Author Topic: What comes after the ACA?  (Read 857261 times)

PiobStache

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Re: What comes after the ACA?
« Reply #5050 on: December 10, 2018, 12:42:15 PM »

it's not always the consumer that eats the bill.

No, only if they give in to the high pressure tactics and agree to pay for the hospital's mistakes.  Otherwise the hospital eats part of it, selling of the debt, and the debt collector eats the rest.  But it's the consumer who takes the credit score hit in that scenario.

Why did you edit out the part where I stated it wasn't just hospitals that used them?  For instance, if you're a SNF or ALF and billing for Medicaid services and the insurance plan is successful at rejecting your UB multiple times?  It's in the facility's contract they will not attempt to bill the member for services not covered by the Medicaid insurance plan and they eat 100% of the balance.

sol

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Re: What comes after the ACA?
« Reply #5051 on: December 10, 2018, 01:43:38 PM »
Why did you edit out the part where I stated it wasn't just hospitals that used them?

I edited out that part because I wasn't replying to that part.  I was not trying to alter your argument, I was just quoting the specific piece that prompted my response.

DreamFIRE

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Re: What comes after the ACA?
« Reply #5052 on: December 10, 2018, 03:56:41 PM »
I can assure you it's more than hospitals that use UBs and that it's not always the consumer that eats the bill.

Yeah, healthcare providers including hospitals are often stuck eating the cost or a lot of it.  Even Medicare an Medicaid don't pay enough to cover the services delivered.  This was also mentioned recently in this thread.

EnjoyIt

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Re: What comes after the ACA?
« Reply #5053 on: December 10, 2018, 04:29:11 PM »


- HUUGE SNIP

Our healthcare industry is an embarrassing mess and screaming socialized healthcare at the top of our lungs will not fix the problem.  For one, because healthcare is such a massive part of US spending, completely gutting the system would force millions of people to lose their jobs and may very well put us into a steep recession.  Which means, the transition must happen gradually over many many years.  I still think it needs to start with lower the cost of delivering care.  I don't mean more hoops to jump through so that the middle man pays less.  I mean serious policy that starts to brings the cost of delivering care in line with the rest of the world.  Just simply decreasing cost by 10% would provide enough resources to cover every American.


Lastly, I believe physicians should be the front line of the solution, but in my experience most physicians are pussies who don't fight back.  They either don't fight because they are beat down into submission or they have created a lifestyle that even a 3 month loss of wages is unsustainable and therefor they are forced to accept whatever pile of shit is thrown their way.  For most, it is the combination of the two.  I hope things improve, but I have yet to see any real policy that is setting us in the right direction.  I think it is going to get a whole lot worse before it gets better.

I like it - a man with a sort of a plan.  It will be better this time to make the change incrementally.  The dog's tail should be cut off a piece at a time rather than all at once.  People should know what is coming for the change and be able to prepare for it.

I'm going to the doctor this afternoon for a checkup.  Typically, I ask what the cost of the checkup is to the girls behind the glass.  They never know.  Sometimes, they tell me your insurance will pay for the checkup.  I still get a bill two months down the road.  Would you buy a car from these folks?

I think this needs to be the first solution to cutting cost and waste.  Make every cost 100% transparent and posted.  Kind of like calories in McDonalds.  It would force simplification and efficiency to the billing process.  No more ridiculous charge master prices, no more confusion if something is less out of pocket vs paying through insurance.  No hidden overpriced charges for gauze and saline flushes. Eliminate the need for complex coding practices.  Patient would love the transparency and know what they are getting into.  Providers would find their cost of delivering patient care lower and less time consuming.  Once we have complete transparency it is much easier to find and eliminate waste and ineficiencies which is why transparency must be at the source of the solution.  With lower cost of delivering healthcare it would become much less expensive to provide care for more and more people who can't fully afford it on their own. 

pecunia

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Re: What comes after the ACA?
« Reply #5054 on: December 11, 2018, 02:34:32 PM »

- SNIP -

I think this needs to be the first solution to cutting cost and waste.  Make every cost 100% transparent and posted.  Kind of like calories in McDonalds.  It would force simplification and efficiency to the billing process.  No more ridiculous charge master prices, no more confusion if something is less out of pocket vs paying through insurance.  No hidden overpriced charges for gauze and saline flushes. Eliminate the need for complex coding practices.  Patient would love the transparency and know what they are getting into.  Providers would find their cost of delivering patient care lower and less time consuming.  Once we have complete transparency it is much easier to find and eliminate waste and ineficiencies which is why transparency must be at the source of the solution.  With lower cost of delivering healthcare it would become much less expensive to provide care for more and more people who can't fully afford it on their own. 

Another weird thing is that I bought I bought the cheapest insurance.  This was done to meet the legal obligation for Obamacare.  This insurance would not pay anything for my doctor's visit because I didn't use a doctor in "their" system.  There were no doctors in "their" system in my area.  So I paid for the visit.

I lost employer's insurance at the end of July or maybe August.  So, I purchased this "filler" insurance to cover the rest of the year.  Even after paying for the doctor's visit, I still made out with the savings in the premium.  Since, I essentially had no insurance, the doctor gave me a better rate.  A better rate for the same product.

Yes - I think this system is crazy.  As predicted, the girls behind the counter could not tell me what my charge would be for my brief question and answer session with the doc until after the checkup.  Transparency would be a big plus.  Illegal drug dealers can tell you prices, why can't these folks?

katsiki

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Re: What comes after the ACA?
« Reply #5055 on: December 11, 2018, 06:32:47 PM »
Illegal drug dealers can tell you prices, why can't these folks?

Ha!  Good one.  If you get bad service from them, you'll find a new supplier.  It's not always that easy with legal medicine.

EnjoyIt

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Re: What comes after the ACA?
« Reply #5056 on: December 12, 2018, 08:19:14 AM »

- SNIP -

I think this needs to be the first solution to cutting cost and waste.  Make every cost 100% transparent and posted.  Kind of like calories in McDonalds.  It would force simplification and efficiency to the billing process.  No more ridiculous charge master prices, no more confusion if something is less out of pocket vs paying through insurance.  No hidden overpriced charges for gauze and saline flushes. Eliminate the need for complex coding practices.  Patient would love the transparency and know what they are getting into.  Providers would find their cost of delivering patient care lower and less time consuming.  Once we have complete transparency it is much easier to find and eliminate waste and ineficiencies which is why transparency must be at the source of the solution.  With lower cost of delivering healthcare it would become much less expensive to provide care for more and more people who can't fully afford it on their own. 

Another weird thing is that I bought I bought the cheapest insurance.  This was done to meet the legal obligation for Obamacare.  This insurance would not pay anything for my doctor's visit because I didn't use a doctor in "their" system.  There were no doctors in "their" system in my area.  So I paid for the visit.

I lost employer's insurance at the end of July or maybe August.  So, I purchased this "filler" insurance to cover the rest of the year.  Even after paying for the doctor's visit, I still made out with the savings in the premium.  Since, I essentially had no insurance, the doctor gave me a better rate.  A better rate for the same product.

Yes - I think this system is crazy.  As predicted, the girls behind the counter could not tell me what my charge would be for my brief question and answer session with the doc until after the checkup.  Transparency would be a big plus.  Illegal drug dealers can tell you prices, why can't these folks?

Love the bolded comment. 
I remember as a child my parents took me to see the family doctor when I was sick.  His office was just him and an assistant.  The office visit was paid in cash and cost $60. The doctor spent close to 30 minutes with as he did not seam very busy. Last week I went went with a friend to take their kid to see the doctor.  The office has a front desk secretary, a billing/coding person, 2 more people I had no idea what they did and a nurse.  My friend paid $185 Co-pay for the visit and not sure if she will be billed more later by the insurance company.  We spent amount 5 minutes with the doctor.  Gee, I wonder who is paying for all those extra employees?

former player

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Re: What comes after the ACA?
« Reply #5057 on: December 12, 2018, 09:01:23 AM »
I think this needs to be the first solution to cutting cost and waste.  Make every cost 100% transparent and posted. 

Yes, but:
Even Medicare an Medicaid don't pay enough to cover the services delivered.  This was also mentioned recently in this thread.


If there was only going to be one price 1) medicare and medicaid costs would have to go up to the price which covered the cost of services, and 2) quite probably a lot of people would opt out of insurance, or only have catastrophic insurance (because they would have more certainty over other costs and wouldn't be financially penalised for not being insured), which would make insurance even less viable and more expensive.


If there was an easy solution it would have been implemented by now.  The only solution is root and branch change by government and the entrenched interests against it are currently too strong.

pecunia

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Re: What comes after the ACA?
« Reply #5058 on: December 12, 2018, 11:14:29 AM »

-SNIP-

If there was an easy solution it would have been implemented by now.  The only solution is root and branch change by government and the entrenched interests against it are currently too strong.


Don't stay a former player.  Don't give up Bunky.  Years ago we chose to go to the moon.  Not because it was easy, because it was hard.

https://www.youtube.com/watch?v=g25G1M4EXrQ

Never say never - Never say die.

One more thing in this vein:

No pain - no gain!  It's more true today than ever.  If you do not put up with the pain and go to the doctor, all your hard earned gains will go to pay the enormous bill to pay said doctor and front desk secretary, a billing/coding person, 2 more people I have no idea what they do and a nurse.


sol

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Re: What comes after the ACA?
« Reply #5060 on: December 14, 2018, 09:24:20 PM »
Anyone following this?

https://www.washingtonpost.com/national/health-science/federal-judge-in-texas-rules-obama-health-care-law-unconstitutional/2018/12/14/9e8bb5a2-fd63-11e8-862a-b6a6f3ce8199_story.html?utm_term=.9cf4cd7202e5

To summarize:
A self-described tea party conservative AG in Texas found a friendly judge to strike down all of the ACA.  Whole cloth, nation wide.  The argument is that the 2012 supreme court ruling that declared the ACA constitutional is now invalid, because that ruling stated that the penalty for people not carrying insurance was a tax and Congress has the power to tax.  So, republicans just repealed the tax, and are now arguing that without the tax the rest of the law must also fall.

Frankly I find that argument very confusing.  The previous case was challenging whether or not the individual mandate was constitutional, and the court said it is.  Republicans can still repeal something that is constitutionally permitted, and they did.  This would appear to have no bearing on the rest of the ACA, which has been functioning just fine without an individual mandate since republicans repealed it as part of the TCJA last December.  The rest of the law is still a law, so I must not be understanding how the judge made the connection between not having an individual mandate and not having a marketplace for health insurance. 

It's as if they decided Congress definitely has the power to levy a tax, but then Congress changed the tax to $0 and therefore everything else contained in the law that includes the $0 tax should now also be illegal?  I'm definitely not a lawyer, because this makes no sense to me.  Most of the law isn't about the tax, and I fail to see how changing the amount of the tax has any bearing on the rest of the law.  I'm baffled that a judge found a connection.
« Last Edit: December 14, 2018, 09:41:50 PM by sol »

Monkey Uncle

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Re: What comes after the ACA?
« Reply #5061 on: December 15, 2018, 04:36:46 AM »
Anyone following this?

https://www.washingtonpost.com/national/health-science/federal-judge-in-texas-rules-obama-health-care-law-unconstitutional/2018/12/14/9e8bb5a2-fd63-11e8-862a-b6a6f3ce8199_story.html?utm_term=.9cf4cd7202e5

To summarize:
A self-described tea party conservative AG in Texas found a friendly judge to strike down all of the ACA.  Whole cloth, nation wide.  The argument is that the 2012 supreme court ruling that declared the ACA constitutional is now invalid, because that ruling stated that the penalty for people not carrying insurance was a tax and Congress has the power to tax.  So, republicans just repealed the tax, and are now arguing that without the tax the rest of the law must also fall.

Frankly I find that argument very confusing.  The previous case was challenging whether or not the individual mandate was constitutional, and the court said it is.  Republicans can still repeal something that is constitutionally permitted, and they did.  This would appear to have no bearing on the rest of the ACA, which has been functioning just fine without an individual mandate since republicans repealed it as part of the TCJA last December.  The rest of the law is still a law, so I must not be understanding how the judge made the connection between not having an individual mandate and not having a marketplace for health insurance. 

It's as if they decided Congress definitely has the power to levy a tax, but then Congress changed the tax to $0 and therefore everything else contained in the law that includes the $0 tax should now also be illegal?  I'm definitely not a lawyer, because this makes no sense to me.  Most of the law isn't about the tax, and I fail to see how changing the amount of the tax has any bearing on the rest of the law.  I'm baffled that a judge found a connection.

I think the line of reasoning they are using is that the mandate is still part of the ACA, it has just been set to $0, so it is no longer a tax.  Therefore, unconstitutional!  Which still sounds like bullshit to my non-lawyer mind, because (1) a tax rate can indeed be 0% (like the rate applied to long term capital gains for those whose taxable income is low enough), and, (2) a $0 penalty doesn't cause injury to anyone, so where is the standing to sue?

DreamFIRE

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Re: What comes after the ACA?
« Reply #5062 on: December 15, 2018, 08:55:35 AM »
Anyone following this?

https://www.washingtonpost.com/national/health-science/federal-judge-in-texas-rules-obama-health-care-law-unconstitutional/2018/12/14/9e8bb5a2-fd63-11e8-862a-b6a6f3ce8199_story.html?utm_term=.9cf4cd7202e5

Yes, and it was completely expected in my view.  Up thread, I had posted:


It's expected by those who followed the questions asked and statements made during oral arguments that the republican appointed judge will rule to invalidate key provisions or the entire ACA and that he has atypically delayed his ruling because he knew it would hurt the republicans in the midterms to rule in advance of that.  So, it shouldn't be much longer at this point.

https://www.nytimes.com/2018/11/06/opinion/republican-lawsuit-pre-existing-coverage.html

It will be interesting to see how long this drags out after an appeal.  You might want to put off your FIRE plans another year or two, or much longer!
« Last Edit: December 15, 2018, 08:57:49 AM by DreamFIRE »

sol

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Re: What comes after the ACA?
« Reply #5063 on: December 15, 2018, 08:56:27 AM »
I think the line of reasoning they are using is that the mandate is still part of the ACA, it has just been set to $0, so it is no longer a tax. 

Yea, I figured that part out.  Okay, I can see you how you can argue it's not a tax anymore because the tax is zero, but what does that have to do with the rest of the law?  It's not like the ACA's existence is in any way predicated on the existence of a tax.

Repealing the individual mandate was a careful and deliberate attempt to undermine the insurance market by robbing it of customers.  They are literally trying to make insurance more expensive, by concentrating the risk pool among only the sick.  But the insurance market established by the law, and the medicaid expansions it included, exist as separate from the individual mandate. 

If Congress wants to repeal the ACA they can just repeal the ACA.  They don't need to try to go through the court system to find a way to invalidate it piece by piece, they have the power to just vote the whole thing down if they want to.  So far, a majority has not wanted to.

I have the same complaint about immigration reform and "build the wall".  You have all the power!  You can pass any damn law you want to!

But of course, repealing the ACA or fixing immigration would remove these as wedge issues that can motivate voter turnout.  At this point, with 100% control of all three branches of government, republicans look to be deliberately failing to deliver on their campaign promises just so that they can make those same promises again.  It's not about policy, it's about preserving power.  What would they run on, if the wall was built and we had a new healthcare plan? 

They have become the party of opposition and outrage, and I'm not sure they even really WANT the things they are publicly clamoring for.  They could certainly have it all, now that they have all the power.  Instead, they can't even pass a budget to keep the government open.

obstinate

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Re: What comes after the ACA?
« Reply #5064 on: December 15, 2018, 11:04:14 AM »
I think the line of reasoning they are using is that the mandate is still part of the ACA, it has just been set to $0, so it is no longer a tax. 

Yea, I figured that part out.  Okay, I can see you how you can argue it's not a tax anymore because the tax is zero, but what does that have to do with the rest of the law?  It's not like the ACA's existence is in any way predicated on the existence of a tax.

Repealing the individual mandate was a careful and deliberate attempt to undermine the insurance market by robbing it of customers.  They are literally trying to make insurance more expensive, by concentrating the risk pool among only the sick.  But the insurance market established by the law, and the medicaid expansions it included, exist as separate from the individual mandate. 

If Congress wants to repeal the ACA they can just repeal the ACA.  They don't need to try to go through the court system to find a way to invalidate it piece by piece, they have the power to just vote the whole thing down if they want to.  So far, a majority has not wanted to.

I have the same complaint about immigration reform and "build the wall".  You have all the power!  You can pass any damn law you want to!

But of course, repealing the ACA or fixing immigration would remove these as wedge issues that can motivate voter turnout.  At this point, with 100% control of all three branches of government, republicans look to be deliberately failing to deliver on their campaign promises just so that they can make those same promises again.  It's not about policy, it's about preserving power.  What would they run on, if the wall was built and we had a new healthcare plan? 

They have become the party of opposition and outrage, and I'm not sure they even really WANT the things they are publicly clamoring for.  They could certainly have it all, now that they have all the power.  Instead, they can't even pass a budget to keep the government open.
I really support the ACA and I agree that removing it is a bad call. However, conservatives can and have made the same case about liberal policies and the courts. Policies like gay marriage and abortion. The real problem is that the founding fathers, for all that we revere them, designed a kinda crappy and broken system of government that was more a product of necessary compromises than grand design. And this is the effect: rural people get an outsized say in how things go, and as a result our country has backwards policies compared to every other industrialized country in the world.

EnjoyIt

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Re: What comes after the ACA?
« Reply #5065 on: December 15, 2018, 11:24:59 AM »
What happened to repeals and replace?  Not just repeal.

This is what pisses me off about so many republicans.  I believe the ACA is mostly garbage except for a few very important provisions that we can not and should not get rid of. Instead of creating a better plan these republicans are willing to dismantle the few good things the ACA has to offer. 

I still don't see any republican or democrat for that matter who has offered any legislation that is actually looking to improve on the ACA or replace it with something better.  This is probably the #1 issue and problem facing the US today and all of our politicians are scumbags in the pockets of the insurance industry.

DreamFIRE

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Re: What comes after the ACA?
« Reply #5066 on: December 15, 2018, 11:37:57 AM »
What happened to repeals and replace?  Not just repeal.

This is what pisses me off about so many republicans.  I believe the ACA is mostly garbage except for a few very important provisions that we can not and should not get rid of. Instead of creating a better plan these republicans are willing to dismantle the few good things the ACA has to offer. 

I still don't see any republican or democrat for that matter who has offered any legislation that is actually looking to improve on the ACA or replace it with something better.  This is probably the #1 issue and problem facing the US today and all of our politicians are scumbags in the pockets of the insurance industry.

It appears that the best thing that would improve the ACA now is to reinstate the penalty.  If removing the penalty makes the ACA unconstitutional, then it appears to me that the act of removing the penalty itself would be unconstitutional (as seen by the result now) and that the removal the of penalty is what should be overturned, not the ACA.

EnjoyIt

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Re: What comes after the ACA?
« Reply #5067 on: December 15, 2018, 11:56:44 AM »
What happened to repeals and replace?  Not just repeal.

This is what pisses me off about so many republicans.  I believe the ACA is mostly garbage except for a few very important provisions that we can not and should not get rid of. Instead of creating a better plan these republicans are willing to dismantle the few good things the ACA has to offer. 

I still don't see any republican or democrat for that matter who has offered any legislation that is actually looking to improve on the ACA or replace it with something better.  This is probably the #1 issue and problem facing the US today and all of our politicians are scumbags in the pockets of the insurance industry.

It appears that the best thing that would improve the ACA now is to reinstate the penalty.  If removing the penalty makes the ACA unconstitutional, then it appears to me that the act of removing the penalty itself would be unconstitutional (as seen by the result now) and that the removal the of penalty is what should be overturned, not the ACA.

meh, penalty, no penalty, it changes nothing.  Unless the goal is to keep the ACA as is without making it better then sure, add the penalty back.  This seams to be the goal of the democrats.  Keep ACA as is without improving on it.  Republicans on the other hand want to get rid of the ACA without replacing it with something better.  Both sides are scum.

sol

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Re: What comes after the ACA?
« Reply #5068 on: December 15, 2018, 12:13:36 PM »
This seams to be the goal of the democrats.  Keep ACA as is without improving on it.

You know that democrats passed like 13 amendments to the ACA in the first few years after it was passed, right?  They absolutely tried to make it better.

Whether or not they succeeded is up for debate, but it's not like they decided to leave it as-is without making any attempted fixes.

Is it maybe just that you want to see additional changes to the law that the democrats weren't able to enact before republicans took control of congress?

Roadrunner53

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Re: What comes after the ACA?
« Reply #5069 on: December 15, 2018, 12:31:41 PM »
ACA is a fairly new program and will continue to need tune ups and improvements. I don't think anyone thought this program was written in stone to never be changed. Any program that includes the entire United States will have issues considering it is in its infancy. Some problems can't be taken care of till they happen. Then the republicans have tried their best to kill it over and over rather than fix it.

Seems that there are so many programs VA, Medicare, ACA, Medicaid that some kind of a study could be done to merge the programs to be more cost effective.

DreamFIRE

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Re: What comes after the ACA?
« Reply #5070 on: December 15, 2018, 01:03:48 PM »
It appears that the best thing that would improve the ACA now is to reinstate the penalty.  If removing the penalty makes the ACA unconstitutional, then it appears to me that the act of removing the penalty itself would be unconstitutional (as seen by the result now) and that the removal the of penalty is what should be overturned, not the ACA.

meh, penalty, no penalty, it changes nothing.

Since it is the difference in being ruled unconstitutional or not, it looks like it would change everything!  Of course, we won't really know if this ruling will stand until the Supreme Court takes it up.   Obviously there are other improvements that should be made, such as government funding of CSR subsidies, increasing subsidies to lower out-of-pocket burden, and national balance billing protections (vs. the limited state protections in some states), to name a few.  But first and foremost, we need to keep the ACA alive.

EnjoyIt

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Re: What comes after the ACA?
« Reply #5071 on: December 15, 2018, 04:10:04 PM »
It appears that the best thing that would improve the ACA now is to reinstate the penalty.  If removing the penalty makes the ACA unconstitutional, then it appears to me that the act of removing the penalty itself would be unconstitutional (as seen by the result now) and that the removal the of penalty is what should be overturned, not the ACA.

meh, penalty, no penalty, it changes nothing.

Since it is the difference in being ruled unconstitutional or not, it looks like it would change everything!  Of course, we won't really know if this ruling will stand until the Supreme Court takes it up.   Obviously there are other improvements that should be made, such as government funding of CSR subsidies, increasing subsidies to lower out-of-pocket burden, and national balance billing protections (vs. the limited state protections in some states), to name a few.  But first and foremost, we need to keep the ACA alive.

I don't now if we "need to keep the ACA alive." I'm not saying repeal it without something better but it doesn't have to be the ACA, it could be something completely different that encompasses the good of the ACA with what the country actually needs.  It could also be keeping the ACA with some serious amendments that help push us to a lower cost of delivering healthcare.  I don't think we should be so blinded as to say we must have the ACA if a better alternative is presented.  it hasn't been but if it is, I'm all for it.

@sol, unfortunately those amendments do not address the real problem in this country regarding healthcare.  Just shifting around who pays for it does not solve the problem.  Especially when the burden falls hardest on the middle class.

des999

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Re: What comes after the ACA?
« Reply #5072 on: December 15, 2018, 04:24:44 PM »
What happened to repeals and replace?  Not just repeal.

This is what pisses me off about so many republicans.  I believe the ACA is mostly garbage except for a few very important provisions that we can not and should not get rid of. Instead of creating a better plan these republicans are willing to dismantle the few good things the ACA has to offer. 

I still don't see any republican or democrat for that matter who has offered any legislation that is actually looking to improve on the ACA or replace it with something better.  This is probably the #1 issue and problem facing the US today and all of our politicians are scumbags in the pockets of the insurance industry.

this!

as long as they figure out a way to keep the pre-existing clause I'm willing to listen to replacements.  I won't be able to retire until my son is 18 (or longer) if they just repeal ACA. 

This is the one thing everyone (dem or rep) can agree on, that we have to be able to insure folks with pre-existing conditions for a reasonable price, not just drop them and tell them to fly a kite when they get sick.  It's easy to say when you and/or your family are healthy, come talk to me when you have a family member that can't get insurance.  I was even a little upset before my son was born that my ins prices kept rising, when we never even went to the Dr, but now i realize I may have to pay a little more to enure everyone has a chance to get insured. 

DreamFIRE

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Re: What comes after the ACA?
« Reply #5073 on: December 15, 2018, 04:39:50 PM »

I keep hearing about "pre-existing conditions".  That's not enough!  Having insurance that covers pre-existing conditions isn't enough when people can't afford the premiums to purchase that insurance.   If you take away the Medicaid expansion (part of the ACA), the PCT, and CSR subsidies, millions of people won't be able to afford healthcare insurance along with the deductibles/out-of-pocket costs, whether or not it covers pre-existing conditions.  The media and politicians like to harp on that one matter, but it's just one piece of the ACA pie.  It's certainly an important part, but alone, many people still wouldn't be able to afford health insurance without the Medicaid expansion, PCT, and CSR.

Roadrunner53

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Re: What comes after the ACA?
« Reply #5074 on: December 15, 2018, 04:40:34 PM »
The Medicare program is not free. Not sure how they would implement it for all since it is now a program for retired people.

It costs quite a bit per person and if you are a family of 4 it could be quite costly to buy prescription plans and supplemental plans.

They can rename ACA, Medicare for all, but it is not going to be free or cheap.



DreamFIRE

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Re: What comes after the ACA?
« Reply #5075 on: December 15, 2018, 04:46:00 PM »
The Medicare program is not free. Not sure how they would implement it for all since it is now a program for retired people.

It costs quite a bit per person and if you are a family of 4 it could be quite costly to buy prescription plans and supplemental plans.

They can rename ACA, Medicare for all, but it is not going to be free or cheap.

That's true.  I've seen Medicare costs (with the parts/supplementals) posted that far exceed the subsidized ACA premiums many people pay, not to mention that many can take advantage of Medicaid for free healthcare coverage.  They'll be surprised when they find out those high Medicare costs!   Then hospitals are not paid sufficiently by Medicare, either, which ties into the whole system.

sol

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Re: What comes after the ACA?
« Reply #5076 on: December 15, 2018, 04:50:30 PM »
The Medicare program is not free. Not sure how they would implement it for all since it is now a program for retired people.

They would implement it by lowering the minimum age requirement.

I agree it is not free, but for many people it is vastly cheaper than what is privately available right now.  Millions of Americans would love to pay for Medicare the same way our senior citizens do, with tiers of fixed pricing and guaranteed coverage.  It's such a simple model, I'm not sure why so many people apparently hate the idea.

If you are poor, you would get free basic coverage (Medicare A).  If you have money and want more insurance than that, the prices are unambiguous to get it.  There's something here for everyone to love.

the_fixer

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Re: What comes after the ACA?
« Reply #5077 on: December 15, 2018, 05:06:48 PM »
"If you are poor, you would get free basic coverage (Medicare A).  If you have money and want more insurance than that, the prices are unambiguous to get it.  There's something here for everyone to love."

And no longer a need for insurance companies to take a cut out of the middle as prices could be negotiated and set as could drug prices.

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des999

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Re: What comes after the ACA?
« Reply #5078 on: December 15, 2018, 05:58:19 PM »

I keep hearing about "pre-existing conditions".  That's not enough!  Having insurance that covers pre-existing conditions isn't enough when people can't afford the premiums to purchase that insurance.   If you take away the Medicaid expansion (part of the ACA), the PCT, and CSR subsidies, millions of people won't be able to afford healthcare insurance along with the deductibles/out-of-pocket costs, whether or not it covers pre-existing conditions.  The media and politicians like to harp on that one matter, but it's just one piece of the ACA pie.  It's certainly an important part, but alone, many people still wouldn't be able to afford health insurance without the Medicaid expansion, PCT, and CSR.

I don't disagree, I'm just saying that the pre-existing condition really hits home for me, and it would hit home for a lot more folks if they actually had to live with it.  It's easy to say 'I'm healthy, and I'm not paying more just so some person who doesn't exercise can get insurance.'  There are a lot more things at stake that one cannot prevent (ie. being born with cancer) .

Roadrunner53

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Re: What comes after the ACA?
« Reply #5079 on: December 15, 2018, 06:03:21 PM »
Medicare A is only for hospitalization. So unless you plan to go to the hospital a lot, Medicare A is not going to help you as far as doctor bills. Also, hospitals try not to ever admit you and keep you on observation status. You need to be ADMITTED in the hospital 3 nights to be transferred to a rehab facility. If you are not admitted 3 nights, they will NOT pay for you to go to rehab or a nursing facility. It is a nightmare. I went thru this with my Mom and they want to throw people into the street rather than keep them in the hospital. Medicare rules.

Medicare B is for doctor appointments and tests. That costs as of 2019 $135.50 a month per person.

Medicare D, prescription drugs costs anywhere from $35 to $72ish per month. The less you pay the higher deductibles you pay. So, I pay $72 per mo. and have no deductibles, HOWEVER, some of my drugs are on the odd ball list and I have to pay around $35 per mo. on top of the $72 a month.

Part B has a $185 deductible per year per person.

If you go to the hospital, the deductible for Part A Medicare is $1,364 per year and if you are admitted more than one time it could be another $1,364 within some time frame.

Medicare pays 80% you pay 20% if you don't have a supplement.

It is NOT cheap. I have a supplement which pays for Part A and Part B deductibles plus the 20% but I pay thru the nose for the supplement.

There are Medicare Advantage plans which are cheaper but I am sure, you will pay thru the nose somehow.

So bottom line, if people think Medicare for all is going to be affordable, I want it too!

StarBright

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Re: What comes after the ACA?
« Reply #5080 on: December 15, 2018, 07:46:28 PM »
Medicare A is only for hospitalization. So unless you plan to go to the hospital a lot, Medicare A is not going to help you as far as doctor bills. Also, hospitals try not to ever admit you and keep you on observation status. You need to be ADMITTED in the hospital 3 nights to be transferred to a rehab facility. If you are not admitted 3 nights, they will NOT pay for you to go to rehab or a nursing facility. It is a nightmare. I went thru this with my Mom and they want to throw people into the street rather than keep them in the hospital. Medicare rules.

Medicare B is for doctor appointments and tests. That costs as of 2019 $135.50 a month per person.

Medicare D, prescription drugs costs anywhere from $35 to $72ish per month. The less you pay the higher deductibles you pay. So, I pay $72 per mo. and have no deductibles, HOWEVER, some of my drugs are on the odd ball list and I have to pay around $35 per mo. on top of the $72 a month.

Part B has a $185 deductible per year per person.

If you go to the hospital, the deductible for Part A Medicare is $1,364 per year and if you are admitted more than one time it could be another $1,364 within some time frame.

Medicare pays 80% you pay 20% if you don't have a supplement.

It is NOT cheap. I have a supplement which pays for Part A and Part B deductibles plus the 20% but I pay thru the nose for the supplement.

There are Medicare Advantage plans which are cheaper but I am sure, you will pay thru the nose somehow.

So bottom line, if people think Medicare for all is going to be affordable, I want it too!

It isn't cheap, but it doesn't sound too bad. I don't mean to get to anecdata-y but we end up paying just over $700 a month for a family of 4 (split over two plans)(we are both in our 30s with two young children), with a $4k deductible for three of them and 3k deductible for me with max out of pockets of of 10k and 6k through company provided insurance (so we are not eligible for ACA anyway). The worst part is that there are some things we need that are just flat-out not in network in our area. We've been on a wait-list for some stuff for my son for 11 months. Heck - we've never been able to get into our pediatrician when our kids had strep or ear infections, so we end up paying out of pocket for minute clinic type places anyway (which half the time, don't even count towards our deductible).

There is a reason a lot of us young-ish parent types dream of a medicare style plan. Obviously nothing is perfect, but boy, does the current system seem unsustainable.

On top of that - with the new ruling including pre-existing conditions, my DH and I had a talk last night about whether we even want to go ahead with my son's diagnostic assessments if we ever get in for them, or just hope that everything turns out okay since it doesn't seem to immediately dangerous. I think these are ridiculous conversations to have to have as middle class people with two full time jobs.

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Re: What comes after the ACA?
« Reply #5081 on: December 15, 2018, 08:26:59 PM »

I keep hearing about "pre-existing conditions".  That's not enough!  Having insurance that covers pre-existing conditions isn't enough when people can't afford the premiums to purchase that insurance.   If you take away the Medicaid expansion (part of the ACA), the PCT, and CSR subsidies, millions of people won't be able to afford healthcare insurance along with the deductibles/out-of-pocket costs, whether or not it covers pre-existing conditions.  The media and politicians like to harp on that one matter, but it's just one piece of the ACA pie.  It's certainly an important part, but alone, many people still wouldn't be able to afford health insurance without the Medicaid expansion, PCT, and CSR.

I don't disagree, I'm just saying that the pre-existing condition really hits home for me, and it would hit home for a lot more folks if they actually had to live with it.  It's easy to say 'I'm healthy, and I'm not paying more just so some person who doesn't exercise can get insurance.'  There are a lot more things at stake that one cannot prevent (ie. being born with cancer) .
I read an article today discussing the Texas court case that said 130 million people in the US have pre-existing conditions. So, save for insurance through employment, insurers could choose to not insure over one third of the population if that provision were to go away.

Roadrunner53

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Re: What comes after the ACA?
« Reply #5082 on: December 16, 2018, 03:35:26 AM »
Medicare A is only for hospitalization. So unless you plan to go to the hospital a lot, Medicare A is not going to help you as far as doctor bills. Also, hospitals try not to ever admit you and keep you on observation status. You need to be ADMITTED in the hospital 3 nights to be transferred to a rehab facility. If you are not admitted 3 nights, they will NOT pay for you to go to rehab or a nursing facility. It is a nightmare. I went thru this with my Mom and they want to throw people into the street rather than keep them in the hospital. Medicare rules.

Medicare B is for doctor appointments and tests. That costs as of 2019 $135.50 a month per person.

Medicare D, prescription drugs costs anywhere from $35 to $72ish per month. The less you pay the higher deductibles you pay. So, I pay $72 per mo. and have no deductibles, HOWEVER, some of my drugs are on the odd ball list and I have to pay around $35 per mo. on top of the $72 a month.

Part B has a $185 deductible per year per person.

If you go to the hospital, the deductible for Part A Medicare is $1,364 per year and if you are admitted more than one time it could be another $1,364 within some time frame.

Medicare pays 80% you pay 20% if you don't have a supplement.

It is NOT cheap. I have a supplement which pays for Part A and Part B deductibles plus the 20% but I pay thru the nose for the supplement.

There are Medicare Advantage plans which are cheaper but I am sure, you will pay thru the nose somehow.

So bottom line, if people think Medicare for all is going to be affordable, I want it too!

It isn't cheap, but it doesn't sound too bad. I don't mean to get to anecdata-y but we end up paying just over $700 a month for a family of 4 (split over two plans)(we are both in our 30s with two young children), with a $4k deductible for three of them and 3k deductible for me with max out of pockets of of 10k and 6k through company provided insurance (so we are not eligible for ACA anyway). The worst part is that there are some things we need that are just flat-out not in network in our area. We've been on a wait-list for some stuff for my son for 11 months. Heck - we've never been able to get into our pediatrician when our kids had strep or ear infections, so we end up paying out of pocket for minute clinic type places anyway (which half the time, don't even count towards our deductible).

There is a reason a lot of us young-ish parent types dream of a medicare style plan. Obviously nothing is perfect, but boy, does the current system seem unsustainable.

On top of that - with the new ruling including pre-existing conditions, my DH and I had a talk last night about whether we even want to go ahead with my son's diagnostic assessments if we ever get in for them, or just hope that everything turns out okay since it doesn't seem to immediately dangerous. I think these are ridiculous conversations to have to have as middle class people with two full time jobs.


You have to consider that people on Medicare are typically on a fixed (very low) income.  So, Medicare costs are too much for many. That is why you see 80 year old people working at Walmart just trying to cover Medicare costs. If you can afford all the Medicare Parts and Plans you will have really good coverage. If you can only afford the basics, it will suck.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #5083 on: December 16, 2018, 04:14:31 AM »
The NY Times seems to think that the ruling won't stand:

http://www.msn.com/en-us/news/us/health-law-could-be-hard-to-knock-down-despite-judge%e2%80%99s-ruling/ar-BBR0iJA

Personally, I'd be a little more cautious about such intimations, because you never know for sure which way a court is going to rule.  But knowing a lot of people think the ruling won't hold up might help me sleep a little better over the next year or so.

pecunia

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Re: What comes after the ACA?
« Reply #5084 on: December 16, 2018, 07:08:26 AM »

- SNIP -

I read an article today discussing the Texas court case that said 130 million people in the US have pre-existing conditions. So, save for insurance through employment, insurers could choose to not insure over one third of the population if that provision were to go away.

Now - what would prompt people to go out and vote?  Hmmmm?  Repeal of this ACA would hurt many people in not being able to get coverage for themselves and sick loved ones and would greatly hurt folks in the pocket book.  It's almost like being poked with a hot poker to go out and vote.

It would be an easy campaign speech.  "Folks, do you want your health care back?  Vote for me and I will work too do this.  It could even work in Texas where that judge resides.  I wonder how long it's been since they tarred and feathered a judge.

WhiteTrashCash

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Re: What comes after the ACA?
« Reply #5085 on: December 16, 2018, 08:51:50 AM »
The NY Times seems to think that the ruling won't stand:

http://www.msn.com/en-us/news/us/health-law-could-be-hard-to-knock-down-despite-judge%e2%80%99s-ruling/ar-BBR0iJA

Personally, I'd be a little more cautious about such intimations, because you never know for sure which way a court is going to rule.  But knowing a lot of people think the ruling won't hold up might help me sleep a little better over the next year or so.

Judges are tyrants in black robes. As long as people enforce their rulings, they can decide anything they want about any law they feel like, particularly when it comes to the Supreme Court. (I emphasize: As long as people enforce their rulings.)

LaineyAZ

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Re: What comes after the ACA?
« Reply #5086 on: December 16, 2018, 09:28:33 AM »
[Judges are tyrants in black robes. As long as people enforce their rulings, they can decide anything they want about any law they feel like, particularly when it comes to the Supreme Court. (I emphasize: As long as people enforce their rulings.)


And don't forget that judges in Texas are elected, not appointed.  That encourages pandering to the campaign donors who in turn support those who will do their bidding. 

Here in AZ, our judges are appointed by the governor from a list nominated by a commission of experienced attorneys in the Bar association.  Typically the governor will still favor those nominees who are of their same political party, but they are still experienced and at least legally moderate.  This process has worked well as our AZ judiciary is the "thin blue line" preventing our right-wing state legislature from doing more damage than they would otherwise get away with.

maizeman

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Re: What comes after the ACA?
« Reply #5087 on: December 16, 2018, 09:45:06 AM »
And don't forget that judges in Texas are elected, not appointed.  That encourages pandering to the campaign donors who in turn support those who will do their bidding. 

Here in AZ, our judges are appointed by the governor from a list nominated by a commission of experienced attorneys in the Bar association.  Typically the governor will still favor those nominees who are of their same political party, but they are still experienced and at least legally moderate.  This process has worked well as our AZ judiciary is the "thin blue line" preventing our right-wing state legislature from doing more damage than they would otherwise get away with.

That's a good distinction to make, and elected judges do tend to decide cases differently (and I'd argue generally less fairly) than appointed judges.

However, I do want to clarify that the judge in this particular case (Reed O'Connor) is a federal judge for the northern district of Texas, so he doesn't have to worry about elections, he's got his job for life.

https://en.wikipedia.org/wiki/Reed_O%27Connor

sol

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Re: What comes after the ACA?
« Reply #5088 on: December 16, 2018, 10:45:42 AM »
The more I think about it, the more disastrous this new ruling looks for the republican party.  The optics of it are just terrible.

The ACA is far from perfect, but in broad outline the idea is popular.  The majority of people want coverage for preexisting conditions, they want their kids to be covered until age 26, and they want some sort of gradational system that offers some sort of subsidized coverage to people who can't afford it.  Particularly on this forum, we like to complain about broader problems with the US healthcare system that are mostly unrelated to the ACA, like cost overruns and billing discrepancies, but the ACA itself seems like a reasonable stab at mitigating the impacts of these problems, if not actually solving them.

The republicans have had full control of the US government for several years now, and instead of repealing the ACA they have made some changes to it.  They removed the individual mandate and reduced funding for some of the cost-reduction measures, in an effort to drive up insurance costs.  You can argue about whether they had good intentions here, but that's what they did regardless.  So the ACA is at least in part a republican-molded law right now.  They're the ones in control of it, and they're the ones who have given it its current form.

After some republicans in congress changed the ACA by removing the mandate, some other republicans from the state challenged the ACA on the basis of not having a mandate, and that looks like a terrible idea.  They are trying to overturn the law they have molded, and success would mean millions of Americans would suddenly be without health insurance.  They have no alternative replacement plan, so are they just trying to screw everyone?  Where's the electoral advantage in that?  Do they think they'll win in 2020 if a hundred million voters see their healthcare premiums double as a direct result of republican efforts to undermine US healthcare?

My suspicion is that this is just lack of discipline on their part.  I suspect people like Mitch McConnell see the hazard here, which is why the republican congress was not involved in this lawsuit.  The lawsuit came from republican state governors in places where the ACA is a blazing hot potato, where there is no danger of them losing elections as a result of harping on it.  They've decided to go all-in locally on an issue that has proven to be a loser for republicans nationally.  I suspect they're harming the party as a whole with this lawsuit, whether it is upheld or not.

If republicans genuinely want to improve the US healthcare system, I'm all for it.  Propose a better plan, and then convince people to vote for it.  So far, they don't actually have a better plan and they haven't been able to find the votes to just ditch the old one without something to replace it with.  They only have a deep-seated hatred for a law nicknamed after a black democrat.  Maybe the solution is to just rename the new republican-molded version to Trumpcare and let republicans adopt it as their own?

EnjoyIt

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Re: What comes after the ACA?
« Reply #5089 on: December 16, 2018, 03:15:28 PM »
The more I think about it, the more disastrous this new ruling looks for the republican party.  The optics of it are just terrible.

The ACA is far from perfect, but in broad outline the idea is popular.  The majority of people want coverage for preexisting conditions, they want their kids to be covered until age 26, and they want some sort of gradational system that offers some sort of subsidized coverage to people who can't afford it . . .

. . .If republicans genuinely want to improve the US healthcare system, I'm all for it.  Propose a better plan, and then convince people to vote for it. 

I hate agreeing with you Sol :wink:, but you are completely right on in the above snippet.  I don't think the Republicans have any intention of improving healthcare in this country.  Again, I don't think the democrats are any better though.

Maybe the goal isn't to improve it but to create controversy that caters to their specific constituents so that they get re-elected in their particular area.

I don't think the goal of the ACA though was to cut costs but to insure more Americans.  That goal was met.  Not 100% but definitely an improvement from pre-ACA. Now we need representatives who want to improve on that. If I see one, I will be all over the internet pandering their ideas and I don't care if they are a democrat, republican, libertarian or other.

DreamFIRE

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Re: What comes after the ACA?
« Reply #5090 on: December 16, 2018, 04:16:29 PM »
I don't think the Republicans have any intention of improving healthcare in this country.  Again, I don't think the democrats are any better though.

They're not- although maybe a little better on healthcare.  The democrats had a super majority and pushed through the flawed ACA.  It's better than what we had, but they didn't think it through and could have given us something better.  Of course, I have zero confidence the republicans would do any better.  They would even like to destroy Medicare and SS - that's no secret.

pecunia

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Re: What comes after the ACA?
« Reply #5091 on: December 16, 2018, 05:11:13 PM »


They're not- although maybe a little better on healthcare.  The democrats had a super majority and pushed through the flawed ACA.  It's better than what we had, but they didn't think it through and could have given us something better.  Of course, I have zero confidence the republicans would do any better.  They would even like to destroy Medicare and SS - that's no secret.

I've asked this before and got some answers that seemed to boil down to ideology.  I've asked why are the Republicans so hell bent on destroying these social programs, the nation's safety net.  I've got to assume it's ideology.  Kinda like Uncle Joe of World War 2 fame with the liquidations and such.  The difference is that these are modern times.  Folks like to do things "naturally."  So, instead of shooting people, they will die of "natural" causes being denied affordable access to health care.

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Re: What comes after the ACA?
« Reply #5092 on: December 16, 2018, 06:30:26 PM »
I've asked this before and got some answers that seemed to boil down to ideology.  I've asked why are the Republicans so hell bent on destroying these social programs, the nation's safety net.  I've got to assume it's ideology.

I think that is at play for many R's.  They don't like the idea of govt requiring health insurance.

EnjoyIt

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Re: What comes after the ACA?
« Reply #5093 on: December 16, 2018, 11:35:40 PM »



They're not- although maybe a little better on healthcare.  The democrats had a super majority and pushed through the flawed ACA.  It's better than what we had, but they didn't think it through and could have given us something better.  Of course, I have zero confidence the republicans would do any better.  They would even like to destroy Medicare and SS - that's no secret.

I don't know if the bolded above is true.  There are definitely some extreme fiscal conservatives that want that, but I do not believe that is the majority of republicans.  Similar to how there are democrats who want total socialism, but that too is not the majority of democrats.

I've asked this before and got some answers that seemed to boil down to ideology.  I've asked why are the Republicans so hell bent on destroying these social programs, the nation's safety net.  I've got to assume it's ideology.  Kinda like Uncle Joe of World War 2 fame with the liquidations and such.  The difference is that these are modern times.  Folks like to do things "naturally."  So, instead of shooting people, they will die of "natural" causes being denied affordable access to health care.

I'm going to butcher the details, but a few months back I remember reading some poster here talking about how he makes decent money but also takes every subsidy including food stamps and anything else available.  I believe it is people like this that the republicans envision and don't approve.

In medicine we see patients on Medicaid driving nicer cars and having better cell phones than the nurses and technicians that I work with and frankly there is something wrong with this picture.  If that is all you see, these nurses and techs become pretty pissed off that they are busting their ass working 40+ hours a week paying for their own health insurance while some "lazy piece of shit" is driving a brand new car, talking on the latest iPhone, getting free healthcare on the taxes that you pay.  ON top of it, the government expanded these resources and made their own healthcare more expensive.  These same nurses and techs are republicans and come to really resent the system.

The above is just an example and I realize that is not all of our society. I am just sharing an example of how and why some republicans come to think the way they do.

Disclaimer: The above are not 100% my views. I am a fiscal conservative though fully understand and endorse the need for a reasonable safety net in our society.  I make such disclaimers because in the past comments like the one above get me attacked often times with ad hominem attacks.

Roadrunner53

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Re: What comes after the ACA?
« Reply #5094 on: December 17, 2018, 03:10:02 AM »



They're not- although maybe a little better on healthcare.  The democrats had a super majority and pushed through the flawed ACA.  It's better than what we had, but they didn't think it through and could have given us something better.  Of course, I have zero confidence the republicans would do any better.  They would even like to destroy Medicare and SS - that's no secret.

I don't know if the bolded above is true.  There are definitely some extreme fiscal conservatives that want that, but I do not believe that is the majority of republicans.  Similar to how there are democrats who want total socialism, but that too is not the majority of democrats.

I've asked this before and got some answers that seemed to boil down to ideology.  I've asked why are the Republicans so hell bent on destroying these social programs, the nation's safety net.  I've got to assume it's ideology.  Kinda like Uncle Joe of World War 2 fame with the liquidations and such.  The difference is that these are modern times.  Folks like to do things "naturally."  So, instead of shooting people, they will die of "natural" causes being denied affordable access to health care.

I'm going to butcher the details, but a few months back I remember reading some poster here talking about how he makes decent money but also takes every subsidy including food stamps and anything else available.  I believe it is people like this that the republicans envision and don't approve.

In medicine we see patients on Medicaid driving nicer cars and having better cell phones than the nurses and technicians that I work with and frankly there is something wrong with this picture.  If that is all you see, these nurses and techs become pretty pissed off that they are busting their ass working 40+ hours a week paying for their own health insurance while some "lazy piece of shit" is driving a brand new car, talking on the latest iPhone, getting free healthcare on the taxes that you pay.  ON top of it, the government expanded these resources and made their own healthcare more expensive.  These same nurses and techs are republicans and come to really resent the system.

The above is just an example and I realize that is not all of our society. I am just sharing an example of how and why some republicans come to think the way they do.

Disclaimer: The above are not 100% my views. I am a fiscal conservative though fully understand and endorse the need for a reasonable safety net in our society.  I make such disclaimers because in the past comments like the one above get me attacked often times with ad hominem attacks.

Some of what you say is true but not everything you see is face value. For instance, years ago my Mom and Dad were going out to lunch. My Mom was driving and pulled into a handicapped parking spot. She got out of the car. She was very able bodied and weighed about 110 lbs. This man on the sidewalk started screaming at her that she was in a handicapped spot. She ignored the JERK and proceeded to the trunk and pulled out this massive wheelchair. She helped my Dad into it (he was partially paralyzed from a stroke) and the JERK went running away to hide his head in shame. There can be other people using those spots who look perfectly healthy but they could have a lung disorder or cancer that you cannot 'see'. The fancy cars you mention could be a family members car, same with the fancy phones. You just never know. Yes, there are many people who scam everything they can and I hate those people too. All I know is that I never want to use a handicapped parking spot and bless those who do need them. Those who don't need them. and use them, Karma will get them.

talltexan

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Re: What comes after the ACA?
« Reply #5095 on: December 17, 2018, 07:14:56 AM »
I don't think the Republicans have any intention of improving healthcare in this country.  Again, I don't think the democrats are any better though.

They're not- although maybe a little better on healthcare.  The democrats had a super majority and pushed through the flawed ACA.  It's better than what we had, but they didn't think it through and could have given us something better.  Of course, I have zero confidence the republicans would do any better.  They would even like to destroy Medicare and SS - that's no secret.

DreamFIRE-
Long ago in this same thread, the reasons that ACA were passed in its form got discussed. As a quick recap, John Boehner agreed to basically the ACA at the negotiating table, then pulled Republican votes at the last minute because big GOP donors told him that--if he witheld the votes--they could give him the Speakership in just a few months in a wave election. McConnell also saw the winds of change, when Tea Partiers were able to win a MA Senate seat for Scott Brown, putting the Democrats into a position in which they needed to come up with 60 Democratic votes in the Senate. Joe Liebermann told Democrats he would never vote for anything with a public option, so they removed the public option in order to get him on board and pass something through the Senate.

I really think no other law would have passed than the one we got.


freya

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Re: What comes after the ACA?
« Reply #5096 on: December 17, 2018, 07:49:19 AM »
In medicine we see patients on Medicaid driving nicer cars and having better cell phones than the nurses and technicians that I work with and frankly there is something wrong with this picture.  If that is all you see, these nurses and techs become pretty pissed off that they are busting their ass working 40+ hours a week paying for their own health insurance while some "lazy piece of shit" is driving a brand new car, talking on the latest iPhone, getting free healthcare on the taxes that you pay.  ON top of it, the government expanded these resources and made their own healthcare more expensive.  These same nurses and techs are republicans and come to really resent the system.

I can confirm this as I've also seen this first hand.  There is also a pervasive entitlement attitude in this population that you don't see in people who pay for their own healthcare.  I think it's just human nature:  if you get something for free, you will devalue it, plus your utilization of it will be less discriminate.

I'm with the Republicans on this one.  Obamacare is what pushed up health care costs, not the Republicans' tinkering.  It was probably the worst approach possible, if your goal is an affordable, sensible health care system.  For example, I'd propose instead to take low-margin and low-cost things like office visits & routine lab tests off insurance entirely.  This would greatly drop prices, open the way for real competition with transparent prices, let the market come up with new innovative solutions like online video calls or AI-produced questionnaires for routine followups.  Then, consolidate insurance for things you really need insurance for into a single risk pool and standardized billing system.



sol

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Re: What comes after the ACA?
« Reply #5097 on: December 17, 2018, 08:21:33 AM »
I'd propose instead to take low-margin and low-cost things like office visits & routine lab tests off insurance entirely.

The problem with this approach, and the reason the ACA went the other direction, is that it actually costs more, not less.  When people have to pay out of pocket for routine stuff, they tend to avoid doing it.  And when they tend to avoid doing it, they don't get the preventative care they need and their long term costs go up.  Some people will go decades without seeing a doctor about persistent problems, just to save a few bucks, and then when they do show up they requires expensive interventions that could have been avoided with cheap or free treatments years ago instead.  Canada and the UK both have decades of research to back this up.

So while I understand your view, and yes it would seem to make sense financially for insurance companies to only insure for expensive stuff, in practice that approach backfires.  People are less healthy overall when they have to pay out of pocket to have a doc look at that annoying knee pain or skin growth, because it incentivizes them to avoid having it looked at until it becomes a full joint replacement or chemo course. 

Just because an out of pocket system is better for you and me, because we can comfortably pay $100 to have a professional look us over regularly, does not mean that this system is best for everyone.  Cheaper, maybe, but that's not really our collective goal is it?  The cheapest healthcare is no healthcare at all, after all, and while that idea may be popular with some republicans it is not what civilized societies choose.  What we're really trying to accomplish is the best medical outcomes for the population as a whole, and that means spending some money for preventative care and early treatment.  Catastrophic-only insurance plans don't provide that.


pecunia

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Re: What comes after the ACA?
« Reply #5098 on: December 17, 2018, 09:01:00 AM »

- SNIP -

I can confirm this as I've also seen this first hand.  There is also a pervasive entitlement attitude in this population that you don't see in people who pay for their own healthcare.  I think it's just human nature:  if you get something for free, you will devalue it, plus your utilization of it will be less discriminate.

I'm with the Republicans on this one.  Obamacare is what pushed up health care costs, not the Republicans' tinkering.  It was probably the worst approach possible, if your goal is an affordable, sensible health care system.  For example, I'd propose instead to take low-margin and low-cost things like office visits & routine lab tests off insurance entirely.  This would greatly drop prices, open the way for real competition with transparent prices, let the market come up with new innovative solutions like online video calls or AI-produced questionnaires for routine followups.  Then, consolidate insurance for things you really need insurance for into a single risk pool and standardized billing system.


Well - For many of us they are already off insurance.  If you have a high deductible, you end up paying for those things out of pocket.  The premium is lower with a high deductible, but still high.  And,.....yes you do not get every minor ache and pain checked out because it will lead to a specialist which is more out of pocket cost.  You live with the little aches and pains.

I do not blame Obamacare for the high rates.  I blame greed and inefficiency.  They were rising before Obamacare.

Mr. Green

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Re: What comes after the ACA?
« Reply #5099 on: December 17, 2018, 09:09:04 AM »
I'd propose instead to take low-margin and low-cost things like office visits & routine lab tests off insurance entirely.

The problem with this approach, and the reason the ACA went the other direction, is that it actually costs more, not less.  When people have to pay out of pocket for routine stuff, they tend to avoid doing it.  And when they tend to avoid doing it, they don't get the preventative care they need and their long term costs go up.  Some people will go decades without seeing a doctor about persistent problems, just to save a few bucks, and then when they do show up they requires expensive interventions that could have been avoided with cheap or free treatments years ago instead.  Canada and the UK both have decades of research to back this up.

So while I understand your view, and yes it would seem to make sense financially for insurance companies to only insure for expensive stuff, in practice that approach backfires.  People are less healthy overall when they have to pay out of pocket to have a doc look at that annoying knee pain or skin growth, because it incentivizes them to avoid having it looked at until it becomes a full joint replacement or chemo course. 

Just because an out of pocket system is better for you and me, because we can comfortably pay $100 to have a professional look us over regularly, does not mean that this system is best for everyone.  Cheaper, maybe, but that's not really our collective goal is it?  The cheapest healthcare is no healthcare at all, after all, and while that idea may be popular with some republicans it is not what civilized societies choose.  What we're really trying to accomplish is the best medical outcomes for the population as a whole, and that means spending some money for preventative care and early treatment.  Catastrophic-only insurance plans don't provide that.
In addition to the statistics backing up what Sol is saying, I can personally attest to it. In the summer of 2017 I had just stopped working and I was having some moderate back pain. I thought maybe I had done something to a disc in my back. I had been sleeping on the floor for weeks. I stopped exercising out of fear that I would aggravate it further. Instead of going to the doctor, I waited because I was going to go onto my wife's insurance in the Fall. My current insurance was a HDHP and I already knew that a simple doctor visit was going to cost $150. For all I knew they would refer me to a specialist and then there might be x-rays or something else, a bill that could easily run into four figures. I delayed, because I was hoping it wasn't anything serious. I was afraid I'd spend a thousand or more dollars for someone to tell me I strained something. But what if it was serious and my delay in seeking treatment actually caused my condition to worsen and now my medical costs were even higher because I waited? This is what happens all over the country, mainly because the system is so confusing you have no idea what is going to happen when you walk in that door. Will there be tests? Will they be expensive? How much will a specialist charge?

Another example. I saw an allergist at the end of November to have a skin test done before receiving my first flu vaccine in my life. I'd had a Tdap vaccine last summer and had what resembled an anaphylactic reaction to it. Not knowing what in the Tdap caused the reaction, I wanted to be cautious in case it was an additive that might also be present in another vaccine. A couple skin tests were done, I was cleared, then they gave me the flu shot. The bill for that service was $472. Thankfully, I didn't pay that because I had insurance. As far as medical procedures go, those skin tests are about as simple as they come. Clean the skin, apply some fluid, and wait. That's it. But how many people would take their chances if they knew the bill would be almost $500 to get tested? After all, no one could be sure that I had an anaphylactic reaction because I didn't actually go to the ER for verification (also because I was on a HDHP in summer of 2017 and I knew that walking in the door would have meant a thousand dollar bill). Instead I had stopped at a pharmacy, taken benadryl, and sat in the ER parking lot on the phone with my father until I knew if I would be okay.

People should not have to make these kinds of choices in the wealthiest country in the world. We're not even talking about serious medical issues here. But the cost is so high for simple things that people simply avoid seeking treatment, and we absolutely know that the end result means higher costs long term, for eventually treating more serious conditions that could have been avoided.