took another 10-15 years to make that happen.

As long as we are making predictions, I can see there being a Trump-lash at the midterms and the next presidential election cycle as he runs the party into the ground.  Republicans are finding themselves having to defend policy (and behavior) that is so at odds with the general public's views and interest that the pendulum will quickly swing the other way opening the door for medicare for all which already polls very well.  The biggest irony being that the ACA was based on a conservative, market-based solution as opposed to single payer universal which should have made both sides reasonably happy.  I think it speaks volumes about the politics of our country that both parties can't find a way to cooperate, fix it, and implement some reasonable measures for cost control. 

pecunia

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Re: What comes after the ACA?
« Reply #4495 on: July 07, 2018, 07:29:02 PM »
The history of this is kind of interesting.  They've been talking about helping people with their medical needs since Teddy Roosevelt.

https://en.wikipedia.org/wiki/History_of_health_care_reform_in_the_United_States

Maybe the Republicans will run a guy like Teddy the next time around.  He was a bit warlike and they like that, but he also wanted to help people and kept big business in line.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4496 on: July 07, 2018, 09:12:42 PM »

Medicare for all?  Unfortunately, Medicare can still be expensive for decent coverage.  If you get plan A, B, D, and supplemental to cover everything else, someone posted earlier in this thread it was costing over $900/mo.  Medicare doesn't mean you get everything for free.

https://forum.mrmoneymustache.com/welcome-to-the-forum/what-comes-after-the-aca/msg2036422/#msg2036422


EnjoyIt

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Re: What comes after the ACA?
« Reply #4498 on: July 07, 2018, 10:29:39 PM »
I believe the ACA is pretty much dead.

Why do you think it's dead? 

It's still the law.  The party that has been trying to deconstruct it failed multiple times, and now looks poised to lose power.  The exchanges are adding insurers, coverage is at an all time high, and subsidies are still being paid.  Why all the doom and gloom?  Just because some pol on the campaign trail used an applause line about repeal and replace?

News coverage about healthcare exchanges adding insurers this year:
 https://www.cnn.com/2018/07/06/politics/obamacare-insurers/index.html

Maybe I should rephrase from dead to dying and will die in the future.  I just don't see any positive rhetoric that is improving healthcare in this country.  Having  more people on the exchange does not equal improved healthcare or a decrease in the cost of healthcare as a whole.  I think we often confuse healthcare and cost with the word insurance and they are not synonymous. 

Selfishly, I am thrilled the individual mandate is removed so that we can finally buy the insurance that we need as opposed to the garbage forced on me. Of note, last few years not a single ACA plan I had access to had a decent surgeon or specialist on their list.  I can deal with a suboptimal primary care doctor since I can make sure they do the right thing.  But if I need surgery I have no control while under the knife.

Anyways, less people above 400% poverty level that go off the exchange will raise the cost of exchange products not for the poor or the lower middle class but for everyone else.  As the price keeps going up it will price the middle class out forcing them to look for other alternatives.  We have to remember that most of the middle class does not max their 401k and HSA decreasing their AGI to 400% of poverty and they pay through the nose particularly on pre-deductible expenses.  Some state will enforce the individual mandate which will prolong the time of the ACA demise or force citizens into states with a lower cost of living.

sixwings

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Re: What comes after the ACA?
« Reply #4499 on: July 08, 2018, 12:05:03 AM »
Realistically if you want to fix ACA/healthcare, the corruption problem has to be addressed. The pharma and insurance lobbies are so powerful after citizens united that any meaningful reform isnt going to happen until that power gets taken away. With what's looking like a conservative supreme for the next 20+ years, that's not going to happen. It'll likely revert back to pre-ACA days.
« Last Edit: July 08, 2018, 12:06:38 AM by sixwings »