Author Topic: What comes after the ACA?  (Read 857254 times)

Roadrunner53

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Re: What comes after the ACA?
« Reply #5100 on: December 17, 2018, 09:24:14 AM »
On January 1, 2020 if you are joining Medicare for the first time and want to buy Medicare Supplement C or F you will no longer be able to do so. Due to the reason that those two supplements pay for the $183 yearly deductible. Congress said these policies cannot be sold to new enrollees starting January 1, 2020. If you have it you can be grandfathered and keep it. Congress seems to think that because Plan C and F pay for the $183 people go wild and go to too many doctors because they don't get charged. OMG, I would rather never go to the doctor or hospital. Are there really droves of people who can't wait to sit in a musty old doctor office waiting to be poked and prodded by basically a stranger? UGH! If there are such people, they should get psychiatrist care. Congress says they want patients to 'have more skin in the game' and to pay the $183 a year. They think this will make people think first before going to the doctor so much. These supplements are not cheap so even if you had to pay $183 a year deductible, I doubt it would stop someone who was hell bent to go the doctor every week.

rantk81

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Re: What comes after the ACA?
« Reply #5101 on: December 17, 2018, 10:26:50 AM »
I know that whenever I meet my deductible, I feel like I should try to use as much as I can before the next plan year rolls over...

EnjoyIt

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Re: What comes after the ACA?
« Reply #5102 on: December 17, 2018, 11:05:47 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.

I fully agree. My thinking is to have publicly funded clinics and hospitals that cater to those who don't want to spend any money.  This is not need based. They are free or maybe something on the order of $5 for a visit.  Really really cheap. It can't be $0 cause that will lead to abuse.  Or it could be $0 for 1 visit a year and the rest are $5 each or something like that. The wait times will be long because it is practically free, but they would get appropriate medical attention.  The medical staff should be paid hourly and paid reasonably well. This eliminates the ability and incentive for fraud. These clinics need to be open on weekends and late evenings.  They use only evidence based medicine and are not allowed to use expensive therapies that have minimal benefit over low cost options.  They can't get sued, they don't need currently crazy documentation or billing practices.  Basically as little wasteful overhead as possible.  As for everyone else, if you don't want to wait 4-6 hours to see a random doctor you can pay $100 or whatever for a doctor of your choice with little to no wait times and that doctor can use whatever they want to treat you. 

The goal is more affordable healthcare as opposed to insurance subsidies.

@sol,
When the government chooses winners and losers, there will always be winners and losers.  The ACA chooses insurance companies to win on the backs of middle class America. We can not blame the insurance companies to win when our policies give them all the resources to do so.  BTW, I am very disgruntled at our health insurance industry.
« Last Edit: December 17, 2018, 11:11:32 AM by EnjoyIt »

sol

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Re: What comes after the ACA?
« Reply #5103 on: December 17, 2018, 11:30:37 AM »
The ACA chooses insurance companies to win on the backs of middle class America. We can not blame the insurance companies to win when our policies give them all the resources to do so.  BTW, I am very disgruntled at our health insurance industry.

We're all a little disgruntled, but are we more or less disgruntled than we were before the ACA?

The ACA is certainly an imperfect solution, as any solution must be, but I think it's a lot closer to perfect than what we had before.  No one else was able to get any other compromise solution passed for 40 years, and things just kept getting worse and worse.  Part of the reason the ACA was finally passed was because it offered insurance companies increased profits for increased work (by expanding their pool of paying customers but regulating their shittiest products to make them less shitty).  There were other proposed solutions on the table, but this was the only one that our elected representatives could agree on in sufficient numbers to do anything at all.  Every previous attempt, some of which resembled your solutions, resulted in jack shit because they couldn't get the votes.  The ACA was absolutely a step in the right direction if only because it was an actual step, after decades of dereliction. 

EnjoyIt

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Re: What comes after the ACA?
« Reply #5104 on: December 17, 2018, 11:51:50 AM »
The ACA chooses insurance companies to win on the backs of middle class America. We can not blame the insurance companies to win when our policies give them all the resources to do so.  BTW, I am very disgruntled at our health insurance industry.

We're all a little disgruntled, but are we more or less disgruntled than we were before the ACA?

The ACA is certainly an imperfect solution, as any solution must be, but I think it's a lot closer to perfect than what we had before.  No one else was able to get any other compromise solution passed for 40 years, and things just kept getting worse and worse.  Part of the reason the ACA was finally passed was because it offered insurance companies increased profits for increased work (by expanding their pool of paying customers but regulating their shittiest products to make them less shitty).  There were other proposed solutions on the table, but this was the only one that our elected representatives could agree on in sufficient numbers to do anything at all.  Every previous attempt, some of which resembled your solutions, resulted in jack shit because they couldn't get the votes.  The ACA was absolutely a step in the right direction if only because it was an actual step, after decades of dereliction.

Can't argue with that.  I think the middle class is the most disgruntled which is what got Trump elected.  The poor are way better off than before as are those with pre-existing conditions outside of employer offered plans. The rich bitch and complain, pay the extra few thousand and move on. I think it was a step forward and a step backwards. Probably more forward than backwards. Now instead of the poor finding healthcare unaffordable it is the working middle class.  I don't think it is fair to those who actually contribute taxes to our society. 

Exflyboy

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Re: What comes after the ACA?
« Reply #5105 on: December 17, 2018, 12:49:49 PM »
So it looks like we are in for another showdown on the ACA based on the law being judged as "unconstitutional" on Friday.

There was quite a backlash in local town hall meetings the last time this happened (when the individual mandate was removed). I wonder if public opinion will come to the fore when it hits the Supreme court sometime I guess in 2020?

EnjoyIt

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Re: What comes after the ACA?
« Reply #5106 on: December 17, 2018, 01:43:44 PM »
So it looks like we are in for another showdown on the ACA based on the law being judged as "unconstitutional" on Friday.

There was quite a backlash in local town hall meetings the last time this happened (when the individual mandate was removed). I wonder if public opinion will come to the fore when it hits the Supreme court sometime I guess in 2020?

These are dangerous waters the republicans are swimming in.  If they get to repeal the ACA they better have an improved alternative on the day that takes affect or they will lose even more elections.

sol

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Re: What comes after the ACA?
« Reply #5107 on: December 17, 2018, 01:57:25 PM »
These are dangerous waters the republicans are swimming in.

The problem is that those water AREN'T dangerous for the folks pushing this lawsuit.  They're republican governors from solidly republican states, and this issue is a winner for them in deep red armpits of the country.  The fact that it might cost them congressional seats in 15 other less red states doesn't really enter into it, because they're only thinking about their own electoral prospects.

I'm sure there are a hundred republicans in congress who are absolutely livid about this ACA lawsuit in Texas.  They know it will hurt their reelection chances the next time around, as you suggested, but they're not the ones who are currently pursuing this version of repeal.

This is the curse of the GOP since the 2010 midterms.  The angry and extremist wing of the party is alienating the voters that constitute their party's majority.  They're self-destructing because they can't get everyone on-message.  This is why, despite having control of every branch of government, they are still so incompetent as national leadership.  It's why they can't repeal and replace, why they can't do immigration reform, why they can't do anything about Russian interference, and why they can't pass a budget.  It's a miracle they were able to cut taxes on the wealthy, but maybe that's because that one has been a unifying theme of the party since even before the 2010 midterms.

Exflyboy

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Re: What comes after the ACA?
« Reply #5108 on: December 17, 2018, 02:01:39 PM »
Of course Trump also tweeted his support for the ruling.. "great day for America" and all that.. But maybe thats just because he out of touch.

iris lily

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Re: What comes after the ACA?
« Reply #5109 on: December 17, 2018, 02:35:58 PM »
So it looks like we are in for another showdown on the ACA based on the law being judged as "unconstitutional" on Friday.

There was quite a backlash in local town hall meetings the last time this happened (when the individual mandate was removed). I wonder if public opinion will come to the fore when it hits the Supreme court sometime I guess in 2020?

 Was there actually a big protest against removing the individual mandate? Are you sure about that? I remember lots of Townhall meetings when Republicans were trying to draft a replacement to the ACA and yes those were contentious meetings with lots of voices rasied. But I donít remember that there was great love among the peoples of the individual mandate.

I guess you have different memory than I do.

Paul der Krake

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Re: What comes after the ACA?
« Reply #5110 on: December 17, 2018, 03:48:39 PM »
Of course Trump also tweeted his support for the ruling.. "great day for America" and all that.. But maybe thats just because he out of touch.
That's a nice theory you've got here.

jim555

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Re: What comes after the ACA?
« Reply #5111 on: December 17, 2018, 07:46:46 PM »
This is the curse of the GOP since the 2010 midterms.  The angry and extremist wing of the party is alienating the voters that constitute their party's majority.  They're self-destructing because they can't get everyone on-message.  This is why, despite having control of every branch of government, they are still so incompetent as national leadership.  It's why they can't repeal and replace, why they can't do immigration reform, why they can't do anything about Russian interference, and why they can't pass a budget.  It's a miracle they were able to cut taxes on the wealthy, but maybe that's because that one has been a unifying theme of the party since even before the 2010 midterms.
They control everything and can't pass a wall.  Then they blame the minority party, it makes no sense.

Exflyboy

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Re: What comes after the ACA?
« Reply #5112 on: December 18, 2018, 12:01:30 AM »
So it looks like we are in for another showdown on the ACA based on the law being judged as "unconstitutional" on Friday.

There was quite a backlash in local town hall meetings the last time this happened (when the individual mandate was removed). I wonder if public opinion will come to the fore when it hits the Supreme court sometime I guess in 2020?

 Was there actually a big protest against removing the individual mandate? Are you sure about that? I remember lots of Townhall meetings when Republicans were trying to draft a replacement to the ACA and yes those were contentious meetings with lots of voices rasied. But I donít remember that there was great love among the peoples of the individual mandate.

I guess you have different memory than I do.

No I didn't (mean to) say there ware protests against removing the mandate. What I meant was there were townhall protests when people thought the GOP was going to repeal and replace (with nothing) the entire ACA.. All they ended up doing is doing away with the mandate in the end.

I.e what you just said..:)

Exflyboy

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Re: What comes after the ACA?
« Reply #5113 on: December 18, 2018, 12:02:42 AM »
Of course Trump also tweeted his support for the ruling.. "great day for America" and all that.. But maybe thats just because he out of touch.
That's a nice theory you've got here.

I was being (uncharacteristically) generous..;)

Monkey Uncle

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Re: What comes after the ACA?
« Reply #5114 on: December 18, 2018, 05:06:35 AM »
These are dangerous waters the republicans are swimming in.

The problem is that those water AREN'T dangerous for the folks pushing this lawsuit.  They're republican governors from solidly republican states, and this issue is a winner for them in deep red armpits of the country.  The fact that it might cost them congressional seats in 15 other less red states doesn't really enter into it, because they're only thinking about their own electoral prospects.

That may be the case in many of the states that joined the lawsuit.  But I think my state (WV) may be an exception.  We're a deep red armpit, but that's a fairly recent political development.  Dems controlled our legislature back when the ACA was passed, and the state chose to expand Medicaid.  Then Republicans took over the legislature and AG's office in 2014.  Our AG, who is an out of state hack who moved to WV simply because he thought it was a good place for a tea party nutcase to get elected, enthusiastically joined the lawsuit against the ACA.  He ran for US Senate this year, and got beaten pretty handily by the Democratic incumbent, largely due to the healthcare issue.  Even though the current mood of the state is deep red, a large proportion of the population is insured through Medicaid, and a large portion of the population is unhealthy (i.e., uninsurable without the ACA's pre-existing conditions protections).  So people didn't want anything to do with Mr. AG's stupid lawsuit.  I wonder if the situation might be similar in any of the other states that signed on to the suit.

PiobStache

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Re: What comes after the ACA?
« Reply #5115 on: December 18, 2018, 11:22:10 AM »
They control everything and can't pass a wall.  Then they blame the minority party, it makes no sense.

That also describes the ACA with the public option.  In no way construe that as support for the worst POTUS in US history but it goes to show the problems the executive office can face in getting their agenda acted on.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5116 on: December 18, 2018, 11:35:50 AM »
A point of order--the GOP can't make any substantial changes to the ACA, because their majority in the Senate is insufficient to override a filibuster.  The same goes for building a wall.  In contrast, the democrats used a tenuous 60-seat majority to pass the ACA.  Eliminating the mandate/penalty/tax last year was possible only because it was part of the budget, and thus wasn't subject to the filibuster because of the complex rules that the Senate follows.

Here's my thinking on the whole ACA thing:  The pre-existing condition issue is a big one, and has a huge impact on those who deal with it.  But paying for pre-existing conditions is contrary to the very nature of insurance.  Insurance is paying now to cover the risk of something big and bad happening later.  If the Big Bad Thing is already happening, and you can't pay for it (and have no hope of *ever* paying for it), what you're looking for isn't insurance, you're looking for rescue

But is it possible to address that issue without causing massive amounts of collateral damage?  The thought process with the ACA is pretty clear:

Problem: People can't afford to pay out of pocket for pre-existing conditions (PEC), and insurance won't touch them with a 10-foot pole.
Solution: Require the insurance companies to accept people with PEC.
Problem: Insurance premiums will be super expensive for people with PEC (PWPEC)
Solution: Require insurance companies to charge PWPEC no more than X% higher than they charge healthy people
Problem: Insurance will become prohibitively expensive, and people will simply sign up once they're sick, creating a vicious cycle
Solution: Require everyone to buy health insurance
Problem: Healthy people will buy bare-bones insurance, which also deprives funds for covering PWPEC
Solution: Require all insurance plans to have more comprehensive coverage, with requirements set by HHS
Problem: Healthy people have to pay for coverage they don't need, and it's expensive.
Solution: Subsidize health insurance based on income
Problem: Subsidies cost lots of money
Solution: Implement taxes on (drumroll, please) health insurance plans! ("cadillac" tax and others)

We may disagree on this, but I see an awful lot of collateral damage in that sequence.  I agree with the original goal of helping those afflicted by pre-existing conditions, and the ACA has accomplished that, but the additional cost it imposes cannot be ignored.  Is it worth it?  I suspect the answer depends heavily on an individual's values and the breadth of the economic scope you're looking at.


PiobStache

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Re: What comes after the ACA?
« Reply #5117 on: December 18, 2018, 12:19:18 PM »
The problem with the above logic is that people cannot enter into a healthcare insurance contract that will be portable and last for decades.  Unlike say car or home owners' insurance, where a possible event is being insured on a yearly basis, health insurance is insuring something that definitely will eventually happen (everyone gets sick at some point) on an annual basis.  Eliminating pre-existing conditions is the only way to make an annual contract, that needs to be in place for a lifetime, function.

Threshkin

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Re: What comes after the ACA?
« Reply #5118 on: December 18, 2018, 12:54:11 PM »
The problem with the above logic is that people cannot enter into a healthcare insurance contract that will be portable and last for decades.  Unlike say car or home owners' insurance, where a possible event is being insured on a yearly basis, health insurance is insuring something that definitely will eventually happen (everyone gets sick at some point) on an annual basis.  Eliminating pre-existing conditions is the only way to make an annual contract, that needs to be in place for a lifetime, function.

Keep in mind that with the car insurance you are not covered for PECs either.  If you had an at-fault accident, DWI, or other bad event this year when you try to get insurance next year your premiums will go up, way up, or your carrier will refuse to cover you at all.

That sounds a lot like health care pre ACA.  Perhaps we need to demand PEC coverage for auto insurance.  Think about all those poor people who cannot afford coverage or (OMG) cannot get insurance at all.

/SarcOFF

rantk81

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Re: What comes after the ACA?
« Reply #5119 on: December 18, 2018, 01:09:36 PM »
The problem with the above logic is that people cannot enter into a healthcare insurance contract that will be portable and last for decades.  Unlike say car or home owners' insurance, where a possible event is being insured on a yearly basis, health insurance is insuring something that definitely will eventually happen (everyone gets sick at some point) on an annual basis.  Eliminating pre-existing conditions is the only way to make an annual contract, that needs to be in place for a lifetime, function.

Keep in mind that with the car insurance you are not covered for PECs either.  If you had an at-fault accident, DWI, or other bad event this year when you try to get insurance next year your premiums will go up, way up, or your carrier will refuse to cover you at all.

That sounds a lot like health care pre ACA.  Perhaps we need to demand PEC coverage for auto insurance.  Think about all those poor people who cannot afford coverage or (OMG) cannot get insurance at all.

/SarcOFF

The problem is, if you bring your totaled car to a repair shop, there isn't the societal expectation that the repair shop will patch up the car to get it back on the road, regardless of your ability to pay.

PiobStache

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Re: What comes after the ACA?
« Reply #5120 on: December 18, 2018, 01:43:16 PM »
The problem with the above logic is that people cannot enter into a healthcare insurance contract that will be portable and last for decades.  Unlike say car or home owners' insurance, where a possible event is being insured on a yearly basis, health insurance is insuring something that definitely will eventually happen (everyone gets sick at some point) on an annual basis.  Eliminating pre-existing conditions is the only way to make an annual contract, that needs to be in place for a lifetime, function.

Keep in mind that with the car insurance you are not covered for PECs either.  If you had an at-fault accident, DWI, or other bad event this year when you try to get insurance next year your premiums will go up, way up, or your carrier will refuse to cover you at all.

That sounds a lot like health care pre ACA.  Perhaps we need to demand PEC coverage for auto insurance.  Think about all those poor people who cannot afford coverage or (OMG) cannot get insurance at all.

/SarcOFF

No, that's a false equivalency.  Getting a DUI or deemed at fault in a car accident is not the same as becoming ill.  And people don't die from letting their car insurance lapse. 

PiobStache

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Re: What comes after the ACA?
« Reply #5121 on: December 18, 2018, 01:44:31 PM »
The problem is, if you bring your totaled car to a repair shop, there isn't the societal expectation that the repair shop will patch up the car to get it back on the road, regardless of your ability to pay.

Right.  Because your car remaining damaged won't kill you.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5122 on: December 18, 2018, 02:08:48 PM »
The problem with the above logic is that people cannot enter into a healthcare insurance contract that will be portable and last for decades.  Unlike say car or home owners' insurance, where a possible event is being insured on a yearly basis, health insurance is insuring something that definitely will eventually happen (everyone gets sick at some point) on an annual basis.  Eliminating pre-existing conditions is the only way to make an annual contract, that needs to be in place for a lifetime, function.
You are right that there are aspects of health insurance that don't fit perfectly into a strict definition of "insurance," and portability is definitely one of them.  You don't insure the 'health' of your car, for example, and car insurance is quite nicely portable.  And a car is a physical possession that can be replaced or repaired in a relatively straightforward way.  If you have a hidden health issue while at one job, but it's discovered after you change to a new job, which insurance company is on the hook, right?

At the same time, though, the regulations of ACA don't recognize individuality in terms of medical values.  For example, one of the major contributors to total healthcare costs is end-of-life care.  One person may spare no expense in prolonging their life for a few years, while another may wish to let nature take its course.  It seems unfair to expect the second person to subsidize the values of the first.  The same goes for lifestyle choices--it seems unfair to expect someone eats healthy and exercises to subsidize health insurance for someone who eats poorly and maintains a sedentary lifestyle. 

No, that's a false equivalency.  Getting a DUI or deemed at fault in a car accident is not the same as becoming ill.  And people don't die from letting their car insurance lapse. 
Did you miss the sarcasm tag? :P

PiobStache

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Re: What comes after the ACA?
« Reply #5123 on: December 18, 2018, 02:23:37 PM »
Did you miss the sarcasm tag? :P

Hah.  Sorry, hard to tell which way the sarcasm is pointed sometimes.

pecunia

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Re: What comes after the ACA?
« Reply #5124 on: December 18, 2018, 06:39:19 PM »
Well, I gave some thought to this pre-existing conditions thing.  I wondered how other countries handled it.  Then I remembered this poem:

"Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tossed to me, I lift my lamp beside the golden door! "

I guess they just send them here to die.  All this humanity stuff is just window dressing.

EnjoyIt

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Re: What comes after the ACA?
« Reply #5125 on: December 19, 2018, 12:55:16 AM »
The problem with the above logic is that people cannot enter into a healthcare insurance contract that will be portable and last for decades.  Unlike say car or home owners' insurance, where a possible event is being insured on a yearly basis, health insurance is insuring something that definitely will eventually happen (everyone gets sick at some point) on an annual basis.  Eliminating pre-existing conditions is the only way to make an annual contract, that needs to be in place for a lifetime, function.

Keep in mind that with the car insurance you are not covered for PECs either.  If you had an at-fault accident, DWI, or other bad event this year when you try to get insurance next year your premiums will go up, way up, or your carrier will refuse to cover you at all.

That sounds a lot like health care pre ACA.  Perhaps we need to demand PEC coverage for auto insurance.  Think about all those poor people who cannot afford coverage or (OMG) cannot get insurance at all.

/SarcOFF

No, that's a false equivalency.  Getting a DUI or deemed at fault in a car accident is not the same as becoming ill.  And people don't die from letting their car insurance lapse.


Contrary to some belief, people don't die from lack of health insurance.  When people are sick the law dictates they get treated even if they don't have the ability to pay.  One of the big confusions in this debate is that insurance does not equal healthcare and insurance does not equal healthy.  I would go on to say that more people die with insurance than without. This statistic is increased because those without insurance who have debilitating conditions qualify for disability and therefor medicaid. 

pecunia

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Re: What comes after the ACA?
« Reply #5126 on: December 19, 2018, 05:26:54 AM »

-SNIP -

Contrary to some belief, people don't die from lack of health insurance. 

- SNIP -


So true, so true.  It's the diseases or accidents that kill them.  The fact that they either can't afford health insurance or have a high deductible and so don't use said health insurance that just helps these "natural" processes along.  Health insurance is basically a business contract and I'm sure there is no clause that directly tells you to die.  That's probably illegal for now.


freya

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Re: What comes after the ACA?
« Reply #5127 on: December 19, 2018, 05:44:40 AM »
Here's the one thing everyone seems to forget:  back in the Good Old Days, eg. the 1960s, people used to pay out of pocket to go see the doctor.  There was no such thing as insurance for office visits or routine care.  The state of health was not suffering as a result, because the prices were reasonable and the idea of paying for a visit was not unimaginable like it is today.  Enter insurance, with all the attendant paperwork, overhead, absurd documentation requirements, pre-authorization requirements, and limited visit time which means you have to come back more frequently etc, and you get massive cost increases.  There's simply no other way it could have played out.  The mantra of "it's cheaper to lower the barrier to office visits" has been pretty well disproven, I'd say.  It was presented as the rationale for assuming that Obamacare would reduce expenses - which it has not done.

I don't see any way out of the mess that doesn't involve replacing Obamacare with something more sensible.  What's happening now with the activist federal judge in Texas of course is NOT the way to do it.  The Republicans need to offer an alternative that won't suddenly wipe out medical insurance for millions of people (maybe say "voters" and they'd get the message?). Totally agree that they're literally committing political suicide with this.

talltexan

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Re: What comes after the ACA?
« Reply #5128 on: December 19, 2018, 07:05:27 AM »
But what changed at the end of the 1960's was LBJ's Medicare compromise: Doctors could no longer refuse elderly patients who couldn't pay, but--if they agreed to accept this--the Doctors were allowed to have their professional organizations and lobbyists set prices.

rantk81

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Re: What comes after the ACA?
« Reply #5129 on: December 19, 2018, 07:32:02 AM »
I noticed that for 2019 ACA-compliant plans, they can have annual out of pocket maximums as high as $15,800.

I also noticed that for 2019 HDHP/HSA compliant plans, they must have an annual out of pocket maximum that DOES NOT EXCEED $13,500.

This appears to be the reason why there aren't many HSA/HDHP choices on the ACA Exchange in my area. Nearly all the exchange plans ratchet up the out-of-pocket max to the maximum legally allowed number.

WHAT THE FUCK?

AlexMar

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Re: What comes after the ACA?
« Reply #5130 on: December 19, 2018, 11:37:09 AM »
The ACA chooses insurance companies to win on the backs of middle class America. We can not blame the insurance companies to win when our policies give them all the resources to do so.  BTW, I am very disgruntled at our health insurance industry.

We're all a little disgruntled, but are we more or less disgruntled than we were before the ACA?

The ACA is certainly an imperfect solution, as any solution must be, but I think it's a lot closer to perfect than what we had before.  No one else was able to get any other compromise solution passed for 40 years, and things just kept getting worse and worse.  Part of the reason the ACA was finally passed was because it offered insurance companies increased profits for increased work (by expanding their pool of paying customers but regulating their shittiest products to make them less shitty).  There were other proposed solutions on the table, but this was the only one that our elected representatives could agree on in sufficient numbers to do anything at all.  Every previous attempt, some of which resembled your solutions, resulted in jack shit because they couldn't get the votes.  The ACA was absolutely a step in the right direction if only because it was an actual step, after decades of dereliction.

Insurance skyrocketed after the ACA.  I have a couple dozen employees and I ended up canceling our insurance policy and sent the staff out on their own.  What used to be $2,000/mo for good coverage turned in to $7,500/mo for terrible coverage.  So I canceled it and don't offer insurance anymore.  Good luck, I didn't vote for it.  Go sign up for Obamacare.  Strangely, they didn't seem to like what they voted for and seem more disgruntled with the new setup.  But I guess I'm saving a ton of money, so it's cool. Thanks Obama! So I would argue that the people who were supposed to get the most help seem MORE disgruntled and get lesser care since the ACA.  Someone earning $30k/year is having a tough time with that $10,000 deductible.  The road to hell is paved with good intentions.... and bad policy.

Why can't people just accept that the ACA failed?  It would be the first real step to coming up with a better solution.  Learn from it, see what works and what didn't, and fix it.  But since it's so highly politicized, we all have to take the side of our "team."  We can't possibly let Trump win (even if it means WE win), we can't admit an Obama failure.... blah blah blah.  The ACA is a disaster.  But it won't get fixed because that would be bad politically for Team A or something.  And as we know, political power is all that matters in this country right now.

ysette9

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What comes after the ACA?
« Reply #5131 on: December 19, 2018, 11:47:58 AM »
I don’t have time to search for more quality links but I know I’ve read them more than once. ACA has slowed the grown of healthcare premiums. They are still going up so it might be easy to claim it was a failure, but the growth is less than it had been before ACA.

Also, the ACA didn’t have as a main goal to decrease prices but to increase coverage.

“Still, the slow rate of growth was good news for premiums: The total average family plan cost increased by 43 percent from 2008 to 2016, but it went up more than double that rate — 97 percent — from 2000 to 2008.”

https://www.factcheck.org/2017/03/employer-premiums-and-the-aca/

***
Edit: add another link

“There are other factors, too: Health care costs still are rising each year, though not as much as before the Affordable Care Act. There also are annual changes in who signs up, changes in provider networks and so on.

"Price increases are lower than we would have expected without exchanges in place," said Rena Conti, a health economist at the University of Chicago.”


https://www.politifact.com/truth-o-meter/statements/2017/feb/28/donald-trump/fact-checking-donald-trumps-claim-about-soaring-ob/
« Last Edit: December 19, 2018, 11:52:04 AM by ysette9 »

mm1970

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Re: What comes after the ACA?
« Reply #5132 on: December 19, 2018, 11:51:51 AM »
The ACA chooses insurance companies to win on the backs of middle class America. We can not blame the insurance companies to win when our policies give them all the resources to do so.  BTW, I am very disgruntled at our health insurance industry.

We're all a little disgruntled, but are we more or less disgruntled than we were before the ACA?

The ACA is certainly an imperfect solution, as any solution must be, but I think it's a lot closer to perfect than what we had before.  No one else was able to get any other compromise solution passed for 40 years, and things just kept getting worse and worse.  Part of the reason the ACA was finally passed was because it offered insurance companies increased profits for increased work (by expanding their pool of paying customers but regulating their shittiest products to make them less shitty).  There were other proposed solutions on the table, but this was the only one that our elected representatives could agree on in sufficient numbers to do anything at all.  Every previous attempt, some of which resembled your solutions, resulted in jack shit because they couldn't get the votes.  The ACA was absolutely a step in the right direction if only because it was an actual step, after decades of dereliction.

Insurance skyrocketed after the ACA.  I have a couple dozen employees and I ended up canceling our insurance policy and sent the staff out on their own.  What used to be $2,000/mo for good coverage turned in to $7,500/mo for terrible coverage.  So I canceled it and don't offer insurance anymore.  Good luck, I didn't vote for it.  Go sign up for Obamacare.  Strangely, they didn't seem to like what they voted for and seem more disgruntled with the new setup.  But I guess I'm saving a ton of money, so it's cool. Thanks Obama! So I would argue that the people who were supposed to get the most help seem MORE disgruntled and get lesser care since the ACA.  Someone earning $30k/year is having a tough time with that $10,000 deductible.  The road to hell is paved with good intentions.... and bad policy.

Why can't people just accept that the ACA failed?  It would be the first real step to coming up with a better solution.  Learn from it, see what works and what didn't, and fix it.  But since it's so highly politicized, we all have to take the side of our "team."  We can't possibly let Trump win (even if it means WE win), we can't admit an Obama failure.... blah blah blah.  The ACA is a disaster.  But it won't get fixed because that would be bad politically for Team A or something.  And as we know, political power is all that matters in this country right now.

I think it's important to note that you are seeing this only from a single lens.

Your experience is an anecdote - we need to look further to more data.

As an example, my husband's insurance (through his employer) - got cheaper with the ACA when they set limits on how much could go towards administration.  In fact, the cost went down more than once.

My neighbor, who is self-employed, found that her insurance costs (premiums) went WAY down AND her coverage got a lot better (she went with silver, I believe).  She has Crohn's and the ACA has saved her bacon.

I have a few other friends with pre-existing conditions who were literally uninsurable before the ACA.  In fact, one of them had Blue Cross insurance (privately purchased) on the East Coast.  When he moved to the West Coast, they refused to insure him due to "pre-existing conditions".

Unfortunately, there are going to be winners and losers.  In general, it seems like the lower income people and the uninsured were the winners.  The "middle" folks, in many cases, ended up the "losers". 

(yes more anecdotes)
« Last Edit: December 19, 2018, 11:57:36 AM by mm1970 »

mm1970

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Re: What comes after the ACA?
« Reply #5133 on: December 19, 2018, 11:54:06 AM »
The problem with the above logic is that people cannot enter into a healthcare insurance contract that will be portable and last for decades.  Unlike say car or home owners' insurance, where a possible event is being insured on a yearly basis, health insurance is insuring something that definitely will eventually happen (everyone gets sick at some point) on an annual basis.  Eliminating pre-existing conditions is the only way to make an annual contract, that needs to be in place for a lifetime, function.

Keep in mind that with the car insurance you are not covered for PECs either.  If you had an at-fault accident, DWI, or other bad event this year when you try to get insurance next year your premiums will go up, way up, or your carrier will refuse to cover you at all.

That sounds a lot like health care pre ACA.  Perhaps we need to demand PEC coverage for auto insurance.  Think about all those poor people who cannot afford coverage or (OMG) cannot get insurance at all.

/SarcOFF

No, that's a false equivalency.  Getting a DUI or deemed at fault in a car accident is not the same as becoming ill.  And people don't die from letting their car insurance lapse.


Contrary to some belief, people don't die from lack of health insurance.  When people are sick the law dictates they get treated even if they don't have the ability to pay.  One of the big confusions in this debate is that insurance does not equal healthcare and insurance does not equal healthy.  I would go on to say that more people die with insurance than without. This statistic is increased because those without insurance who have debilitating conditions qualify for disability and therefor medicaid.

This is not actually true.  My college roommate's brother died due to lack of insurance.  Contrary to popular belief, you aren't guaranteed treatment for illness, and you don't always qualify for disability or medicaid.

They don't have to treat you.  In the ER, you only have to be stabilized.

mm1970

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Re: What comes after the ACA?
« Reply #5134 on: December 19, 2018, 11:56:31 AM »
Here's the one thing everyone seems to forget:  back in the Good Old Days, eg. the 1960s, people used to pay out of pocket to go see the doctor.  There was no such thing as insurance for office visits or routine care. The state of health was not suffering as a result, because the prices were reasonable and the idea of paying for a visit was not unimaginable like it is today.  Enter insurance, with all the attendant paperwork, overhead, absurd documentation requirements, pre-authorization requirements, and limited visit time which means you have to come back more frequently etc, and you get massive cost increases.  There's simply no other way it could have played out.  The mantra of "it's cheaper to lower the barrier to office visits" has been pretty well disproven, I'd say.  It was presented as the rationale for assuming that Obamacare would reduce expenses - which it has not done.

I don't see any way out of the mess that doesn't involve replacing Obamacare with something more sensible.  What's happening now with the activist federal judge in Texas of course is NOT the way to do it.  The Republicans need to offer an alternative that won't suddenly wipe out medical insurance for millions of people (maybe say "voters" and they'd get the message?). Totally agree that they're literally committing political suicide with this.
In 1960, the life expectancy was what, 52 years?
Now it's 80.

AlexMar

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Re: What comes after the ACA?
« Reply #5135 on: December 19, 2018, 12:26:16 PM »
The ACA chooses insurance companies to win on the backs of middle class America. We can not blame the insurance companies to win when our policies give them all the resources to do so.  BTW, I am very disgruntled at our health insurance industry.

We're all a little disgruntled, but are we more or less disgruntled than we were before the ACA?

The ACA is certainly an imperfect solution, as any solution must be, but I think it's a lot closer to perfect than what we had before.  No one else was able to get any other compromise solution passed for 40 years, and things just kept getting worse and worse.  Part of the reason the ACA was finally passed was because it offered insurance companies increased profits for increased work (by expanding their pool of paying customers but regulating their shittiest products to make them less shitty).  There were other proposed solutions on the table, but this was the only one that our elected representatives could agree on in sufficient numbers to do anything at all.  Every previous attempt, some of which resembled your solutions, resulted in jack shit because they couldn't get the votes.  The ACA was absolutely a step in the right direction if only because it was an actual step, after decades of dereliction.

Insurance skyrocketed after the ACA.  I have a couple dozen employees and I ended up canceling our insurance policy and sent the staff out on their own.  What used to be $2,000/mo for good coverage turned in to $7,500/mo for terrible coverage.  So I canceled it and don't offer insurance anymore.  Good luck, I didn't vote for it.  Go sign up for Obamacare.  Strangely, they didn't seem to like what they voted for and seem more disgruntled with the new setup.  But I guess I'm saving a ton of money, so it's cool. Thanks Obama! So I would argue that the people who were supposed to get the most help seem MORE disgruntled and get lesser care since the ACA.  Someone earning $30k/year is having a tough time with that $10,000 deductible.  The road to hell is paved with good intentions.... and bad policy.

Why can't people just accept that the ACA failed?  It would be the first real step to coming up with a better solution.  Learn from it, see what works and what didn't, and fix it.  But since it's so highly politicized, we all have to take the side of our "team."  We can't possibly let Trump win (even if it means WE win), we can't admit an Obama failure.... blah blah blah.  The ACA is a disaster.  But it won't get fixed because that would be bad politically for Team A or something.  And as we know, political power is all that matters in this country right now.

I think it's important to note that you are seeing this only from a single lens.

Your experience is an anecdote - we need to look further to more data.

As an example, my husband's insurance (through his employer) - got cheaper with the ACA when they set limits on how much could go towards administration.  In fact, the cost went down more than once.

My neighbor, who is self-employed, found that her insurance costs (premiums) went WAY down AND her coverage got a lot better (she went with silver, I believe).  She has Crohn's and the ACA has saved her bacon.

I have a few other friends with pre-existing conditions who were literally uninsurable before the ACA.  In fact, one of them had Blue Cross insurance (privately purchased) on the East Coast.  When he moved to the West Coast, they refused to insure him due to "pre-existing conditions".

Unfortunately, there are going to be winners and losers.  In general, it seems like the lower income people and the uninsured were the winners.  The "middle" folks, in many cases, ended up the "losers". 

(yes more anecdotes)

And this is fair.  I know from myself and my friends (who own businesses) that it's been a disaster.  That doesn't mean it's bad for everyone in all scenarios.

I would say, just because we can come up with some examples like your friend with pre-existing conditions doesn't mean the ACA is working.  That's kind of the big lie right now.  That if we dump the ACA, then people with pre-existing conditions are screwed.  It's simply not the case.

We still have the opportunity to dump the ACA and replace it with something better.  But that won't happen because it's way too highly politicized.  The Democrats couldn't have Trump get credit for fixing healthcare.  Anything good that he can do, they have to oppose, because him getting credit hurts their chances at gaining more power.  It's not about YOU and ME but about their power.  And it's similar to the strategy Republicans took during the Obama years, I'm not letting them off the hook, either.  Our current system is so broken, that it's truly become all about obstructing and not fixing.  It makes getting meaningful legislation done nearly impossible.  So you end up with highly politicized, one sided dumpster fires like the ACA.

But looking at the recent criminal justice reform... who knows, I guess anything can happen.

ysette9

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Re: What comes after the ACA?
« Reply #5136 on: December 19, 2018, 12:30:39 PM »
I completely agree with you that our system is very broken. I can’t speak for what the Democrats would or would not do, whether they would help the president pass an ACA improvement/replacement or block it for revenge. I don’t think we will ever be able to find out because for all of their whining, the Republicans never did the hard work to put together anything better. It isn’t easy and reality doesn’t bend to ideology. Combined with the president’s attention span of a goldfish and I don’t think improving healthcare is going to get done by this administration.

PathtoFIRE

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Re: What comes after the ACA?
« Reply #5137 on: December 19, 2018, 12:55:11 PM »
...
The Democrats couldn't have Trump get credit for fixing healthcare.  Anything good that he can do, they have to oppose, because him getting credit hurts their chances at gaining more power.
...

I'm going to call out this lie.

First of all, Republicans have controlled all branches of the federal government for nearly two years now. Second, there have been a number of issues that Democrats have attempted to work with the White House on, most recently prison reform, but also immigration reform, proposing a compromise on border security to protect Dreamers, "infrastructure", etc. Third, regarding healthcare, the only thing that Republicans have done is attempt multiple times during both the Obama and Trump presidencies to repeal part or all of the ACA. There has been no serious replacement plan proposed much less presented to either house. Fourth, the goshdarn ACA is chock full of Republican ideas and policies. It is by definition a compromise bill.

It's the Republicans who are guilty of what you accuse Democrats of doing. I mean holy shit! It's gotten to the point with Trump and most national Republicans that whenever I hear them accuse someone else of something, I just automatically assume that the accuser must be the one who's guilty.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5138 on: December 19, 2018, 01:51:05 PM »
Insurance skyrocketed after the ACA.  I have a couple dozen employees and I ended up canceling our insurance policy and sent the staff out on their own.  What used to be $2,000/mo for good coverage turned in to $7,500/mo for terrible coverage.  So I canceled it and don't offer insurance anymore.  Good luck, I didn't vote for it.  Go sign up for Obamacare.  Strangely, they didn't seem to like what they voted for and seem more disgruntled with the new setup.  But I guess I'm saving a ton of money, so it's cool. Thanks Obama! So I would argue that the people who were supposed to get the most help seem MORE disgruntled and get lesser care since the ACA.  Someone earning $30k/year is having a tough time with that $10,000 deductible.  The road to hell is paved with good intentions.... and bad policy.



None of this makes any sense. 
In any case under the ACA a small business was eventually supposed to be required to provide health insurance to his employees. That rule was removed by Donald Trump.
So now you get to screw over your employees who work their tail off for you to get rich, while you don't have to give them any health insurance.

Chances are your low paid employees get huge subsidies to cover the cost of their health insurance.
Basically, you've socialized out your employee costs to taxpayers.

SugarMountain

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Re: What comes after the ACA?
« Reply #5139 on: December 19, 2018, 04:04:36 PM »
In 1960, the life expectancy was what, 52 years?
Now it's 80.

In the US it was 67 for a white man, 74 for a white woman born in 1960, less for African Americans and other minorities (which is still sadly the case).
 
https://www.seniorliving.org/history/1900-2000-changes-life-expectancy-united-states/

maizeman

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Re: What comes after the ACA?
« Reply #5140 on: December 19, 2018, 04:17:56 PM »
Keep in mind a lot of that change comes from decreases in infant mortality.

Remaining life expectancy as age 65 was 13 years for men and 15 years for women in 1940 and is about 18 years for men and about 20 years for women today.

EnjoyIt

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Re: What comes after the ACA?
« Reply #5141 on: December 19, 2018, 10:53:53 PM »
The problem with the above logic is that people cannot enter into a healthcare insurance contract that will be portable and last for decades.  Unlike say car or home owners' insurance, where a possible event is being insured on a yearly basis, health insurance is insuring something that definitely will eventually happen (everyone gets sick at some point) on an annual basis.  Eliminating pre-existing conditions is the only way to make an annual contract, that needs to be in place for a lifetime, function.

Keep in mind that with the car insurance you are not covered for PECs either.  If you had an at-fault accident, DWI, or other bad event this year when you try to get insurance next year your premiums will go up, way up, or your carrier will refuse to cover you at all.

That sounds a lot like health care pre ACA.  Perhaps we need to demand PEC coverage for auto insurance.  Think about all those poor people who cannot afford coverage or (OMG) cannot get insurance at all.

/SarcOFF

No, that's a false equivalency.  Getting a DUI or deemed at fault in a car accident is not the same as becoming ill.  And people don't die from letting their car insurance lapse.


Contrary to some belief, people don't die from lack of health insurance.  When people are sick the law dictates they get treated even if they don't have the ability to pay.  One of the big confusions in this debate is that insurance does not equal healthcare and insurance does not equal healthy.  I would go on to say that more people die with insurance than without. This statistic is increased because those without insurance who have debilitating conditions qualify for disability and therefor medicaid.

This is not actually true.  My college roommate's brother died due to lack of insurance.  Contrary to popular belief, you aren't guaranteed treatment for illness, and you don't always qualify for disability or medicaid.

They don't have to treat you.  In the ER, you only have to be stabilized.

Can you please provide more detail?  I am curious to hear about how this occurred. 

Yes, you are right the ER just has to stabilize, but the word stabilize means that you will not be sent out on the street to die.  It means your condition must be treated to the point of being stable. 

I realize this does not fit 100% of all disease processes and can come up with examples where this doesn't fly, but I also see options offered to those people.  I see people being given direction on what to do and how to get the treatment they need.  Some people take that direction while others ignore it and yes, eventually die. It sucks because they could have done something but chose to do nothing.

I can also provide you stories of people with insurance who died as well.

thebrowze

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Re: What comes after the ACA?
« Reply #5142 on: December 19, 2018, 11:00:54 PM »
Insurance skyrocketed after the ACA.  I have a couple dozen employees and I ended up canceling our insurance policy and sent the staff out on their own.  What used to be $2,000/mo for good coverage turned in to $7,500/mo for terrible coverage.  So I canceled it and don't offer insurance anymore.  Good luck, I didn't vote for it.  Go sign up for Obamacare.  Strangely, they didn't seem to like what they voted for and seem more disgruntled with the new setup.  But I guess I'm saving a ton of money, so it's cool. Thanks Obama! So I would argue that the people who were supposed to get the most help seem MORE disgruntled and get lesser care since the ACA.  Someone earning $30k/year is having a tough time with that $10,000 deductible.  The road to hell is paved with good intentions.... and bad policy.



None of this makes any sense. 
In any case under the ACA a small business was eventually supposed to be required to provide health insurance to his employees. That rule was removed by Donald Trump.
So now you get to screw over your employees who work their tail off for you to get rich, while you don't have to give them any health insurance.

Chances are your low paid employees get huge subsidies to cover the cost of their health insurance.
Basically, you've socialized out your employee costs to taxpayers.

The fact that such a large percentage of working age people have their health insurance tied to their employers is one of the biggest problems with the US healthcare system, with or without the ACA.  Why is it the employer's job to provide health insurance?  It's a vestige of WWII when the government imposed wage caps to help the war effort and employers got around them by providing non-wage compensation (like health insurance).  Unfortunately, I suspect that putting the onus on the individual to find one's own health insurance (rather than big-brother employer making the decision for them) would result in the same result we've seen when employers started backing away from pensions and putting the responsibility of retirement planning on the individual: a few people figure it out and flourish, the majority put their heads in the sand and end up with major problems down the road.

Since we are all having 'fun' posting our personal anecdotes:  the company I work for has been looking into offering health insurance, which it has never done previously (I have insurance through my spouse's employer).  A good chunk of the employees have ACA plans through the exchange, and because of the industry and location (and the fact that they have families) they often get subsidies and very low premiums.  The moment the company offers a plan of its own, all those employees become ineligible for the subsidies and would have to pay full-freight, making their premiums un-affordable and effectively screwing those employees.  Also, the cost (for the employer-sponsored plan) to the employee can't be more than a certain percentage of the gross income of the LOWEST PAID ELIGIBLE EMPLOYEE, which means that the employer has to set the contribution level based solely off affordability for the $9/hr 30hr/week high school drop-out.  This results in a cost for the plan that is a multiple of the company's net income.  Instant bankruptcy.  Also, the insurance companies in the state have a requirement that a very high percentage of the eligible employees sign up, or THEY WON'T ISSUE THE PLAN AT ALL, basically making it impossible to meet the ACA requirement.

It was eventually determined that it is cheaper to pay the ESRP penalty (employer penalty for not offering insurance), encourage the employees to sign up for subsidized on the exchanges, and then reimburse them for a large portion of their premiums.  Talk about messed up incentives.

radram

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Re: What comes after the ACA?
« Reply #5143 on: December 20, 2018, 07:57:31 AM »


Why can't people just accept that the ACA failed?  It would be the first real step to coming up with a better solution.  Learn from it, see what works and what didn't, and fix it.  But since it's so highly politicized, we all have to take the side of our "team."  We can't possibly let Trump win (even if it means WE win), we can't admit an Obama failure.... blah blah blah.  The ACA is a disaster.  But it won't get fixed because that would be bad politically for Team A or something.  And as we know, political power is all that matters in this country right now.

This is so simple to prove. Provide the House and/or Senate Bill number that provided better coverage and/or provided similar coverage at a lower price. We can then get the results of the vote and discuss. I'll wait.

The last piece of shit was so bad John McCain had to vote no. If your claim is the only way to do this is full repeal, followed by the best plan the world has ever seen, we'll just have to agree to disagree. I welcome the republicans to introduce ANY change that covers more people, or better coverage at a lower cost. If I get wind the democrats are planning to vote no, we can work together to get them replaced in the next election. ACA has dozens of simple ways to make it better, all are non-starters for political reasons of the REPUBLICANS. Republicans are the political chess players here, and I am getting tired of it.

As proof that political power doesn't have to be the end-all, look at the recent criminal justice bill. How many DECADES have the democrats been trying to get lower sentencing. Now Trump is some kind of hero and his son-in-law was this brain child that came up with the idea. Yes, the Democrats wanted to go further, but when they saw an opportunity to make things better, they jumped at the chance, giving Trump a political success. When was the last time the republicans did anything other than a collective NO for political reasons?

Now that I think about this some more, how bizarro-world is all this? The REPUBLICANS, as their crowning achievement for 2018, LOWERED sentencing requirements and provided EDUCATION to prisoners. Before this bill, their crowning achievement for 2018 was taxing their citizens through tariffs. Am I dreaming?

Luck12

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Re: What comes after the ACA?
« Reply #5144 on: December 20, 2018, 11:58:37 AM »
...
The Democrats couldn't have Trump get credit for fixing healthcare.  Anything good that he can do, they have to oppose, because him getting credit hurts their chances at gaining more power.
...

I'm going to call out this lie.

First of all, Republicans have controlled all branches of the federal government for nearly two years now. Second, there have been a number of issues that Democrats have attempted to work with the White House on, most recently prison reform, but also immigration reform, proposing a compromise on border security to protect Dreamers, "infrastructure", etc. Third, regarding healthcare, the only thing that Republicans have done is attempt multiple times during both the Obama and Trump presidencies to repeal part or all of the ACA. There has been no serious replacement plan proposed much less presented to either house. Fourth, the goshdarn ACA is chock full of Republican ideas and policies. It is by definition a compromise bill.

It's the Republicans who are guilty of what you accuse Democrats of doing. I mean holy shit! It's gotten to the point with Trump and most national Republicans that whenever I hear them accuse someone else of something, I just automatically assume that the accuser must be the one who's guilty.

Damn you really covered it here, nice work.   I'll just add that Republicans shut out the Democrats during the repeal/replace process .  To the contrary, Democrats welcomed Republican ideas and amendments in 2009.  Republicans are the obstruction party, Democrats the compromise party.  And as a Democrat I am not happy that Democrats are always trying to compromise.  Fuck that.  Eric Holder is right:  When they go low, we gotta kick 'em.  No more Mr. Nice Guy.  Next time we control all 3 branches I want us to just ram through bills without welcoming input from Republicans.  Having control of all 3 branches doesn't last long and we have the ideas and legislation that actually benefit people so ends justify the means as far as I'm concerned.         

Gotta weep for this country that truly ignorant thinking like that of AlexMar's comments are so prevalent in America.  Gotta hand it to Republicans for doing such a good job brainwashing the American people. 
« Last Edit: December 20, 2018, 12:05:40 PM by Luck12 »

pecunia

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Re: What comes after the ACA?
« Reply #5145 on: December 20, 2018, 02:21:11 PM »
Both parties are bad news.  Gotta get a third party, a serious one.  Scare the beejeesuz out of all of them and then they'll fix things.

DreamFIRE

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Re: What comes after the ACA?
« Reply #5146 on: December 20, 2018, 06:45:02 PM »
The fact that such a large percentage of working age people have their health insurance tied to their employers is one of the biggest problems with the US healthcare system, with or without the ACA.  Why is it the employer's job to provide health insurance?

I'm not complaining.  It's another benefit.  I've always had very low premiums (my share of the cost) for health insurance and medical out of pocket costs throughout my career using employer based healthcare plans.  My costs would go up quite a bit on an ACA plan.

Both parties are bad news.  Gotta get a third party, a serious one.  Scare the beejeesuz out of all of them and then they'll fix things.

+1  They both disappointment in different ways.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #5147 on: December 20, 2018, 10:02:06 PM »
Keep in mind a lot of that change comes from decreases in infant mortality.

Remaining life expectancy as age 65 was 13 years for men and 15 years for women in 1940 and is about 18 years for men and about 20 years for women today.

That is a huge increase in life expectancy actually.  A 38% increase in years to live after age 65 (for men)

calimom

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Re: What comes after the ACA?
« Reply #5148 on: December 20, 2018, 10:26:54 PM »
...
The Democrats couldn't have Trump get credit for fixing healthcare.  Anything good that he can do, they have to oppose, because him getting credit hurts their chances at gaining more power.
...

I'm going to call out this lie.

First of all, Republicans have controlled all branches of the federal government for nearly two years now. Second, there have been a number of issues that Democrats have attempted to work with the White House on, most recently prison reform, but also immigration reform, proposing a compromise on border security to protect Dreamers, "infrastructure", etc. Third, regarding healthcare, the only thing that Republicans have done is attempt multiple times during both the Obama and Trump presidencies to repeal part or all of the ACA. There has been no serious replacement plan proposed much less presented to either house. Fourth, the goshdarn ACA is chock full of Republican ideas and policies. It is by definition a compromise bill.

It's the Republicans who are guilty of what you accuse Democrats of doing. I mean holy shit! It's gotten to the point with Trump and most national Republicans that whenever I hear them accuse someone else of something, I just automatically assume that the accuser must be the one who's guilty.

Damn you really covered it here, nice work.   I'll just add that Republicans shut out the Democrats during the repeal/replace process .  To the contrary, Democrats welcomed Republican ideas and amendments in 2009.  Republicans are the obstruction party, Democrats the compromise party.  And as a Democrat I am not happy that Democrats are always trying to compromise.  Fuck that.  Eric Holder is right:  When they go low, we gotta kick 'em.  No more Mr. Nice Guy.  Next time we control all 3 branches I want us to just ram through bills without welcoming input from Republicans.  Having control of all 3 branches doesn't last long and we have the ideas and legislation that actually benefit people so ends justify the means as far as I'm concerned.         

Gotta weep for this country that truly ignorant thinking like that of AlexMar's comments are so prevalent in America.  Gotta hand it to Republicans for doing such a good job brainwashing the American people.

This bears repeating. @Luck12 is spot on.

Bucksandreds

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Re: What comes after the ACA?
« Reply #5149 on: December 21, 2018, 05:53:19 AM »
...
The Democrats couldn't have Trump get credit for fixing healthcare.  Anything good that he can do, they have to oppose, because him getting credit hurts their chances at gaining more power.
...

I'm going to call out this lie.

First of all, Republicans have controlled all branches of the federal government for nearly two years now. Second, there have been a number of issues that Democrats have attempted to work with the White House on, most recently prison reform, but also immigration reform, proposing a compromise on border security to protect Dreamers, "infrastructure", etc. Third, regarding healthcare, the only thing that Republicans have done is attempt multiple times during both the Obama and Trump presidencies to repeal part or all of the ACA. There has been no serious replacement plan proposed much less presented to either house. Fourth, the goshdarn ACA is chock full of Republican ideas and policies. It is by definition a compromise bill.

It's the Republicans who are guilty of what you accuse Democrats of doing. I mean holy shit! It's gotten to the point with Trump and most national Republicans that whenever I hear them accuse someone else of something, I just automatically assume that the accuser must be the one who's guilty.

Damn you really covered it here, nice work.   I'll just add that Republicans shut out the Democrats during the repeal/replace process .  To the contrary, Democrats welcomed Republican ideas and amendments in 2009.  Republicans are the obstruction party, Democrats the compromise party.  And as a Democrat I am not happy that Democrats are always trying to compromise.  Fuck that.  Eric Holder is right:  When they go low, we gotta kick 'em.  No more Mr. Nice Guy.  Next time we control all 3 branches I want us to just ram through bills without welcoming input from Republicans.  Having control of all 3 branches doesn't last long and we have the ideas and legislation that actually benefit people so ends justify the means as far as I'm concerned.         

Gotta weep for this country that truly ignorant thinking like that of AlexMar's comments are so prevalent in America.  Gotta hand it to Republicans for doing such a good job brainwashing the American people.

This bears repeating. @Luck12 is spot on.

+2