Author Topic: What comes after the ACA?  (Read 237095 times)

KaizenSoze

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Re: What comes after the ACA?
« Reply #500 on: January 17, 2017, 07:32:28 AM »
In its purest form, the free market solution would be no insurance.  Each person would pay the full cost of his own health care with no help from anyone else.  That would surely discourage a person from eating, drinking, or smoking too much.  I realize this is a step too far for most people, as they aren't going to be okay with not having any form of health insurance.  In my opinion, the next best thing is for people who are out of shape to pay higher premiums.  The insurance companies would have to decide what "out of shape" means to them.  They should know which health indicators typically lead to higher costs better than anyone.

How about accidents or injuries caused by another party and that other party has no money? Kids with cancer?

This is a completely unrealistic idea.

sol

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Re: What comes after the ACA?
« Reply #501 on: January 17, 2017, 07:44:11 AM »
Not 1 republican senator voted for Obamacare
Not 1 republican congressman voted for

Technically, exactly one lifelong Republican voted for it, immediately after changing his  party affiliation.  His name was Arlen Specter.  Look him up.

There were a bunch of other Republicans who helped craft the bill though, including the ones at the heritage foundation who wrote most of the original text, and the ones in Congress who attached a bunch of Republican amendments to try to strengthen it.  I won't count the ones in MA that wrote and then passed and then successfully implemented Romneycare.

farmecologist

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Re: What comes after the ACA?
« Reply #502 on: January 17, 2017, 08:05:03 AM »

How about accidents or injuries caused by another party and that other party has no money? Kids with cancer?

This is a completely unrealistic idea.

I agree...ever heard of the Hippocratic Oath?  Doctors are required to abide by ethical standards. They will not throw someone out on the street..even if they have "signed a waiver". 

Again..this all seems to come back to the various forms of the silly "I'm not sick - I don't need insurance" argument.  And yes, you can get ill even if you "are in shape", "take care of yourself", etc... It happens to millions of people every year.  Amazing revelation..eh?  Many of these conditions are then classified as "pre-existing".   Thus the need for insurance.  This is not a difficult concept to understand.  Maybe it is denial/rationalization ...i.e. - "it will never happen to me"?

And to throw people that have a pre-existing condition under the bus...well that is just a complete lack of empathy...which I see in droves around here.  In fact, I think some of you need a healthy dose of empathy to "understand" where some of us are coming from.  Either that or have it happen to yourself or someone in your family ( god forbid )...that will build 'empathy' really fast.





jim555

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Re: What comes after the ACA?
« Reply #503 on: January 17, 2017, 08:11:35 AM »
Where I worked, one person got prostate cancer, one got a tumor on the kidneys, one got leukemia, one has sleep apnea, another has Crohn's disease.  These are all in their late 40s and 50s.  It CAN happen to you, no matter what you eat or how much you exercise.

mathlete

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Re: What comes after the ACA?
« Reply #504 on: January 17, 2017, 08:12:51 AM »
In its purest form, the free market solution would be no insurance.

How is this more of a free market than one in which individuals can freely buy insurance and firms can freely sell it?

In my opinion, the next best thing is for people who are out of shape to pay higher premiums.  The insurance companies would have to decide what "out of shape" means to them.  They should know which health indicators typically lead to higher costs better than anyone.

This existed prior to ACA in the individual market. It was called Medical underwriting. As it turns out, the best indicators of morbidity were that the person was currently sick, had been sick before, is taking expensive prescriptions, etc.

Insurers also already impose an extra surcharge on tobacco users. I suppose they could start doing something similar for obesity, but I'm not sure there is a reliable indicator for that. There are some obviously healthy people who have a BMI that would call them overweight, etc.

Besides, healthy and fit non-smokers who live forever eventually become a huge burden on the healthcare system too.

I also believe that people should be allowed to have no insurance.  They should have to sign some sort of waiver indicating that they understand the risk - from both a health and financial perspective.  They should not get a taxpayer bailout.  If they get sick, they'll be relying on their own resources and the charity of others to help them out.  If they can't get the help they need, then they'll pass away the same way people have died for most of human history (i.e. without insurance).

I think that letting people die is a politically impossible thing to propose. No matter how financially irresponsible the person was.

Think of it this way; We feed, clothe, and house murders and rapists, but the non-violent but kind of deadbeatish dude doesn't get emergency surgery when his appendix bursts?

sol

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Re: What comes after the ACA?
« Reply #505 on: January 17, 2017, 08:25:01 AM »
How is this more of a free market than one in which individuals can freely buy insurance and firms can freely sell it?

By definition, insurers collectivize risk.  That's the nature of their product, but some people oppose it on philosophical grounds because it seems contrary to our American "rugged individualism".  This is exactly why so many conservatives like the idea of high risk pools.  By dividing everyone up into different premium categories, and lumping people of similar risks together, we move incrementally closer to having risk pools of one person each.  In that end-member case, each person pays their own costs and ignores everyone else, which is the conservative ideal but is definitely not insurance.

Gal2016

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Re: What comes after the ACA?
« Reply #506 on: January 17, 2017, 08:35:55 AM »
You know who also is a large country that has simpler healthcare than us, fucking Russia... They are about half our size, yet we have about 18x the GDP...

I have yet to meet a single person who has come to the US from another major nation that isn't absolutely baffled by our health care system and the staggering costs to the individual.

There is no doubt that having state governments and a fairly large population ensures that creating our system will bear some extra degree of complexity and uncertainty but it is far from impossible to improve on what we have.

You've had people come from Russia and complain about our healthcare?

How about we ask natives of China and India  (the only two countries with higher populations than the US) how they're managing "universal healthcare" for ALL of their many citizens? -- Yeah. Comparing the US to any other country regarding "universal healthcare" is disingenuous. We're kind of unique and some cookie cutter, "well it worked for Canada" proposal just isn't going to work.

I work in healthcare (RN and then in management, which is where I am currently).  The ACA has made a mess of things. It didn't fix the things that were previously broken and things that were running relatively smoothly (those who already had insurance) it royally screwed up.

And Trump's promises sound an awful lot like Obama's "you can choose your own doctor and you don't have to change providers" line.  bleh.
Honestly reading this makes me cringe.

Everyone says this like it's truth, it's truth!  Or when people say that the ACA made their costs go up, and it's horrible.

Do people not understand that it DEPENDS??

it depends on where you live
it depends on how your state implemented the ACA
it depends on how much money you make
it depends on whether or not you were even insurable before.

I have a very good friend who is a NP and has done a LOT of work in public health.  For her, in her city in her state, she's been thrilled because FINALLY a lot of hard working people have access to care, are getting checkups, and are able to afford necessary medications (these are NOT people living in poverty - they were already covered).  "It's been a slog seeing a lot of new patients but has been SO WORTH IT."

And my neighbor, self employed and middle class who requires a fair bit of medication due to a genetic disease - ACA is literally the best insurance she's had as an adult.  Better than any employer sponsored insurance she had before becoming self employed.

And my friends who were uninsurable due to preexisting conditions - saved their bacon.

My husband's insurance costs went down, mine went up.

IT DEPENDS PEOPLE!!

If you're working in "public health", you're probably highly subsidized by the government or other funding (grant funding, state run programs, etc).  Not necessarily unbiased.  Let me state that during the last 10 years I have worked for 3 different hospitals.  1 was a small local community hospital. 2 are large healthcare systems.  These hospitals and hospital systems covered 4 states. I've worked in both inpatient and outpatient settings. I've come into contact with literally thousands of patients and their families. From a care delivery perspective, the ACA (which is much more than "universal healthcare") has been terrible for hospitals , making it incredibly difficult to actually provide care and get paid for it.  Hospitals are going bankrupt and its become far more about what the ACA requires than what's good for the patient or their family. Everyone know someone or even a couple of people that the ACA "helped". I live everyday within a system that now has to look at what we are allowed to do rather than what we should do for the patient. If their insurance won't pay, how can we justify doing something when we know it will result in a huge bill for the patient? -- we give them the options that their insurance tells us they will cover. It's a monumental change in how medical care is being practiced.

From a consumer standpoint, my health insurance premiums have increased, my co-pays have increased, I am now charged for having my working spouse on my insurance (because he could get his through his employer) and the coverage has decreased.  I and everyone else in my healthcare system (10,000 or more employees) is paying more for less.  And this same thing was happening in the other hospital system I worked for (another 10,000 employees).  So, there's 20,000 people who's insurance deteriorated due to the ACA.

mathlete

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Re: What comes after the ACA?
« Reply #507 on: January 17, 2017, 08:37:45 AM »
By definition, insurers collectivize risk.  That's the nature of their product, but some people oppose it on philosophical grounds because it seems contrary to our American "rugged individualism".  This is exactly why so many conservatives like the idea of high risk pools.  By dividing everyone up into different premium categories, and lumping people of similar risks together, we move incrementally closer to having risk pools of one person each.  In that end-member case, each person pays their own costs and ignores everyone else, which is the conservative ideal but is definitely not insurance.

Sure but financial security instruments that handle uncertainty don't run counter to the free market. I guess if we could all predict with 100% certainty what our lifetime medical costs would be, then the free market would have no place for insurance. Until then, medical insurance seems like a logical result of a free market to me.

The rest of your post I agree with.

sol

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Re: What comes after the ACA?
« Reply #508 on: January 17, 2017, 08:55:23 AM »
Sure but financial security instruments that handle uncertainty don't run counter to the free market.

I think that CDOs are just as counter to free market principles as are health insurance policies, which is to say "not at all."   

But conservatives disagree with me.  They seem to think that health insurance policies, by collecting premiums from people who end up not needing insurance and then distributing to the unlucky few who do need insurance, are fundamentally contrary to American ideals.  Apparently, those ideals don't include compassion, or kindness, or even index funds.

rtrnow

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Re: What comes after the ACA?
« Reply #509 on: January 17, 2017, 09:06:11 AM »

 Everyone know someone or even a couple of people that the ACA "helped". I live everyday within a system that now has to look at what we are allowed to do rather than what we should do for the patient. If their insurance won't pay, how can we justify doing something when we know it will result in a huge bill for the patient? -- we give them the options that their insurance tells us they will cover. It's a monumental change in how medical care is being practiced.

From a consumer standpoint, my health insurance premiums have increased, my co-pays have increased, I am now charged for having my working spouse on my insurance (because he could get his through his employer) and the coverage has decreased.  I and everyone else in my healthcare system (10,000 or more employees) is paying more for less.  And this same thing was happening in the other hospital system I worked for (another 10,000 employees).  So, there's 20,000 people who's insurance deteriorated due to the ACA.

I'll call bs on this. Are you saying insurance was not dictating what care would be provided before the ACA? You have to know that's not true. I argued constantly with insurance before the ACA and that didn't change after.

As to your other point, maybe take a look at the millions of us who didn't have employer sponsored insurance.

waltworks

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Re: What comes after the ACA?
« Reply #510 on: January 17, 2017, 09:26:10 AM »
EMTALA (signed into law by president Reagan and massively popular then/now) precludes a true free market - you will get emergency care whether you can pay or not, period.

So folks, we already have socialized medicine. Either propose repealing EMTALA and deal with the blowback as pregnant ladies bleed out at the front doors of the hospital, or else stop whining about socialism and try to implement it more efficiently - because the socialism cow left the barn a while ago.

-W

jim555

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Re: What comes after the ACA?
« Reply #511 on: January 17, 2017, 09:39:09 AM »
EMTALA (signed into law by president Reagan and massively popular then/now) precludes a true free market - you will get emergency care whether you can pay or not, period.

So folks, we already have socialized medicine. Either propose repealing EMTALA and deal with the blowback as pregnant ladies bleed out at the front doors of the hospital, or else stop whining about socialism and try to implement it more efficiently - because the socialism cow left the barn a while ago.

-W
A total free market means lots of people will die outside the ER doors.  Those who advocate for it should own up to its consequences and make arguments as to why this is a just way to have things set up.  Yet I don't hear them advocating for repeal of EMTALA like they should be.  They are cowardly avoiding the true issues.

Schaefer Light

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Re: What comes after the ACA?
« Reply #512 on: January 17, 2017, 10:41:15 AM »
How is this more of a free market than one in which individuals can freely buy insurance and firms can freely sell it?

By definition, insurers collectivize risk.  That's the nature of their product, but some people oppose it on philosophical grounds because it seems contrary to our American "rugged individualism".  This is exactly why so many conservatives like the idea of high risk pools.  By dividing everyone up into different premium categories, and lumping people of similar risks together, we move incrementally closer to having risk pools of one person each.  In that end-member case, each person pays their own costs and ignores everyone else, which is the conservative ideal but is definitely not insurance.

That's just it.  The whole idea of insurance (or anything that's collectivized) just runs counter to my principles.

sol

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Re: What comes after the ACA?
« Reply #513 on: January 17, 2017, 10:42:46 AM »
That's just it.  The whole idea of insurance (or anything that's collectivized) just runs counter to my principles.

Fascinating.  I assume you also hate index funds, then?

Schaefer Light

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Re: What comes after the ACA?
« Reply #514 on: January 17, 2017, 10:43:34 AM »
That's just it.  The whole idea of insurance (or anything that's collectivized) just runs counter to my principles.

Fascinating.  I assume you also hate index funds, then?

No.  I can profit from them ;).

sol

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Re: What comes after the ACA?
« Reply #515 on: January 17, 2017, 10:50:32 AM »
That's just it.  The whole idea of insurance (or anything that's collectivized) just runs counter to my principles.

Fascinating.  I assume you also hate index funds, then?

No.  I can profit from them ;).

How about social security?

waltworks

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Re: What comes after the ACA?
« Reply #516 on: January 17, 2017, 10:56:33 AM »
You can in fact profit from insurance - if you get very sick and need more care than you could otherwise afford.

It's a bit different wager (the inverse, really) than an index fund, but still a wager that can result in huge profits.

Insurance isn't "collectivized" anything. It's a contract between you and someone else where you're betting you'll get sick, and they're betting you won't.

-W

sol

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Re: What comes after the ACA?
« Reply #517 on: January 17, 2017, 11:06:49 AM »
t's a contract between you and someone else where you're betting you'll get sick, and they're betting you won't.

It's the same bet as car insurance (you're buying protection against having an accident, they hope you don't), your unemployment insurance (you're buying protection against losing your job, they hope you stay employed), or social security (you're buying protection against becoming disabled or outliving your money, they are hoping you stay healthy and then die young).

These are all forms of collectived risk pools, and they make sense for the buyers and are profitable for the sellers.  Index funds are the exact same thing.

CDP45

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Re: What comes after the ACA?
« Reply #518 on: January 17, 2017, 11:08:52 AM »
Sure but financial security instruments that handle uncertainty don't run counter to the free market.

I think that CDOs are just as counter to free market principles as are health insurance policies, which is to say "not at all."   

But conservatives disagree with me.  They seem to think that health insurance policies, by collecting premiums from people who end up not needing insurance and then distributing to the unlucky few who do need insurance, are fundamentally contrary to American ideals.  Apparently, those ideals don't include compassion, or kindness, or even index funds.

Excellent straw-man Sol, you are a partisan demagogue with little regard for reality.

Because if you're against total federal government control of the health care system when the current system is already exponentially increasing in cost, waste, and threatening to overtake the entire budget- such folks apparently are devoid of compassion and kindness.

Hey you know what? You can start helping people yourself, no need to wait on government and forcing others to contribute. What a compassion soul you are.

BFGirl

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Re: What comes after the ACA?
« Reply #519 on: January 17, 2017, 11:16:43 AM »


I think that letting people die is a politically impossible thing to propose. No matter how financially irresponsible the person was.

Think of it this way; We feed, clothe, and house murders and rapists, but the non-violent but kind of deadbeatish dude doesn't get emergency surgery when his appendix bursts?

I have a friend (Pre-ACA) who didn't get health insurance through his job (temp position) and he couldn't afford to buy it outright.  He was diagnosed with colon cancer.  The doctor recommended chemotherapy, but it would have cost over $100,000.  He and his wife applied to several programs, but they didn't qualify because they made something like $20 too much.  As he was being told he didn't qualify, they brought in the prisoner from the jail for his chemotherapy.  He and his wife joked that he should commit a crime so that he could get healthcare.  He elected to forego chemo (they are still paying the bills from his surgery).  Fortunately his cancer has not recurred and he now has a job with health insurance.  This situation is one of the reasons why my thinking changed and I now believe we need a universal system.

sol

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Re: What comes after the ACA?
« Reply #520 on: January 17, 2017, 11:27:34 AM »
Hey you know what? You can start helping people yourself, no need to wait on government and forcing others to contribute. What a compassion soul you are.

You have no idea what my charitable contributions are.  And even if they were 100% of my income, that would not change my perspective on what protections the US government should provide to US citizens. 

Look, you already have government insurance provided to you through your taxes. You have accepted this fact and never once complained.  Why are people so bent out of shape about health insurance, but not OASDI?

It's now come up a few different times in this thread... and I feel like this ongoing argument of what defines "insurance" is a sideshow to the larger questions here.  If we had single payer, we wouldn't even be having this discussion. 

Single payer is still insurance, it's just insurance provided without a profit motive, by Uncle Sam, with premiums paid by your taxes.

Gal2016

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Re: What comes after the ACA?
« Reply #521 on: January 17, 2017, 12:24:50 PM »

 Everyone know someone or even a couple of people that the ACA "helped". I live everyday within a system that now has to look at what we are allowed to do rather than what we should do for the patient. If their insurance won't pay, how can we justify doing something when we know it will result in a huge bill for the patient? -- we give them the options that their insurance tells us they will cover. It's a monumental change in how medical care is being practiced.

From a consumer standpoint, my health insurance premiums have increased, my co-pays have increased, I am now charged for having my working spouse on my insurance (because he could get his through his employer) and the coverage has decreased.  I and everyone else in my healthcare system (10,000 or more employees) is paying more for less.  And this same thing was happening in the other hospital system I worked for (another 10,000 employees).  So, there's 20,000 people who's insurance deteriorated due to the ACA.

I'll call bs on this. Are you saying insurance was not dictating what care would be provided before the ACA? You have to know that's not true. I argued constantly with insurance before the ACA and that didn't change after.

As to your other point, maybe take a look at the millions of us who didn't have employer sponsored insurance.

I am absolutely telling you that there has been a MAJOR shift in care delivery, and much of it has not been good.  When every nurse (not even administration) is looking to cost savings and when doctors have to order the X-ray (x2) before getting to the MRI or CT that the patient actually needs... when we change medications because the insurance doesn't cover the one the patient actually needs or we are required to first use this medication, then this one, and then that one, before finally getting to the one we know will work for the patient (all with extensive documentation) because insurance won't pay ... yeah.  That's new.

And for the person who said their friend had colon cancer and he couldn't "afford" the chemotherapy because they made (like $20 more) than the program allowed.  I call BS. I've worked with those programs -- which, *gasp* are run by the pharmaceutical companies, that give FREE chemotherapy to patients who cannot pay -- it's not that hard to get qualified for the program.  So the friend must have had some assets or other income or insurance that would pay.  They do ask for your tax returns, as part of determining need, after all. And unless he was going to a for-profit hospital, the hospital would likely have written off the bill, anyway.  No one really gets turned down for life-saving medical care in the US.  Sure, you might get a bill and have to apply for assistance through the hospital (to write off your bill), but they're not going to withhold treatment.

Gin1984

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Re: What comes after the ACA?
« Reply #522 on: January 17, 2017, 01:34:35 PM »

 Everyone know someone or even a couple of people that the ACA "helped". I live everyday within a system that now has to look at what we are allowed to do rather than what we should do for the patient. If their insurance won't pay, how can we justify doing something when we know it will result in a huge bill for the patient? -- we give them the options that their insurance tells us they will cover. It's a monumental change in how medical care is being practiced.

From a consumer standpoint, my health insurance premiums have increased, my co-pays have increased, I am now charged for having my working spouse on my insurance (because he could get his through his employer) and the coverage has decreased.  I and everyone else in my healthcare system (10,000 or more employees) is paying more for less.  And this same thing was happening in the other hospital system I worked for (another 10,000 employees).  So, there's 20,000 people who's insurance deteriorated due to the ACA.

I'll call bs on this. Are you saying insurance was not dictating what care would be provided before the ACA? You have to know that's not true. I argued constantly with insurance before the ACA and that didn't change after.

As to your other point, maybe take a look at the millions of us who didn't have employer sponsored insurance.

I am absolutely telling you that there has been a MAJOR shift in care delivery, and much of it has not been good.  When every nurse (not even administration) is looking to cost savings and when doctors have to order the X-ray (x2) before getting to the MRI or CT that the patient actually needs... when we change medications because the insurance doesn't cover the one the patient actually needs or we are required to first use this medication, then this one, and then that one, before finally getting to the one we know will work for the patient (all with extensive documentation) because insurance won't pay ... yeah.  That's new.

And for the person who said their friend had colon cancer and he couldn't "afford" the chemotherapy because they made (like $20 more) than the program allowed.  I call BS. I've worked with those programs -- which, *gasp* are run by the pharmaceutical companies, that give FREE chemotherapy to patients who cannot pay -- it's not that hard to get qualified for the program.  So the friend must have had some assets or other income or insurance that would pay.  They do ask for your tax returns, as part of determining need, after all. And unless he was going to a for-profit hospital, the hospital would likely have written off the bill, anyway.  No one really gets turned down for life-saving medical care in the US.  Sure, you might get a bill and have to apply for assistance through the hospital (to write off your bill), but they're not going to withhold treatment.
It is in no way new that there were meds that insurances would not cover and you would need to try other meds within the same family first to prove that the patient needed the meds.
My mom represented nurses for over a decade before retiring (thanks to the ACA).  The ACA had no effect on overall compensation (she negotiated it, she should know) according to her for nurses.  Their insurance did not get worse, they did not have to do more work post-ACA than prior.  She represented two different hospital systems and her local coworkers another three.  I'm calling BS on your statements, maybe you just work for bad employers.
t's a contract between you and someone else where you're betting you'll get sick, and they're betting you won't.

It's the same bet as car insurance (you're buying protection against having an accident, they hope you don't), your unemployment insurance (you're buying protection against losing your job, they hope you stay employed), or social security (you're buying protection against becoming disabled or outliving your money, they are hoping you stay healthy and then die young).

These are all forms of collectived risk pools, and they make sense for the buyers and are profitable for the sellers.  Index funds are the exact same thing.


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radram

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Re: What comes after the ACA?
« Reply #523 on: January 17, 2017, 01:37:21 PM »

 Everyone know someone or even a couple of people that the ACA "helped". I live everyday within a system that now has to look at what we are allowed to do rather than what we should do for the patient. If their insurance won't pay, how can we justify doing something when we know it will result in a huge bill for the patient? -- we give them the options that their insurance tells us they will cover. It's a monumental change in how medical care is being practiced.

From a consumer standpoint, my health insurance premiums have increased, my co-pays have increased, I am now charged for having my working spouse on my insurance (because he could get his through his employer) and the coverage has decreased.  I and everyone else in my healthcare system (10,000 or more employees) is paying more for less.  And this same thing was happening in the other hospital system I worked for (another 10,000 employees).  So, there's 20,000 people who's insurance deteriorated due to the ACA.

I'll call bs on this. Are you saying insurance was not dictating what care would be provided before the ACA? You have to know that's not true. I argued constantly with insurance before the ACA and that didn't change after.

As to your other point, maybe take a look at the millions of us who didn't have employer sponsored insurance.

I am absolutely telling you that there has been a MAJOR shift in care delivery, and much of it has not been good.  When every nurse (not even administration) is looking to cost savings and when doctors have to order the X-ray (x2) before getting to the MRI or CT that the patient actually needs... when we change medications because the insurance doesn't cover the one the patient actually needs or we are required to first use this medication, then this one, and then that one, before finally getting to the one we know will work for the patient (all with extensive documentation) because insurance won't pay ... yeah.  That's new.

And for the person who said their friend had colon cancer and he couldn't "afford" the chemotherapy because they made (like $20 more) than the program allowed.  I call BS. I've worked with those programs -- which, *gasp* are run by the pharmaceutical companies, that give FREE chemotherapy to patients who cannot pay -- it's not that hard to get qualified for the program.  So the friend must have had some assets or other income or insurance that would pay.  They do ask for your tax returns, as part of determining need, after all. And unless he was going to a for-profit hospital, the hospital would likely have written off the bill, anyway.  No one really gets turned down for life-saving medical care in the US.  Sure, you might get a bill and have to apply for assistance through the hospital (to write off your bill), but they're not going to withhold treatment.

And speaking of BS:

Pre-ACA never had insurance companies dictating the drugs they cover and the drugs they do not. If the doctor said a test was needed, it was approved and paid for by the insurance company. Nobody ever had to work their way up in medicines, usually based on cost, even though the doctor knew the drug that would most likely work (you know, the same one that he was paid to push).

Yup, all the fault of the ACA. BS.

You can in no way state these are new problems started by ACA. What was already driving those changes was run-away premium increases which were absorbed largely by your employer until they just could not do it anymore. Some held out longer than others, but eventually everyone was paying a lot more out of pocket. This was right around the time the ACA was passed, so those costs were increasingly pushed to the employee. At the same time cost increases SLOWED(still cost increases, but slower percentages), the percentage of the increase pushed to the employee increased so high it gave the appearance the ACA was the cause.

http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS




acroy

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Re: What comes after the ACA?
« Reply #524 on: January 17, 2017, 01:40:32 PM »

 Everyone know someone or even a couple of people that the ACA "helped". I live everyday within a system that now has to look at what we are allowed to do rather than what we should do for the patient. If their insurance won't pay, how can we justify doing something when we know it will result in a huge bill for the patient? -- we give them the options that their insurance tells us they will cover. It's a monumental change in how medical care is being practiced.

From a consumer standpoint, my health insurance premiums have increased, my co-pays have increased, I am now charged for having my working spouse on my insurance (because he could get his through his employer) and the coverage has decreased.  I and everyone else in my healthcare system (10,000 or more employees) is paying more for less.  And this same thing was happening in the other hospital system I worked for (another 10,000 employees).  So, there's 20,000 people who's insurance deteriorated due to the ACA.

I'll call bs on this. Are you saying insurance was not dictating what care would be provided before the ACA? You have to know that's not true. I argued constantly with insurance before the ACA and that didn't change after.

As to your other point, maybe take a look at the millions of us who didn't have employer sponsored insurance.

I am absolutely telling you that there has been a MAJOR shift in care delivery, and much of it has not been good.  When every nurse (not even administration) is looking to cost savings and when doctors have to order the X-ray (x2) before getting to the MRI or CT that the patient actually needs... when we change medications because the insurance doesn't cover the one the patient actually needs or we are required to first use this medication, then this one, and then that one, before finally getting to the one we know will work for the patient (all with extensive documentation) because insurance won't pay ... yeah.  That's new.

And for the person who said their friend had colon cancer and he couldn't "afford" the chemotherapy because they made (like $20 more) than the program allowed.  I call BS. I've worked with those programs -- which, *gasp* are run by the pharmaceutical companies, that give FREE chemotherapy to patients who cannot pay -- it's not that hard to get qualified for the program.  So the friend must have had some assets or other income or insurance that would pay.  They do ask for your tax returns, as part of determining need, after all. And unless he was going to a for-profit hospital, the hospital would likely have written off the bill, anyway.  No one really gets turned down for life-saving medical care in the US.  Sure, you might get a bill and have to apply for assistance through the hospital (to write off your bill), but they're not going to withhold treatment.
Interesting feedback, thanks.
It seems the healthcare industry is run according to bureaucracy and regulatory needs, not the patient needs. Pretty sick.
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CDP45

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Re: What comes after the ACA?
« Reply #525 on: January 17, 2017, 01:43:37 PM »
New thought here:

Would you expect a life insurance company to insure a 100 year old person for anything less than the value of the policy?

Now think of another market, long-term care; Is that a disaster that needs to be nationalized and cause additional financial instability to the economy or are individuals and families coming together to make the best decisions for themselves?

protostache

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Re: What comes after the ACA?
« Reply #526 on: January 17, 2017, 01:55:01 PM »
New thought here:

Would you expect a life insurance company to insure a 100 year old person for anything less than the value of the policy?

Now think of another market, long-term care; Is that a disaster that needs to be nationalized and cause additional financial instability to the economy or are individuals and families coming together to make the best decisions for themselves?

Social Security effectively bundles a type of life insurance for minor children and surviving spouses. And we already have a nationalized long term care insurance program. It's called Medicaid.

calimom

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Re: What comes after the ACA?
« Reply #527 on: January 17, 2017, 01:59:07 PM »
The "free market" is alive and well. Here's a partial list of the highest paid CEOs of heath insurance firms from 2015:

1) Joseph Swedish, Anthem $13.6 million

2) Bruce Broussard, Humana $10.3 million

3) Stephen Hemsley, United Heath Care $14.5 million

Guess who's paying their salaries, bonuses and stock options?


GuitarStv

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Re: What comes after the ACA?
« Reply #528 on: January 17, 2017, 01:59:11 PM »
Now think of another market, long-term care; Is that a disaster that needs to be nationalized and cause additional financial instability to the economy or are individuals and families coming together to make the best decisions for themselves?

The problem with off-loading all costs on individuals/families is that one of two things happens when they're poor:

- Keep Grandma alive at tremendous financial hardship to the family, which damages the ability of the people in the family to be productive members of society.

- Choose to let Grandma die because of the costs/time, which damages faith and trust in the system . . . and thus reduces the chance that people in that family will go on to be productive members of society.

Either way, everyone loses.

I believe that individuals and families should be freed to make decisions that are good for themselves and society . . . that's why a certain level of minimum care should be available to everyone.

radram

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Re: What comes after the ACA?
« Reply #529 on: January 17, 2017, 02:02:33 PM »
New thought here:

Would you expect a life insurance company to insure a 100 year old person for anything less than the value of the policy?

Now think of another market, long-term care; Is that a disaster that needs to be nationalized and cause additional financial instability to the economy or are individuals and families coming together to make the best decisions for themselves?

The oldest of the baby boomers reaches 70.5 this month. That is still a little too early to call long term care plans a disaster. 10 years from now, you better believe that mass amounts of families left to "make the best decision for themselves" will have done NOTHING, and a more comprehensive long term care program will be "in play".

BFGirl

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Re: What comes after the ACA?
« Reply #530 on: January 17, 2017, 03:32:34 PM »
There is already essentially universal coverage for long term care in a nursing home.  It is called Medicaid.  If a person proves a medical need for skilled nursing care in a facility and meets the income and resources tests, then Medicaid will pick up the balance of nursing home care after any income is applied. 

https://www.medicaid.gov/medicaid/ltss/institutional/index.html

Roland of Gilead

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Re: What comes after the ACA?
« Reply #531 on: January 17, 2017, 03:33:52 PM »
The "free market" is alive and well. Here's a partial list of the highest paid CEOs of heath insurance firms from 2015:

1) Joseph Swedish, Anthem $13.6 million

2) Bruce Broussard, Humana $10.3 million

3) Stephen Hemsley, United Heath Care $14.5 million

Guess who's paying their salaries, bonuses and stock options?

Really so what?  You have California commissioners and other public officials pulling in $400,000 plus salaries with huge pensions.   Occasionally you will also hear about big salaries for CEOs of charities and such.

People in power always seem to make money, in any industry.

CDP45

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Re: What comes after the ACA?
« Reply #532 on: January 17, 2017, 03:41:00 PM »
There is already essentially universal coverage for long term care in a nursing home.  It is called Medicaid.  If a person proves a medical need for skilled nursing care in a facility and meets the income and resources tests, then Medicaid will pick up the balance of nursing home care after any income is applied. 

https://www.medicaid.gov/medicaid/ltss/institutional/index.html

Not quite universal, and my understanding if very onerous for this benefit, basically you have to be flat broke for 5 years straight, and transferring wealth is a disqualifier. Definitely not a majority who use long-term care get it from Medicaid.

http://longtermcare.gov/medicare-medicaid-more/medicaid/medicaid-eligibility/financial-requirements/

"The amount of countable assets a person can have is similar to other pathways, about $2,000 for an individual."

And of course alleviating the consequences of poor decision making is the best practice right?

Helvegen

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Re: What comes after the ACA?
« Reply #533 on: January 17, 2017, 03:47:38 PM »
Something that just came up in a WaPo article, which I had forgotten. Back in the good old days, pregnancy was widely considered a preexisting condition. Not pregnancy as in "are you currently pregnant?" But pregnancy as in "have you ever, in your life, been pregnant?"

Yes. Let's go back to that. Sounds reasonable.

Forgetting to state that you had your tonsils out when you were 14 was grounds for rescission.

Too many head colds was grounds for denial.

Those were the good ol' days. America! Fuck yeah!

My BIL got denied for his own individual coverage because his wife was pregnant. @_@


realDonaldTrump

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Re: What comes after the ACA?
« Reply #534 on: January 17, 2017, 04:06:34 PM »
After ACA comes dismantled Medicare plus something Terrific for Redneck Voters :)

nereo

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Re: What comes after the ACA?
« Reply #535 on: January 17, 2017, 04:52:43 PM »
After ACA comes dismantled Medicare plus something Terrific for Redneck Voters :)
Given your name and comments, I can't quite decide if you are a troll, a satire of a troll, or something else entirely.
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RosieTR

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Re: What comes after the ACA?
« Reply #536 on: January 18, 2017, 02:09:54 PM »
No one really gets turned down for life-saving medical care in the US.  Sure, you might get a bill and have to apply for assistance through the hospital (to write off your bill), but they're not going to withhold treatment.

Well, what a hospital defines as "life-saving medical care" and what is actually life-saving medical care can differ significantly. The example I always come back to is a friend of mine who was diagnosed with Type I diabetes in his late teens. He was into music, so started a band, worked at some shitty CD stores earning minimum wage with no benefits, etc. No insurance, no possibility of insurance with a pre-existing condition like that one. He became an entrepreneur at one point, with a successful small business. He kinda managed his diabetes but you know, he had to buy insulin, syringes, and blood testing supplies. I have no idea how much it was back then, but this month I had to buy insulin for a cat (there is no special cat insulin, this is normally sold for humans) to the tune of $275-$300 for 10ml. The cat, at 11.5 lbs, gets 0.04ml/day but I would imagine a human uses much more. If it's a linear extrapolation, a 115 lb human would use 0.4ml/day, so about 25 days worth. I can't remember what the syringes cost and the blood testing kits are purchased by the vet and incorporated into the vet visits. I will guess that if the cat's diabetes costs $300 or more a month, a human would be at least that. So on minimum wage, that's a pretty significant portion of one's take-home pay. Gross pay would be $290/week for a 40 hr week-all of this in today's dollars. So, one week out of each month is going to basic "don't die" maintenance.
Suffice to say, I'll hazard a guess that this friend tried to stretch things a little. Test the blood less often than recommended. Fiddle with the insulin to make it last the whole month (25 days isn't even all of February). Etc. Maybe he had a particularly difficult manifestation of the disease, I don't know. I didn't talk to him about the details of his medical care because I barely do that with my blood relatives. What I do know is, eventually his kidneys were basically non-functional because of this. He lost most of his eyesight. He had some strokes. His nerves to his legs failed and he became paralyzed. His digestive system become problematic. Along the way, he could no longer maintain his work and at some point in this process, yes, Medicaid picked up the tab because in their definition it became "life-saving care". The United States health care system, touted by conservatives at the time as "the best in the world", would not pay for his insulin or testing or regular visits to an internal med MD, but happily gave him dialysis several times a week and MRIs for some strokes and then after his wife couldn't care for him at home, housing and care in a long term care facility until even that wasn't enough and he passed away in 2016.

He was 40 years old. Forty. Now, I have zero idea how much Medicare paid out for his care over the last few years of his short life. I surmise it was a FUCKTON MORE THAN INSULIN FOR FUCK'S SAKE. Insulin! Which, by the way, was discovered well over 100 years ago, so who the fuck knows why there are still patents all over the place and it costs as much as many people here pay in rent. All this due to the "best health care system in the world". Saying it's the best does not make it the best. If this person had been born in and lived in any other industrialized nation, he would still be not only alive, but quite possibly thriving. When a normal person dies at half his age expectancy from a fully treatable disease that lacked for nothing more than support to pay for it, it is in no way the best health care system or even anywhere close to all that great. If the ACA had been passed when conservatives were shitting a brick over Hillary's first attempt at a better system, he would have gotten the support he needed and would probably be alive today. And paying taxes.

So yeah, if the ACA is repealed and there is no reasonably decent alternative, people like this WILL die. Not just obese people or smokers...regular people who just happen to have bad luck or who are poor. This includes children and babies, and women giving birth, for those of you who think you are "pro-life" but also that everyone "should take care of themselves". You either have to accept that lack of a health care system will mean preventable deaths of Americans, or you have to support a comprehensive health care system, or you have to be OK with huge deficit spending (if you mandate health care but don't tax the population appropriately to pay for it). Or I suppose you would have to compel doctors and nurses to work for much less/free, and somehow seize pharmaceuticals from the companies that charge high prices for them. It's math plus morality. I think that the people advocating no system or a "free market" system are immoral.

OurTown

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Re: What comes after the ACA?
« Reply #537 on: January 18, 2017, 02:16:23 PM »
^^^ +1000 ^^^

ysette9

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Re: What comes after the ACA?
« Reply #538 on: January 18, 2017, 02:21:24 PM »
Powerful story. Thanks for sharing.
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sol

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Re: What comes after the ACA?
« Reply #539 on: January 18, 2017, 02:23:16 PM »
Following the news, it looks like all of the talk about "healthcare for everybody" was just misdirection.  They're seriously proposing kicking 20 million people who currently have coverage to the curb, and then declaring it a victory.  Expanded Medicaid will not only die, they want to block grant Medicaid so that individual states can turn people away who are currently guaranteed coverage due to poverty.

Apparently the republican version of "for everybody" means that insurance companies cannot deny you coverage on the individual market, but they can charge you a million dollars per day for coverage that excludes any pre-existing conditions.  They think that qualifies as "universally available"'.

So my bet now is that they repeal the ACA by reconciliation, leaving in the guaranteed coverage rules but removing all regulations on what needs to be covered and what they can charge for it.  They will claim that this is a better and more fair system and that you will be better off if you can no longer afford insurance. 

I predict Trump and Paul Ryan bro-hug awkwardly on television at their party celebrating this amazing new plan that is so much better for the country, you're going to love it. 

OurTown

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Re: What comes after the ACA?
« Reply #540 on: January 18, 2017, 02:53:03 PM »
And that is exactly what we deserve.  America, you built this.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #541 on: January 18, 2017, 05:02:18 PM »
He was 40 years old. Forty. Now, I have zero idea how much Medicare paid out for his care over the last few years of his short life. I surmise it was a FUCKTON MORE THAN INSULIN FOR FUCK'S SAKE. Insulin! Which, by the way, was discovered well over 100 years ago, so who the fuck knows why there are still patents all over the place and it costs as much as many people here pay in rent. All this due to the "best health care system in the world". Saying it's the best does not make it the best. If this person had been born in and lived in any other industrialized nation, he would still be not only alive, but quite possibly thriving. When a normal person dies at half his age expectancy from a fully treatable disease that lacked for nothing more than support to pay for it, it is in no way the best health care system or even anywhere close to all that great. If the ACA had been passed when conservatives were shitting a brick over Hillary's first attempt at a better system, he would have gotten the support he needed and would probably be alive today. And paying taxes.

It's a biological, so you can't make it as easily as you can with other medications. There are biosimilar products, which are equivalent to generic drugs.

Not a defense of what happened (which is indefensible), just an explanation.
The first step is acknowledging you have a problem, right?

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Helvegen

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Re: What comes after the ACA?
« Reply #542 on: January 18, 2017, 05:50:01 PM »
Oh boy, I love being permanently tethered to my employer because of health insurance!

We sort of have an escape hatch in that we can always go back to the EU, but we really don't want to. It has its own issues, which is why we are living here and not there in the first place. Lucky in that regard, but it is ridiculous that that is what it has to come down to. People will suffer and die because healthcare is seen as nothing more than a political football. Why do they hate America?

golden1

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Re: What comes after the ACA?
« Reply #543 on: January 18, 2017, 07:00:40 PM »
When they repeal the ACA, my son, who has Autism which is a pre-existing condition, will be kicked off my insurance when he is 21 instead of 26, and will likely be uninsurable.  That is a real world consequence.  The diabetes example above is another good one.  My next door neighbor has type 1 and may face similar struggles.

What really, REALLY pisses me off is all the political gamesmanship.  They are playing with people's lives to score points.  If McCain had been president and proposed the ACA instead of Obama, the conservatives in this thread would be jumping all over how great it was, guaranteed.  It was Romneys plan after all.  It was a decent starting place, and it is obvious it has flaws, but because the GOP doesn't want to give the Democrats the win, they will call it a disaster, and tweak it, call it Trump or Ryan care and then declare it a victory.  Whatever they replace it with won't be fundamentally different except in how it is funded, which is to say that the middle class and poor will pay more while the rich get a huge tax cut, which is cruel and stupid. 

Paul der Krake

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Re: What comes after the ACA?
« Reply #544 on: January 18, 2017, 07:07:49 PM »
When they repeal the ACA, my son, who has Autism which is a pre-existing condition, will be kicked off my insurance when he is 21 instead of 26, and will likely be uninsurable.  That is a real world consequence.  The diabetes example above is another good one.  My next door neighbor has type 1 and may face similar struggles.
Haven't there been signs that the 26 age limit is here to stay? Everyone loves it and white middle aged voters who vote Republican rely on it heavily when their kids go to college. If anything remains, that's probably it.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #545 on: January 18, 2017, 08:59:18 PM »
That is the one big problem I have with republicans, even though I do sometimes vote republican (didn't vote trump, did vote for GJ but in WA state which really was always going for Jillary).

They are all about pro-life, abortion is murder, get out in the street and hold up signs.

then Baby is born

Fuck paying for that!  Die in the street kid if you can't support yourself.

They are a funny bunch.

sol

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Re: What comes after the ACA?
« Reply #546 on: January 18, 2017, 09:31:00 PM »
Haven't there been signs that the 26 age limit is here to stay?

I think the age 26 rule will stay, at least for now, just because they CAN'T repeal it.  They don't have 60 votes in the Senate to overcome a Democratic filibuster, so they can't repeal that part (or some of the other non-financial rules, like the guaranteed issue clause).  Because they're repealing it using the budget reconciliation provision, all they can really do for now is defund the law. 

That means no more subsidies, no more expanded medicaid, and no more surtax on the high income earners.  It also means no more regulations about what sorts of things will be covered, and what the insurance companies can charge, since those rules were only ever in effect for plans sold through the exchanges and the exchanges will disappear. 

So people like golden1 will be able to keep their son on the plan, but the plan can cost any crazy amount of money and won't be required to cover anything autism related.  The Republicans will claim "no one was kicked off of their insurance" despite your insurance becoming both useless and unaffordable as a result of their plan.

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #547 on: January 18, 2017, 09:32:52 PM »
Even more shocking these days, constituents know more about the laws on the books than legislators!

Quote
...(Congressman) Brady moved from one goal of dismantling ACA to another of defunding Planned Parenthood, which he said used taxpayer money for abortion.

"The Hyde Amendment," she sputtered, incredulously, as Brady continued to talk over her.  Hoppel (constituent) referred to the legislative provision that already prohibits the use of federal funds to pay for abortion.
Transitioning to FIRE'd albeit somewhat cautiously...

Paul der Krake

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Re: What comes after the ACA?
« Reply #548 on: January 18, 2017, 09:47:09 PM »
Haven't there been signs that the 26 age limit is here to stay?

I think the age 26 rule will stay, at least for now, just because they CAN'T repeal it.  They don't have 60 votes in the Senate to overcome a Democratic filibuster, so they can't repeal that part (or some of the other non-financial rules, like the guaranteed issue clause).  Because they're repealing it using the budget reconciliation provision, all they can really do for now is defund the law. 

That means no more subsidies, no more expanded medicaid, and no more surtax on the high income earners.  It also means no more regulations about what sorts of things will be covered, and what the insurance companies can charge, since those rules were only ever in effect for plans sold through the exchanges and the exchanges will disappear. 

So people like golden1 will be able to keep their son on the plan, but the plan can cost any crazy amount of money and won't be required to cover anything autism related.  The Republicans will claim "no one was kicked off of their insurance" despite your insurance becoming both useless and unaffordable as a result of their plan.
Wouldn't employer plans remain the same, at least in near future, since they are negotiated as a group? Obviously that doesn't help people who get their plans on the exchange. It will be interesting to see the effect on W-2/self-employment, if it can be controlled out of other economic factors.

A glimmer of hope is that if everything falls apart so badly, Americans may start demanding a real system. I'm not holding my breath, but that'd be nice.

Metric Mouse

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Re: What comes after the ACA?
« Reply #549 on: January 19, 2017, 02:22:10 AM »
That is the one big problem I have with republicans, even though I do sometimes vote republican (didn't vote trump, did vote for GJ but in WA state which really was always going for Jillary).

They are all about pro-life, abortion is murder, get out in the street and hold up signs.

then Baby is born

Fuck paying for that!  Die in the street kid if you can't support yourself.

They are a funny bunch.

Wouldn't the opposite of this be "Take care of all the babies, more money for the babies!
Except for the ones no one wants, kill those bastards."?

About as useful a picture of either side...
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