Author Topic: What comes after the ACA?  (Read 303417 times)

Warhead

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Re: What comes after the ACA?
« Reply #50 on: January 07, 2017, 06:02:23 PM »
One thing I love to bring up when anyone wants to defend the United states way of doing health care is the fact we are

#1 in health care spending while only being #31 in life expectancy.


2015 numbers

USA $9451.00 per person - Life expectancy 79.3

And how bout comparing that to our good buddy Canada

Canada $4608 per person - Life expectancy 82.2

Its stupidly obvious shit aint working in the USA. And Obamacare was merely the band aid over the gunshot wound. Nuke the whole united states healthcare system from orbit (but have a replacement system ready to go of course, Obviously easier said than done but it NEEDS to happen)

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

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

I would also LOVE to hear from people who had cheap non employer health insurance before obamacare and actually USED it for major events (cancer, heart surgery, etc)

I constantly hear people bitching their plan was so cheap before Obamacare yet they never actually USED it so they did not get to see that it didn't actually cover anything.
« Last Edit: January 07, 2017, 06:15:44 PM by Warhead »

bacchi

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Re: What comes after the ACA?
« Reply #51 on: January 07, 2017, 06:05:39 PM »
We want to be free to spend 2x as much as our neighbor and 30% over the second highest per capita spending OECD country (Switzerland) and STILL get worse results.

What do you have against freedom, commie?

Quidnon?

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Re: What comes after the ACA?
« Reply #52 on: January 07, 2017, 06:09:28 PM »

Its stupidly obvious shit aint working in USA. And Obamacare was merely the band aid over the gunshot wound. Much much more needs to be done and fast.


I love this one, and it is so true.  The problem that I see is that, like Obamacare, a band-aid over a gunshot wound was entirely the wrong thing to do, and it wasted both resources and time in the doing. 
"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."
~ Frederic Bastiat

Quidnon?

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Re: What comes after the ACA?
« Reply #53 on: January 07, 2017, 06:11:55 PM »
I am particularly worried about Medicaid- I think one of the largest ( if not largest) uses for Medicaid is nursing home care after assets are exhausted.

This is true.
"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."
~ Frederic Bastiat

protostache

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Re: What comes after the ACA?
« Reply #54 on: January 07, 2017, 06:15:08 PM »

Quote
If we revoke guaranteed issue, lots of people who want insurance will be unable to get it, at any price.  For now, Republicans are publicly saying they DON'T want this to happen, despite it being their official written policy.

<sigh> This is false, as I have shown in many ways before.  I am not going to repeat myself in full, but in short, there were solutions to these problems before ACA.

<sigh> This is false, as has been shown before. I'm not going to repeat others but, in short, there weren't what anyone sane would call solutions to these problems before ACA.

Before ACA, if you lost your job because you were throwing up from cancer and couldn't go to work, you could go on COBRA.

Before ACA, if you got cancer and had an individual policy (you didn't work at a corporation that provided a group plan), you could be rescinded.

After COBRA/rescission, you could apply and apply and NO MONEY would give you a policy. You could call and offer thousands a month (if you had thousands a month to offer) and you wouldn't get a policy.

Unbelievably, these companies wouldn't take your money -- yeah, I offered lots of money, offered to sign an exclusionary rider, and got nada, zilch, nothing.

Then you could turn to the state health pools, after being denied several times. Ahh, but there's a waiting list. You don't just sign up and, 2 weeks later, get approved and start receiving benefits. The state has limited funds in its pool and doesn't accept every sick, sad, sack that turns up. You get in when, presumably, a previous insured person is planted 6 feet under. The premiums are also a multitude what regular premiums are for your age group.

It's not a solution anyone sane or civilized would create.

"Fuck you, you're sick" as a health policy is a cruel policy.

If you even lived in a state with a high risk pool to begin with! Only 35 states had them and some of them were extremely limited. At their height the state run high risk pools insured 200,000 people and cost states more than $2 billion a year even after their premiums, rated at up to 200% of the standard rate in some states. See this Kaiser brief for more details: http://kff.org/health-reform/issue-brief/high-risk-pools-for-uninsurable-individuals/

It's not that they can't work, but the effect is that everyone pays for these pools through their state and federal taxes, assuming the state has money and/or Congress feels like funding them that year.

Quidnon?

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Re: What comes after the ACA?
« Reply #55 on: January 07, 2017, 06:23:02 PM »

Quote
If we revoke guaranteed issue, lots of people who want insurance will be unable to get it, at any price.  For now, Republicans are publicly saying they DON'T want this to happen, despite it being their official written policy.

<sigh> This is false, as I have shown in many ways before.  I am not going to repeat myself in full, but in short, there were solutions to these problems before ACA.

<sigh> This is false, as has been shown before. I'm not going to repeat others but, in short, there weren't what anyone sane would call solutions to these problems before ACA.

Before ACA, if you lost your job because you were throwing up from cancer and couldn't go to work, you could go on COBRA.

Before ACA, if you got cancer and had an individual policy (you didn't work at a corporation that provided a group plan), you could be rescinded.

After COBRA/rescission, you could apply and apply and NO MONEY would give you a policy. You could call and offer thousands a month (if you had thousands a month to offer) and you wouldn't get a policy.

Unbelievably, these companies wouldn't take your money -- yeah, I offered lots of money, offered to sign an exclusionary rider, and got nada, zilch, nothing.

Then you could turn to the state health pools, after being denied several times. Ahh, but there's a waiting list. You don't just sign up and, 2 weeks later, get approved and start receiving benefits. The state has limited funds in its pool and doesn't accept every sick, sad, sack that turns up. You get in when, presumably, a previous insured person is planted 6 feet under. The premiums are also a multitude what regular premiums are for your age group.

It's not a solution anyone sane or civilized would create.

"Fuck you, you're sick" as a health policy is a cruel policy.

Perhaps, Bacchi.  Did this happen to you, or is this a hypothetical?  According to some, however, the situation has not materially improved since the ACA...
Quote
In New York, for instance, 250 cancer patients who were receiving treatment at Memorial Sloan Kettering Cancer Center nearly lost both their coverage and their provider when the Empire State’s co-op, Health Republic, announced last year it was shutting down after losing $130 million, stranding 100,000 New Yorkers without coverage. Of those 250 cancer patients, 114 — supposedly those undergoing active treatment at the time — were rescued by New York City taxpayers when the city’s public health system agreed to cover them through 2016.

The Tennessee co-op, Community Health Alliance, shut its door at the end of 2015, leaving about 27,000 Volunteer Staters without coverage and causing more red tape and anxiety for those in the midst of treatment. John Vickers of Knoxville, who was diagnosed with stage three colon cancer last year, told WATE-TV that the change of insurers has wreaked havoc on his course of treatment. Vickers said the co-op paid for his surgery in November, and he bought exchange coverage through United Healthcare because it seemed the best fit for his treatment and had Fort Sanders Regional Medical Center in its network. But after he ended up hospitalized in early January, he found out Fort Sanders wasn’t in his plan’s network after all.

“I’m sure that three day stay in the hospital is going to be expensive,” Vickers said. “I’ve got a $50,000 copay to meet.”

Vickers was later treated at his previous medical center under a special waiver, only to be told once again he wouldn’t be covered, costing him about $25,000 more. That’s “affordable” healthcare for you, courtesy of Uncle Sam.


http://www.thenewamerican.com/usnews/health-care/item/22569-cancer-and-obamacare-a-double-whammy
"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."
~ Frederic Bastiat

protostache

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Re: What comes after the ACA?
« Reply #56 on: January 07, 2017, 06:29:47 PM »

Quote
If we revoke guaranteed issue, lots of people who want insurance will be unable to get it, at any price.  For now, Republicans are publicly saying they DON'T want this to happen, despite it being their official written policy.

<sigh> This is false, as I have shown in many ways before.  I am not going to repeat myself in full, but in short, there were solutions to these problems before ACA.

<sigh> This is false, as has been shown before. I'm not going to repeat others but, in short, there weren't what anyone sane would call solutions to these problems before ACA.

Before ACA, if you lost your job because you were throwing up from cancer and couldn't go to work, you could go on COBRA.

Before ACA, if you got cancer and had an individual policy (you didn't work at a corporation that provided a group plan), you could be rescinded.

After COBRA/rescission, you could apply and apply and NO MONEY would give you a policy. You could call and offer thousands a month (if you had thousands a month to offer) and you wouldn't get a policy.

Unbelievably, these companies wouldn't take your money -- yeah, I offered lots of money, offered to sign an exclusionary rider, and got nada, zilch, nothing.

Then you could turn to the state health pools, after being denied several times. Ahh, but there's a waiting list. You don't just sign up and, 2 weeks later, get approved and start receiving benefits. The state has limited funds in its pool and doesn't accept every sick, sad, sack that turns up. You get in when, presumably, a previous insured person is planted 6 feet under. The premiums are also a multitude what regular premiums are for your age group.

It's not a solution anyone sane or civilized would create.

"Fuck you, you're sick" as a health policy is a cruel policy.

Perhaps, Bacchi.  Did this happen to you, or is this a hypothetical?  According to some, however, the situation has not materially improved since the ACA...
Quote
In New York, for instance, 250 cancer patients who were receiving treatment at Memorial Sloan Kettering Cancer Center nearly lost both their coverage and their provider when the Empire State’s co-op, Health Republic, announced last year it was shutting down after losing $130 million, stranding 100,000 New Yorkers without coverage. Of those 250 cancer patients, 114 — supposedly those undergoing active treatment at the time — were rescued by New York City taxpayers when the city’s public health system agreed to cover them through 2016.

The Tennessee co-op, Community Health Alliance, shut its door at the end of 2015, leaving about 27,000 Volunteer Staters without coverage and causing more red tape and anxiety for those in the midst of treatment. John Vickers of Knoxville, who was diagnosed with stage three colon cancer last year, told WATE-TV that the change of insurers has wreaked havoc on his course of treatment. Vickers said the co-op paid for his surgery in November, and he bought exchange coverage through United Healthcare because it seemed the best fit for his treatment and had Fort Sanders Regional Medical Center in its network. But after he ended up hospitalized in early January, he found out Fort Sanders wasn’t in his plan’s network after all.

“I’m sure that three day stay in the hospital is going to be expensive,” Vickers said. “I’ve got a $50,000 copay to meet.”

Vickers was later treated at his previous medical center under a special waiver, only to be told once again he wouldn’t be covered, costing him about $25,000 more. That’s “affordable” healthcare for you, courtesy of Uncle Sam.


http://www.thenewamerican.com/usnews/health-care/item/22569-cancer-and-obamacare-a-double-whammy

The co-ops failed across the country because the Federal government neglected to fund them as ACA promised. It wasn't because of any inherent flaw, it's because a GOP controlled congress refused to pass a budget that funded the promise they were built on.

Quidnon?

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Re: What comes after the ACA?
« Reply #57 on: January 07, 2017, 06:37:49 PM »

The co-ops failed across the country because the Federal government neglected to fund them as ACA promised. It wasn't because of any inherent flaw, it's because a GOP controlled congress refused to pass a budget that funded the promise they were built on.

I consider an economic system dependent upon unfunded promises to be inherently flawed already, even before we consider any other faults of the law.  The Democrats who pushed the ACA through congress (using reconciliation, btw; the same process that the Republicans are planning on using to dismantle it without threat of a filibuster) knew that the Republicans hated this law, and left those issues unfunded because they expected that once the system was up and running, the public pressure from those voters whom benefited would keep the Republicans from repealing or defunding the program.  Looks like they were wrong.
"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."
~ Frederic Bastiat

ysette9

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Re: What comes after the ACA?
« Reply #58 on: January 07, 2017, 08:09:35 PM »
The part that fascinates me in all of this ridiculous debate is how we seem to struggle mightily with these moral quandaries of taxing some folks to provide coverage for other folks and the idea of risk pools and whatnot. All of this while every other rich, industrialized country has figured this shit out years ago and gets better results for less money. It is like we are getting into crazy bar fights over whether to require catalytic converters on our gas-guzzling land yachts while the rest of the world is using hydrogen fuel cells or electric cars to get around. We do a lot of things great in this country but this is one of those topics that completely confuses me and makes me want to run to another country to hide among people who actually see the value in human decency and universal health.
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v8rx7guy

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Re: What comes after the ACA?
« Reply #59 on: January 07, 2017, 08:46:28 PM »
I think that if everyone had an HDHP and HSA's we will begin to make care providers have to be more competitive with their pricing.  When your average person knows they are paying for a procedure, medication, visit etc. with their HSA they shop around a bit bringing more pricing competition into the market and I believe that will make costs more reasonable over time.  I know for our family certainly shops around more and thinks things thru more often now that we are on an HDHP paying with our HSA.  Before there was essentially no thinking involved because we knew it would just be a small deductible.

Perhaps, but this falls apart in the case of an emergency (major accident, heart attack, stroke, etc.). No time to price shop in those scenarios.

This is true, but these are the very low risk, very high consequence events that true insurance is properly designed to deal with.  That is why a high-deductable health plan is a requirement for an HSA while contributing, to force the owner to have such a policy in order to benefit from the tax favorable savings vehicle.

Exacltly.  Put everyone on an HDHP like real "insurance" should be (a safety net).  And have people pay attention to where their ACTUAL money is going in terms of heath care costs.  Then, watch Americans start to pay attention to heath care and actually shop around a bit.  That keeps health care suppliers in check with competition and health care users in check with the funds they actually have available since they have real skin in the game.

I am looking forward to what the future brings for america!

Cpa Cat

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Re: What comes after the ACA?
« Reply #60 on: January 07, 2017, 09:01:38 PM »
If I were to guess, we'll see coverage for pre-existing conditions, provided you maintain some continuous term of coverage (probably 3 years) beforehand. Expanded HSAs. Non-refundable tax credits for premiums.

They'll drop some of the requirements like free birth control and maternity coverage and pediatric dental/vision.

The medicaid expansion won't get rescinded because the vote is too close and a couple of Republicans like it. In fact, it may get broadened and adopted by the Republican states that refused it initially. That way they can pretend they did something good for poor people with their Obamacare repeal.

The end result is that people too rich to get subsidies currently will laugh all the way to bank, people who fall in the gap between Medicaid and being able to pay for insurance outright will get screwed, W-2 employees will see few differences, insurance premiums will still rise because even with a 3 year continuous coverage provision, it'll be expensive to cover pre-existing conditions.

This is like the ACA deathpool. I kind of want to see how many of my predictions come true!

calimom

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Re: What comes after the ACA?
« Reply #61 on: January 07, 2017, 09:49:49 PM »
These poor idiots. They voted against their own interest, which is funny for people who only have their own self interests at the top of their lists. They didn't want a smart sassy woman telling them what to do. Even though she knew better than what they did as to what they needed. Confounding!



Paul der Krake

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Re: What comes after the ACA?
« Reply #62 on: January 07, 2017, 10:16:55 PM »
Trigger warning: profanity ladden post below- you've been warned

Exacltly.  Put everyone on an HDHP like real "insurance" should be (a safety net).  And have people pay attention to where their ACTUAL money is going in terms of heath care costs.  Then, watch Americans start to pay attention to heath care and actually shop around a bit.  That keeps health care suppliers in check with competition and health care users in check with the funds they actually have available since they have real skin in the game.

This idea of people having "skin in the game" in order to reduce medical costs is popular, but there's almost no evidence to back up that it works.
For example, just a random recent study looking at individual behavior:
"They found that even when people were responsible for more of their health costs, they weren’t more likely to consider cost or shop around for the best deal on medical treatments."

And an analysis of amount of "skin in the game" across different countries: http://theincidentaleconomist.com/wordpress/skin-in-the-game/
American's pay more out of pocket than other countries, but have higher healthcare costs.

I like the idea that the market will fix our healthcare problems as much as anyone else. But it's not hard to find arguments why market failures show up so readily in healthcare

I think the big ones are the information asymmetry and also the nature and often time sensitiveness of the product being delivered. If your child fell and hit their head, the first doctor you saw says the smartest thing to do would be a CT scan to rule out cranial hemorrhaging, are you going to argue with them, are you going to shop around? Even if you did shop around, and the second doctor said you should do an MRI instead, and then the third doctor said you should do both, are you equipped to choose from the most effective and most cost effective choice?
I think you're right on the money (ha!) here. It's a combination of opaqueness, and a lack of culture of shopping around that reverberates at the highest levels of bureaucracy.

I mentioned in the other thread the insanity of paying 30+ fucking dollars for birth control. When you mention that to normally intelligent people, they will just say oh yeah it's covered by insurance, or oh yeah but my ovaries are special so it's totally justified blablablabla zzzzz STFU.

BULL FUCKING SHIT.

There is NOTHING that justifies the average woman, whether directly or indirectly, paying anywhere near $400 per woman per year for the privilege of not getting pregnant in 2017. The pills are barely worth the fucking packaging and shipping they came in. Guess what snowflake, people are boning everywhere else in the world, take similar pills, and don't pay anywhere near what you do. The drug companies take money from them, and make a profit there too.

American women do not get better tasting pills, enhanced sex life, more comfortable periods, or however the fuck you would want to objectively measure the value out of birth control, by paying more than everyone else by one order of magnitude.

Now I'm using birth control as an example because it's often "free" (opaqueness problem), virtually the only health expense that I see on my statement, and consumed daily by tens of millions (how is that for a chronic condition), and just simply infuriatingly stupid. MRI prices are another favorite of mine, just add a couple zeros. An MRI should cost about $50, maybe $100 if a hot technician holds your hand. No ifs and buts, STFU. It's not that expensive a machine, only requires one technician to operate, and you can crank out dozens of them per day.

The US government bends over and approves everything that isn't so outrageously overpriced that people will talk about it on CNN. Anything with less than a 50% increase is totally justified, wink wink. In the meantime, the American public continues to compare their stupid health plan terms and argue about stupid shit like who's going to pay for poor people's McDonald's and Marlboro habits.

justchristine

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Re: What comes after the ACA?
« Reply #63 on: January 08, 2017, 05:47:30 AM »
I think that if everyone had an HDHP and HSA's we will begin to make care providers have to be more competitive with their pricing.  When your average person knows they are paying for a procedure, medication, visit etc. with their HSA they shop around a bit bringing more pricing competition into the market and I believe that will make costs more reasonable over time.  I know for our family certainly shops around more and thinks things thru more often now that we are on an HDHP paying with our HSA.  Before there was essentially no thinking involved because we knew it would just be a small deductible.

Perhaps, but this falls apart in the case of an emergency (major accident, heart attack, stroke, etc.). No time to price shop in those scenarios.

This is true, but these are the very low risk, very high consequence events that true insurance is properly designed to deal with.  That is why a high-deductable health plan is a requirement for an HSA while contributing, to force the owner to have such a policy in order to benefit from the tax favorable savings vehicle.

Exacltly.  Put everyone on an HDHP like real "insurance" should be (a safety net).  And have people pay attention to where their ACTUAL money is going in terms of heath care costs.  Then, watch Americans start to pay attention to heath care and actually shop around a bit.  That keeps health care suppliers in check with competition and health care users in check with the funds they actually have available since they have real skin in the game.

I am looking forward to what the future brings for america!

Personally I love the idea of being able to shop around and think all providers should have a published rate schedule.  I don't think it would completely bring our costs under control but think it might help.  Although I have to wonder how much prices differ within a given network.  My insurance confines me pretty much to one of the two major medical groups that dominate the several counties around me.  So if I needed an MRI, for example, I would have several choices within 60 miles of me but since they are all part of the same medical group would the prices be substantially different?  Now I'm genuinely curious...Anyone have experience or inside knowledge on that?

rtrnow

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Re: What comes after the ACA?
« Reply #64 on: January 08, 2017, 07:44:35 AM »


http://www.thenewamerican.com/usnews/health-care/item/22569-cancer-and-obamacare-a-double-whammy


Wow! What a horrible site. It was amusing to poke around and see how obviously extreme right it was.

Iplawyer

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Re: What comes after the ACA?
« Reply #65 on: January 08, 2017, 07:49:04 AM »

Quote
If we revoke guaranteed issue, lots of people who want insurance will be unable to get it, at any price.  For now, Republicans are publicly saying they DON'T want this to happen, despite it being their official written policy.

<sigh> This is false, as I have shown in many ways before.  I am not going to repeat myself in full, but in short, there were solutions to these problems before ACA.

<sigh> This is false, as has been shown before. I'm not going to repeat others but, in short, there weren't what anyone sane would call solutions to these problems before ACA.

Before ACA, if you lost your job because you were throwing up from cancer and couldn't go to work, you could go on COBRA.

Before ACA, if you got cancer and had an individual policy (you didn't work at a corporation that provided a group plan), you could be rescinded.

After COBRA/rescission, you could apply and apply and NO MONEY would give you a policy. You could call and offer thousands a month (if you had thousands a month to offer) and you wouldn't get a policy.

Unbelievably, these companies wouldn't take your money -- yeah, I offered lots of money, offered to sign an exclusionary rider, and got nada, zilch, nothing.

Then you could turn to the state health pools, after being denied several times. Ahh, but there's a waiting list. You don't just sign up and, 2 weeks later, get approved and start receiving benefits. The state has limited funds in its pool and doesn't accept every sick, sad, sack that turns up. You get in when, presumably, a previous insured person is planted 6 feet under. The premiums are also a multitude what regular premiums are for your age group.

It's not a solution anyone sane or civilized would create.

"Fuck you, you're sick" as a health policy is a cruel policy.

Exactly! Quidnon - who was never in such a situation - thinks that (s)he KNOWS us highly educated, business running, typically savvy people just couldn't pull our heads our of our arses to see solutions where (s)he says they existed.  Well - I did look high and low and everywhere and no amount of money could solve the problem.  And as much as I hate parts of the ACA I don't want to go back there.

As I've said before - the young people here with disdain of providing  health care to all as a minimum - have no idea what life can hand to them that they have no control over.  You can eat all the right foods, exercise like a mad person, not drink, not smoke, and still get into an accident or come down with a terminal illness or expensive disease through no fault of your own. 

GrumpyPenguin

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Re: What comes after the ACA?
« Reply #66 on: January 08, 2017, 08:09:13 AM »
Thanks Sol for summarizing the Republicans stance on the ACA with some detail.  I was only aware of what Trump had been saying, which lacked any details whatsoever.

Iplawyer

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Re: What comes after the ACA?
« Reply #67 on: January 08, 2017, 08:23:13 AM »
Thanks Sol for summarizing the Republicans stance on the ACA with some detail.  I was only aware of what Trump had been saying, which lacked any details whatsoever.

And, to be fair, what Sol posted also lacks any actual details.  Further - it isn't what Trump has been saying - just want Congress has been saying.  It is nothing like what the the cabinet member from hell proposes either.

sol

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Re: What comes after the ACA?
« Reply #68 on: January 08, 2017, 09:19:04 AM »
Thanks Sol for summarizing the Republicans stance on the ACA with some detail.  I was only aware of what Trump had been saying, which lacked any details whatsoever.

And, to be fair, what Sol posted also lacks any actual details.  Further - it isn't what Trump has been saying - just want Congress has been saying.  It is nothing like what the the cabinet member from hell proposes either.

If anyone else would like to summarize another source of information about what the Republicans will replace the ACA with, I would love to read it.  This appears to be the only written plan.  Everything else is just talk.

fuzzy math

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Re: What comes after the ACA?
« Reply #69 on: January 08, 2017, 09:31:00 AM »


I think that if everyone had an HDHP and HSA's we will begin to make care providers have to be more competitive with their pricing.  When your average person knows they are paying for a procedure, medication, visit etc. with their HSA they shop around a bit bringing more pricing competition into the market and I believe that will make costs more reasonable over time.  I know for our family certainly shops around more and thinks things thru more often now that we are on an HDHP paying with our HSA.  Before there was essentially no thinking involved because we knew it would just be a small deductible.

This is simply not true.

1) Your HDHP still comes with a "in network" and "out of network" pricing. This is a prorated charge of what a provider can charge. If you were to call an office you would likely not be able to get a number. Many providers are now affiliated with hospitals and so you see a separate "facility charge" which is essentially an extra $200 that goes to the hospital for the privilege of having the office based on the hospital campus (which may still be across the street in a separate building with the hospital's name on it).

2) You may live in an area where you have very few options to see the specialist you need. In many areas there is 1 provider of a certain service. There is no price comparison when you need that person.

3) You may want the better provider to see you. If there's a shitty Dr in practice and a good one that everyone recommends, you have very little recourse if you want the better treatment.

4) If you fall off a ladder and are bleeding profusely with multiple injuries you do not have time to price compare your ambulance ride, your hospital, your ER doc, or the Dr on call who will provide your surgeries. Same thing if you develop pneumonia and can't breathe, or the other hundreds of most common hospital admissions. You are at your most vulnerable, in pain, sick and while the cost is in the back of your mind, you have very little power or even mental ability at that point to say "excuse me, what is this Xray going to cost? I'd like to be transported to another hospital please"


Lets back this down to the most simple level - most people can't even be bothered to price compare paper towels. Those of us who do certainly haven't caused enough of a fuss to lower costs of paper towels industry wide.
« Last Edit: January 08, 2017, 09:38:07 AM by fuzzy math »

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Re: What comes after the ACA?
« Reply #70 on: January 08, 2017, 09:35:03 AM »


If anyone else would like to summarize another source of information about what the Republicans will replace the ACA with, I would love to read it.  This appears to be the only written plan.  Everything else is just talk.

Thanks for a well researched post sol!

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Re: What comes after the ACA?
« Reply #71 on: January 08, 2017, 10:05:20 AM »

Quote
If we revoke guaranteed issue, lots of people who want insurance will be unable to get it, at any price.  For now, Republicans are publicly saying they DON'T want this to happen, despite it being their official written policy.

<sigh> This is false, as I have shown in many ways before.  I am not going to repeat myself in full, but in short, there were solutions to these problems before ACA.

<sigh> This is false, as has been shown before. I'm not going to repeat others but, in short, there weren't what anyone sane would call solutions to these problems before ACA.

Before ACA, if you lost your job because you were throwing up from cancer and couldn't go to work, you could go on COBRA.

Before ACA, if you got cancer and had an individual policy (you didn't work at a corporation that provided a group plan), you could be rescinded.

After COBRA/rescission, you could apply and apply and NO MONEY would give you a policy. You could call and offer thousands a month (if you had thousands a month to offer) and you wouldn't get a policy.

Unbelievably, these companies wouldn't take your money -- yeah, I offered lots of money, offered to sign an exclusionary rider, and got nada, zilch, nothing.

Then you could turn to the state health pools, after being denied several times. Ahh, but there's a waiting list. You don't just sign up and, 2 weeks later, get approved and start receiving benefits. The state has limited funds in its pool and doesn't accept every sick, sad, sack that turns up. You get in when, presumably, a previous insured person is planted 6 feet under. The premiums are also a multitude what regular premiums are for your age group.

It's not a solution anyone sane or civilized would create.

"Fuck you, you're sick" as a health policy is a cruel policy.

Exactly! Quidnon - who was never in such a situation - thinks that (s)he KNOWS us highly educated, business running, typically savvy people just couldn't pull our heads our of our arses to see solutions where (s)he says they existed.  Well - I did look high and low and everywhere and no amount of money could solve the problem.  And as much as I hate parts of the ACA I don't want to go back there.

As I've said before - the young people here with disdain of providing  health care to all as a minimum - have no idea what life can hand to them that they have no control over.  You can eat all the right foods, exercise like a mad person, not drink, not smoke, and still get into an accident or come down with a terminal illness or expensive disease through no fault of your own.

Could we as a society be hurting ourselves further by treating those diseases that are terminal and/or expensive and allowing reproduction. 
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Re: What comes after the ACA?
« Reply #72 on: January 08, 2017, 10:58:08 AM »

Quote
If we revoke guaranteed issue, lots of people who want insurance will be unable to get it, at any price.  For now, Republicans are publicly saying they DON'T want this to happen, despite it being their official written policy.

<sigh> This is false, as I have shown in many ways before.  I am not going to repeat myself in full, but in short, there were solutions to these problems before ACA.

<sigh> This is false, as has been shown before. I'm not going to repeat others but, in short, there weren't what anyone sane would call solutions to these problems before ACA.

Before ACA, if you lost your job because you were throwing up from cancer and couldn't go to work, you could go on COBRA.

Before ACA, if you got cancer and had an individual policy (you didn't work at a corporation that provided a group plan), you could be rescinded.

After COBRA/rescission, you could apply and apply and NO MONEY would give you a policy. You could call and offer thousands a month (if you had thousands a month to offer) and you wouldn't get a policy.

Unbelievably, these companies wouldn't take your money -- yeah, I offered lots of money, offered to sign an exclusionary rider, and got nada, zilch, nothing.

Then you could turn to the state health pools, after being denied several times. Ahh, but there's a waiting list. You don't just sign up and, 2 weeks later, get approved and start receiving benefits. The state has limited funds in its pool and doesn't accept every sick, sad, sack that turns up. You get in when, presumably, a previous insured person is planted 6 feet under. The premiums are also a multitude what regular premiums are for your age group.

It's not a solution anyone sane or civilized would create.

"Fuck you, you're sick" as a health policy is a cruel policy.

Exactly! Quidnon - who was never in such a situation - thinks that (s)he KNOWS us highly educated, business running, typically savvy people just couldn't pull our heads our of our arses to see solutions where (s)he says they existed.  Well - I did look high and low and everywhere and no amount of money could solve the problem.  And as much as I hate parts of the ACA I don't want to go back there.

As I've said before - the young people here with disdain of providing  health care to all as a minimum - have no idea what life can hand to them that they have no control over.  You can eat all the right foods, exercise like a mad person, not drink, not smoke, and still get into an accident or come down with a terminal illness or expensive disease through no fault of your own.

Could we as a society be hurting ourselves further by treating those diseases that are terminal and/or expensive and allowing reproduction.

Is this a serious question or a devils advocate question? Not giving transplants to 80 year olds I'm pretty ok with. Withholding treatment for curable but expensive diseases in young or otherwise healthy people I am not ok with. "Allowing reproduction" gets very close to eugenics and ideas about "genetic purity" which are abhorrent.

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Re: What comes after the ACA?
« Reply #73 on: January 08, 2017, 11:12:14 AM »
Yeah it's serious. Let's keep people with genetic disorders alive so they can reproduce and get rid of natural selection. Sounds dumb for society as a whole.  Don't quite understand how one can say universal healthcare for all BC it's in the best interests of society and avoid the natural selection issue with society.
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Re: What comes after the ACA?
« Reply #74 on: January 08, 2017, 11:17:57 AM »
Yeah it's serious. Let's keep people with genetic disorders alive so they can reproduce and get rid of natural selection. Sounds dumb for society as a whole.  Don't quite understand how one can say universal healthcare for all BC it's in the best interests of society and avoid the natural selection issue with society.

So would you advocate sterilization? Or should we just kill all the undesirables and spare them their inevitable inferiority-induced pain and suffering?

boarder42

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Re: What comes after the ACA?
« Reply #75 on: January 08, 2017, 11:22:18 AM »
Not sure what the best solution would be but we're already over populating or planet and killing it so why keep someone alive who can pass on a gene to keep a costly disorder in society when it could just be eliminated. Do we not currently do similar things with deadly viral outbreaks.
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Re: What comes after the ACA?
« Reply #76 on: January 08, 2017, 11:22:25 AM »
If anyone else would like to summarize another source of information about what the Republicans will replace the ACA with, I would love to read it.  This appears to be the only written plan.  Everything else is just talk.

Summarizing the Protections for Patients section of the "A Better Way" document (see page 20):

Preexisting conditions are completely covered at the standard rate for the group as a whole (even if you switch insurance) PROVIDED one maintains continuous coverage.  Note that this is exactly how employer-provided insurance has worked for years, and that seems to work fine for most people.  Rescissions are illegal, and you cannot be dropped when you get sick.  High risk pools are for those who previously did not purchase insurance and maintain continuous coverage but now want to sign up once they get sick, but there's also a one-time grace period open enrollment where people with preexisting conditions can skip the high risk pools and get insurance at the standard rate like everyone else.  However, if you skip that opportunity and try to sign up later the lower rates are no longer guaranteed. 

All of that sounds perfectly reasonable to me, and I'd personally have no issue buying insurance under that system and dutifully maintaining continuous coverage to preserve my rights as a patient.  We'll see how it ultimately shakes out, but if it also succeeds in reducing costs and expanding coverage options (my ACA options this year were depressingly narrow) this could end up a net positive for early retirees. 
« Last Edit: January 08, 2017, 12:42:40 PM by Tyler »
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Re: What comes after the ACA?
« Reply #77 on: January 08, 2017, 11:35:43 AM »


I think that if everyone had an HDHP and HSA's we will begin to make care providers have to be more competitive with their pricing.  When your average person knows they are paying for a procedure, medication, visit etc. with their HSA they shop around a bit bringing more pricing competition into the market and I believe that will make costs more reasonable over time.  I know for our family certainly shops around more and thinks things thru more often now that we are on an HDHP paying with our HSA.  Before there was essentially no thinking involved because we knew it would just be a small deductible.

This is simply not true.

4) If you fall off a ladder and are bleeding profusely with multiple injuries you do not have time to price compare your ambulance ride, your hospital, your ER doc, or the Dr on call who will provide your surgeries. Same thing if you develop pneumonia and can't breathe, or the other hundreds of most common hospital admissions. You are at your most vulnerable, in pain, sick and while the cost is in the back of your mind, you have very little power or even mental ability at that point to say "excuse me, what is this Xray going to cost? I'd like to be transported to another hospital please"


Lets back this down to the most simple level - most people can't even be bothered to price compare paper towels. Those of us who do certainly haven't caused enough of a fuss to lower costs of paper towels industry wide.

For big catostrophic things like that, that is what your max OOP is for.  Insurance is meant to be a safety net but has morphed into people expecting to not have to pay for anything health related because they have insurance.  It's the hundreds of other health related things that happen throughout your life time that you do have the ability to scrutinize and think about the costs involved that slowly start to bring health care costs down.  Just because you can think up a catastrophic event where you don't have the time to cost compare doesn't mean the system is flawed.  HDHP and HSA for all is in my opinion a promising option.


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Re: What comes after the ACA?
« Reply #78 on: January 08, 2017, 11:37:24 AM »
Great summary Sol, and great discussion. In my opinion health care costs are the biggest concern for early retirees. There is nothing that can destroy a budget faster than a serious medical problem. The ACA was a gift to the early retiree, too good to be true in many ways. I think the biggest lesson here is that changes in health care, tax or entitlement policy can have a massively negative impact.

Working in medicine I can tell you that using the 'free market' to control your costs will probably not work, because you are not the customer. The insurance company is the customer and you are just along for the ride. Insurance companies will fight to control their costs, but they don't really care what you pay. Navigating the 'in/out of network' maze is infuriating, and many times there is a shortage of specialists in your geographic area anyways so it's a moot point. Sure, you can negotiate on non-emergent services if you are self-pay and save a bit, but the big costs come from medical emergencies where you don't have any negotiating power. A trip to the ICU for a few days can wipe out a decade worth of HSA contributions. Cancer or some other chronic illness can max your deductible every year. It's a real problem.

What we really need is to find  way to decrease costs of medical care in the US. I'm not sure how to do this. The ACA was designed to get everyone insured, but it didn't really address the cost issue. Until this problem is solved there is no math that will make medical care affordable on a population level. We spend over $10,000 per person each year. There is no magical way to pay for this without people paying huge premiums and out of pocket costs. The ACA was designed to smooth this cost out a bit, mainly by forcing healthy and rich people to pay more. http://www.pbs.org/newshour/rundown/new-peak-us-health-care-spending-10345-per-person/

Insane. There is no solution to this problem with any of the proposals. Maybe a single payer could accomplish this, but as others have stated this is politically impossible. Whatever comes next will be great for healthy people, and not so great for sick people. You will likely be OK if you are either really rich or really poor (assuming Medicaid isn't destroyed). Don't get sick in the United States.
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Re: What comes after the ACA?
« Reply #79 on: January 08, 2017, 11:52:19 AM »


I think that if everyone had an HDHP and HSA's we will begin to make care providers have to be more competitive with their pricing.  When your average person knows they are paying for a procedure, medication, visit etc. with their HSA they shop around a bit bringing more pricing competition into the market and I believe that will make costs more reasonable over time.  I know for our family certainly shops around more and thinks things thru more often now that we are on an HDHP paying with our HSA.  Before there was essentially no thinking involved because we knew it would just be a small deductible.

This is simply not true.

4) If you fall off a ladder and are bleeding profusely with multiple injuries you do not have time to price compare your ambulance ride, your hospital, your ER doc, or the Dr on call who will provide your surgeries. Same thing if you develop pneumonia and can't breathe, or the other hundreds of most common hospital admissions. You are at your most vulnerable, in pain, sick and while the cost is in the back of your mind, you have very little power or even mental ability at that point to say "excuse me, what is this Xray going to cost? I'd like to be transported to another hospital please"


Lets back this down to the most simple level - most people can't even be bothered to price compare paper towels. Those of us who do certainly haven't caused enough of a fuss to lower costs of paper towels industry wide.

For big catostrophic things like that, that is what your max OOP is for.  Insurance is meant to be a safety net but has morphed into people expecting to not have to pay for anything health related because they have insurance.  It's the hundreds of other health related things that happen throughout your life time that you do have the ability to scrutinize and think about the costs involved that slowly start to bring health care costs down.  Just because you can think up a catastrophic event where you don't have the time to cost compare doesn't mean the system is flawed.  HDHP and HSA for all is in my opinion a promising option.

My family has encountered three major health care events over the last 15 years or so.  All three cases involved a trip to the ER (two ER trips for one of the cases), followed by immediate admission to the hospital for emergency surgery or other emergency procedures.  I don't recall the total costs of all three incidents, but I do remember that one of them was in the neighborhood of $20k.  The other two likely were in the same ballpark.  Needless to say, we had no opportunity to comparison shop.  All of our office visits, tests, and Rx drugs combined for the last 15 years pale in comparison to the cost of these three events.  If you can't comparison shop for the events that make up the lion's share of costs, there is no way that competition is going to make a dent in prices.
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Re: What comes after the ACA?
« Reply #80 on: January 08, 2017, 12:27:32 PM »
Trigger warning: profanity ladden post below- you've been warned

Snip
I think you're right on the money (ha!) here. It's a combination of opaqueness, and a lack of culture of shopping around that reverberates at the highest levels of bureaucracy.

I mentioned in the other thread the insanity of paying 30+ fucking dollars for birth control. When you mention that to normally intelligent people, they will just say oh yeah it's covered by insurance, or oh yeah but my ovaries are special so it's totally justified blablablabla zzzzz STFU.

BULL FUCKING SHIT.

There is NOTHING that justifies the average woman, whether directly or indirectly, paying anywhere near $400 per woman per year for the privilege of not getting pregnant in 2017. The pills are barely worth the fucking packaging and shipping they came in. Guess what snowflake, people are boning everywhere else in the world, take similar pills, and don't pay anywhere near what you do. The drug companies take money from them, and make a profit there too.

American women do not get better tasting pills, enhanced sex life, more comfortable periods, or however the fuck you would want to objectively measure the value out of birth control, by paying more than everyone else by one order of magnitude.

Now I'm using birth control as an example because it's often "free" (opaqueness problem), virtually the only health expense that I see on my statement, and consumed daily by tens of millions (how is that for a chronic condition), and just simply infuriatingly stupid. MRI prices are another favorite of mine, just add a couple zeros. An MRI should cost about $50, maybe $100 if a hot technician holds your hand. No ifs and buts, STFU. It's not that expensive a machine, only requires one technician to operate, and you can crank out dozens of them per day.

The US government bends over and approves everything that isn't so outrageously overpriced that people will talk about it on CNN. Anything with less than a 50% increase is totally justified, wink wink. In the meantime, the American public continues to compare their stupid health plan terms and argue about stupid shit like who's going to pay for poor people's McDonald's and Marlboro habits.

+1 for referring to fertility as a chronic condition, and because I'd happy pay an extra $50 (out of pocket) for a cute tech to hold my hand if I ever have to go in for an MRI.

As other in this thread have said, our entire healthcare system here in the US costs close to $1,000 per person per month.

Either we can figure out ways to reduce how much our healthcare system costs, which helps everyone. Or we can argue about who deserves to pay more than a $1000/month in premiums+taxes+deductibles+co-pays (old people, young people, sick people, healthy people, rich people, poor people) so that other people (young people, old people, healthy people, sick people, poor people, rich people) pay less.

My personal pet peeve is credential bloat in medical staff. It takes us 11-15 years after high school to train a doctor in the US (BA+MD+residency), but most other countries, including in europe, manage the same training in 8. Then once we train those doctors, we insistent that you need an MD to take care of all sorts of cuts and bruises and sniffles at the local doctors office when 90% of cases could be properly treated by someone with only a couple of years training as a medic without having to pass them on up the chain to someone with more expertise. The same thing is starting to happen with Nurse Practitioners, which used to just be an additional 1-2 year masters after a bachelors in nursing (5-6 years total) but is now being pushed towards requiring doctorate level degree after the bachelors degree  (8-10 years total). And of course more school means more student debt, which means you need to pay people in the field more, which means total medical spending goes up.
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Re: What comes after the ACA?
« Reply #81 on: January 08, 2017, 12:31:23 PM »


I think that if everyone had an HDHP and HSA's we will begin to make care providers have to be more competitive with their pricing.  When your average person knows they are paying for a procedure, medication, visit etc. with their HSA they shop around a bit bringing more pricing competition into the market and I believe that will make costs more reasonable over time.  I know for our family certainly shops around more and thinks things thru more often now that we are on an HDHP paying with our HSA.  Before there was essentially no thinking involved because we knew it would just be a small deductible.

This is simply not true.

4) If you fall off a ladder and are bleeding profusely with multiple injuries you do not have time to price compare your ambulance ride, your hospital, your ER doc, or the Dr on call who will provide your surgeries. Same thing if you develop pneumonia and can't breathe, or the other hundreds of most common hospital admissions. You are at your most vulnerable, in pain, sick and while the cost is in the back of your mind, you have very little power or even mental ability at that point to say "excuse me, what is this Xray going to cost? I'd like to be transported to another hospital please"


Lets back this down to the most simple level - most people can't even be bothered to price compare paper towels. Those of us who do certainly haven't caused enough of a fuss to lower costs of paper towels industry wide.

For big catostrophic things like that, that is what your max OOP is for.  Insurance is meant to be a safety net but has morphed into people expecting to not have to pay for anything health related because they have insurance.  It's the hundreds of other health related things that happen throughout your life time that you do have the ability to scrutinize and think about the costs involved that slowly start to bring health care costs down.  Just because you can think up a catastrophic event where you don't have the time to cost compare doesn't mean the system is flawed.  HDHP and HSA for all is in my opinion a promising option.

My family has encountered three major health care events over the last 15 years or so.  All three cases involved a trip to the ER (two ER trips for one of the cases), followed by immediate admission to the hospital for emergency surgery or other emergency procedures.  I don't recall the total costs of all three incidents, but I do remember that one of them was in the neighborhood of $20k.  The other two likely were in the same ballpark.  Needless to say, we had no opportunity to comparison shop.  All of our office visits, tests, and Rx drugs combined for the last 15 years pale in comparison to the cost of these three events.  If you can't comparison shop for the events that make up the lion's share of costs, there is no way that competition is going to make a dent in prices.

I get the feeling neither of you is in an HDHP with HSA currently.  Please correct me if Im wrong?

Yes, there absolutely is going to be catostrophic things that happen to you or your family in your lifetime, and its going to cost you when they do.  But wht I am saying is that people are actually going to have the funds available to pay for them when they do.  And because its going to be real money they can see in their accounts, they are going to be more cautious about how they use it when they have time to make decisions (aka smaller events, choosing generics, etc.).

You talk like $20,000 is a ton of money, and it most certainly is.  But dont forget, a family can pay that much per year in PREMIUMS these days!  That is seriously wrong,

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Re: What comes after the ACA?
« Reply #82 on: January 08, 2017, 12:40:51 PM »
Another way is to finally get to single payer and cover most healthcare costs through our progressive tax system. 

Everyone here keeps saying this, and it totally makes sense, but it's never going to happen.  Republicans will never allow the US government to destroy an industry that employs millions of people (and spends billions of dollars on lobbying).

I agree with this and it's only fair to say that it's not only Republicans that are against single payer. Many unions are against it because many collective bargaining contracts accepted better health insurance plans in lieu of higher pay. A single payer system would be better for the nation as a whole, but not necessarily for those who have excellent health insurance benefits as part of unions.


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Re: What comes after the ACA?
« Reply #83 on: January 08, 2017, 01:08:21 PM »
I agree with this and it's only fair to say that it's not only Republicans that are against single payer. Many unions are against it because many collective bargaining contracts accepted better health insurance plans in lieu of higher pay.

I agree that we now have a variety of entrenched interests that favor keeping the status quo, but isn't that always the case?

I suspect that the health insurance industry KNOWS it is a parasitic drain on the economy, and should be replaced by a government-run single payer system, but will continue to fight for their right to profit by exploiting sick people. 

What's the alternative?  Is there any credible path forwards towards single payer?

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Re: What comes after the ACA?
« Reply #84 on: January 08, 2017, 01:17:45 PM »


I think that if everyone had an HDHP and HSA's we will begin to make care providers have to be more competitive with their pricing.  When your average person knows they are paying for a procedure, medication, visit etc. with their HSA they shop around a bit bringing more pricing competition into the market and I believe that will make costs more reasonable over time.  I know for our family certainly shops around more and thinks things thru more often now that we are on an HDHP paying with our HSA.  Before there was essentially no thinking involved because we knew it would just be a small deductible.

This is simply not true.

4) If you fall off a ladder and are bleeding profusely with multiple injuries you do not have time to price compare your ambulance ride, your hospital, your ER doc, or the Dr on call who will provide your surgeries. Same thing if you develop pneumonia and can't breathe, or the other hundreds of most common hospital admissions. You are at your most vulnerable, in pain, sick and while the cost is in the back of your mind, you have very little power or even mental ability at that point to say "excuse me, what is this Xray going to cost? I'd like to be transported to another hospital please"


Lets back this down to the most simple level - most people can't even be bothered to price compare paper towels. Those of us who do certainly haven't caused enough of a fuss to lower costs of paper towels industry wide.

For big catostrophic things like that, that is what your max OOP is for.  Insurance is meant to be a safety net but has morphed into people expecting to not have to pay for anything health related because they have insurance.  It's the hundreds of other health related things that happen throughout your life time that you do have the ability to scrutinize and think about the costs involved that slowly start to bring health care costs down.  Just because you can think up a catastrophic event where you don't have the time to cost compare doesn't mean the system is flawed.  HDHP and HSA for all is in my opinion a promising option.

My family has encountered three major health care events over the last 15 years or so.  All three cases involved a trip to the ER (two ER trips for one of the cases), followed by immediate admission to the hospital for emergency surgery or other emergency procedures.  I don't recall the total costs of all three incidents, but I do remember that one of them was in the neighborhood of $20k.  The other two likely were in the same ballpark.  Needless to say, we had no opportunity to comparison shop.  All of our office visits, tests, and Rx drugs combined for the last 15 years pale in comparison to the cost of these three events.  If you can't comparison shop for the events that make up the lion's share of costs, there is no way that competition is going to make a dent in prices.

I get the feeling neither of you is in an HDHP with HSA currently.  Please correct me if Im wrong?

Yes, there absolutely is going to be catostrophic things that happen to you or your family in your lifetime, and its going to cost you when they do.  But wht I am saying is that people are actually going to have the funds available to pay for them when they do.  And because its going to be real money they can see in their accounts, they are going to be more cautious about how they use it when they have time to make decisions (aka smaller events, choosing generics, etc.).

You talk like $20,000 is a ton of money, and it most certainly is.  But dont forget, a family can pay that much per year in PREMIUMS these days!  That is seriously wrong,

HSAs are great. I have one and think many people should consider it, but it really will not solve cost containment problems. Coupling an HSA with HDHP is wonderful for healthy people, probably terrible for sick people. It basically shifts money that you would be paying for premiums into an investment/savings account. If you don't consume health care this is a win for you.

As insurance has become less comprehensive, costs have still gone up, in spite of people having to make more decisions that affect them financially. It helps a little, but not all that much in the grand scheme of things. Most of the health care dollar is spent on a small minority of really sick people that max out their deductible - end of life care, massive traumas, etc. There is no cost shopping that is involved. The insurance company eats this cost and passes on to us in the forms of higher insurance, worse coverage, etc.

The current model of medicine in this country makes cost shopping almost impossible except for completely elective procedures where there is massive competition (think cosmetic surgery, lasik, etc.)
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Re: What comes after the ACA?
« Reply #85 on: January 08, 2017, 01:32:04 PM »
Just a friendly reminder for everyone worried about the republicans ruining everything. You all love your HSA, correct? Remember it was George W. Bush and the Republican controlled congress in 2003 who created it.

You love your Roth IRA? It was a republican senator, William Roth, who created it.

With that let's not get all crazy that Trump and the republican controlled congress are going to destroy everything. The ACA needs to be replaced because it is broken. I have faith something better will be put in place that will benefit the masses. Not everyone can be happy, there is no 100% perfect system but we need to benefit as many people as possible and the ACA does not do that, the ACA has hurt a lot more than helped. It really should be called the UCA, I am sure you know what the U stands for. We need a plan in place where hopefully (or selfishly on my end ) the HSA MAX will be increased (and accessible by all, not just high deductible), there is no individual mandate so you are not forced to get coverage or pay a penalty if you don't, and a fair rate is charged based on your individual health risk (not having to pay more if you are young and healthy). Also we should not get rid of Medicaid but we need to do a better job of monitoring Medicaid (and other government welfare programs) to ensure those that are on it deserve it and are not just abusing the system.

thenextguy

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Re: What comes after the ACA?
« Reply #86 on: January 08, 2017, 02:00:25 PM »
Just a friendly reminder for everyone worried about the republicans ruining everything. You all love your HSA, correct? Remember it was George W. Bush and the Republican controlled congress in 2003 who created it.

You love your Roth IRA? It was a republican senator, William Roth, who created it.

With that let's not get all crazy that Trump and the republican controlled congress are going to destroy everything. The ACA needs to be replaced because it is broken. I have faith something better will be put in place that will benefit the masses. Not everyone can be happy, there is no 100% perfect system but we need to benefit as many people as possible and the ACA does not do that, the ACA has hurt a lot more than helped. It really should be called the UCA, I am sure you know what the U stands for. We need a plan in place where hopefully (or selfishly on my end ) the HSA MAX will be increased (and accessible by all, not just high deductible), there is no individual mandate so you are not forced to get coverage or pay a penalty if you don't, and a fair rate is charged based on your individual health risk (not having to pay more if you are young and healthy). Also we should not get rid of Medicaid but we need to do a better job of monitoring Medicaid (and other government welfare programs) to ensure those that are on it deserve it and are not just abusing the system.

I certainly hope you're right that Republicans will somehow come up with a great plan. But it's been 6 years and they really don't have much to show for it. What have they been doing all this time? Further, their opposition to the ACA is political and not ideological. The individual mandate was originally a conservative idea. Hell, the whole ACA was largely the conservative plan to oppose a single payer system.

Also, I don't think it's accurate to say that the ACA is broken. There are certainly areas that can be improved, but fixing minor issues is certainly going to be easier than throwing everything out and starting over.

Edit: Consider this:

Times Republican Congress voted to repeal the ACA: 60
Times Republican Congress voted to replace the ACA: 0
« Last Edit: January 08, 2017, 02:49:17 PM by thenextguy »

RedwoodDreams

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Re: What comes after the ACA?
« Reply #87 on: January 08, 2017, 03:39:47 PM »
The part that fascinates me in all of this ridiculous debate is how we seem to struggle mightily with these moral quandaries of taxing some folks to provide coverage for other folks and the idea of risk pools and whatnot. All of this while every other rich, industrialized country has figured this shit out years ago and gets better results for less money. It is like we are getting into crazy bar fights over whether to require catalytic converters on our gas-guzzling land yachts while the rest of the world is using hydrogen fuel cells or electric cars to get around. We do a lot of things great in this country but this is one of those topics that completely confuses me and makes me want to run to another country to hide among people who actually see the value in human decency and universal health.

+100000000000

Iplawyer

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Re: What comes after the ACA?
« Reply #88 on: January 08, 2017, 05:08:53 PM »

Quote
If we revoke guaranteed issue, lots of people who want insurance will be unable to get it, at any price.  For now, Republicans are publicly saying they DON'T want this to happen, despite it being their official written policy.

<sigh> This is false, as I have shown in many ways before.  I am not going to repeat myself in full, but in short, there were solutions to these problems before ACA.

<sigh> This is false, as has been shown before. I'm not going to repeat others but, in short, there weren't what anyone sane would call solutions to these problems before ACA.

Before ACA, if you lost your job because you were throwing up from cancer and couldn't go to work, you could go on COBRA.

Before ACA, if you got cancer and had an individual policy (you didn't work at a corporation that provided a group plan), you could be rescinded.

After COBRA/rescission, you could apply and apply and NO MONEY would give you a policy. You could call and offer thousands a month (if you had thousands a month to offer) and you wouldn't get a policy.

Unbelievably, these companies wouldn't take your money -- yeah, I offered lots of money, offered to sign an exclusionary rider, and got nada, zilch, nothing.

Then you could turn to the state health pools, after being denied several times. Ahh, but there's a waiting list. You don't just sign up and, 2 weeks later, get approved and start receiving benefits. The state has limited funds in its pool and doesn't accept every sick, sad, sack that turns up. You get in when, presumably, a previous insured person is planted 6 feet under. The premiums are also a multitude what regular premiums are for your age group.

It's not a solution anyone sane or civilized would create.

"Fuck you, you're sick" as a health policy is a cruel policy.

Exactly! Quidnon - who was never in such a situation - thinks that (s)he KNOWS us highly educated, business running, typically savvy people just couldn't pull our heads our of our arses to see solutions where (s)he says they existed.  Well - I did look high and low and everywhere and no amount of money could solve the problem.  And as much as I hate parts of the ACA I don't want to go back there.

As I've said before - the young people here with disdain of providing  health care to all as a minimum - have no idea what life can hand to them that they have no control over.  You can eat all the right foods, exercise like a mad person, not drink, not smoke, and still get into an accident or come down with a terminal illness or expensive disease through no fault of your own.

Could we as a society be hurting ourselves further by treating those diseases that are terminal and/or expensive and allowing reproduction.

I see - not treating a 40 year old with curable cancer is something you advocate? 

Iplawyer

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Re: What comes after the ACA?
« Reply #89 on: January 08, 2017, 05:38:06 PM »
The part that fascinates me in all of this ridiculous debate is how we seem to struggle mightily with these moral quandaries of taxing some folks to provide coverage for other folks and the idea of risk pools and whatnot. All of this while every other rich, industrialized country has figured this shit out years ago and gets better results for less money. It is like we are getting into crazy bar fights over whether to require catalytic converters on our gas-guzzling land yachts while the rest of the world is using hydrogen fuel cells or electric cars to get around. We do a lot of things great in this country but this is one of those topics that completely confuses me and makes me want to run to another country to hide among people who actually see the value in human decency and universal health.

+1000000000

Iplawyer

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Re: What comes after the ACA?
« Reply #90 on: January 08, 2017, 05:41:42 PM »
Trump's Plan from:
https://www.donaldjtrump.com/positions/healthcare-reform
Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.
Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.
Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.

Iplawyer

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Re: What comes after the ACA?
« Reply #91 on: January 08, 2017, 06:13:52 PM »
Yeah it's serious. Let's keep people with genetic disorders alive so they can reproduce and get rid of natural selection. Sounds dumb for society as a whole.  Don't quite understand how one can say universal healthcare for all BC it's in the best interests of society and avoid the natural selection issue with society.

Really? You want our country to be based on natural selection?  Really?  Well - let's also not school those with lower IQs.  That sounds dumb too.  We only have so many education dollars after all. Why waste them on stupid people?

golden1

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Re: What comes after the ACA?
« Reply #92 on: January 08, 2017, 06:59:57 PM »
Quote
Yeah it's serious. Let's keep people with genetic disorders alive so they can reproduce and get rid of natural selection. Sounds dumb for society as a whole.  Don't quite understand how one can say universal healthcare for all BC it's in the best interests of society and avoid the natural selection issue with society.

Ok, lets start with the sociopaths, since they seem to be the most dangerous to the human race. 

Monkey Uncle

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Re: What comes after the ACA?
« Reply #93 on: January 08, 2017, 07:00:07 PM »


I think that if everyone had an HDHP and HSA's we will begin to make care providers have to be more competitive with their pricing.  When your average person knows they are paying for a procedure, medication, visit etc. with their HSA they shop around a bit bringing more pricing competition into the market and I believe that will make costs more reasonable over time.  I know for our family certainly shops around more and thinks things thru more often now that we are on an HDHP paying with our HSA.  Before there was essentially no thinking involved because we knew it would just be a small deductible.

This is simply not true.

4) If you fall off a ladder and are bleeding profusely with multiple injuries you do not have time to price compare your ambulance ride, your hospital, your ER doc, or the Dr on call who will provide your surgeries. Same thing if you develop pneumonia and can't breathe, or the other hundreds of most common hospital admissions. You are at your most vulnerable, in pain, sick and while the cost is in the back of your mind, you have very little power or even mental ability at that point to say "excuse me, what is this Xray going to cost? I'd like to be transported to another hospital please"


Lets back this down to the most simple level - most people can't even be bothered to price compare paper towels. Those of us who do certainly haven't caused enough of a fuss to lower costs of paper towels industry wide.

For big catostrophic things like that, that is what your max OOP is for.  Insurance is meant to be a safety net but has morphed into people expecting to not have to pay for anything health related because they have insurance.  It's the hundreds of other health related things that happen throughout your life time that you do have the ability to scrutinize and think about the costs involved that slowly start to bring health care costs down.  Just because you can think up a catastrophic event where you don't have the time to cost compare doesn't mean the system is flawed.  HDHP and HSA for all is in my opinion a promising option.

My family has encountered three major health care events over the last 15 years or so.  All three cases involved a trip to the ER (two ER trips for one of the cases), followed by immediate admission to the hospital for emergency surgery or other emergency procedures.  I don't recall the total costs of all three incidents, but I do remember that one of them was in the neighborhood of $20k.  The other two likely were in the same ballpark.  Needless to say, we had no opportunity to comparison shop.  All of our office visits, tests, and Rx drugs combined for the last 15 years pale in comparison to the cost of these three events.  If you can't comparison shop for the events that make up the lion's share of costs, there is no way that competition is going to make a dent in prices.

I get the feeling neither of you is in an HDHP with HSA currently.  Please correct me if Im wrong?

Yes, there absolutely is going to be catostrophic things that happen to you or your family in your lifetime, and its going to cost you when they do.  But wht I am saying is that people are actually going to have the funds available to pay for them when they do.  And because its going to be real money they can see in their accounts, they are going to be more cautious about how they use it when they have time to make decisions (aka smaller events, choosing generics, etc.).

You talk like $20,000 is a ton of money, and it most certainly is.  But dont forget, a family can pay that much per year in PREMIUMS these days!  That is seriously wrong,

You're missing the point.  If I spend $70k over a given period of time on health care, and $60k of it is spent in situations where I have no opportunity to shop around or negotiate prices, it makes no difference whether I pay for it out of a HSA or through insurance reimbursements.  Either way, I'm not forcing anyone to compete for my health care dollars.  My numbers may not be completely accurate, but I would guess that most Americans are in a similar situation.  The majority of their health care spending occurs in situations that afford them no ability to shop around or negotiate.  If most of the country's health care spending is not subject to competition, competition will not succeed in forcing prices down.
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Iplawyer

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Re: What comes after the ACA?
« Reply #94 on: January 09, 2017, 05:52:17 AM »
These poor idiots. They voted against their own interest, which is funny for people who only have their own self interests at the top of their lists. They didn't want a smart sassy woman telling them what to do. Even though she knew better than what they did as to what they needed. Confounding!

+10000000000000000

What I don't get is why anyone believes agent orange is good for anyone but himself.  His family's wealth will increase a 100 fold during is administration on the backs of the middle class - most of whom will get poorer and lose benefits.   He won't separate himself from business deals and is already inviting the family he has running his company to high level foreign meetings. 

I was a dyed in the wool republican for most of my life.  Now I can only cry at what the party has done and who fewer than 25% of the American people have elected as president. 

But what kills me is the total repeal of a health plan that will leave millions without basic insurance, women (and the men they are with) without birth control, families without maternity coverage (doesn't that make sense - take away birth control and maternity coverage?), and people with pre-existing conditions out in the cold.  And people here on this forum and everywhere are celebrating this.  The Republicans have had years to change it and improve it - replace parts of it - and they have done nothing. 

And then there are people - even in this forum - who think that people with genetic conditions should be left out in the cold due to natural selection.  Well - I'll take Stephen Hawking over you any day as improving all of our lives - F**K your natural selection comment. And may I add that Karma will catch up with you someday.  You could have a genetic issue that you aren't even aware of yet. 

I do think the Republicans will take care of me - after all I'm rich and white.  I doubt I'll be left without options for insurance when I retire soon. And I no longer require birth control or maternity care - so what the hell - take it away coverage for that to reduce my premiums and screw those who need it. So as an individual - I will be able to afford whatever ridiculously priced solution they come up with.  Many of you here, however, who are retiring young, will be forced to pay what I  will pay  when you get to be my age.  Please save  $1M more to be able to afford that when it happens.  You scoff at me about it because you'll have an HSA.  I too have an HSA - but I imagine my insurance premiums will run at least $2K per month for a high deductible policy - and the HSA does not pay health insurance premiums.  I think the Republican's will make those premiums pre-tax on an above the line basis - but we don't know that yet.  Either way - I've got it covered.  And I'll likely make over 5% more on a sale of a home because I won't have to pay the medicare premium on the capital gains - because - as I understand it - that part is getting repealed immediately.  That savings, in and of itself, is enough to fund my premiums for 3 years. 

All of this being said - I think the mean spirited nature of the forum members I have been exposed to in this conversation almost makes me want to leave it forever.  I thought I had a lot to learn here and something to contribute.  I came from nothing and put myself through undergrad and graduate engineering school with no loans and then law school.  We have built a business, a career outside of it, and a small family fortune from minding our pennies and never, ever, spending more than we made or carrying anything other than mortgage debt. And we've done it with our community and family in our hearts as we've always given between 20-40% of our before tax income away.  Are we richer for it - yes I think so.  Could we have retired earlier if we hadn't - probably. 

In short - I don't think being frugal is equal to being mean spirited or selfishly only looking out for yourself while the community around you crumbles. 

protostache

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Re: What comes after the ACA?
« Reply #95 on: January 09, 2017, 06:35:58 AM »
I don't think being frugal is equal to being mean spirited or selfishly only looking out for yourself while the community around you crumbles.

Thank you for for the wonderful thoughtful comment that I didn't have the words to say.

MayDay

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Re: What comes after the ACA?
« Reply #96 on: January 09, 2017, 06:59:30 AM »
As a straight, white, upper class-ish woman who is unlikely to need an abortion in the next 4 years (and could easily afford to travel to Mexico for one, or an IUD, etc), the ACA related issues are what is most likely to affect me during Dumpster Fire's presidency.

We'l be able to retire when H is about 50 and I am about 45.  That is 15-20 years without Medicare.

When H was 36, he had a routine EKG, which was abnormal, then an echo, then a stress test, then a cath, then a triple bypass.  No family history.  Not overweight.  Not a smoker.  Exercised regularly (he was famous in the hospital for being their only patient who had ever run 5 miles the day before being admitted). 

He will never be able to be insured on the individual market.

My mother was diagnosed with colon cancer 8 years ago.  It was a genetic type.  No worries, she is fine.  My siblings and I, if we had the gene (50% chance- none of us have it) have a ~100% chance of getting colon cancer.  No matter how healthy we are before then.  If we were on individual insurance we would be dropped instantly.

The individual market was shit pre-ACA.  People bitch about ACA prices, but when H was self-employed for a year (at the time COBRA was extended to 18 months during the recession) our premiums were 1500/month for a family.  And that was a 8 years ago!  And it was a HD plan with a 10K OOP Max (which we hit that year, yay us!). 

We looked into our state's high risk pool in case H continued to be self insured when COBRA ran out.  His condition wasn't on the list, so he didn't qualify.  Luckily he found a new job after a year on COBRA.

I could go on for days with the anecdotes.  Lets do one more!  We were on a HD plan at the time.  H needed non-emergency hernia surgery.  We tried like you wouldn't believe to price shop or at least get pricing info up front so we could plan.  We couldn't get the price.  Literally- could.not.get.the.price.  Dr. doesn't know. He says call office manager.  She doesn't know.  Says call insurance.  Insurance says it depends what the dr. bills.  Back to the dr.  he says regardless of what he bills, it depends what the insurance pays.  Round and round. 

The idea that knowing the price will change how people consume healthcare is a nice goal to get to some day, but HSA's and HD plans have been around for about a decade IIRC, and it hasn't happened yet. 

As it stands, unless the situation has stabilized, I don't know if both of us will retire when we can, financially.  Its too risky right now, that is for sure.  Our profession (engineering) isn't always kind to older folks, and if we quite at 50 and needed insurance at 60, I doubt we could get hired. 

And plus also, I'm just a decent human being who thinks that everyone in this country should have a basic level of healthcare.  Now if you want to talk Death Panels, I am all in (in other words, yes I am in favor of rationing health care based on age and likelihood of success).
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boarder42

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Re: What comes after the ACA?
« Reply #97 on: January 09, 2017, 07:07:26 AM »
I don't think being frugal is equal to being mean spirited or selfishly only looking out for yourself while the community around you crumbles.

Thank you for for the wonderful thoughtful comment that I didn't have the words to say.

its a devils advocate statement ... can you not see that we could be slowing crumbling our society thru giving everyone medical treatment and not letting natural selection work in some instances.  i'm pretty sure Stephen Hawking didnt procreate and therefore continue on his disorder.  You guys cant see past this dude has this we must help everyone, assuming its for a better society as a whole.  well in 200 years they may look back and say WTF were these people thinking allowing the procreation of these genetic mutations that have lead to a crumbled society.  You're not looking past first quarter earnings so your stock price stays high like most companies in america do.  this doesnt fully fall under the ACA or anything like that but its a fully plausible situation which everyone here isnt really taking into account. 

I'm all for a single payer system.  but under such a system things like this can and should be considered when giving treatment to someone who may be selfish enough to procreate and continue a disorder that should be naturally selected away.
« Last Edit: January 09, 2017, 07:09:50 AM by boarder42 »
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jim555

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Re: What comes after the ACA?
« Reply #98 on: January 09, 2017, 07:17:25 AM »
In the good old days (pre-2010) insurers would look for any excuse not to pay out a claim.  They would go back in the medical history to find if a person omitted ANYTHING and use that as an excuse not to pay.  The business model is the more they deny claims the more profit to the bottom line.  The free market rewards such behaviour.  The ACA is a reaction to the abuses of the pre-2010 era.

The biggest part of the ACA is expanded Medicaid.  Those on Medicaid have no way to afford medical insurance and survive at the same time without the ACA expansion.  So they flood the ER and go bankrupt when the bills come in.  People should not have to loose everything due to a medical event.  The US is so far behind the rest of the world on this topic it is stunning.

boarder42

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Re: What comes after the ACA?
« Reply #99 on: January 09, 2017, 07:24:35 AM »
couldnt all this simply be fixed with insurance regulation and reform.  It seems to me the largest complaint against the old system is my house burned down and now insurance says they arent gonna pay and dropped me.  How is this insurance.  A simple rule could fix that i'd think. 

still putting everyone in a big pot and then giving credits for being healthier and getting preventative treatments done/ attempting to be healthier and taking classes much like are offered thru large employer group plans seems to be a better cheaper overall system.  then the higher risk people are either taking steps towards becoming less high risk and the rest of the healthy people can keep on about their lives as they have been.  I'm sure invasion of privacy will come up with this but its a credit you dont have to participate if you want to just pay the full tax.
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