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General Discussion => Welcome and General Discussion => Topic started by: sol on January 06, 2017, 06:39:08 PM

Title: What comes after the ACA?
Post by: sol on January 06, 2017, 06:39:08 PM
Who knows what the Republicans will propose after they repeal the ACA?   One hint:  look at what they say they will replace it with.

The bullet points below are taken from the current GOP "replace" plan called "A Better Way".  They've had seven years of hating Obamacare to put this alternative plan together, and this is the current state of the art version.

1.  Remove the "guaranteed issue" clause so people with pre-existing conditions can be denied private insurance, then provide federal dollars in support of high-risk pools for people denied coverage because of pre-existing conditions.  Trump has waffled on this point, but this is what the Republicans in Congress want.

This plan just redistributes how the deficit will be used to pay health insurance companies, giving it to them through a concentrated sub-market of sick people instead of giving it to them distributed over all buyers.  Unless we increase deficit spending on healthcare, this will increase costs for healthy people (by reducing the average subsidy) while potentially lowering costs for sick people.  This seems like a backwards incentive to me, like Uncle Sam saying "it's okay to be an overweight smoker, we've got your back."  High risk pools have consistently failed everywhere they've been tried, but we can make anything pencil out if we throw enough deficit spending at it.

(As a side note, I should mention that every penny of the ACA was paid for with new taxes and spending cuts.  Democrats showed an uncharacteristic level of restraint on that one, and the cost-controls reduce future deficits, but I don't expect a Republican-controlled Congress to follow suit.  I'm expecting radical new deficit spending for the next four years.)

2.  Remove the individual mandate, which hurts insurance companies because they will lose customers.  But not to worry, those companies can be soothed with higher government subsidies for healthcare.

All the insurers care about is their bottom line staying in the black, so as long as the GOP plan keeps them profitable without an individual mandate, they'll be happy.  Millions of Americans will lose insurance, though.  Under the ACA, the individual mandate is used to offset the costs of "guaranteed issue", so in theory you can repeal them both and end up with the same costs to taxpayers, but fewer people who have insurance.  Or you can keep the same number of people insured by increasing deficit spending to prop up insurer profit margins.  The ACA is the lowest-cost fix to get the most people insured, which is why Republicans proposed it in the first place.

3.  Segregate health insurance regulations down to the state by state level, removing federal protections and letting each state decide what rules to enforce.  This includes passing continuous coverage protection so you don't get dinged for losing coverage when you switch between insurance plans (just like employer plans currently have under HIPAA).

Note that this is NOT the same as the oft-touted GOP line about "buying insurance across state lines."  Insurers can already sell insurance across state lines, but most of them don't because it's not cost effective for them. 

This suggestion is purely an attempt to shrink the federal regulatory framework that keeps fraudulent insurers from selling garbage insurance and then refusing to pay claims, instead letting each state bear responsibility for keeping insurers solvent and effective.  Some states (CA, MA, TX) can totally do this.  Some states (WY, MS, AL) will fail miserably, and some of their residents will get screwed.  I feel like regulating markets is one of those things that is better done federally, for the protection of people who live in shitty states, but if they really want to screw over poor red states I'm inclined to let them.

4.  Expand access to HSAs by making them available to everyone regardless of plan type, giving them higher contribution limits, and allowing more more costs (like OTC medications) to be deductible. 

This is a plan I could maybe get behind!  We have an HSA, and we love it.  It's a great tax shelter for rich folks like me, though I admit it is totally worthless to the majority of Americans who already pay little or no taxes and who don't have any surplus income to sock away in a tax shelter.  This bullet point is effectively just another tax cut for the rich.  Hey I'm rich, sign me up!  The GOP thinks that all you poor folks can suck it, apparently.

5.  Provide "refundable advanced tax credits" for people without employer insurance, regardless of income.

This is just like the ACA plan except they're calling them "credits" instead of "subsidies" but the idea is the same.  Uncle Sam will foot the bill for some portion of your insurance coverage (though they would shutter the exchanges that currently allow you to shop for insurance, so get used to calling around for rate quotes).  The key difference here is that under the GOP plan, Uncle Sam will provide that subsidy to everyone, instead of just for poor people.  This bullet point is effectively just another tax cut for the rich.  Hey I'm rich, sign me up!  The GOP thinks that all you poor folks can suck it, apparently.

6.  "Enact medical liability reform"

This is a meaningless phrase, without some specifics.  Any state can already do this at any time, and several states already have.  For example by placing maximum caps on jury awards for malpractice cases, so you only get a quarter million instead of a million dollars if a doctor removes the wrong kidney by mistake.  Unfortunately, these changes don't seem to make any difference in the cost of insurance in the states that have done it.  It's a fine idea, but it doesn't provide anyone with insurance or reduce anyone's costs.

7.  Loosen the cost controls on age-related premium pricing, so that old people will pay more for insurance.

The ACA caps the ratio of max to min premiums at 3:1, so that old folks can never pay more than 300% as much as young healthy folks pay.  The GOP plan wants to change this ratio to 5:1, effectively transferring the cost of coverage away from the young and onto the old.  The GOP thinks all of you poor old folks can suck it, apparently.

8.  Change Medicaid to block-grant funding.  This fundamentally alter the nature of this program from an entitlement, available as a social safety net to anyone who meets the criteria, to a blank check for each state to spend as they see fit.  Maybe they'll expand coverage to pregnant women and children (WIC), or maybe they'll cancel medicaid entirely and use the money on tax breaks for rich people.  Each state would get to decide.  Red states have been pushing hard to reduce medicaid eligibility, because they don't like helping poor people.

Medicaid is currently the country's largest single insurer, providing low-cost insurance to tens of millions of low-income families and people with disabilities.  It's also one of the most expensive things our government does.

Most Democrats strongly oppose ending this 54 year old program, in part because the GOP plan to dismantle medicaid (which benefits the poor and disabled) is just the first step in their plan to also dismantle medicare and social security (programs that benefit senior citizens).  The GOP hates all of the entitlement programs, and medicaid is the easiest one to attack because poor people and the disabled don't vote with quite the same power that senior citizens do. 

If they successfully kill medicaid, everyone's retirement plans are about to get a lot more complicated.
Title: Re: What comes after the ACA?
Post by: Knaak on January 06, 2017, 08:23:50 PM
7.  Loosen the cost controls on age-related premium pricing, so that old people will pay more for insurance.

The ACA caps the ratio of max to min premiums at 3:1, so that old folks can never pay more than 300% as much as young healthy folks pay.  The GOP plan wants to change this ratio to 5:1, effectively transferring the cost of coverage away from the young and onto the old.  The GOP thinks all of you poor old folks can suck it, apparently.

It has been several years since I read articles about this, but IIRC, the actual healthcare costs are a 6:1 ratio and most states had a cap at 5:1 pre-ACA.  This means our old plans already had the youngest age band subsidizing the oldest age band.  When the ACA went into effect it capped the max at a 3:1 ratio.  This is forcing the youngest group to pay an extra 75% over what their costs really are so the oldest group can get a discount.  Considering the Boomers never had to pay that extra amount when they were younger, they are now getting one hell of a deal.

The Democrats think all of you young folks can suck it, apparently.

Disclaimer:  I'm not a Republican and I'm in favor of single payer.  I just wanted to point out the 3:1 ratio really fucked over young people.
Title: Re: What comes after the ACA?
Post by: protostache on January 06, 2017, 08:41:14 PM
So essentially everything is worse for people who are not rich, and even rich people will get screwed unless they're really really rich because of the Medicaid changes.

It seems like the overriding message is to get a job and work until you die and never get disabled or have bigger ambitions. It just seems so... small minded.
Title: Re: What comes after the ACA?
Post by: Lagom on January 06, 2017, 08:43:20 PM
7.  Loosen the cost controls on age-related premium pricing, so that old people will pay more for insurance.

The ACA caps the ratio of max to min premiums at 3:1, so that old folks can never pay more than 300% as much as young healthy folks pay.  The GOP plan wants to change this ratio to 5:1, effectively transferring the cost of coverage away from the young and onto the old.  The GOP thinks all of you poor old folks can suck it, apparently.

It has been several years since I read articles about this, but IIRC, the actual healthcare costs are a 6:1 ratio and most states had a cap at 5:1 pre-ACA.  This means our old plans already had the youngest age band subsidizing the oldest age band.  When the ACA went into effect it capped the max at a 3:1 ratio.  This is forcing the youngest group to pay an extra 75% over what their costs really are so the oldest group can get a discount.  Considering the Boomers never had to pay that extra amount when they were younger, they are now getting one hell of a deal.

The Democrats think all of you young folks can suck it, apparently.

Disclaimer:  I'm not a Republican and I'm in favor of single payer.  I just wanted to point out the 3:1 ratio really fucked over young people.

I mean I agree with you, but then the rest of Sol's post still stands. Would love to hear a measured response from a Republican (seriously). That said, wealthy boomers are definitely among the most entitled individuals out there and the Dems in their own way kowtow to them as much as anyone.
Title: Re: What comes after the ACA?
Post by: Knaak on January 06, 2017, 09:24:30 PM
I mean I agree with you, but then the rest of Sol's post still stands. Would love to hear a measured response from a Republican (seriously). That said, wealthy boomers are definitely among the most entitled individuals out there and the Dems in their own way kowtow to them as much as anyone.

Oh yeah, sol's post was an entertaining summary of what the Republicans are proposing and most of their plans are somewhere between bad and terrible.  I just really took issue with the ratio change back when it first happened.  It was absolutely ridiculous to push the ratio so far away from the true costs.

I'm guessing sol didn't know what the real cost ratios were between the age bands, otherwise he would have realized 5:1 is still a great deal for the oldest band.  He made it sound like the young were putting such a huge burden on the old ("...transferring the cost of coverage away from the young and onto the old.") when in fact the heavy burden is so far in the opposite direction right now.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 06, 2017, 09:25:59 PM
I don't agree with most of your commentary, Sol, so I'm going to ignore that part for now, and focus on the actual proposals.

Who knows what the Republicans will propose after they repeal the ACA?   One hint:  look at what they say they will replace it with.

The bullet points below are taken from the current GOP "replace" plan called "A Better Way".  They've had seven years of hating Obamacare to put this alternative plan together, and this is the current state of the art version.

1.  Remove the "guaranteed issue" clause so people with pre-existing conditions can be denied private insurance, then provide federal dollars in support of high-risk pools for people denied coverage because of pre-existing conditions.

I'm in favor of this one, I consider it a necessary step towards reviving true insurance.  I'm also somewhat in favor of some support for high risk pools, but the devil is in the details there.  I will assume that they would manage to screw that up, somehow, until I see evidence to the contrary.

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2.  Remove the individual mandate,

I'm definitely in favor of this one.  I consider the idea that individuals can get taxed for not purchasing a product from private business to be fundamentally wrong in many ways.
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3.  Segregate health insurance regulations down to the state by state level, removing federal protections and letting each state decide what rules to enforce.


I'm mostly neutral on this issue.  Generally, I'm in favor of letting state governments manage public policy whenever possible, but I can take it or leave it.

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4.  Expand access to HSAs by making them available to everyone regardless of plan type, giving them higher contribution limits, and allowing more more costs (like OTC medications) to be deductible. 


I'm in favor of this one.  I think that my HSA is the best thing to ever happen in the health care industry, and I believe that once enough people have them, at a certain point health care providers will be forced to publish their pricing or offer binding estimates for most non-critical care or quality-of-life maintenance issues.  That may, or may not, lower costs due to reviving local competition, but I can't see how it could actually make it worse.

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5.  Provide "refundable advanced tax credits" for people without employer insurance, regardless of income.


I'm straight up opposed to this one.  I agree that, mathematically, it's not much different from subsidies.  Maybe worse, since this would mostly favor the self-employed, not the unemployed.

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6.  "Enact medical liability reform"


Neutral without more details.  Like you said, a meaningless statement.

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7.  Loosen the cost controls on age-related premium pricing, so that old people will pay more for insurance.


I'm straight up in favor of this one.  I'm starting to get up there, and I have always consider forcing companies to price the young and healthy high in order to subsidize the older people in the same risk pool to be wrong.  Insurance should be priced to reflect the real risks of the insured during the term covered under the policy, just like life insurance, homeowners' insurance, auto collision insurance and flood insurance are.  It would reduce the tendency of the childless, single and young to skip out on health insurance while "rolling the dice" because their insurance is too expensive.  Perhaps a bit of public education on the matter coupled with #4 above would be a good public policy, and help convince those same young adults to both pay their true cost of premiums, while contributing to their HSA so they can afford to pay the true cost of their premiums in 30+ years as well.

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8.  Change Medicaid to block-grant funding.

I'm neutral on this one, simply because I don't know enough about the idea to have an opinion.

Title: Re: What comes after the ACA?
Post by: sol on January 06, 2017, 10:16:39 PM
the actual healthcare costs are a 6:1 ratio and most states had a cap at 5:1 pre-ACA.  This means our old plans already had the youngest age band subsidizing the oldest age band.

I think the young are supposed to subsidize the old, just like the healthy are supposed to subsidize the sick.  That's how insurance works.  Everyone pays more than their actual costs, unless they have sudden large costs and then they pay less.  That's the whole point of insurance.

The shift from the ACA's 3:1 ratio to a 5:1 ratio means old people will pay more and young people will pay less.  It's theoretically the same deal as unsubsidized high risk pools.  If being old were considered high risk.

(allowing insurers to deny coverage for pre-existing conditions) I'm in favor of this one, I consider it a necessary step towards reviving true insurance.

If you're in favor of letting insurance companies deny people coverage, are you also okay with millions of people not having health insurance, and only getting medical care when they go to the ER?  The whole point of this guaranteed issue clause was to reduce overall costs by getting people into more cost effective preventative care, instead of letting them go uninsured and thus untreated until they had some sort of catastrophic malfunction.

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

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(individual mandate) I'm definitely in favor of this one.  I consider the idea that individuals can get taxed for not purchasing a product from private business to be fundamentally wrong in many ways.

That seem exactly backwards.  I consider it fundamentally wrong that an individual can weasel out of paying for a service that they are 100% guaranteed to use.  Everyone uses healthcare at some point of their lives, no exceptions.  Some folks just get it for free because they don't buy insurance, and those people are freeloaders.

And to be clear, the individual mandate doesn't force everyone to buy insurance.  Only the ~10% of folks who don't already have insurance, and it offers them financial incentives to help them do it, and VERY light tax penalties for turning down the financial incentives.  I consider those tax penalties to be a great deal, since those folks are still going to get unlimited amounts of free healthcare anyway.

Would the individual mandate be more or less palatable to you if people were buying insurance directly from the government, for example by enrolling in expanded medicaid/medicare programs?  Is it the "private companies" part that upsets you?  Because that part infuriates me too, I see no reason for Uncle Sam to be giving money to inefficient insurance companies as middle men when they could just provide the same service themselves at a lower cost, with no profit motive.

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(change age-related premiums from 3:1 to 5:1) I'm straight up in favor of this one. I'm starting to get up there, and I have always consider forcing companies to price the young and healthy high in order to subsidize the older people in the same risk pool to be wrong.

I've always considered forcing the young and healthy into the same risk pool as the old and sick to be the defining characteristic of insurance plans.  My employer-provided insurance does this, for example.  Every employee is in the same pool, regardless of age or health.  We all pay the same amount.  I think the individual market should work the same way.

Otherwise, it's not really insurance.  Why not take this argument to its logical extreme, and put each person into a risk pool of one, with an appropriate weighted premium based on their unique characteristics?    At that point, every person would pay their actual costs and it's no longer insurance.  Segregating risk pools is just taking the first step in this direction, and it's designed to deliberately undermine the very idea of insurance. 

I do appreciate the feedback from a contrary perspective.  I'm still trying to decide if Republicans even care whether or not Americans can actually get affordable insurance, or just care about protecting insurance company profits regardless of what is best for Americans.
Title: Re: What comes after the ACA?
Post by: calimom on January 06, 2017, 10:22:46 PM
So essentially everything is worse for people who are not rich, and even rich people will get screwed unless they're really really rich because of the Medicaid changes.

It seems like the overriding message is to get a job and work until you die and never get disabled or have bigger ambitions. It just seems so... small minded.

Pretty much this. The Republican Heath Plan, such as it it is, is "don't get sick".

Happy now, Trump voters?
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 06, 2017, 10:30:01 PM

Happy now, Trump voters?

Yes.  So  far, I'm upbeat.  I'm truly sorry that life went so sideways for you, but it's still not my fault.
Title: Re: What comes after the ACA?
Post by: gimp on January 06, 2017, 10:31:08 PM
Don't worry, they'll still have social security and medicare for old people.

I mean, some old people.

I mean, people who are currently old, or will be very shortly.

They'll gut it for anyone under 50 or 55, but don't worry, if you already have it, they won't gut it, because they know you have nothing better to do than vote and write lots of letters.
Title: Re: What comes after the ACA?
Post by: Raeon on January 06, 2017, 11:32:04 PM
Younger middle class here, and I feel the pinch of ACA very hard.  31 years old. 

For the past 10 years I have had private health insurance to the tune of roughly $250/ month.  I am a non-smoker with no history of disease or illness in my family. I almost never get sick; last doctor visit was roughly 8 years ago for a z-pack.  My wife's has been about $300; she's a little higher maintenance but no glaring illnesses or disease.  $550 total.  For 2017, both of our plans were cancelled.  For the cheaper bronze level coverage a new plan together this year is going to cost us $1250/ month.  Our combined income puts us just outside of the subsidy brackets. 

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"every penny of the ACA was paid for with new taxes and spending cuts"

Maybe there's no extra line in the tax code, but I see an increase of $700/month...  Makes me sick to my stomach.

There are people I know working 20 hours a week at a gas station, going home to smoke and drink their paycheck away, and qualifying for insurance payments around $100/month.  Now, I don't mind the principle of pitching in a little to help my fellow man (an extra 50-100 a month maybe?), but when I work 80 hours a week trying to get ahead, I don't do it so I can pay an insurance bill larger than my mortgage and utilities combined.

My situation is the broken side of the ACA.  I won't be sorry to see it go.  Unfortunately, I don't see prices ever coming back down.  As it sits now, the extra cost is going to come out of my IRA contributions.  I just can't quite find the words to describe my frustration with this. 
Title: Re: What comes after the ACA?
Post by: rpr on January 07, 2017, 12:51:22 AM

You've missed the parts of the "A Better Way" document that directly address this.  Long story short -- you can never be denied coverage for preexisting conditions or have your rates jacked up when you switch plans PROVIDED you maintain continuous coverage.  High risk pools are only for people who do not maintain continuous coverage and then want insurance once they get sick.  This basically is a commonsense replacement for the individual mandate, and notably is very similar to the way the current system works for corporate health coverage.  They also propose a one-time grace signup period where anyone can bypass the high risk pools and start continuous coverage at the normal rates right away.
I admit I have not read the document you mention. What happens when, with current preexisting conditions, you lose your job with health care benefits (at a small company with less than 20 employees) and are then are able to find a job that does not offer health care benefits.  Since there is no COBRA you will have to buy private individual insurance. I would assume that your rates would either be sky high since you will be in the high risk pool. Are you saying that this is not the case?
Title: Re: What comes after the ACA?
Post by: sol on January 07, 2017, 01:01:36 AM
you can never be denied coverage for preexisting conditions or have your rates jacked up when you switch plans PROVIDED you maintain continuous coverage.

I think the details of this plan are severely lacking.  Everyone gets one and only one sign up period, but what about the people who can't sign up then?  Say they are currently bankrupt and can't afford insurance.  Or homeless.  Or in jail, or rehab, or travelling abroad.  Or under age 18.  Or legal immigrants.  Or they have employer insurance and get laid off.  There are about a million ways for a person to have a gap in their insurance coverage (or miss the one-time-only sign up period) through no fault of their own.  The Republican plan, like most Republican plans, works out okay for straight white people with 9-5 jobs, and kind of ignores everyone who is less fortunate.

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High risk pools are only for people who do not maintain continuous coverage and then want insurance once they get sick. 

Technically, it looks like the high risk pools are for people to whom insurance companies have denied coverage, for any reason.  You don't need to be sick to end up there.

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This basically is a commonsense replacement for the individual mandate, and notably is very similar to the way the current system works for corporate health coverage.

I think making comparisons to employer-sponsored insurance is only a valid strategy if you're also willing to adopt the rest of that model, namely "everyone pays the same rates for insurance regardless of age or health."  Personally I'm fine with this.  The federal government could just stop giving tax breaks to corporations to provide insurance, and give them directly to individuals instead, in the same amount.  Don't subsidize people who don't buy insurance (no  mandate), just like employers.  Put everyone into one risk pool, just like employers do, and let the government subsidize the insurers.  Better yet, go one farther and just let the government 100% subsidize the insurers and skip the tax breaks entirely!

The risk here is that some people will go without insurance, and end up back in the ER as freeloaders again, receiving care and expecting the rest of us who DO buy insurance to subsidize those healthcare providers with our inflated premiums.  This system really only works if you do it for everyone, or are willing to refuse service to folks who don't pay. 
Title: Re: What comes after the ACA?
Post by: rpr on January 07, 2017, 01:15:18 AM

I think making comparisons to employer-sponsored insurance is only a valid strategy if you're also willing to adopt the rest of that model, namely "everyone pays the same rates for insurance regardless of age or health."  Personally I'm fine with this.  The federal government could just stop giving tax breaks to corporations to provide insurance, and give them directly to individuals instead, in the same amount.  Don't subsidize people who don't buy insurance (no  mandate), just like employers.  Put everyone into one risk pool, just like employers do, and let the government subsidize the insurers.  Better yet, go one farther and just let the government 100% subsidize the insurers and skip the tax breaks entirely!

The risk here is that some people will go without insurance, and end up back in the ER as freeloaders again, receiving care and expecting the rest of us who DO buy insurance to subsidize those healthcare providers with our inflated premiums.  This system really only works if you do it for everyone, or are willing to refuse service to folks who don't pay.

+1. I agree. We should get rid of the tax breaks for workplace obtained health insurance both employee and employer portions.  This is basically a subsidy for health care insurers and ultimately the providers.   
Title: Re: What comes after the ACA?
Post by: bacchi on January 07, 2017, 04:11:50 AM

I think making comparisons to employer-sponsored insurance is only a valid strategy if you're also willing to adopt the rest of that model, namely "everyone pays the same rates for insurance regardless of age or health."  Personally I'm fine with this.  The federal government could just stop giving tax breaks to corporations to provide insurance, and give them directly to individuals instead, in the same amount.  Don't subsidize people who don't buy insurance (no  mandate), just like employers.  Put everyone into one risk pool, just like employers do, and let the government subsidize the insurers.  Better yet, go one farther and just let the government 100% subsidize the insurers and skip the tax breaks entirely!

The risk here is that some people will go without insurance, and end up back in the ER as freeloaders again, receiving care and expecting the rest of us who DO buy insurance to subsidize those healthcare providers with our inflated premiums.  This system really only works if you do it for everyone, or are willing to refuse service to folks who don't pay.

+1. I agree. We should get rid of the tax breaks for workplace obtained health insurance both employee and employer portions.  This is basically a subsidy for health care insurers and ultimately the providers.

That would definitely solve some budgetary problems from the other proposed ideas.

Re: 1.  Remove the "guaranteed issue" clause, they'll do this by underfunding the high risk pools. Look at the numbers being thrown around for the pools -- it's extremely low and won't be anywhere near enough. The end result will be either people dying because they can't afford the $2000/month coverage or states running deficits to make up for the fed's negligible contribution.
Title: Re: What comes after the ACA?
Post by: boarder42 on January 07, 2017, 04:33:06 AM
The issue with the pre existing conditions clause is that isn't how any other insurance works. If my house burns down and I don't have insurance I can't go buy it to fix my house. No insurance company would do that for less than the rebuild price.

If I choose to not have insurance and get cancer I shouldn't be able to wait till November and go sign up  so if you don't require everyone to always have it or pay a penalty then you must drop this clause also those 2 go hand in hand
Title: Re: What comes after the ACA?
Post by: Monkey Uncle on January 07, 2017, 04:34:04 AM
I still curse Obama for taking single payer off the table at the very beginning of the health care debate.  Simplicity, and better health outcomes, at about half the cost of our current fucked up system.  Couldn't we have at least talked about it?
Title: Re: What comes after the ACA?
Post by: boarder42 on January 07, 2017, 04:35:53 AM
Also while I fully support HSA expansion. Isn't this just the 401k all over again and will be severely under utilized by the avg incompetent American who doesn't understand money.
Title: Re: What comes after the ACA?
Post by: Boxcat on January 07, 2017, 04:43:16 AM
What comes after the ACA? Universal health care would be the ideal option, but since the Republicans control all three branches of government nothing will. The results will likely cause millions of deaths overall, but it'll be ignored and forgotten.
Title: Re: What comes after the ACA?
Post by: chasesfish on January 07, 2017, 06:02:30 AM
The expansion of 3:1 to 5:1 could work, provided an individual mandate is enforced.

The reality is its not enforced now, so any "repeal the individual mandate" is just a waste of time.
Title: Re: What comes after the ACA?
Post by: brooklynguy on January 07, 2017, 06:12:24 AM
5.  Provide "refundable advanced tax credits" for people without employer insurance, regardless of income.

This is just like the ACA plan except they're calling them "credits" instead of "subsidies" but the idea is the same.

It's just like the ACA in name as well as in substance.  The primary "subsidies" conferred by the ACA are "refundable tax credits" and are referred to as such in the provision of the ACA that implements the statutory changes to the Internal Revenue Code that make them available.
Title: Re: What comes after the ACA?
Post by: StarBright on January 07, 2017, 06:28:21 AM


I think the details of this plan are severely lacking.  Everyone gets one and only one sign up period, but what about the people who can't sign up then?  Say they are currently bankrupt and can't afford insurance.  Or homeless.  Or in jail, or rehab, or travelling abroad.  Or under age 18.  Or legal immigrants.  Or they have employer insurance and get laid off.  There are about a million ways for a person to have a gap in their insurance coverage (or miss the one-time-only sign up period) through no fault of their own.  The Republican plan, like most Republican plans, works out okay for straight white people with 9-5 jobs, and kind of ignores everyone who is less fortunate.


I'm pretty sure "qualifying life event" would still apply right? - so getting laid off and getting released from prison both would count as a qualifying event and you can purchase coverage on the exchange.

The other options (homeless, gaps, etc) are a problem but there are definitely ways of navigating around  some of them - primarily medicaid based.

That said, I think switching to single payer is such a no brainer and I think it would actually help US businesses become more competitive - we are basically the only country that relies on employer provided health insurance and it if you can remove that benefit cost from US businesses it could be a huge boon.
Title: Re: What comes after the ACA?
Post by: Can't Wait on January 07, 2017, 06:34:13 AM
Younger middle class here, and I feel the pinch of ACA very hard.  31 years old. 

For the past 10 years I have had private health insurance to the tune of roughly $250/ month.  I am a non-smoker with no history of disease or illness in my family. I almost never get sick; last doctor visit was roughly 8 years ago for a z-pack.  My wife's has been about $300; she's a little higher maintenance but no glaring illnesses or disease.  $550 total.  For 2017, both of our plans were cancelled.  For the cheaper bronze level coverage a new plan together this year is going to cost us $1250/ month.  Our combined income puts us just outside of the subsidy brackets. 

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"every penny of the ACA was paid for with new taxes and spending cuts"

Maybe there's no extra line in the tax code, but I see an increase of $700/month...  Makes me sick to my stomach.

There are people I know working 20 hours a week at a gas station, going home to smoke and drink their paycheck away, and qualifying for insurance payments around $100/month.  Now, I don't mind the principle of pitching in a little to help my fellow man (an extra 50-100 a month maybe?), but when I work 80 hours a week trying to get ahead, I don't do it so I can pay an insurance bill larger than my mortgage and utilities combined.

My situation is the broken side of the ACA.  I won't be sorry to see it go.  Unfortunately, I don't see prices ever coming back down.  As it sits now, the extra cost is going to come out of my IRA contributions.  I just can't quite find the words to describe my frustration with this.


That's crazy that your bronze level plan is $1250 a month for both of you. I just signed my wife up for a gold and its $377 a month. For shits and giggles I added myself to it to see how much it would be and it was like $600 or so. We also do not qualify for any subsidies.
Title: Re: What comes after the ACA?
Post by: protostache on January 07, 2017, 07:53:44 AM
The thing that baffles me about this forum in particular is the disdain for ACA. If your goal is FIRE, how does that square with the probability of getting some disqualifying condition after leaving work and having to pay the price for a high risk pool or preexisting condition rider, if you even have access so such things? Doesn't that torpedo everyone's FIRE plans?
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 07, 2017, 08:13:17 AM
The expansion of 3:1 to 5:1 could work, provided an individual mandate is enforced.

The reality is its not enforced now, so any "repeal the individual mandate" is just a waste of time.

It is enforced in that your penalty is taken out of any tax refund or check from the government.  That will catch up with everyone eventually - maybe not until social security time - but it will.
Title: Re: What comes after the ACA?
Post by: mathlete on January 07, 2017, 08:18:34 AM
What comes after the ACA? Universal health care would be the ideal option, but since the Republicans control all three branches of government nothing will. The results will likely cause millions of deaths overall, but it'll be ignored and forgotten.

Come on now...
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 07, 2017, 08:36:16 AM
I am only 54 but I think the younger people here with any disdain of the ACA are short sighted.  You can exercise, eat right, not smoke, etc. and get a disease or have an accident that has a permanent consequence.  As much as you would like to think so - you simply are not in control of this.  I was paying over $1000 per month for insurance when we had our own business 20 years ago before any conditions that are now issues to getting health insurance. I began working outside of our business so had access to employer insurance when I had such a health issue that is now considered a permanent pre-existing condition.  I could not get health insurance on the private market if I tried through absolutely no fault of my own.  Even with my employer's insurance - neither my husband nor I have consumed over the deductible amount of insurance in the last 10 years - but that doesn't mean that we could get private insurance now.  (That doesn't count some annual tests that are required to be provided before the deductible.)

Without some guarantee that I can get health insurance - I cannot afford to retire even with a NW of almost $4M.  Now that is sad and it wouldn't happen in any other top 30 country on earth. 

And while I don't think everything about the ACA is right or good - I think it at least provided health insurance for people who couldn't afford it before - or who simply could not get it at all.  And for most already retired on this board - it provided a way for them to retire.   

And no, since I've worked for 35 years paying into social security and medicare, and at the maximum level for most of those, I want them in place for me. (Thanks you Mr. Black, for encouraging me to become an electrical engineer.)  AND THAT DOES NOT MAKE ME A BABY BOOMER SUCKING ON YOUNG PEOPLES TEAT.  I sincerely doubt I will get back what I have paid in, what my employer has paid in, and conservative returns on that money.  And, frankly, I have paid far more into these systems than most ERs on this board did or ever will. And I have paid in more federal, state, local, and property tax than most ERs on this board.  Don't tell me this Baby Boomer is sucking on anyone's tit.  And I'm not finished paying yet.  The sale of my principle residence will come with  medicare taxes (unless they are repealed) and I will owe income tax on my 401K withdrawals. 

I don't want a government subsidy for health insurance - and I'm not asking for one.  I just want to be able to purchase a high deductible policy that will reliably pay after I've self-insured the high deductible for any health issue (predictable or otherwise) that I might have with no lifetime cap.  That is simply not a lot to ask for living and contributing, in one of the most affluent countries in the world, for 35 years so far - and likely 37 before I retire.   Otherwise - no amount of NW will be enough. 
Title: Re: What comes after the ACA?
Post by: mathlete on January 07, 2017, 08:37:16 AM
I don't think the Republicans have a plan. Not a plan that addresses sick/poor people who can't get insurance anyway.

Block-grant and state lines might as well be pixie dust. They were non-solutions proposed just so they could sort of say they had a plan ready to replace ACA at any of the 30 times that they tried to do it.

We've had high risk pools at the state level for years and that still left tens of millions without insurance. I don't know if Federal money is going to help. Not in the amounts they're talking about anyway.

HSAs are great for folks like us. Expanding access to them will help very few people that need help though. Poor people have (surprise) not a lot of money to save. They also see a much smaller marginal benefit from saving pre-tax/tax-deferred dollars.

Title: Re: What comes after the ACA?
Post by: rpr on January 07, 2017, 09:41:50 AM
Also while I fully support HSA expansion. Isn't this just the 401k all over again and will be severely under utilized by the avg incompetent American who doesn't understand money.
+1. I agree that it will be the 401k all over again.

I am totally against the HSA system. Why in the heck should there be a tax break for health expenses? Get rid of it completely.
Title: Re: What comes after the ACA?
Post by: Knaak on January 07, 2017, 09:52:48 AM
the actual healthcare costs are a 6:1 ratio and most states had a cap at 5:1 pre-ACA.  This means our old plans already had the youngest age band subsidizing the oldest age band.

I think the young are supposed to subsidize the old, just like the healthy are supposed to subsidize the sick.  That's how insurance works.  Everyone pays more than their actual costs, unless they have sudden large costs and then they pay less.  That's the whole point of insurance.

The shift from the ACA's 3:1 ratio to a 5:1 ratio means old people will pay more and young people will pay less.  It's theoretically the same deal as unsubsidized high risk pools.  If being old were considered high risk.

By compressing the ratios you are forcing young healthy people to not only subsidize young unhealthy people and old unhealthy people, but old healthy people as well.  The ones that can most afford to subsidize others -- old people that are healthy and have the highest incomes -- are given a discount while the healthy young people just starting their careers are forced to pick up the difference.  Do you honestly think that's fair?  That's about as regressive a policy as you can get.
Title: Re: What comes after the ACA?
Post by: rpr on January 07, 2017, 10:15:24 AM
One way to apportion costs could be based on incomes. The income ratio between old people and young is likely to be less than 3:1. It is definitely not 5:1.
Title: Re: What comes after the ACA?
Post by: Knaak on January 07, 2017, 10:59:11 AM
One way to apportion costs could be based on incomes. The income ratio between old people and young is likely to be less than 3:1. It is definitely not 5:1.

That's one way.  Another way is to finally get to single payer and cover most healthcare costs through our progressive tax system.  Just like our income taxes now, the heaviest burden will fall on rich old people.  Those making the lowest amounts (which is where most young people starting out will fall) won't be expected to shoulder such a big portion of the burden just because of their age.
Title: Re: What comes after the ACA?
Post by: sol on January 07, 2017, 11:24:54 AM
Another way is to finally get to single payer and cover most healthcare costs through our progressive tax system. 

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

The fact that many of those people would need to be re-employed by the government's version of insurance does not soothe Republicans, because their concern is for the business and not the worker.  Unemployment would go up, as all of those redundant insurance adjusters and claims processors were fired from insurance companies suddenly made obsolete.  You can argue that efficiency is a good thing for the economy overall, but Republicans care more about protecting corporate profits than they do about advancing the economy.  They would make the same last stand for buggy whip manufacturers.
Title: Re: What comes after the ACA?
Post by: Roland of Gilead on January 07, 2017, 11:40:26 AM
Why should people who get coverage through their employer continue to get a subsidy (through the tax exempt nature of that compensation) while others not?
Title: Re: What comes after the ACA?
Post by: Knaak on January 07, 2017, 11:52:52 AM
Another way is to finally get to single payer and cover most healthcare costs through our progressive tax system. 

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

The fact that many of those people would need to be re-employed by the government's version of insurance does not soothe Republicans, because their concern is for the business and not the worker.  Unemployment would go up, as all of those redundant insurance adjusters and claims processors were fired from insurance companies suddenly made obsolete.  You can argue that efficiency is a good thing for the economy overall, but Republicans care more about protecting corporate profits than they do about advancing the economy.  They would make the same last stand for buggy whip manufacturers.

So because Republicans don't want single payer, your answer (and the ACA's answer) is to implement a system that pushes the burden from old healthy people onto young healthy people?  I don't quite follow that logic.  It's an idea I would expect from a bunch of old Republicans.
Title: Re: What comes after the ACA?
Post by: v8rx7guy on January 07, 2017, 12:01:55 PM
Also while I fully support HSA expansion. Isn't this just the 401k all over again and will be severely under utilized by the avg incompetent American who doesn't understand money.
+1. I agree that it will be the 401k all over again.

I am totally against the HSA system. Why in the heck should there be a tax break for health expenses? Get rid of it completely.

I think that if everyone had an HDHP and HSA's we will begin to make care providers have to be more competitive with their pricing.  When your average person knows they are paying for a procedure, medication, visit etc. with their HSA they shop around a bit bringing more pricing competition into the market and I believe that will make costs more reasonable over time.  I know for our family certainly shops around more and thinks things thru more often now that we are on an HDHP paying with our HSA.  Before there was essentially no thinking involved because we knew it would just be a small deductible.
Title: Re: What comes after the ACA?
Post by: seattlecyclone on January 07, 2017, 12:49:53 PM
Why should people who get coverage through their employer continue to get a subsidy (through the tax exempt nature of that compensation) while others not?

They shouldn't. It's crazy that an employer paying me $10k in the form of health insurance is taxed differently than if they paid me $10k in cash and I bought my own health insurance. It's time for that to end, so that companies have less incentive to pay their employees in the form of health insurance that is often different from what the employee would choose if they were using their own money.
Title: Re: What comes after the ACA?
Post by: Davids on January 07, 2017, 02:54:08 PM
A few things I want to see happen.

1) Remove the individual mandate, no one should be forced to purchase health insurance or pay a tax penalty if they do not. That is ridiculous.

2) Being charged based on your individual risk. No offense but a younger healthy person should pay much less than what they are paying now and an older person who has a preexisting condition should pay more than what they are paying now for coverage. With that I would keep the mandate that an insurance company cannot deny coverage for preexisting conditions but they can at least properly price for it.

3) Expand the HSA - It should be available for everyone who has health insurance coverage regardless of deductible amount, instead of just those with high deductible. I would also increase the HSA MAX contribution rate to $15,000.00 for family and $7,500.00 for Individual and have the MAX increase at a rate of 3% annually. Yes it can be seen as benefiting the rich with a bigger tax cut but I say so what, this can only help, not hurt people. 

4) Do not get rid of Medicaid - We should not get rid of Medicaid. What needs to be done is a better review of those who are on Medicaid (or any other Government Welfare program) to ensure those who are on it are truly the ones who qualify/need it and not just milking the system.
Title: Re: What comes after the ACA?
Post by: Lagom on January 07, 2017, 02:57:43 PM
I think that if everyone had an HDHP and HSA's we will begin to make care providers have to be more competitive with their pricing.  When your average person knows they are paying for a procedure, medication, visit etc. with their HSA they shop around a bit bringing more pricing competition into the market and I believe that will make costs more reasonable over time.  I know for our family certainly shops around more and thinks things thru more often now that we are on an HDHP paying with our HSA.  Before there was essentially no thinking involved because we knew it would just be a small deductible.

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

Title: Re: What comes after the ACA?
Post by: Iplawyer on January 07, 2017, 02:59:35 PM
A few things I want to see happen.

1) Remove the individual mandate, no one should be forced to purchase health insurance or pay a tax penalty if they do not. That is ridiculous.

2) Being charged based on your individual risk. No offense but a younger healthy person should pay much less than what they are paying now and an older person who has a preexisting condition should pay more than what they are paying now for coverage. With that I would keep the mandate that an insurance company cannot deny coverage for preexisting conditions but they can at least properly price for it.

3) Expand the HSA - It should be available for everyone who has health insurance coverage regardless of deductible amount, instead of just those with high deductible. I would also increase the HSA MAX contribution rate to $15,000.00 for family and $7,500.00 for Individual and have the MAX increase at a rate of 3% annually. Yes it can be seen as benefiting the rich with a bigger tax cut but I say so what, this can only help, not hurt people. 

4) Do not get rid of Medicaid - We should not get rid of Medicaid. What needs to be done is a better review of those who are on Medicaid (or any other Government Welfare program) to ensure those who are on it are truly the ones who qualify/need it and not just milking the system.

So you think insurance companies will price insurance for a person who has had cancer before at any rate that anybody could reasonably pay?  No - they won't unless forced. 

I hope for your sake you never get a disease or have an accident that gives you a pre-existing condition.
Title: Re: What comes after the ACA?
Post by: protostache on January 07, 2017, 03:09:40 PM
A few things I want to see happen.

1) Remove the individual mandate, no one should be forced to purchase health insurance or pay a tax penalty if they do not. That is ridiculous.

2) Being charged based on your individual risk. No offense but a younger healthy person should pay much less than what they are paying now and an older person who has a preexisting condition should pay more than what they are paying now for coverage. With that I would keep the mandate that an insurance company cannot deny coverage for preexisting conditions but they can at least properly price for it.

3) Expand the HSA - It should be available for everyone who has health insurance coverage regardless of deductible amount, instead of just those with high deductible. I would also increase the HSA MAX contribution rate to $15,000.00 for family and $7,500.00 for Individual and have the MAX increase at a rate of 3% annually. Yes it can be seen as benefiting the rich with a bigger tax cut but I say so what, this can only help, not hurt people. 

4) Do not get rid of Medicaid - We should not get rid of Medicaid. What needs to be done is a better review of those who are on Medicaid (or any other Government Welfare program) to ensure those who are on it are truly the ones who qualify/need it and not just milking the system.

So you think insurance companies will price insurance for a person who has had cancer before at any rate that anybody could reasonably pay?  No - they won't unless forced. 

I hope for your sake you never get a disease or have an accident that gives you a pre-existing condition.

Based on the rate I pay for a simple $250k term life insurance policy because I happened to survive cancer ($339/mo), I would expect to pay more than $4,000 per month for a bronze-equivalent plan. This is what happens when you force coverage without price controls. And my cancer was one of the random survivable kinds! I can only imagine someone with worse prospects would be priced completely out.
Title: Re: What comes after the ACA?
Post by: Boxcat on January 07, 2017, 03:29:48 PM
What comes after the ACA? Universal health care would be the ideal option, but since the Republicans control all three branches of government nothing will. The results will likely cause millions of deaths overall, but it'll be ignored and forgotten.

Come on now...
I realize it's bold claim, but I try not to underestimate the glory of Republican governance anymore.

Here's a scenario: 3,121 people die this year due to lacking healthcare, do the powers that be clamor for a War on Health and spend trillions? I don't see that happening, instead they'll make some joke policies that weaken the bottom 90% and engage in corporate plundering.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 07, 2017, 03:31:50 PM


(allowing insurers to deny coverage for pre-existing conditions) I'm in favor of this one, I consider it a necessary step towards reviving true insurance.

If you're in favor of letting insurance companies deny people coverage, are you also okay with millions of people not having health insurance, and only getting medical care when they go to the ER?  The whole point of this guaranteed issue clause was to reduce overall costs by getting people into more cost effective preventative care, instead of letting them go uninsured and thus untreated until they had some sort of catastrophic malfunction.

I don't agree that was the point of it at all, but if it was, it failed.  And in a predictable way, because that is contrary to human nature.  The main reason that so many people over-use emergency care services is not because they neglect their preventative care, so much as it is that they are in the habit of doing whatever is most convenient for themselves, and never bothering to attend a general prac for a regular checkup is more convenient than doing so.  Even forcing people to get an ACA compliant plan won't solve this problem, even if it worked to an absolute degree, because then you just moved the responsible party from the taxpayer to the taxpayer subsidized insurance plan.  Irresponsible people are irresponsible people because they can get away with it in our modern society without much consequence.

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

<sigh> This is false, as I have shown in many ways before.  I am not going to repeat myself in full, but in short, there were solutions to these problems before ACA.  Some were expensive, some required a waiting period for pre-existing conditions, sometimes a state subsidized high risk pool was the only solution.  Often it was a combination of things, and often the solution could not be identified by the unfortunate seeker of solutions; but they existed.
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Quote
(individual mandate) I'm definitely in favor of this one.  I consider the idea that individuals can get taxed for not purchasing a product from private business to be fundamentally wrong in many ways.

That seem exactly backwards.  I consider it fundamentally wrong that an individual can weasel out of paying for a service that they are 100% guaranteed to use.  Everyone uses healthcare at some point of their lives, no exceptions.  Some folks just get it for free because they don't buy insurance, and those people are freeloaders.
Okay, I can see your perspective here, but I don't agree that insurance is the only way to pay for health care.  In fact, I don't consider it the best way.  If the mandate could be satisfied with an emergency hospitalization only plan, or a true catastrophic plan (such as I could get before the ACA, that didn't cover annually reoccurring expenses that everyone should expect, nor regular care for which it is actually impossible for me to need), then I would be okay with such a mandate.  Still wouldn't like that as a solution, but okay with it.  Such as it is, the ACA regulations don't compare to requiring legally mandated liability insurance in order to drive a car; but both comprehensive auto insurance with a plan that paid for free oil changes every three months and a new set of brake pads every few years.  I should have the option of a minimalist plan and have that qualify for the penalty exemption.

Quote

And to be clear, the individual mandate doesn't force everyone to buy insurance.  Only the ~10% of folks who don't already have insurance, and it offers them financial incentives to help them do it, and VERY light tax penalties for turning down the financial incentives.  I consider those tax penalties to be a great deal, since those folks are still going to get unlimited amounts of free healthcare anyway.

I think that we both know that doesn't really happen in practice.  With or without the ACA.

Quote

Would the individual mandate be more or less palatable to you if people were buying insurance directly from the government, for example by enrolling in expanded medicaid/medicare programs?  Is it the "private companies" part that upsets you?


On some level, yes.  If it was a default enrollment for the lazy, with an opt-out option, I could see a minimalist version of a single payer system being acceptable.  I doubt that it would work well, but I wouldn't find it as offensive on ideological grounds.
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(change age-related premiums from 3:1 to 5:1) I'm straight up in favor of this one. I'm starting to get up there, and I have always consider forcing companies to price the young and healthy high in order to subsidize the older people in the same risk pool to be wrong.

I've always considered forcing the young and healthy into the same risk pool as the old and sick to be the defining characteristic of insurance plans.  My employer-provided insurance does this, for example.  Every employee is in the same pool, regardless of age or health.  We all pay the same amount.  I think the individual market should work the same way.

It has become that, but it doesn't need to be that.  Your's can work that way at your employer without requiring the entire industry to operate in that manner. 

Quote

Otherwise, it's not really insurance.  Why not take this argument to its logical extreme, and put each person into a risk pool of one, with an appropriate weighted premium based on their unique characteristics?    At that point, every person would pay their actual costs and it's no longer insurance.  Segregating risk pools is just taking the first step in this direction, and it's designed to deliberately undermine the very idea of insurance. 
It is most certainly insurance.  And your HSA certainly can be a risk pool of one, but spread over a lifespan instead spread across a risk pool during a single calendar year.  The defining character of insurance is that it is a contract to limit risk of economic destruction, not that the insurance company spreads that risk over a broad group of people.  The latter is just one way of doing it.

Quote

I do appreciate the feedback from a contrary perspective.  I'm still trying to decide if Republicans even care whether or not Americans can actually get affordable insurance, or just care about protecting insurance company profits regardless of what is best for Americans.

I couldn't really say.  I'm not a Republican.  I'm a conservative, and I'm not registered as affiliated with any political party.  I don't agree that conservative equates to Republican today.
Title: Re: What comes after the ACA?
Post by: Paul der Krake on January 07, 2017, 03:39:41 PM
My ideal ACA replacement magically punishes people that I, Benevolent Health Overlord, deem unworthy of receiving care. Everyone will be graded by an impartial algorithm of my choosing, and placed into different pools.

Some criteria used to be placed in the naughty pool:
- proven pattern of smoking while sober or before 10pm
- BMI over 25
- has injured themselves more than twice over the last decade in their own kitchen

Some criteria used to be placed in the fabulous pool:
- meets or exceeds general attractiveness standards as defined by the yearly report of the specially anointed Swedish Immigration Task Force
- ability to convincingly talk about triathlon training regimens for more than 10 minutes
- have kids who can behave in a restaurant

 Doctors will be prohibited by law to cater to patients outside of the risk pool they have been assigned to. The worst offenders are to be relocated to Wyoming and placed on a non-heated reservation where they will be compelled to reflect on their lifestyle choices and do hard labor.

-------

But failing that, I will take higher HSA contribution limits, please.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 07, 2017, 04:02:25 PM
I think that if everyone had an HDHP and HSA's we will begin to make care providers have to be more competitive with their pricing.  When your average person knows they are paying for a procedure, medication, visit etc. with their HSA they shop around a bit bringing more pricing competition into the market and I believe that will make costs more reasonable over time.  I know for our family certainly shops around more and thinks things thru more often now that we are on an HDHP paying with our HSA.  Before there was essentially no thinking involved because we knew it would just be a small deductible.

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

This is true, but these are the very low risk, very high consequence events that true insurance is properly designed to deal with.  That is why a high-deductable health plan is a requirement for an HSA while contributing, to force the owner to have such a policy in order to benefit from the tax favorable savings vehicle.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 07, 2017, 04:14:05 PM
What comes after the ACA? Universal health care would be the ideal option, but since the Republicans control all three branches of government nothing will. The results will likely cause millions of deaths overall, but it'll be ignored and forgotten.

Come on now...
I realize it's bold claim, but I try not to underestimate the glory of Republican governance anymore.

Here's a scenario: 3,121 people die this year due to lacking healthcare, do the powers that be clamor for a War on Health and spend trillions? I don't see that happening, instead they'll make some joke policies that weaken the bottom 90% and engage in corporate plundering.

Hold on, now.  Let's clarify a bit.  While people can die prematurely due to lack of health care services, no one dies as a direct result of lack of insurance coverage.  No one dies because they don't have a particular type of contract in effect, but people really do die because they don't get necessary care.  Please don't mix the two concepts, it promotes a deceptive thought process.  These people die because they have diseases or injuries that kill them.  Sol complains that not having insurance (often) leads to bankruptcy in the event of a major health problem, which (often) ends up costing taxpayers money due to health care write-offs and increased insurance costs for others.  This much is true enough, but bankruptcy never actually killed anyone, as far I know.  Killed the realistic possibility of a retirement, sure.  But retirement, early or not, has always been a luxury feature of modern society.  No one deserves to quit working and still eat.  Hopefully most/all of us will be able to afford to quit working and still eat, but none of us are entitled to that simply because we are still alive when we reach any special age.
Title: Re: What comes after the ACA?
Post by: Beardog on January 07, 2017, 04:17:30 PM
I am only 54 but I think the younger people here with any disdain of the ACA are short sighted.  You can exercise, eat right, not smoke, etc. and get a disease or have an accident that has a permanent consequence.  As much as you would like to think so - you simply are not in control of this.  ...

+1  The cause of many horrible diseases is unknown and can strike anyone.  Look at Lou Gehrig, and Ann Romney (wife of Mitt Romney, who has MS).  Certainly you can't blame these people for their illnesses. 

A major overhall of our health care system is needed so that insurance can be provided at a reasonable cost.  The profit motive has taken over the 'health care' industry.  I don't go to see a doctor unless I have an acute infection that requires antibiotics or something.  There is little to no scientific foundation to justify many regular screening procedures such as mamograms and colonoscopies for most ordinary people.  And there is no evidence that life spans are actually being extended by performing many of these procedures.  The medical system is crammed full of expensive procedures and pharmaceuticals of minimal or no benefit.  Americans expect to receive all possible diagnostic procedures and treatments, no matter how expensive and how small the likely benefit.  Unless there is some way to deal with this, I think the health care system is sunk.
Title: Re: What comes after the ACA?
Post by: marion10 on January 07, 2017, 04:34:12 PM
I am particularly worried about Medicaid- I think one of the largest ( if not largest) uses for Medicaid is nursing home care after assets are exhausted. My MIl who had Alzheimer's lived for six years in a very good nursing home after she exhausted her assets ( which took about 18 months). With that - what would we do- her care was over 100,000  a year.
Title: Re: What comes after the ACA?
Post by: Cassie on January 07, 2017, 05:10:45 PM
SOL: you make some excellent points and it is really scary that we will go backwards instead of forward in regard to health care.  I am a guardian for a friend with early onset alzheimer's and she could afford her care between pension and SS but now she needs more care and the cost has doubled and we applied for Medicaid. No clue what would happen to her without it. She has no family left.
Title: Re: What comes after the ACA?
Post by: bacchi on January 07, 2017, 05:35:03 PM

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

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

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

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

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

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

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

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

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

"Fuck you, you're sick" as a health policy is a cruel policy.
Title: Re: What comes after the ACA?
Post by: Warhead on January 07, 2017, 06:02:23 PM
One thing I love to bring up when anyone wants to defend the United states way of doing health care is the fact we are

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


2015 numbers

USA $9451.00 per person - Life expectancy 79.3

And how bout comparing that to our good buddy Canada

Canada $4608 per person - Life expectancy 82.2

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

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

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

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

I constantly hear people bitching their plan was so cheap before Obamacare yet they never actually USED it so they did not get to see that it didn't actually cover anything.
Title: Re: What comes after the ACA?
Post by: bacchi on January 07, 2017, 06:05:39 PM
We want to be free to spend 2x as much as our neighbor and 30% over the second highest per capita spending OECD country (Switzerland) and STILL get worse results.

What do you have against freedom, commie?
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 07, 2017, 06:09:28 PM

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


I love this one, and it is so true.  The problem that I see is that, like Obamacare, a band-aid over a gunshot wound was entirely the wrong thing to do, and it wasted both resources and time in the doing. 
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 07, 2017, 06:11:55 PM
I am particularly worried about Medicaid- I think one of the largest ( if not largest) uses for Medicaid is nursing home care after assets are exhausted.

This is true.
Title: Re: What comes after the ACA?
Post by: protostache on January 07, 2017, 06:15:08 PM

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

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

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

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

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

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

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

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

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

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

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

It's not that they can't work, but the effect is that everyone pays for these pools through their state and federal taxes, assuming the state has money and/or Congress feels like funding them that year.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 07, 2017, 06:23:02 PM

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

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

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

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

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

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

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

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

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

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

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

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

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

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


http://www.thenewamerican.com/usnews/health-care/item/22569-cancer-and-obamacare-a-double-whammy
Title: Re: What comes after the ACA?
Post by: protostache on January 07, 2017, 06:29:47 PM

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

The co-ops failed across the country because the Federal government neglected to fund them as ACA promised. It wasn't because of any inherent flaw, it's because a GOP controlled congress refused to pass a budget that funded the promise they were built on.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 07, 2017, 06:37:49 PM

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

I consider an economic system dependent upon unfunded promises to be inherently flawed already, even before we consider any other faults of the law.  The Democrats who pushed the ACA through congress (using reconciliation, btw; the same process that the Republicans are planning on using to dismantle it without threat of a filibuster) knew that the Republicans hated this law, and left those issues unfunded because they expected that once the system was up and running, the public pressure from those voters whom benefited would keep the Republicans from repealing or defunding the program.  Looks like they were wrong.
Title: Re: What comes after the ACA?
Post by: ysette9 on January 07, 2017, 08:09:35 PM
The part that fascinates me in all of this ridiculous debate is how we seem to struggle mightily with these moral quandaries of taxing some folks to provide coverage for other folks and the idea of risk pools and whatnot. All of this while every other rich, industrialized country has figured this shit out years ago and gets better results for less money. It is like we are getting into crazy bar fights over whether to require catalytic converters on our gas-guzzling land yachts while the rest of the world is using hydrogen fuel cells or electric cars to get around. We do a lot of things great in this country but this is one of those topics that completely confuses me and makes me want to run to another country to hide among people who actually see the value in human decency and universal health.
Title: Re: What comes after the ACA?
Post by: v8rx7guy on January 07, 2017, 08:46:28 PM
I think that if everyone had an HDHP and HSA's we will begin to make care providers have to be more competitive with their pricing.  When your average person knows they are paying for a procedure, medication, visit etc. with their HSA they shop around a bit bringing more pricing competition into the market and I believe that will make costs more reasonable over time.  I know for our family certainly shops around more and thinks things thru more often now that we are on an HDHP paying with our HSA.  Before there was essentially no thinking involved because we knew it would just be a small deductible.

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

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

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

I am looking forward to what the future brings for america!
Title: Re: What comes after the ACA?
Post by: Cpa Cat on January 07, 2017, 09:01:38 PM
If I were to guess, we'll see coverage for pre-existing conditions, provided you maintain some continuous term of coverage (probably 3 years) beforehand. Expanded HSAs. Non-refundable tax credits for premiums.

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

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

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

This is like the ACA deathpool. I kind of want to see how many of my predictions come true!
Title: Re: What comes after the ACA?
Post by: calimom on January 07, 2017, 09:49:49 PM
These poor idiots. They voted against their own interest, which is funny for people who only have their own self interests at the top of their lists. They didn't want a smart sassy woman telling them what to do. Even though she knew better than what they did as to what they needed. Confounding!


Title: Re: What comes after the ACA?
Post by: Paul der Krake on January 07, 2017, 10:16:55 PM
Trigger warning: profanity ladden post below- you've been warned

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

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

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

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

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

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

BULL FUCKING SHIT.

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

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

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

The US government bends over and approves everything that isn't so outrageously overpriced that people will talk about it on CNN. Anything with less than a 50% increase is totally justified, wink wink. In the meantime, the American public continues to compare their stupid health plan terms and argue about stupid shit like who's going to pay for poor people's McDonald's and Marlboro habits.
Title: Re: What comes after the ACA?
Post by: justchristine on January 08, 2017, 05:47:30 AM
I think that if everyone had an HDHP and HSA's we will begin to make care providers have to be more competitive with their pricing.  When your average person knows they are paying for a procedure, medication, visit etc. with their HSA they shop around a bit bringing more pricing competition into the market and I believe that will make costs more reasonable over time.  I know for our family certainly shops around more and thinks things thru more often now that we are on an HDHP paying with our HSA.  Before there was essentially no thinking involved because we knew it would just be a small deductible.

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

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

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

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

Personally I love the idea of being able to shop around and think all providers should have a published rate schedule.  I don't think it would completely bring our costs under control but think it might help.  Although I have to wonder how much prices differ within a given network.  My insurance confines me pretty much to one of the two major medical groups that dominate the several counties around me.  So if I needed an MRI, for example, I would have several choices within 60 miles of me but since they are all part of the same medical group would the prices be substantially different?  Now I'm genuinely curious...Anyone have experience or inside knowledge on that?
Title: Re: What comes after the ACA?
Post by: rtrnow on January 08, 2017, 07:44:35 AM


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


Wow! What a horrible site. It was amusing to poke around and see how obviously extreme right it was.
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 08, 2017, 07:49:04 AM

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

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

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

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

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

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

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

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

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

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

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

As I've said before - the young people here with disdain of providing  health care to all as a minimum - have no idea what life can hand to them that they have no control over.  You can eat all the right foods, exercise like a mad person, not drink, not smoke, and still get into an accident or come down with a terminal illness or expensive disease through no fault of your own. 
Title: Re: What comes after the ACA?
Post by: GrumpyPenguin on January 08, 2017, 08:09:13 AM
Thanks Sol for summarizing the Republicans stance on the ACA with some detail.  I was only aware of what Trump had been saying, which lacked any details whatsoever.
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 08, 2017, 08:23:13 AM
Thanks Sol for summarizing the Republicans stance on the ACA with some detail.  I was only aware of what Trump had been saying, which lacked any details whatsoever.

And, to be fair, what Sol posted also lacks any actual details.  Further - it isn't what Trump has been saying - just want Congress has been saying.  It is nothing like what the the cabinet member from hell proposes either.
Title: Re: What comes after the ACA?
Post by: sol on January 08, 2017, 09:19:04 AM
Thanks Sol for summarizing the Republicans stance on the ACA with some detail.  I was only aware of what Trump had been saying, which lacked any details whatsoever.

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

If anyone else would like to summarize another source of information about what the Republicans will replace the ACA with, I would love to read it.  This appears to be the only written plan.  Everything else is just talk.
Title: Re: What comes after the ACA?
Post by: fuzzy math on January 08, 2017, 09:31:00 AM


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

This is simply not true.

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

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

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

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


Lets back this down to the most simple level - most people can't even be bothered to price compare paper towels. Those of us who do certainly haven't caused enough of a fuss to lower costs of paper towels industry wide.
Title: Re: What comes after the ACA?
Post by: fuzzy math on January 08, 2017, 09:35:03 AM


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

Thanks for a well researched post sol!
Title: Re: What comes after the ACA?
Post by: boarder42 on January 08, 2017, 10:05:20 AM

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Is this a serious question or a devils advocate question? Not giving transplants to 80 year olds I'm pretty ok with. Withholding treatment for curable but expensive diseases in young or otherwise healthy people I am not ok with. "Allowing reproduction" gets very close to eugenics and ideas about "genetic purity" which are abhorrent.
Title: Re: What comes after the ACA?
Post by: boarder42 on January 08, 2017, 11:12:14 AM
Yeah it's serious. Let's keep people with genetic disorders alive so they can reproduce and get rid of natural selection. Sounds dumb for society as a whole.  Don't quite understand how one can say universal healthcare for all BC it's in the best interests of society and avoid the natural selection issue with society.
Title: Re: What comes after the ACA?
Post by: protostache on January 08, 2017, 11:17:57 AM
Yeah it's serious. Let's keep people with genetic disorders alive so they can reproduce and get rid of natural selection. Sounds dumb for society as a whole.  Don't quite understand how one can say universal healthcare for all BC it's in the best interests of society and avoid the natural selection issue with society.

So would you advocate sterilization? Or should we just kill all the undesirables and spare them their inevitable inferiority-induced pain and suffering?
Title: Re: What comes after the ACA?
Post by: boarder42 on January 08, 2017, 11:22:18 AM
Not sure what the best solution would be but we're already over populating or planet and killing it so why keep someone alive who can pass on a gene to keep a costly disorder in society when it could just be eliminated. Do we not currently do similar things with deadly viral outbreaks.
Title: Re: What comes after the ACA?
Post by: Tyler on January 08, 2017, 11:22:25 AM
If anyone else would like to summarize another source of information about what the Republicans will replace the ACA with, I would love to read it.  This appears to be the only written plan.  Everything else is just talk.

Summarizing the Protections for Patients section of the "A Better Way (http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf)" document (see page 20):

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

All of that sounds perfectly reasonable to me, and I'd personally have no issue buying insurance under that system and dutifully maintaining continuous coverage to preserve my rights as a patient.  We'll see how it ultimately shakes out, but if it also succeeds in reducing costs and expanding coverage options (my ACA options this year were depressingly narrow) this could end up a net positive for early retirees. 
Title: Re: What comes after the ACA?
Post by: v8rx7guy on January 08, 2017, 11:35:43 AM


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

This is simply not true.

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


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

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

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

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

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

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


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

This is simply not true.

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


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

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

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

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

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

BULL FUCKING SHIT.

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

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

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

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

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

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

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

My personal pet peeve is credential bloat in medical staff. It takes us 11-15 years after high school to train a doctor in the US (BA+MD+residency), but most other countries, including in europe, manage the same training in 8. Then once we train those doctors, we insistent that you need an MD to take care of all sorts of cuts and bruises and sniffles at the local doctors office when 90% of cases could be properly treated by someone with only a couple of years training as a medic without having to pass them on up the chain to someone with more expertise. The same thing is starting to happen with Nurse Practitioners, which used to just be an additional 1-2 year masters after a bachelors in nursing (5-6 years total) but is now being pushed towards requiring doctorate level degree after the bachelors degree  (8-10 years total). And of course more school means more student debt, which means you need to pay people in the field more, which means total medical spending goes up.
Title: Re: What comes after the ACA?
Post by: v8rx7guy on January 08, 2017, 12:31:23 PM


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

This is simply not true.

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


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

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

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

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

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

You talk like $20,000 is a ton of money, and it most certainly is.  But dont forget, a family can pay that much per year in PREMIUMS these days!  That is seriously wrong,
Title: Re: What comes after the ACA?
Post by: thenextguy on January 08, 2017, 12:40:51 PM
Another way is to finally get to single payer and cover most healthcare costs through our progressive tax system. 

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

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

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

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

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

What's the alternative?  Is there any credible path forwards towards single payer?
Title: Re: What comes after the ACA?
Post by: The Happy Philosopher on January 08, 2017, 01:17:45 PM


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

This is simply not true.

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


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

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

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

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

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

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

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

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

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

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

With that let's not get all crazy that Trump and the republican controlled congress are going to destroy everything. The ACA needs to be replaced because it is broken. I have faith something better will be put in place that will benefit the masses. Not everyone can be happy, there is no 100% perfect system but we need to benefit as many people as possible and the ACA does not do that, the ACA has hurt a lot more than helped. It really should be called the UCA, I am sure you know what the U stands for. We need a plan in place where hopefully (or selfishly on my end ) the HSA MAX will be increased (and accessible by all, not just high deductible), there is no individual mandate so you are not forced to get coverage or pay a penalty if you don't, and a fair rate is charged based on your individual health risk (not having to pay more if you are young and healthy). Also we should not get rid of Medicaid but we need to do a better job of monitoring Medicaid (and other government welfare programs) to ensure those that are on it deserve it and are not just abusing the system.
Title: Re: What comes after the ACA?
Post by: thenextguy on January 08, 2017, 02:00:25 PM
Just a friendly reminder for everyone worried about the republicans ruining everything. You all love your HSA, correct? Remember it was George W. Bush and the Republican controlled congress in 2003 who created it.

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

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

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

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

Edit: Consider this:

Times Republican Congress voted to repeal the ACA: 60
Times Republican Congress voted to replace the ACA: 0
Title: Re: What comes after the ACA?
Post by: RedwoodDreams on January 08, 2017, 03:39:47 PM
The part that fascinates me in all of this ridiculous debate is how we seem to struggle mightily with these moral quandaries of taxing some folks to provide coverage for other folks and the idea of risk pools and whatnot. All of this while every other rich, industrialized country has figured this shit out years ago and gets better results for less money. It is like we are getting into crazy bar fights over whether to require catalytic converters on our gas-guzzling land yachts while the rest of the world is using hydrogen fuel cells or electric cars to get around. We do a lot of things great in this country but this is one of those topics that completely confuses me and makes me want to run to another country to hide among people who actually see the value in human decency and universal health.

+100000000000
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 08, 2017, 05:08:53 PM

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

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

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

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

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

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

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

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

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

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

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

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

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

I see - not treating a 40 year old with curable cancer is something you advocate? 
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 08, 2017, 05:38:06 PM
The part that fascinates me in all of this ridiculous debate is how we seem to struggle mightily with these moral quandaries of taxing some folks to provide coverage for other folks and the idea of risk pools and whatnot. All of this while every other rich, industrialized country has figured this shit out years ago and gets better results for less money. It is like we are getting into crazy bar fights over whether to require catalytic converters on our gas-guzzling land yachts while the rest of the world is using hydrogen fuel cells or electric cars to get around. We do a lot of things great in this country but this is one of those topics that completely confuses me and makes me want to run to another country to hide among people who actually see the value in human decency and universal health.

+1000000000
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 08, 2017, 05:41:42 PM
Trump's Plan from:
https://www.donaldjtrump.com/positions/healthcare-reform
Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.
Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.
Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.
Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.
Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.
Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.
Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 08, 2017, 06:13:52 PM
Yeah it's serious. Let's keep people with genetic disorders alive so they can reproduce and get rid of natural selection. Sounds dumb for society as a whole.  Don't quite understand how one can say universal healthcare for all BC it's in the best interests of society and avoid the natural selection issue with society.

Really? You want our country to be based on natural selection?  Really?  Well - let's also not school those with lower IQs.  That sounds dumb too.  We only have so many education dollars after all. Why waste them on stupid people?
Title: Re: What comes after the ACA?
Post by: golden1 on January 08, 2017, 06:59:57 PM
Quote
Yeah it's serious. Let's keep people with genetic disorders alive so they can reproduce and get rid of natural selection. Sounds dumb for society as a whole.  Don't quite understand how one can say universal healthcare for all BC it's in the best interests of society and avoid the natural selection issue with society.

Ok, lets start with the sociopaths, since they seem to be the most dangerous to the human race. 
Title: Re: What comes after the ACA?
Post by: Monkey Uncle on January 08, 2017, 07:00:07 PM


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

This is simply not true.

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


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

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

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

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

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

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

You're missing the point.  If I spend $70k over a given period of time on health care, and $60k of it is spent in situations where I have no opportunity to shop around or negotiate prices, it makes no difference whether I pay for it out of a HSA or through insurance reimbursements.  Either way, I'm not forcing anyone to compete for my health care dollars.  My numbers may not be completely accurate, but I would guess that most Americans are in a similar situation.  The majority of their health care spending occurs in situations that afford them no ability to shop around or negotiate.  If most of the country's health care spending is not subject to competition, competition will not succeed in forcing prices down.
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 09, 2017, 05:52:17 AM
These poor idiots. They voted against their own interest, which is funny for people who only have their own self interests at the top of their lists. They didn't want a smart sassy woman telling them what to do. Even though she knew better than what they did as to what they needed. Confounding!

+10000000000000000

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

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

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

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

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

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

In short - I don't think being frugal is equal to being mean spirited or selfishly only looking out for yourself while the community around you crumbles. 
Title: Re: What comes after the ACA?
Post by: protostache on January 09, 2017, 06:35:58 AM
I don't think being frugal is equal to being mean spirited or selfishly only looking out for yourself while the community around you crumbles.

Thank you for for the wonderful thoughtful comment that I didn't have the words to say.
Title: Re: What comes after the ACA?
Post by: MayDay on January 09, 2017, 06:59:30 AM
As a straight, white, upper class-ish woman who is unlikely to need an abortion in the next 4 years (and could easily afford to travel to Mexico for one, or an IUD, etc), the ACA related issues are what is most likely to affect me during Dumpster Fire's presidency.

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

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

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

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

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

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

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

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

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

And plus also, I'm just a decent human being who thinks that everyone in this country should have a basic level of healthcare.  Now if you want to talk Death Panels, I am all in (in other words, yes I am in favor of rationing health care based on age and likelihood of success).
Title: Re: What comes after the ACA?
Post by: boarder42 on January 09, 2017, 07:07:26 AM
I don't think being frugal is equal to being mean spirited or selfishly only looking out for yourself while the community around you crumbles.

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

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

I'm all for a single payer system.  but under such a system things like this can and should be considered when giving treatment to someone who may be selfish enough to procreate and continue a disorder that should be naturally selected away.
Title: Re: What comes after the ACA?
Post by: jim555 on January 09, 2017, 07:17:25 AM
In the good old days (pre-2010) insurers would look for any excuse not to pay out a claim.  They would go back in the medical history to find if a person omitted ANYTHING and use that as an excuse not to pay.  The business model is the more they deny claims the more profit to the bottom line.  The free market rewards such behaviour.  The ACA is a reaction to the abuses of the pre-2010 era.

The biggest part of the ACA is expanded Medicaid.  Those on Medicaid have no way to afford medical insurance and survive at the same time without the ACA expansion.  So they flood the ER and go bankrupt when the bills come in.  People should not have to loose everything due to a medical event.  The US is so far behind the rest of the world on this topic it is stunning.
Title: Re: What comes after the ACA?
Post by: boarder42 on January 09, 2017, 07:24:35 AM
couldnt all this simply be fixed with insurance regulation and reform.  It seems to me the largest complaint against the old system is my house burned down and now insurance says they arent gonna pay and dropped me.  How is this insurance.  A simple rule could fix that i'd think. 

still putting everyone in a big pot and then giving credits for being healthier and getting preventative treatments done/ attempting to be healthier and taking classes much like are offered thru large employer group plans seems to be a better cheaper overall system.  then the higher risk people are either taking steps towards becoming less high risk and the rest of the healthy people can keep on about their lives as they have been.  I'm sure invasion of privacy will come up with this but its a credit you dont have to participate if you want to just pay the full tax.
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 09, 2017, 07:59:33 AM
couldnt all this simply be fixed with insurance regulation and reform.  It seems to me the largest complaint against the old system is my house burned down and now insurance says they arent gonna pay and dropped me.  How is this insurance.  A simple rule could fix that i'd think. 

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

boarder42 - I am going to try one more time.  How do you know you don't have a defective gene that you are passing on?  Many genetic disorders aren't discovered until they become issues.  And what about people who don't have genetic disorders but have operable and curable cancer but then are considered to have a pre existing condition who exercise, run marathons, eat right, and don't procreate?  what would you do with them?  How do they take steps to get less "high risk" according to you?  You cannot erase having cancer.  Or maybe you think those people should just curl up in a hole and die? 

You - boarder42- aren't a force or nature nor are you God. You have no idea what your genetic makeup is.  Have you procreated anyway?  I really find you one of the most offensive and awful people here.  Karma is a bitch.  It might catch up with you. In the meantime - please don't procreate.  The world doesn't need anymore people without love in their hearts.  Clearly 25% of our country is already there.


For everyone else - just a little reminder to PUT A LITTLE LOVE IN YOUR HEARTS:
https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=lyrics%20to%20put%20a%20little%20love%20in%20your%20heart

 Think of your fellow man
Lend him a helping hand
Put a little love in your heart
You see it's getting late
Oh, please don't hesitate
Put a little love in your heart
And the world will be a better place [x2]
For you and me
You just wait and see
Another day goes by
Still the children cry
Put a little love in your heart
If you want the world to know
We won't let hatred grow
Put a little love in your heart
And the world (and the world) will be a better place
All the world (all the world) will be a better place
For you (for you)
And me (and me)
You just wait (just wait)
And see, wait and see
Take a good look around
And if you're looking down
Put a little love in your heart
I hope when you decide
Kindness will be your guide
Put a little love in your heart
Title: Re: What comes after the ACA?
Post by: packlawyer04 on January 09, 2017, 08:09:52 AM
The ACA did not fix anything which is why it failed. And make no mistake, it failed. It was simply changing who is paying for healthcare and shifted the burdens around.  Dumping $14,000 deductibles with $1,200 a month premiums on working class families is a failure. The underlying problems are still present, i.e. the actual costs of healthcare.

Until a law actually addresses the costs of healthcare, you can play the hide the ball under the cup game until you are blue in the face but it won't do anything.  Nobody wants to actually discuss the problems, folks just want to talk about how to pay for the problems, ACA, private insurance, single payer, on and on and on.

The reality is we are a fat, sick and out of shape country.
Title: Re: What comes after the ACA?
Post by: boarder42 on January 09, 2017, 08:10:39 AM
couldnt all this simply be fixed with insurance regulation and reform.  It seems to me the largest complaint against the old system is my house burned down and now insurance says they arent gonna pay and dropped me.  How is this insurance.  A simple rule could fix that i'd think. 

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

boarder42 - I am going to try one more time.  How do you know you don't have a defective gene that you are passing on?  Many genetic disorders aren't discovered until they become issues.  And what about people who don't have genetic disorders but have operable and curable cancer but then are considered to have a pre existing condition who exercise, run marathons, eat right, and don't procreate?  what would you do with them? 

You - boarder42- aren't a force or nature nor are you God. You have no idea what your genetic makeup is.  Have yo procreated anyway?  I really find you one of the most offensive and awful people here.  Karma is a bitch.  It might catch up with you. In the meantime - please don't procreate.  The world doesn't need anymore people without love in their hearts.


never said i was god.  I have yet to procreate but would not knowlingly procreate with a genetic disorder that could be past on.  Curable things like cancer etc. arent something i brought up, i was tlaking of genetic disorders that are passed on.  and i was playing a devils advocate to all of you who think everyone deserves everything.
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 09, 2017, 08:25:59 AM
My mother was diagnosed with colon cancer 8 years ago.  It was a genetic type.  No worries, she is fine.  My siblings and I, if we had the gene (50% chance- none of us have it) have a ~100% chance of getting colon cancer.  No matter how healthy we are before then.  If we were on individual insurance we would be dropped instantly.

On a positive note, this is actually untrue. Congress passed the Genetic Information Nondiscrimination Act in 2008, so they can't drop you (or raise premiums) for carrying a genetic mutation. In the pre-ACA world, as long as you didn't have any coverage gaps, you would be fine.

Minor downside: you will spend months arguing with the insurance company about this. Ask me how I know.
Title: Re: What comes after the ACA?
Post by: packlawyer04 on January 09, 2017, 08:27:39 AM
Great summary Sol, and great discussion. In my opinion health care costs are the biggest concern for early retirees. There is nothing that can destroy a budget faster than a serious medical problem. The ACA was a gift to the early retiree, too good to be true in many ways. I think the biggest lesson here is that changes in health care, tax or entitlement policy can have a massively negative impact.

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

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

Insane. There is no solution to this problem with any of the proposals. Maybe a single payer could accomplish this, but as others have stated this is politically impossible. Whatever comes next will be great for healthy people, and not so great for sick people. You will likely be OK if you are either really rich or really poor (assuming Medicaid isn't destroyed). Don't get sick in the United States.

Thank you. Nobody wants to talk about this because it is not easy and simple. It is simple to just talk about how to pay for things.

The facts are the ACA does not need to be replaced. It needs to be repealed, slowly. There then needs to be a whole bunch of legislation passed to actually address the problem. Not who is paying for the problem.  Sure you can move to single payer, U.S. government is simply going to go belly up paying for healthcare then.  There is not an easy answer to actuall adress healthcare costs but it affects tons of industries from education to big pharma to the court system.

And please, lets just stop with the comparisons between the U.S and Europe.  American's drive their cars to the end of their driveway to get their mail in route to the all you can eat buffet.  Europeans don't think twice about a vacation that involves biking around for a week. You can't compare the two.
Title: Re: What comes after the ACA?
Post by: protostache on January 09, 2017, 08:35:37 AM
Great summary Sol, and great discussion. In my opinion health care costs are the biggest concern for early retirees. There is nothing that can destroy a budget faster than a serious medical problem. The ACA was a gift to the early retiree, too good to be true in many ways. I think the biggest lesson here is that changes in health care, tax or entitlement policy can have a massively negative impact.

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

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

Insane. There is no solution to this problem with any of the proposals. Maybe a single payer could accomplish this, but as others have stated this is politically impossible. Whatever comes next will be great for healthy people, and not so great for sick people. You will likely be OK if you are either really rich or really poor (assuming Medicaid isn't destroyed). Don't get sick in the United States.

Thank you. Nobody wants to talk about this because it is not easy and simple. It is simple to just talk about how to pay for things.

The facts are the ACA does not need to be replaced. It needs to be repealed, slowly. There then needs to be a whole bunch of legislation passed to actually address the problem. Not who is paying for the problem.  Sure you can move to single payer, U.S. government is simply going to go belly up paying for healthcare then.  There is not an easy answer to actuall adress healthcare costs but it affects tons of industries from education to big pharma to the court system.

And please, lets just stop with the comparisons between the U.S and Europe.  American's drive their cars to the end of their driveway to get their mail in route to the all you can eat buffet.  Europeans don't think twice about a vacation that involves biking around for a week. You can't compare the two.

ACA was never intended to be the end all be all of health care legislation. It was always a first step toward a better future. Cost controls were next on the docket, but we had to get everyone covered first. Of course, ACA was followed immediately by six years of congressional obstruction and so the cost control component never happened and now here we are.
Title: Re: What comes after the ACA?
Post by: scantee on January 09, 2017, 08:39:29 AM
Access to health care is a basic human right. Development of this right has been a quickly-evolving phenomenon over the past century. 100 years ago, health insurance was completely unnecessary because we didn't have the knowledge or technology to really effect health outcomes through health care. By 50 years ago, that had changed drastically: huge leaps were made in our understanding of disease such that health care did have a noticeable effect on outcomes and insurance was a way to subsidize access to those new technologies. Today, health care technology has improved so quickly that barring access to it constitutes a violation of basic human rights. Now, you might not agree with that, you can think that health care and the insurance to pay for it should only be available to those who can afford it, but realize that the rest of western society has moved on without you and considers that viewpoint barbaric.

Once we acknowledge that access to basic health care is a human right, there are really two main concerns in administering it across a large population like that of the US: 1) determining the most efficient way to provide health care services to hundreds of millions of people, in drastically different economic and social contexts, and 2) figuring out how to keep costs manageable, since access to unlimited care is infeasible.

Obamacare was our first attempt as a society to address these concerns. As most first attempts at addressing extremely complicated problems go, it was far from perfect. It's hard to imagine that anyone who thinks it should be perfect is arguing in good faith. Trashing the ACA entirely because it wasn't perfect is not a good faith solution. A true commitment to improving the ACA would involve identifying what has worked with the system, what has not, and then testing alternative solutions to address the systems defects to figure out which one best addresses the concerns listed above.

The Better Way plan does none of this. It basically knocks down the ACA house of cards, only to rebuild it with the same cards in the same configuration. It a political move and nothing more. The reason it does not offer a compelling alternative to the ACA is because there is no compelling alternative. Republicans absolutely know this, but they also know that they can't go back to the old private insurer market because it will be a political nightmare for them (it's very hard to take away benefits that are available to the middle-class, once they have access to them) and the alternative of a public option or single payer are even more ideologically offensive to them. So we get this Better Way plan, which is just ACA repackaged with a few Paul Ryans bitch slaps thrown in (i.e., Medicaid block grant).

What is the primary complaint of those in the ACA market? Cost. Premiums are too high. How do we lower cost? By increasing subsidies. How do we increases subsidies? Higher taxes or diverting funds from other public programs. That's it, that is what needs to happen. That is what will happen after all of this political showmanship. There is no short cut. And really, once subsidies are raised, that in itself is just a one stop in our inevitable progression to a public option, and then single payer.
Title: Re: What comes after the ACA?
Post by: iowajes on January 09, 2017, 08:41:15 AM
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.
Title: Re: What comes after the ACA?
Post by: boarder42 on January 09, 2017, 08:48:06 AM
access isnt the issue.  cost is.
Title: Re: What comes after the ACA?
Post by: jim555 on January 09, 2017, 08:51:14 AM
The Emergency Medical Treatment & Labor Act (EMTALA) ensures public access to emergency services regardless of ability to pay.  The Republicans should repeal this and make sure no free loaders are getting free stuff.  Let the market work and thin out the weak.  Perhaps an area can be set up where the poor can go to die.
Title: Re: What comes after the ACA?
Post by: wenchsenior on January 09, 2017, 08:52:16 AM
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

There's a lot of people on this board that I'm quite sure don't accept it either.   This vast philosophical gulf is the main reason we can't progress politically on this issue.
Title: Re: What comes after the ACA?
Post by: iowajes on January 09, 2017, 08:52:31 AM
access isnt the issue.  cost is.

If you can't pay, you don't have access.

What most people need care for isn't things the ER treats, but for chronic conditions that are going to end up killing them.
Title: Re: What comes after the ACA?
Post by: protostache on January 09, 2017, 08:53:05 AM
access isnt the issue.  cost is.

Access and cost are effectively the same thing. If your choices are putting food on the table, paying for premiums, or bankruptcy after emergency stabilizing treatment, that's not really access. If you can't get insurance because you don't qualify for a high risk pool and no private company will touch you and you can't get a job with benefits for whatever reason, that's not really access.
Title: Re: What comes after the ACA?
Post by: boarder42 on January 09, 2017, 08:53:32 AM
correct everyone has access.  now how do we fund that access. 

i assume what is meant by basic access is a right is that if you have cancer you have a right to have it treated.  you 100% do but how are you going to pay for it.  and are those costs correct or too high. 

Money doesnt grow on trees someone has to pay for all of it.
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 09, 2017, 08:54:22 AM
My mother was diagnosed with colon cancer 8 years ago.  It was a genetic type.  No worries, she is fine.  My siblings and I, if we had the gene (50% chance- none of us have it) have a ~100% chance of getting colon cancer.  No matter how healthy we are before then.  If we were on individual insurance we would be dropped instantly.

On a positive note, this is actually untrue. Congress passed the Genetic Information Nondiscrimination Act in 2008, so they can't drop you (or raise premiums) for carrying a genetic mutation. In the pre-ACA world, as long as you didn't have any coverage gaps, you would be fine.

Minor downside: you will spend months arguing with the insurance company about this. Ask me how I know.

And of course the law did nothing at all for an insurance company dropping you after the onset of the genetic disorder.  It just guaranteed you got insurance to begin with.
Title: Re: What comes after the ACA?
Post by: protostache on January 09, 2017, 08:54:36 AM
access isnt the issue.  cost is.

If you can't pay, you don't have access.

What most people need care for isn't things the ER treats, but for chronic conditions that are going to end up killing them.

Right. The ER doesn't administer chemo and they don't do maintenance dialysis and they won't write you a long term scrip for thyroid maintenance.
Title: Re: What comes after the ACA?
Post by: scantee on January 09, 2017, 08:55:11 AM
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

I'm sure they don't. But they're smart enough to realize that most Americans, the people they represent, even the very conservative ones, do. If there is one thing that is clear, it's that Americans really love health care. They like it a lot. Too much, really, which is why containing costs is and has been so hard.

It's also important to note that the health care industry is huge and pays ten of millions of Americans at middle-class wages. A lot the exorbitant costs of health care are baked-in inefficiencies that allow a huge segment of the population to have good jobs and good lives. When we start to contain costs, that will almost certainly negatively impact the individual people who work in the health care industry. People will lose jobs, wages will flatten. What is our plan for that? What do we want these people to do, if we don't have jobs for them in health care?

All of this is interconnected and there is no easy solution. Anyone trying to suggest there is, is lying to you.
Title: Re: What comes after the ACA?
Post by: packlawyer04 on January 09, 2017, 08:57:08 AM
Great summary Sol, and great discussion. In my opinion health care costs are the biggest concern for early retirees. There is nothing that can destroy a budget faster than a serious medical problem. The ACA was a gift to the early retiree, too good to be true in many ways. I think the biggest lesson here is that changes in health care, tax or entitlement policy can have a massively negative impact.

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

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

Insane. There is no solution to this problem with any of the proposals. Maybe a single payer could accomplish this, but as others have stated this is politically impossible. Whatever comes next will be great for healthy people, and not so great for sick people. You will likely be OK if you are either really rich or really poor (assuming Medicaid isn't destroyed). Don't get sick in the United States.

Thank you. Nobody wants to talk about this because it is not easy and simple. It is simple to just talk about how to pay for things.

The facts are the ACA does not need to be replaced. It needs to be repealed, slowly. There then needs to be a whole bunch of legislation passed to actually address the problem. Not who is paying for the problem.  Sure you can move to single payer, U.S. government is simply going to go belly up paying for healthcare then.  There is not an easy answer to actuall adress healthcare costs but it affects tons of industries from education to big pharma to the court system.

And please, lets just stop with the comparisons between the U.S and Europe.  American's drive their cars to the end of their driveway to get their mail in route to the all you can eat buffet.  Europeans don't think twice about a vacation that involves biking around for a week. You can't compare the two.

ACA was never intended to be the end all be all of health care legislation. It was always a first step toward a better future. Cost controls were next on the docket, but we had to get everyone covered first. Of course, ACA was followed immediately by six years of congressional obstruction and so the cost control component never happened and now here we are.

I never saw any plans or proposals or ideas from Obama or anyone else regarding the next step.  We were told when the law was in the works that it would reduce healthcare costs but anyone that has actually read the law, which is probably less than 1,000 people knew that was al lie.
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 09, 2017, 08:57:36 AM
In the good old days (pre-2010) insurers would look for any excuse not to pay out a claim.  They would go back in the medical history to find if a person omitted ANYTHING and use that as an excuse not to pay.  The business model is the more they deny claims the more profit to the bottom line.  The free market rewards such behaviour.  The ACA is a reaction to the abuses of the pre-2010 era.

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

I once had an insurance company try to deny coverage based on my BMI of 19.5 (just let that sink in for a minute). This was after they tried (and failed) to deny based on genetic information. All this to avoid writing a policy on an early twenties graduate student.
Title: Re: What comes after the ACA?
Post by: packlawyer04 on January 09, 2017, 08:59:51 AM
The Emergency Medical Treatment & Labor Act (EMTALA) ensures public access to emergency services regardless of ability to pay.  The Republicans should repeal this and make sure no free loaders are getting free stuff.  Let the market work and thin out the weak.  Perhaps an area can be set up where the poor can go to die.

I love how this is all republicans. Republicans didn't pass this trash law that is crushing the middle class.  Democrats did.  Along with all of the crap companies had to to to comply with this law, implement EMR, on and on and on.  It didn't work. Time to actually address the problem.  But, I doubt republicans will actually address the problem.  They will pass another bill that just talks about paying for insurance and the saga will continue.
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 09, 2017, 09:02:34 AM
couldnt all this simply be fixed with insurance regulation and reform.  It seems to me the largest complaint against the old system is my house burned down and now insurance says they arent gonna pay and dropped me.  How is this insurance.  A simple rule could fix that i'd think. 

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

boarder42 - I am going to try one more time.  How do you know you don't have a defective gene that you are passing on?  Many genetic disorders aren't discovered until they become issues.  And what about people who don't have genetic disorders but have operable and curable cancer but then are considered to have a pre existing condition who exercise, run marathons, eat right, and don't procreate?  what would you do with them? 

You - boarder42- aren't a force or nature nor are you God. You have no idea what your genetic makeup is.  Have yo procreated anyway?  I really find you one of the most offensive and awful people here.  Karma is a bitch.  It might catch up with you. In the meantime - please don't procreate.  The world doesn't need anymore people without love in their hearts.


never said i was god.  I have yet to procreate but would not knowlingly procreate with a genetic disorder that could be past on.  Curable things like cancer etc. arent something i brought up, i was tlaking of genetic disorders that are passed on.  and i was playing a devils advocate to all of you who think everyone deserves everything.

boarder42 - please make SURE you are genetically perfect before procreating.  It is possible to KNOW your genetic disorders - so not finding out would be the same thing as knowingly procreating and passing that on to some poor unsuspecting child - that - in your mind - doesn't deserve to be here - even he or she turned out to be like Stephen Hawking. And yes - having curable cancer places you in the pre-existing pot that you talked about being unhealthy. 

You can say you were acting as a devil's advocate - but I think these are your true spots.  I never said "everyone deserves everything." Ever. I'm a self-made person.  But I do think that every human being in this - one of the richest countries on earth -  deserves a basic level of healthcare.  And I don't think that after contributing to society at the maximum level for over 35 years - I should be denied the mere opportunity to pay for health insurance.
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 09, 2017, 09:09:49 AM
The Emergency Medical Treatment & Labor Act (EMTALA) ensures public access to emergency services regardless of ability to pay.  The Republicans should repeal this and make sure no free loaders are getting free stuff.  Let the market work and thin out the weak.  Perhaps an area can be set up where the poor can go to die.

I love how this is all republicans. Republicans didn't pass this trash law that is crushing the middle class.  Democrats did.

Crushing the middle class?  What are talking about?  Most middle class people are insured through their employer.  Most people helped by the ACA are the poor now on medicaid and the lower middle class now getting subsidies paid for upper middle class people - ie the 1% charge on married couple earning over $250K, the 4+% charge on capital gains for those making more than $250K etc.  I am one of those people subsidizing.  I doubt many people here are.  So how is this "crushing" the middle class?

http://www.motherjones.com/politics/2015/03/obamacare-charts-stats-health-care-reform
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 09, 2017, 09:13:46 AM
The Emergency Medical Treatment & Labor Act (EMTALA) ensures public access to emergency services regardless of ability to pay.  The Republicans should repeal this and make sure no free loaders are getting free stuff.  Let the market work and thin out the weak.  Perhaps an area can be set up where the poor can go to die.

I love how this is all republicans. Republicans didn't pass this trash law that is crushing the middle class.  Democrats did.  Along with all of the crap companies had to to to comply with this law, implement EMR, on and on and on.  It didn't work. Time to actually address the problem.  But, I doubt republicans will actually address the problem.  They will pass another bill that just talks about paying for insurance and the saga will continue.

Plenty of good things came from ACA, and I would strongly argue that EMR is one of them. The next step should be to work on linking EMR across health systems. Does ACA have problems? Absolutely. But I'm firmly on the side of "let's work on improving what we did in 2009-10."
Title: Re: What comes after the ACA?
Post by: boarder42 on January 09, 2017, 09:15:47 AM
couldnt all this simply be fixed with insurance regulation and reform.  It seems to me the largest complaint against the old system is my house burned down and now insurance says they arent gonna pay and dropped me.  How is this insurance.  A simple rule could fix that i'd think. 

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

boarder42 - I am going to try one more time.  How do you know you don't have a defective gene that you are passing on?  Many genetic disorders aren't discovered until they become issues.  And what about people who don't have genetic disorders but have operable and curable cancer but then are considered to have a pre existing condition who exercise, run marathons, eat right, and don't procreate?  what would you do with them? 

You - boarder42- aren't a force or nature nor are you God. You have no idea what your genetic makeup is.  Have yo procreated anyway?  I really find you one of the most offensive and awful people here.  Karma is a bitch.  It might catch up with you. In the meantime - please don't procreate.  The world doesn't need anymore people without love in their hearts.


never said i was god.  I have yet to procreate but would not knowlingly procreate with a genetic disorder that could be past on.  Curable things like cancer etc. arent something i brought up, i was tlaking of genetic disorders that are passed on.  and i was playing a devils advocate to all of you who think everyone deserves everything.

boarder42 - please make SURE you are genetically perfect before procreating.  It is possible to KNOW your genetic disorders - so not finding out would be the same thing as knowingly procreating and passing that on to some poor unsuspecting child - that - in your mind - doesn't deserve to be here - even he or she turned out to be like Stephen Hawking. And yes - having curable cancer places you in the pre-existing pot that you talked about being unhealthy. 

You can say you were acting as a devil's advocate - but I think these are your true spots.  I never said "everyone deserves everything." Ever. I'm a self-made person.  But I do think that every human being in this - one of the richest countries on earth -  deserves a basic level of healthcare.  And I don't think that after contributing to society at the maximum level for over 35 years - I should be denied the mere opportunity to pay for health insurance.

so you're on a FIRE forum why? 35 years of working jobs others could have held so you can sit on your high horse and tell all us yunguns how it should be.  you've had a lifetime to fix the issues you've seen ... what have you personally done about it besides "working at the maximum level" for 35 years.
Title: Re: What comes after the ACA?
Post by: packlawyer04 on January 09, 2017, 09:19:13 AM
The Emergency Medical Treatment & Labor Act (EMTALA) ensures public access to emergency services regardless of ability to pay.  The Republicans should repeal this and make sure no free loaders are getting free stuff.  Let the market work and thin out the weak.  Perhaps an area can be set up where the poor can go to die.

I love how this is all republicans. Republicans didn't pass this trash law that is crushing the middle class.  Democrats did.  Along with all of the crap companies had to to to comply with this law, implement EMR, on and on and on.  It didn't work. Time to actually address the problem.  But, I doubt republicans will actually address the problem.  They will pass another bill that just talks about paying for insurance and the saga will continue.

Plenty of good things came from ACA, and I would strongly argue that EMR is one of them. The next step should be to work on linking EMR across health systems. Does ACA have problems? Absolutely. But I'm firmly on the side of "let's work on improving what we did in 2009-10."

Won't be too hard to link the EMR systems now since every provider is moving to working for a large conglomerate due to overhead costs.
Title: Re: What comes after the ACA?
Post by: bacchi on January 09, 2017, 09:24:56 AM
Plenty of good things came from ACA, and I would strongly argue that EMR is one of them. The next step should be to work on linking EMR across health systems. Does ACA have problems? Absolutely. But I'm firmly on the side of "let's work on improving what we did in 2009-10."

Won't be too hard to link the EMR systems now since every provider is moving to working for a large conglomerate due to overhead costs.

No, they're not. Relax and stop with the hyperbole.
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 09, 2017, 09:34:08 AM
The Emergency Medical Treatment & Labor Act (EMTALA) ensures public access to emergency services regardless of ability to pay.  The Republicans should repeal this and make sure no free loaders are getting free stuff.  Let the market work and thin out the weak.  Perhaps an area can be set up where the poor can go to die.

I love how this is all republicans. Republicans didn't pass this trash law that is crushing the middle class.  Democrats did.  Along with all of the crap companies had to to to comply with this law, implement EMR, on and on and on.  It didn't work. Time to actually address the problem.  But, I doubt republicans will actually address the problem.  They will pass another bill that just talks about paying for insurance and the saga will continue.

Plenty of good things came from ACA, and I would strongly argue that EMR is one of them. The next step should be to work on linking EMR across health systems. Does ACA have problems? Absolutely. But I'm firmly on the side of "let's work on improving what we did in 2009-10."

Won't be too hard to link the EMR systems now since every provider is moving to working for a large conglomerate due to overhead costs.

Full disclosure: I work for an absolutely massive 501c3 health system.

I've received care in pretty much every model of practice over the course of my life, but I much prefer what I have right now.

I've seen some insanely remarkable things first-hand. Yes, there are problems, but we work really hard to fix them when they happen. Private practice has plenty of problems too.
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 09, 2017, 09:51:38 AM
couldnt all this simply be fixed with insurance regulation and reform.  It seems to me the largest complaint against the old system is my house burned down and now insurance says they arent gonna pay and dropped me.  How is this insurance.  A simple rule could fix that i'd think. 

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

boarder42 - I am going to try one more time.  How do you know you don't have a defective gene that you are passing on?  Many genetic disorders aren't discovered until they become issues.  And what about people who don't have genetic disorders but have operable and curable cancer but then are considered to have a pre existing condition who exercise, run marathons, eat right, and don't procreate?  what would you do with them? 

You - boarder42- aren't a force or nature nor are you God. You have no idea what your genetic makeup is.  Have yo procreated anyway?  I really find you one of the most offensive and awful people here.  Karma is a bitch.  It might catch up with you. In the meantime - please don't procreate.  The world doesn't need anymore people without love in their hearts.


never said i was god.  I have yet to procreate but would not knowlingly procreate with a genetic disorder that could be past on.  Curable things like cancer etc. arent something i brought up, i was tlaking of genetic disorders that are passed on.  and i was playing a devils advocate to all of you who think everyone deserves everything.

boarder42 - please make SURE you are genetically perfect before procreating.  It is possible to KNOW your genetic disorders - so not finding out would be the same thing as knowingly procreating and passing that on to some poor unsuspecting child - that - in your mind - doesn't deserve to be here - even he or she turned out to be like Stephen Hawking. And yes - having curable cancer places you in the pre-existing pot that you talked about being unhealthy. 

You can say you were acting as a devil's advocate - but I think these are your true spots.  I never said "everyone deserves everything." Ever. I'm a self-made person.  But I do think that every human being in this - one of the richest countries on earth -  deserves a basic level of healthcare.  And I don't think that after contributing to society at the maximum level for over 35 years - I should be denied the mere opportunity to pay for health insurance.

so you're on a FIRE forum why? 35 years of working jobs others could have held so you can sit on your high horse and tell all us yunguns how it should be.  you've had a lifetime to fix the issues you've seen ... what have you personally done about it besides "working at the maximum level" for 35 years.

I'm on a FIRE forum because I thought I could learn more about being frugal in a retirement I hope to have soon.  I did not know that the board was limited to "yunguns" as you put it. And as I've already said here - we have committed a large portion of our income in all of those 35 years to healthcare, housing, education, and feeding those less advantaged than us.  We are both on local and national boards and both have committed our time to the same causes.

What are you doing other than spouting your mouth off about natural selection here on this forum?

Finally - could a moderator please tell me if those of us that have worked for 35 years are not welcome here.  If so - I'll immediately sign off.
Title: Re: What comes after the ACA?
Post by: boarder42 on January 09, 2017, 09:57:49 AM
but the system is still broke.  so nothing has changed in your lifetime ... its just gotten worse?
Title: Re: What comes after the ACA?
Post by: packlawyer04 on January 09, 2017, 10:03:21 AM
Plenty of good things came from ACA, and I would strongly argue that EMR is one of them. The next step should be to work on linking EMR across health systems. Does ACA have problems? Absolutely. But I'm firmly on the side of "let's work on improving what we did in 2009-10."

Won't be too hard to link the EMR systems now since every provider is moving to working for a large conglomerate due to overhead costs.

No, they're not. Relax and stop with the hyperbole.

A 5 second google search shows I'm correct.
Title: Re: What comes after the ACA?
Post by: MayDay on January 09, 2017, 10:04:14 AM
My mother was diagnosed with colon cancer 8 years ago.  It was a genetic type.  No worries, she is fine.  My siblings and I, if we had the gene (50% chance- none of us have it) have a ~100% chance of getting colon cancer.  No matter how healthy we are before then.  If we were on individual insurance we would be dropped instantly.

On a positive note, this is actually untrue. Congress passed the Genetic Information Nondiscrimination Act in 2008, so they can't drop you (or raise premiums) for carrying a genetic mutation. In the pre-ACA world, as long as you didn't have any coverage gaps, you would be fine.

Minor downside: you will spend months arguing with the insurance company about this. Ask me how I know.

And of course the law did nothing at all for an insurance company dropping you after the onset of the genetic disorder.  It just guaranteed you got insurance to begin with.

Correct. I could be privately insured now. But as soon as I got cancer, an individual plan could drop me, and no other individual plan will take me.

So I might sit for 2 years on my states high risk pool waiting list to get that insurance. Except not really because I'll be dead by then! Yay!
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 09, 2017, 10:13:41 AM
Plenty of good things came from ACA, and I would strongly argue that EMR is one of them. The next step should be to work on linking EMR across health systems. Does ACA have problems? Absolutely. But I'm firmly on the side of "let's work on improving what we did in 2009-10."

Won't be too hard to link the EMR systems now since every provider is moving to working for a large conglomerate due to overhead costs.

No, they're not. Relax and stop with the hyperbole.

A 5 second google search shows I'm correct.

Correct sentence is correct? What are you even talking about? Is this supposed to be ironic? Is five seconds the amount of research time we're not going to allow for an authoritative statement?
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 09, 2017, 10:16:25 AM
but the system is still broke.  so nothing has changed in your lifetime ... its just gotten worse?

The ACA made the system much better - yes - because this person could not get dropped for developing the disease.  And that went across every health insurance policy sold on the exchange or not - that is right - this rule applied to every health insurance policy sold - even that provided by employers. And this person's rate could not be jacked up either - so that they could actually afford insurance.

For all of the bad things you talk about - whatever they are - the ACA made insurance a guarantee for people when it wasn't before AT ANY PRICE.  That was a huge improvement for everyone. 
Title: Re: What comes after the ACA?
Post by: BFGirl on January 09, 2017, 10:42:32 AM
The part that fascinates me in all of this ridiculous debate is how we seem to struggle mightily with these moral quandaries of taxing some folks to provide coverage for other folks and the idea of risk pools and whatnot. All of this while every other rich, industrialized country has figured this shit out years ago and gets better results for less money. It is like we are getting into crazy bar fights over whether to require catalytic converters on our gas-guzzling land yachts while the rest of the world is using hydrogen fuel cells or electric cars to get around. We do a lot of things great in this country but this is one of those topics that completely confuses me and makes me want to run to another country to hide among people who actually see the value in human decency and universal health.

I agree... what seems to get lost in this debate is the moral issue of whether or not healthcare should be a right or a privilege.  It is hard to fashion a solution while our country has not settled on this basic answer.  If it is a right, then universal healthcare seems to be the best and most fair answer.  If it is a privilege, then our society has made a moral judgement that those who have health issues should carry the burden of their own care.
Title: Re: What comes after the ACA?
Post by: mm1970 on January 09, 2017, 10:44:40 AM
The ACA did not fix anything which is why it failed. And make no mistake, it failed. It was simply changing who is paying for healthcare and shifted the burdens around.  Dumping $14,000 deductibles with $1,200 a month premiums on working class families is a failure. The underlying problems are still present, i.e. the actual costs of healthcare.

Until a law actually addresses the costs of healthcare, you can play the hide the ball under the cup game until you are blue in the face but it won't do anything.  Nobody wants to actually discuss the problems, folks just want to talk about how to pay for the problems, ACA, private insurance, single payer, on and on and on.

The reality is we are a fat, sick and out of shape country.

I don't know if it really failed everyone though.  It certainly helped several of my friends who were not able to get insurance AT ALL due to pre-existing conditions.  And these were reasonably healthy, fit, trim individuals.

From someone else's post:
Quote
People should not have to loose everything due to a medical event.

I agree with this statement.  Though there has to be a caveat on spending.  I know people don't like the term "death panels".  I have a friend whose brother died in his 30s because he could not afford insurance.  I have a friend whose father just died last week in his 90s, and for the last 20 years was undergoing extremely expensive medical treatments to keep him alive, because he had great insurance.  So why not?  I see that happening in my family too.  I have retired family members who were lucky enough to have state sponsored pensions.  Once the doctors see that insurance that comes with the pension, they order way more tests and treatments.

It's a sliding scale and I personally don't know where to draw the line.
Title: Re: What comes after the ACA?
Post by: bender on January 09, 2017, 10:44:55 AM
Best thing about ACA is guarantee of coverage.  Regardless of the plans being put forward currently, I don't think the guarantee will go away.

Worst thing is the ACA did nothing to address underlying costs of healthcare.  Addressing this issue should be the main focus as it will make all the other problems less severe. 

I think it would also be good to incentivize people to become healthier as this will reduce consumption of health care resources and lower costs overall.  Many or our issues are self-inflicted...

Title: Re: What comes after the ACA?
Post by: mm1970 on January 09, 2017, 10:47:13 AM
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.
I simply don't understand. Honestly, if you are going to repeal the ACA, then you simply MUST remove all health care from Congress members and their staffers.  Let them purchase their own insurance on the open market, no exceptions.
Title: Re: What comes after the ACA?
Post by: boarder42 on January 09, 2017, 10:49:02 AM
Best thing about ACA is guarantee of coverage.  Regardless of the plans being put forward currently, I don't think the guarantee will go away.

Worst thing is the ACA did nothing to address underlying costs of healthcare.  Addressing this issue should be the main focus as it will make all the other problems less severe. 

I think it would also be good to incentivize people to become healthier as this will reduce consumption of health care resources and lower costs overall.  Many or our issues are self-inflicted...

Agree

There is even scientific evidence relating eating animal products ESP dairy to increased heart disease and cancer. I eat smoked foods linked to increases in stomach cancer risk. Should society as a whole be responsible for these choices people made? 
Title: Re: What comes after the ACA?
Post by: mm1970 on January 09, 2017, 10:51:56 AM
Quote
Finally - could a moderator please tell me if those of us that have worked for 35 years are not welcome here.  If so - I'll immediately sign off.

I've been working for 25 years, so I'd say you're good.

To add to my prior post on my friends who now can finally get insurance...

I see it as important now, not just for the poor.  Because honestly, I don't know that many people who are that poor.  Some are poor enough to be on Medi-Cal or the like. 

In my circle, it's generally friends who are unemployed or self-employed in their 40s to 60s whom it benefited.  Some who had pre-existing conditions, some who were laid off and not able to find another job with insurance.
Title: Re: What comes after the ACA?
Post by: protostache on January 09, 2017, 11:03:38 AM
Best thing about ACA is guarantee of coverage.  Regardless of the plans being put forward currently, I don't think the guarantee will go away.

Worst thing is the ACA did nothing to address underlying costs of healthcare.  Addressing this issue should be the main focus as it will make all the other problems less severe. 

I think it would also be good to incentivize people to become healthier as this will reduce consumption of health care resources and lower costs overall.  Many or our issues are self-inflicted...

The ACA does many things to attempt to control costs. (http://obamacarefacts.com/obamacare-control-costs/) Primarily it changed out Medicaid payouts happened, but it also funded lots of experiments on different ways to pay. It also mandated EHRs which would have allowed extensive data collection on costs and outcomes which allowed measurements of the experiments.

Over time costs would have come down as markets settled and data from the experiments started to come in. Indeed, the inflation curve has been coming down. Two years was not enough time for all of this to settle, however, and now it's all going to change again and costs will probably start rising faster again.
Title: Re: What comes after the ACA?
Post by: boarder42 on January 09, 2017, 11:09:39 AM
Incorporate things properly thru the legislative process and we won't be whipsawed with every organizational change

Fixed
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 09, 2017, 11:26:03 AM
Inactive things properly thru the legislative process and we won't be whipsawed with every organizational change

I cannot parse this sentence anyway to make any sense of it at all.
Title: Re: What comes after the ACA?
Post by: boarder42 on January 09, 2017, 11:30:51 AM
Inactive things properly thru the legislative process and we won't be whipsawed with every organizational change

I cannot parse this sentence anyway to make any sense of it at all.

Fixed it. The reason this is so easily thrown out is the way it was put in place.  Executive order and fillibuster blocks can be done away with every time we have a simple majority party change in Congress and the president.
Title: Re: What comes after the ACA?
Post by: BFGirl on January 09, 2017, 11:34:53 AM
couldnt all this simply be fixed with insurance regulation and reform.  It seems to me the largest complaint against the old system is my house burned down and now insurance says they arent gonna pay and dropped me.  How is this insurance.  A simple rule could fix that i'd think. 

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

boarder42 - I am going to try one more time.  How do you know you don't have a defective gene that you are passing on?  Many genetic disorders aren't discovered until they become issues.  And what about people who don't have genetic disorders but have operable and curable cancer but then are considered to have a pre existing condition who exercise, run marathons, eat right, and don't procreate?  what would you do with them? 

You - boarder42- aren't a force or nature nor are you God. You have no idea what your genetic makeup is.  Have yo procreated anyway?  I really find you one of the most offensive and awful people here.  Karma is a bitch.  It might catch up with you. In the meantime - please don't procreate.  The world doesn't need anymore people without love in their hearts.


never said i was god.  I have yet to procreate but would not knowlingly procreate with a genetic disorder that could be past on.  Curable things like cancer etc. arent something i brought up, i was tlaking of genetic disorders that are passed on.  and i was playing a devils advocate to all of you who think everyone deserves everything.

From a purely logical non-emotional standpoint, your arguments could make sense, if society's main criteria is that a person's value to society is their genetic makeup and that the resources available should only be allocated to the strongest and brightest.  However, we are creatures that have emotions and individual ideas.  We do not operate on a purely logical basis, so a completely "logical" solution is unlikely to address the reality of the situation. What happens if criteria are put in place to prevent procreation/treatment of a certain genetic disorder/disease that is much more prevalent in one race over another?  Can that effectively be used to reduce the numbers of a certain race?  If we are truly going to try natural selection, then why not take your argument one step further and decree that based on some objective criteria, that medical care should be withheld from people not meeting a certain level of contribution to society?

I don't think that we need a system that pays for every possible treatment for every possible situation, but I do believe that since we have developed the technology and have resources beyond just the means to feed, clothe and shelter ourselves, that there should be some level of healthcare provided to individuals and paid for by the collective.

Title: Re: What comes after the ACA?
Post by: Iplawyer on January 09, 2017, 11:38:23 AM
Inactive things properly thru the legislative process and we won't be whipsawed with every organizational change

I cannot parse this sentence anyway to make any sense of it at all.

Fixed it. The reason this is so easily thrown out is the way it was put in place.  Executive order and fillibuster blocks can be done away with every time we have a simple majority party change in Congress and the president.

And even if it wasn't filibustered it could be done away with - what is your point?  Right now the Republicans aren't even going to try and pass legislation - they are going to kill it with budget reconciliation. 

By the way - I answered your question about what I've been doing for 35 years to make things better.  I've not heard what you've been doing to make healthcare more accessible. 
Title: Re: What comes after the ACA?
Post by: boarder42 on January 09, 2017, 11:44:55 AM
Inactive things properly thru the legislative process and we won't be whipsawed with every organizational change

I cannot parse this sentence anyway to make any sense of it at all.

Fixed it. The reason this is so easily thrown out is the way it was put in place.  Executive order and fillibuster blocks can be done away with every time we have a simple majority party change in Congress and the president.

And even if it wasn't filibustered it could be done away with - what is your point?  Right now the Republicans aren't even going to try and pass legislation - they are going to kill it with budget reconciliation. 

By the way - I answered your question about what I've been doing for 35 years to make things better.  I've not heard what you've been doing to make healthcare more accessible.

I didn't reply BC i was done having a dick measuring contest with an internet stranger that was adding no value to this discussion.  But if you'd like to continue to grow yours feel free

Please read the forum rules.  I don't care who "started" what, being rude is not okay.
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 09, 2017, 12:04:51 PM
Inactive things properly thru the legislative process and we won't be whipsawed with every organizational change

I cannot parse this sentence anyway to make any sense of it at all.


Fixed it. The reason this is so easily thrown out is the way it was put in place.  Executive order and fillibuster blocks can be done away with every time we have a simple majority party change in Congress and the president.

And even if it wasn't filibustered it could be done away with - what is your point?  Right now the Republicans aren't even going to try and pass legislation - they are going to kill it with budget reconciliation. 

By the way - I answered your question about what I've been doing for 35 years to make things better.  I've not heard what you've been doing to make healthcare more accessible.

I didn't reply BC i was done having a dick measuring contest with an internet stranger that was adding no value to this discussion.  But if you'd like to continue to grow yours feel free

You start a dick measuring contest and then duck out when you don't measure up?

That is nice - it is a classic gas lighting move to try and prove to the forum with your challenge that somebody that disagreed with you 1.) shouldn't be on the forum (I've been assured you are VERY wrong about that), and 2.) somehow spend the last 35 years not contributing to society to back up my beliefs.

And then when challenged AFTER you have challenged first - you do the immature thing and talk about your dick.  Really?

Since you started - as you call it - "a dick measuring contest" - with your challenge - you should have checked to make sure I had one first.

Grow up.


Please read the forum rules.  I don't care who "started" what, being rude is not okay.
Title: Re: What comes after the ACA?
Post by: tct on January 09, 2017, 01:03:08 PM
Exacltly.  Put everyone on an HDHP like real "insurance" should be (a safety net).  And have people pay attention to where their ACTUAL money is going in terms of heath care costs.  Then, watch Americans start to pay attention to heath care and actually shop around a bit.  That keeps health care suppliers in check with competition and health care users in check with the funds they actually have available since they have real skin in the game.

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

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

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

I think the big ones are the information asymmetry and also the nature and often time sensitiveness of the product being delivered. If your child fell and hit their head, the first doctor you saw says the smartest thing to do would be a CT scan to rule out cranial hemorrhaging, are you going to argue with them, are you going to shop around? Even if you did shop around, and the second doctor said you should do an MRI instead, and then the third doctor said you should do both, are you equipped to choose from the most effective and most cost effective choice?

Let's not forget that there is a very heavily enforced monopoly on who can offer these services. I could perform surgery on you a lot cheaper than most surgeons, hell even give you a CT scan pretty cheap if I had enough capital. I can't guarantee the effectiveness, but you and the population as a whole are smart enough to gauge me for effectiveness right? Unfortunately or fortunately, the government restricts who can legally cut people up or irradiate them. I have no comment on the matter, but some libertarian somewhere is muttering "fucking government" under their breath.
Whenever you have a monopoly of one sort or another, it's hard to see market forces working fully

see also http://theincidentaleconomist.com/wordpress/health-care-market-failures-and-what-can-be-done-about-them/

Health care providers must be forced to publish pricing. After time the decision to go with one provider over the another  will be the same as choosing to purchase your clothes at Walmart as opposed to Neiman Marcus.
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 09, 2017, 01:16:08 PM
Exacltly.  Put everyone on an HDHP like real "insurance" should be (a safety net).  And have people pay attention to where their ACTUAL money is going in terms of heath care costs.  Then, watch Americans start to pay attention to heath care and actually shop around a bit.  That keeps health care suppliers in check with competition and health care users in check with the funds they actually have available since they have real skin in the game.

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

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

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

I think the big ones are the information asymmetry and also the nature and often time sensitiveness of the product being delivered. If your child fell and hit their head, the first doctor you saw says the smartest thing to do would be a CT scan to rule out cranial hemorrhaging, are you going to argue with them, are you going to shop around? Even if you did shop around, and the second doctor said you should do an MRI instead, and then the third doctor said you should do both, are you equipped to choose from the most effective and most cost effective choice?

Let's not forget that there is a very heavily enforced monopoly on who can offer these services. I could perform surgery on you a lot cheaper than most surgeons, hell even give you a CT scan pretty cheap if I had enough capital. I can't guarantee the effectiveness, but you and the population as a whole are smart enough to gauge me for effectiveness right? Unfortunately or fortunately, the government restricts who can legally cut people up or irradiate them. I have no comment on the matter, but some libertarian somewhere is muttering "fucking government" under their breath.
Whenever you have a monopoly of one sort or another, it's hard to see market forces working fully

see also http://theincidentaleconomist.com/wordpress/health-care-market-failures-and-what-can-be-done-about-them/

Health care providers must be forced to publish pricing. After time the decision to go with one provider over the another  will be the same as choosing to purchase your clothes at Walmart as opposed to Neiman Marcus.

That would be nice.  Right now the pricing on anything is dependent on so many things - including if you have insurance and who the insurance is with - that I doubt anybody at any doctor's office anywhere can quote a price.
Title: Re: What comes after the ACA?
Post by: coppertop on January 09, 2017, 01:24:07 PM
My personal pet peeve is credential bloat in medical staff. It takes us 11-15 years after high school to train a doctor in the US (BA+MD+residency), but most other countries, including in europe, manage the same training in 8. Then once we train those doctors, we insistent that you need an MD to take care of all sorts of cuts and bruises and sniffles at the local doctors office when 90% of cases could be properly treated by someone with only a couple of years training as a medic without having to pass them on up the chain to someone with more expertise. The same thing is starting to happen with Nurse Practitioners, which used to just be an additional 1-2 year masters after a bachelors in nursing (5-6 years total) but is now being pushed towards requiring doctorate level degree after the bachelors degree  (8-10 years total). And of course more school means more student debt, which means you need to pay people in the field more, which means total medical spending goes up.

My husband is a radiologic technician.  He received his education for this in a certificate program at a community college at quite a reasonable cost.  However, the ARRT and other organizations for rad techs are now pushing to require a bachelor's degree to be licensed for this job.  The compensation does not support it and it is not necessary at any rate to do the job.  But that's the way we roll in America.  Everyone has to have a college degree for every job.
Title: Re: What comes after the ACA?
Post by: golden1 on January 09, 2017, 02:03:18 PM
Quote
Health care providers must be forced to publish pricing. After time the decision to go with one provider over the another  will be the same as choosing to purchase your clothes at Walmart as opposed to Neiman Marcus.

I really don't think this is true.  People really don't make decisions about their health in the same way that people make other decisions.  If I found out that one doctor was charging 2x more per procedure, I would not just reflexively go for the cheapest available.  I would factor in how many times the doctor has performed the procedure, what his success rate is, the equipment he is using etc....  For example, when I got Lasik surgery, I could have had it done for half the price, but I chose an experienced ophthalmologist to perform the procedure, and he had a policy of free touch ups if your prescription was worse than 20/40. 

 Also, and I think this was stated upthread, in emergency situations, you aren't equipped to make these kind of decisions. 
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 09, 2017, 02:08:38 PM
My mother was diagnosed with colon cancer 8 years ago.  It was a genetic type.  No worries, she is fine.  My siblings and I, if we had the gene (50% chance- none of us have it) have a ~100% chance of getting colon cancer.  No matter how healthy we are before then.  If we were on individual insurance we would be dropped instantly.

On a positive note, this is actually untrue. Congress passed the Genetic Information Nondiscrimination Act in 2008, so they can't drop you (or raise premiums) for carrying a genetic mutation. In the pre-ACA world, as long as you didn't have any coverage gaps, you would be fine.

Minor downside: you will spend months arguing with the insurance company about this. Ask me how I know.

Oh, I want to know.
Title: Re: What comes after the ACA?
Post by: powskier on January 09, 2017, 02:17:47 PM
There was a good cartoon in the New Yorker that had a couple opening a letter :
" It says here that our health insurance is going to be replaced by a series of tweets telling us we are losers."

Title: Re: What comes after the ACA?
Post by: Quidnon? on January 09, 2017, 02:19:33 PM
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

I don't believe this statement.  One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record.  Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves.  For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.
Title: Re: What comes after the ACA?
Post by: dogboyslim on January 09, 2017, 02:29:43 PM
I think the young are supposed to subsidize the old, just like the healthy are supposed to subsidize the sick.  That's how insurance works.  Everyone pays more than their actual costs, unless they have sudden large costs and then they pay less.  That's the whole point of insurance.

I just started reading this so its probably already been addressed, but no, this isn't how insurance works.  Insurance works by saying there is a homogeneous group of risks with a certain likely expense.  We pool those risks and charge the average cost of that pool to everyone in the pool.  That way, by having enough people in the group, the random variation of a large individual loss is washed out and the average cost is born by all. (Ignoring expense).  So far this sounds like what you said.  Here's where it gets different.  The american academy of actuaries (and many state legislatures) state that a rate should provide for the costs of individual risk transfer.

If young people on average have 2 claims per year at 500 per claim (Meaning the pool of young people would on average need to pay $1000) and old people on average have 12 claims per year at 500 per claim ($6000), then the rate should work regardless of the individuals in the group.  Each individual should pay based upon their individual expected risks.  This concept is why it costs more to insure a ferrari than a focus.

The use of 5:1 or 3:1 gets at affordability, which is different than the true function of insurance, as it requires a group to subsidize another group.
Title: Re: What comes after the ACA?
Post by: Gin1984 on January 09, 2017, 02:32:01 PM
I think the young are supposed to subsidize the old, just like the healthy are supposed to subsidize the sick.  That's how insurance works.  Everyone pays more than their actual costs, unless they have sudden large costs and then they pay less.  That's the whole point of insurance.

I just started reading this so its probably already been addressed, but no, this isn't how insurance works.  Insurance works by saying there is a homogeneous group of risks with a certain likely expense.  We pool those risks and charge the average cost of that pool to everyone in the pool.  That way, by having enough people in the group, the random variation of a large individual loss is washed out and the average cost is born by all. (Ignoring expense).  So far this sounds like what you said.  Here's where it gets different.  The american academy of actuaries (and many state legislatures) state that a rate should provide for the costs of individual risk transfer.

If young people on average have 2 claims per year at 500 per claim (Meaning the pool of young people would on average need to pay $1000) and old people on average have 12 claims per year at 500 per claim ($6000), then the rate should work regardless of the individuals in the group.  Each individual should pay based upon their individual expected risks.  This concept is why it costs more to insure a ferrari than a focus.

The use of 5:1 or 3:1 gets at affordability, which is different than the true function of insurance, as it requires a group to subsidize another group.
Except we don't have that for employee health insurance nor life insurance at my employer. 

Sent from my SPH-L710 using Tapatalk

Title: Re: What comes after the ACA?
Post by: OurTown on January 09, 2017, 02:33:45 PM
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

I don't believe this statement.  One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record.  Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves.  For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.

Scrooge, is that you?
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 09, 2017, 02:45:53 PM
I think the young are supposed to subsidize the old, just like the healthy are supposed to subsidize the sick.  That's how insurance works.  Everyone pays more than their actual costs, unless they have sudden large costs and then they pay less.  That's the whole point of insurance.

I just started reading this so its probably already been addressed, but no, this isn't how insurance works.  Insurance works by saying there is a homogeneous group of risks with a certain likely expense.  We pool those risks and charge the average cost of that pool to everyone in the pool.  That way, by having enough people in the group, the random variation of a large individual loss is washed out and the average cost is born by all. (Ignoring expense).  So far this sounds like what you said.  Here's where it gets different.  The american academy of actuaries (and many state legislatures) state that a rate should provide for the costs of individual risk transfer.

If young people on average have 2 claims per year at 500 per claim (Meaning the pool of young people would on average need to pay $1000) and old people on average have 12 claims per year at 500 per claim ($6000), then the rate should work regardless of the individuals in the group.  Each individual should pay based upon their individual expected risks.  This concept is why it costs more to insure a ferrari than a focus.

The use of 5:1 or 3:1 gets at affordability, which is different than the true function of insurance, as it requires a group to subsidize another group.
Except we don't have that for employee health insurance nor life insurance at my employer


Key information is highlighted.  In fact, as is common for most places of employment, your coworkers and yourself constitute "the group" in question, which is why it probably says "group health" or "group life" on your employer sponsored plans.  This is an advantage of employer subsidized group plans, that the older employees benefit, and that they can't be fired because they are older.  They actually can legally be charged more for being older, but that is not common, because the company benefits from retention of experienced employees, particularly those with children still at home.  This also highlights a work-around for those of us that manage to retire early, and wish to still get cheap-ish health care.  Get a part-time job at a business that typically employees more young adults, but still allows buy-ins for the part-timers.  This is hard, but not terribly uncommon.  I know that, once upon a time, Wal-Mart permitted part-timers with at least a year of time at the company to 'buy-in' to the health plan, as well as many national chain grocers.  Since a great many of these jobs are barely above minimum wage anyway, they are often transitional jobs for teens & young adults, which suppresses the average liability and (in theory) should keep the average cost of the group plan lower.  Not cheap, likely, since the company doesn't typically subsidize the part-timers much or any; but cheaper (for the mid to high risk, certainly) than a private plan on the open market.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 09, 2017, 02:46:55 PM
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

I don't believe this statement.  One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record.  Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves.  For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.

Scrooge, is that you?

I'm approaching that age group, so I'll answer to that name if it means that much to you.
Title: Re: What comes after the ACA?
Post by: sol on January 09, 2017, 03:37:04 PM
So no, you don't have a right to healthcare.

You don't have a "right" to disability or unemployment insurance either, and yet we provide them to everyone anyway because it's what is best for the country as a whole.
Title: Re: What comes after the ACA?
Post by: sol on January 09, 2017, 03:41:56 PM
Several people in this thread have mentioned that there is no way to make health insurance affordable to all Americans as long as healthcare costs are so high.  I think this is wrong.  There IS a way to give everyone affordable insurance without controlling costs at all.  Insurers and hospitals/doctors can continue to get rich, and everyone can have access to affordable care.  I think I've cracked the nut.

What secret sauce have I invented?  The key is in the definition of "affordable".  Just pay 100% of everyone's private health insurance premium with tax dollars. 

Think about this.  Taxes are already designed to be "affordable" to everyone.  They are progressive (for income tax, so the rich pay more) and they are also a flat tax (for OASDI, which everyone pays the same percentage regardless of income).  No one ever goes broke because of taxes.  If you have no income, you pay no taxes.  If you have lots of money, you pay lots of taxes but you still have lots of money.  In both cases, taxes are "affordable" to you.  Why can't health insurance work the same way?

The 100% covered premiums would have to be for basic services, of course, not cadillac plans.  Maybe make them similar to current subsidized silver plans, say 100% coverage for routine preventative care, $25 copays for other stuff, and $1k per person deductibles so everyone pays for their first basic care out of pocket.  People who want more than basic coverage could still buy it, if they can afford it.  Exclude cosmetic procedures.  Revoke HSAs.  Your doctor would bill your insurance company just like it does now, and your insurance company would bill Uncle Sam instead of you.  The private insurance industry would become just like the post office, a quasi-government for-profit corporation subject to federal oversight and regulation, that provides a uniformly available service for the common good and receives periodic bailouts when necessary and makes good money the rest of the time.

If you have employer-sponsored insurance, nothing would need to change.  The money your employer currently pays towards your insurance would get paid to Uncle Sam as taxes.  If you run a small business, you don't need to worry about providing healthcare to your employees if you don't want to.  If you are unemployed or retired, your health insurance is now covered just like your unemployment insurance and disability insurance are already covered under current law.

So this solutions obviously isn't a 100% free ride for everyone.  If Uncle Sam is paying all of this extra money for health insurance premiums, where is the money coming from?  Your taxes, of course.  You can either raise tax rates (either the progressive income tax brackets or the flat OASDI taxes or both, or other taxes) or you can cut spending.  Doesn't really matter.  The key is that taxes are always "affordable" by design, so we're piggy-backing on that system.  Theoretically, your savings from not buying your current insurance should cover your costs from higher taxes.

In either case, the government basically becomes the only end-consumer of health insurance.  They can negotiate rates with the private insurance companies, who can negotiate with providers, to bring long term costs under control.  Medicare already pays a fixed amount for MRIs, and that amount should be the MRI price for EVERYONE, not just old people.  Similar arguments apply for any other billable procedure.  They also get to ration care, for example by denying cosmetic surgery for old ladies who are vain or providing palliative care instead of invasive surgery for 90 year-olds with aggressive cancer.  If you are a billionaire 90 year-old with brain cancer, you can buy additional insurance or pay out of pocket, but even if you don't your basic care is covered just like it is for everyone else.

Everyone gets affordable health care!  You are covered, your rates are affordable to you, and no one will ever go medically bankrupt again!

There is no individual mandate!  You're not forced to buy anything.  The government is buying it for you, just like it buys national defense for you, because we all need it.

There is no denial for pre-existing conditions!  Everyone gets (reasonable) care regardless of health history.  And you can always buy more if you can afford it.

Health outcomes will improve!  Preventative care is free for everyone!  Here's your "how to quit smoking" pamphlet and free nicorette gum.

Emergency care is still available to everyone, but won't be the only care available to poor people!  There is no need to repeal EMTALA.

It's not single payer!  The insurance industry isn't nationalized, and they continue to exist as profitable private corporations.


I'm open to suggestions and criticisms of this plan.  There are clearly a thousand details to complicate the implementation, but the overarching idea of just raising taxes to pay for universally available private insurance seems like the only way to give everyone what they want. 
Title: Re: What comes after the ACA?
Post by: Lagom on January 09, 2017, 03:57:38 PM
At first glance it seems pretty interesting. But how would this not become defacto single-payer (which of course I do support)? Why would the government want to pay premiums to dozens of different companies? Would individuals still be picking their preferred provider? Does this become complicated when one provider provides better service for less costs than another (not always easy to measure of course)? Are we OK with the inevitable waste/corruption that could arise?

This also wouldn't address the underlying issue of the ridiculous pricing system in place for individual medical procedures. I'm struggling to see how it could possibly be more effective or remotely as efficient as a single-payer system. I mean, the insurance industry does get to continue existing, I suppose...

ETA - I guess the government could mandate that all providers provide the same basic plan for the same price, and it would be the premium plans that would be subject to the market? Hmm.
Title: Re: What comes after the ACA?
Post by: sol on January 09, 2017, 04:07:10 PM
I'm struggling to see how it could possibly be more effective or remotely as efficient as a single-payer system.

It's not.  Single payer is a financially more logical idea, but it it politically impossible right now.  This plan is like single payer, but with government subsidies to private companies, which is just like what we have now but on a larger scale.

Private insurers would be the middle man, just like defense contractors.  They make a profit by doing the government's job for them, even if the government could do it more efficiently itself.

But it would accomplish many of the same goals as single payer, without the primary drawback (destroying the private insurance industry).  I think insurers would have to be regulated, to ensure they provided this service uniformly to all Americans at a reasonable level of profit (also like the post office).  And to ensure they remained solvent, because a bankrupt insurance provider is no good to anyone.
Title: Re: What comes after the ACA?
Post by: nereo on January 09, 2017, 04:16:47 PM
Interesting thread Sol - I've enjoyed reading the various responses.

in response to "how could this be more effective as a single payer system" I'd offer this:
It might be possible to have both:  A single-payer health care system that provides basic services similar to what Sol describes above, and the "additional" health care provided by private insurance companies with profit limitations that provides more extensive coverage. 
Title: Re: What comes after the ACA?
Post by: sol on January 09, 2017, 04:33:02 PM
Heck, Republicans could repeal the ACA and replace it with 100% premiums paid guaranteed issue basic coverage required by law to be available from every insurance company, and claim victory without even bothering to raise taxes.  They're already talking about a trillion dollars of deficit spending on infrastructure, why not make it a half trillion and spend the other half trillion on sticking it to Obama by offering a viable replacement plan that makes Obamacare look like shit?

No worries about 5:1 ratios, no more subsidy cliffs, no more mandate, it's everything they ever wanted and it might actually be good for both the American people AND their big money private business donors.  They might even get some democrats to vote for it.

And it seems so easy to do.  Congress just spells out the provisions of a basic insurance plan, and requires every insurer in every US market to sell it to everyone for the same specified price or pay ~100% tax rates (to subsidize the ones that do comply).  Each insurer that complies would get to claim the premium payments for each new customer from the government directly, and would get a bailout guarantee if the policies don't turn out to be profitable.

Everyone wins?
Title: Re: What comes after the ACA?
Post by: MilesTeg on January 09, 2017, 04:43:19 PM
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

I don't believe this statement.  One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record.  Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves.  For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.

So, you'd eliminate pretty much all the rights enumerated in the constitution?
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 09, 2017, 05:07:37 PM
Heck, Republicans could repeal the ACA and replace it with 100% premiums paid guaranteed issue basic coverage required by law to be available from every insurance company, and claim victory without even bothering to raise taxes.  They're already talking about a trillion dollars of deficit spending on infrastructure, why not make it a half trillion and spend the other half trillion on sticking it to Obama by offering a viable replacement plan that makes Obamacare look like shit?

No worries about 5:1 ratios, no more subsidy cliffs, no more mandate, it's everything they ever wanted and it might actually be good for both the American people AND their big money private business donors.  They might even get some democrats to vote for it.

And it seems so easy to do.  Congress just spells out the provisions of a basic insurance plan, and requires every insurer in every US market to sell it to everyone for the same specified price or pay ~100% tax rates (to subsidize the ones that do comply).  Each insurer that complies would get to claim the premium payments for each new customer from the government directly, and would get a bailout guarantee if the policies don't turn out to be profitable.

Everyone wins?

Agreed - and let's go a step further and give every person over 18 poverty level payment too.  So everyone gets say - $1000 a month. And then we close housing, welfare, food stamps, etc.  You get $200 per month for each kid up to 2.  Want more kids - make it work on what you get.  Once you are able to take social security - you choose based on what pays more - social security or your poverty payment.  It turns out that eliminating all of the bureaucracy of welfare, housing, food stamps, etc. - this will save money. Want to live a better life and have more - get a job.
Title: Re: What comes after the ACA?
Post by: jim555 on January 09, 2017, 05:24:21 PM
I remember Milton Friedman once advocated a negative income tax so everyone gets a minimum amount of income.  Interesting since he is known as Mr. Free Market.
Title: Re: What comes after the ACA?
Post by: sol on January 09, 2017, 05:25:05 PM
Agreed - and let's go a step further and give every person over 18 poverty level payment too. 

I don't think the country is ready for universal basic income yet, but your premise is probably relevant in the health insurance world.  They could certainly flat out repeal Medicaid and Medicare to help pay for 100% federal coverage of premiums for guaranteed-issue basic health insurance.  Who needs those programs when everyone already has Trumpcare?
Title: Re: What comes after the ACA?
Post by: jim555 on January 09, 2017, 06:45:19 PM
3 Former GOP Presidential Candidates Blast Plan to Repeal ACA With No Plan To Replace It
https://www.youtube.com/watch?v=wJrdOUvpFsM
Title: Re: What comes after the ACA?
Post by: protostache on January 09, 2017, 07:05:53 PM
Heck, Republicans could repeal the ACA and replace it with 100% premiums paid guaranteed issue basic coverage required by law to be available from every insurance company, and claim victory without even bothering to raise taxes.  They're already talking about a trillion dollars of deficit spending on infrastructure, why not make it a half trillion and spend the other half trillion on sticking it to Obama by offering a viable replacement plan that makes Obamacare look like shit?

No worries about 5:1 ratios, no more subsidy cliffs, no more mandate, it's everything they ever wanted and it might actually be good for both the American people AND their big money private business donors.  They might even get some democrats to vote for it.

And it seems so easy to do.  Congress just spells out the provisions of a basic insurance plan, and requires every insurer in every US market to sell it to everyone for the same specified price or pay ~100% tax rates (to subsidize the ones that do comply).  Each insurer that complies would get to claim the premium payments for each new customer from the government directly, and would get a bailout guarantee if the policies don't turn out to be profitable.

Everyone wins?

sol I think this is the first logical plan I've read that preserves or expands the intent of ACA while still giving everyone something they want. Kudos! Now how do we communicate it to the people that write the laws?
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 09, 2017, 07:57:49 PM

I'm open to suggestions and criticisms of this plan.  There are clearly a thousand details to complicate the implementation, but the overarching idea of just raising taxes to pay for universally available private insurance seems like the only way to give everyone what they want.

First objection...  Who decides what defines a "Basic" level plan?  I consider the current bronze to be way beyond what I practically need.  Even if I were to agree that the starting plan really was "basic", will I actually have an effective opt-out option?  Can I freely agree to a less comprehensive plan than the "basic" standard without an economic penalty (compared to my basic plan peer with his premiums paid by taxes)?  Or am I going to have to forego the basic plan's subsidies while still paying for my peer's plan through my own taxes?

Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone.  I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 09, 2017, 07:59:21 PM
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

I don't believe this statement.  One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record.  Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves.  For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.

So, you'd eliminate pretty much all the rights enumerated in the constitution?

If you think that the Bill of Rights compel other citizens to do something for me, you don't understand what they are.
Title: Re: What comes after the ACA?
Post by: v8rx7guy on January 09, 2017, 08:02:05 PM
Heck, Republicans could repeal the ACA and replace it with 100% premiums paid guaranteed issue basic coverage required by law to be available from every insurance company, and claim victory without even bothering to raise taxes.  They're already talking about a trillion dollars of deficit spending on infrastructure, why not make it a half trillion and spend the other half trillion on sticking it to Obama by offering a viable replacement plan that makes Obamacare look like shit?

No worries about 5:1 ratios, no more subsidy cliffs, no more mandate, it's everything they ever wanted and it might actually be good for both the American people AND their big money private business donors.  They might even get some democrats to vote for it.

And it seems so easy to do.  Congress just spells out the provisions of a basic insurance plan, and requires every insurer in every US market to sell it to everyone for the same specified price or pay ~100% tax rates (to subsidize the ones that do comply).  Each insurer that complies would get to claim the premium payments for each new customer from the government directly, and would get a bailout guarantee if the policies don't turn out to be profitable.

Everyone wins?

What percentage of my income does it cost?
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 09, 2017, 08:27:53 PM

I'm open to suggestions and criticisms of this plan.  There are clearly a thousand details to complicate the implementation, but the overarching idea of just raising taxes to pay for universally available private insurance seems like the only way to give everyone what they want.

First objection...  Who decides what defines a "Basic" level plan?  I consider the current bronze to be way beyond what I practically need.  Even if I were to agree that the starting plan really was "basic", will I actually have an effective opt-out option?  Can I freely agree to a less comprehensive plan than the "basic" standard without an economic penalty (compared to my basic plan peer with his premiums paid by taxes)?  Or am I going to have to forego the basic plan's subsidies while still paying for my peer's plan through my own taxes?

Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone.  I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

Everybody gets coverage at no cost to them. There is no tax penalty if you don't sign up and use it.  Use it or not.  And there would have to be HSAs to cover deductibles and out of pocket maximums. 
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 09, 2017, 08:34:18 PM

I'm open to suggestions and criticisms of this plan.  There are clearly a thousand details to complicate the implementation, but the overarching idea of just raising taxes to pay for universally available private insurance seems like the only way to give everyone what they want.

First objection...  Who decides what defines a "Basic" level plan?  I consider the current bronze to be way beyond what I practically need.  Even if I were to agree that the starting plan really was "basic", will I actually have an effective opt-out option?  Can I freely agree to a less comprehensive plan than the "basic" standard without an economic penalty (compared to my basic plan peer with his premiums paid by taxes)?  Or am I going to have to forego the basic plan's subsidies while still paying for my peer's plan through my own taxes?

Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone.  I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

Everybody gets coverage at no cost to them. There is no tax penalty if you don't sign up and use it.  Use it or not.  And there would have to be HSAs to cover deductibles and out of pocket maximums.

So, yes, I would lose the advantage of the tax subsidy if I were to chose a different plan, then?  At least with my local school district taxes, I benefit that there aren't a bunch of ignorant pre-teens running around my neighborhood like stray dogs in the middle of the daytime.  With this "basic" plan idea, I'd not even get a token benefit for my taxes.
Title: Re: What comes after the ACA?
Post by: EnjoyIt on January 09, 2017, 08:48:30 PM
Great summary Sol, and great discussion. In my opinion health care costs are the biggest concern for early retirees. There is nothing that can destroy a budget faster than a serious medical problem. The ACA was a gift to the early retiree, too good to be true in many ways. I think the biggest lesson here is that changes in health care, tax or entitlement policy can have a massively negative impact.

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

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

Insane. There is no solution to this problem with any of the proposals. Maybe a single payer could accomplish this, but as others have stated this is politically impossible. Whatever comes next will be great for healthy people, and not so great for sick people. You will likely be OK if you are either really rich or really poor (assuming Medicaid isn't destroyed). Don't get sick in the United States.

^ One of the best post I have read so far on the topic.
 
As long as we have insurance taking a cut on every medical expense expecting large profits,
As long as we have government regulations forcing extra personel to comply with them yet provide no patient benefit
As long as the FDA has difficult and expensive hurdles to create a new products
As long as we have no price transparency in medicine
As long as people expect to pay nothing and get everything
As long as people continue dangerous lifestyle choices and get bailed out by our healthcare industry
As long as we continue providing expensive healthcare to the almost brain dead or those with no quality of life
No health care plan will fix the problem

Me personally, I am saving extra to cover those scary future health care costs before I retire.
Title: Re: What comes after the ACA?
Post by: rpr on January 09, 2017, 08:52:18 PM


Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone.  I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

I don't remember reading about the right to an HSA in the "Bill of Rights". ;)
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 09, 2017, 08:54:19 PM


Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone.  I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

I don't remember reading about the right to an HSA in the "Bill of Rights". ;)

Well, I don't remember reading about the right to social security payments at 65 either, so be careful what you might advocate abolishing!
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 09, 2017, 08:54:30 PM

I'm open to suggestions and criticisms of this plan.  There are clearly a thousand details to complicate the implementation, but the overarching idea of just raising taxes to pay for universally available private insurance seems like the only way to give everyone what they want.

First objection...  Who decides what defines a "Basic" level plan?  I consider the current bronze to be way beyond what I practically need.  Even if I were to agree that the starting plan really was "basic", will I actually have an effective opt-out option?  Can I freely agree to a less comprehensive plan than the "basic" standard without an economic penalty (compared to my basic plan peer with his premiums paid by taxes)?  Or am I going to have to forego the basic plan's subsidies while still paying for my peer's plan through my own taxes?

Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone.  I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

Everybody gets coverage at no cost to them. There is no tax penalty if you don't sign up and use it.  Use it or not.  And there would have to be HSAs to cover deductibles and out of pocket maximums.

So, yes, I would lose the advantage of the tax subsidy if I were to chose a different plan, then?  At least with my local school district taxes, I benefit that there aren't a bunch of ignorant pre-teens running around my neighborhood like stray dogs in the middle of the daytime.  With this "basic" plan idea, I'd not even get a token benefit for my taxes.

EVERYBODY is covered by the same bronze plan at no cost to them.  The government pays the premium if you want that coverage.  If you don't want the coverage - don't use it.  There is no tax subsidy.  It is like the highways - use them if you want - or not.  You pay the same either way.  In this manner - emergency rooms would have limited exposure (the deductible).  Want better insurance - buy it.  Want less insurance - use less. I don't understand what you don't understand.  There is no tax "subsidy" to lose.  It is, of course, highly unlikely that anybody would offer a plan with less coverage because you are the only person who would buy it.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 09, 2017, 08:56:00 PM
I don't understand what you don't understand.  There is no tax "subsidy" to lose. It is, of course, highly unlikely that anybody would offer a plan with less coverage because you are the only person who would buy it.

Of course there is, just because you don't see it, doesn't mean it's not there.
Title: Re: What comes after the ACA?
Post by: adamb on January 09, 2017, 09:01:52 PM
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

I don't believe this statement.  One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record.  Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves.  For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.

So, you'd eliminate pretty much all the rights enumerated in the constitution?

If you think that the Bill of Rights compel other citizens to do something for me, you don't understand what they are.

Public defenders everywhere are quite shocked to hear that!

https://en.wikipedia.org/wiki/Sixth_Amendment_to_the_United_States_Constitution
Title: Re: What comes after the ACA?
Post by: adamb on January 09, 2017, 09:04:20 PM
Heck, Republicans could repeal the ACA and replace it with 100% premiums paid guaranteed issue basic coverage required by law to be available from every insurance company, and claim victory without even bothering to raise taxes.  They're already talking about a trillion dollars of deficit spending on infrastructure, why not make it a half trillion and spend the other half trillion on sticking it to Obama by offering a viable replacement plan that makes Obamacare look like shit?

No worries about 5:1 ratios, no more subsidy cliffs, no more mandate, it's everything they ever wanted and it might actually be good for both the American people AND their big money private business donors.  They might even get some democrats to vote for it.

And it seems so easy to do.  Congress just spells out the provisions of a basic insurance plan, and requires every insurer in every US market to sell it to everyone for the same specified price or pay ~100% tax rates (to subsidize the ones that do comply).  Each insurer that complies would get to claim the premium payments for each new customer from the government directly, and would get a bailout guarantee if the policies don't turn out to be profitable.

Everyone wins?

Sounds good to me! Of course it'll never happen (quibbles over what qualifies as basic insurance for women's health immediately comes to mind).
Title: Re: What comes after the ACA?
Post by: rpr on January 09, 2017, 09:10:50 PM


Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone.  I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

I don't remember reading about the right to an HSA in the "Bill of Rights". ;)

Well, I don't remember reading about the right to social security payments at 65 either, so be careful what you might advocate abolishing!

In general I'm against all itemized deductions for health care. There should be no deductions for premiums, costs, HSAs etc. Such deductions almost always increase costs. I have said this before, I'm pretty much against most deductions.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 09, 2017, 09:40:15 PM


Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone.  I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

I don't remember reading about the right to an HSA in the "Bill of Rights". ;)

Well, I don't remember reading about the right to social security payments at 65 either, so be careful what you might advocate abolishing!

In general I'm against all itemized deductions for health care. There should be no deductions for premiums, costs, HSAs etc. Such deductions almost always increase costs. I have said this before, I'm pretty much against most deductions.

I understand, and respect, your position.  I'm just saying that I don't agree, and in order to get your way, odds are high you are going to lose something you like as well.
Title: Re: What comes after the ACA?
Post by: rpr on January 09, 2017, 09:57:10 PM


Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone.  I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

I don't remember reading about the right to an HSA in the "Bill of Rights". ;)

Well, I don't remember reading about the right to social security payments at 65 either, so be careful what you might advocate abolishing!

In general I'm against all itemized deductions for health care. There should be no deductions for premiums, costs, HSAs etc. Such deductions almost always increase costs. I have said this before, I'm pretty much against most deductions.

I understand, and respect, your position.  I'm just saying that I don't agree, and in order to get your way, odds are high you are going to lose something you like as well.

Yes, there are things that I hugely benefit from like the 401k/IRA deductions, the health insurance premium deductions, the mortgage interest deductions, the reduced tax rates on capital gains and dividends. But, I'd rather have a larger standard deduction that benefits everyone and a plan that will significantly simplify the tax code. It is theoretical at this point, but I'm willing to take some of that pain. For the good of our country and the vast majority of its citizens, it is required to have a dialogue that results in coming up with a plan and scheme that benefits this majority.
Title: Re: What comes after the ACA?
Post by: sol on January 09, 2017, 10:14:51 PM
First objection...  Who decides what defines a "Basic" level plan?

The same people who determined what defines a "basic" level of disability insurance and unemployment were, and then provided them to you.  You currently have those, paid for with your tax dollars.  Do you feel like they are excessive?  Do you want to opt out of them?  Congress disagrees with you.  Do you feel like you are unfairly being asked to pay for your peers plans?  That's kind of the point of insurance.

Quote
Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone.

I love my HSA too, but I also recognize it is a tax break for the rich and I personally think we can safely repeal some tax breaks in order to pay for providing affordable insurance to everyone.   I'd rather have affordable health insurance than a worthless tax deduction.  I can't afford $20k/year for medical no matter what kind of tax deduction you give me, once I am retired and living on $40k/year and not paying any income taxes.

(quibbles over what qualifies as basic insurance for women's health immediately comes to mind).

I don't think that one is really so hard, personally, but I'm not the one who would have to vote for it in Congress.  What do medicaid and medicare currently pay for?  Just pay for that, and let people who want more than that either pay for it themselves, or buy additional insurance.

What percentage of my income does it cost?

That depends on your income, I suppose.  What percentage of your income does your healthcare currently cost?

I suppose the answer could be "zero" if you have no income and thus pay no taxes.  I think even homeless people deserve an annual checkup.  Maybe it will keep them out of emergency rooms.

For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything.  But it would be mixed in with everything else the government buys with your tax dollars.  No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes.  At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.
Title: Re: What comes after the ACA?
Post by: Lagom on January 09, 2017, 10:33:57 PM
For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything.  But it would be mixed in with everything else the government buys with your tax dollars.  No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes.  At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.

This is a key point. Of course the "taxes are theft" folks will still disagree on principle, but their principles are based on an ignorance of historical context, understanding of how the economy works, and/or empathy for others, so I'm not sure their opinions are particularly relevant.

 
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 09, 2017, 11:37:59 PM
For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything.  But it would be mixed in with everything else the government buys with your tax dollars.  No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes.  At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.

This is a key point. Of course the "taxes are theft" folks will still disagree on principle, but their principles are based on an ignorance of historical context, understanding of how the economy works, and/or empathy for others, so I'm not sure their opinions are particularly relevant.

Do you not proof read your posts first?  Or do you just not care how offensive you sound to those whose opinions you do not share?
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 09, 2017, 11:51:31 PM
First objection...  Who decides what defines a "Basic" level plan?

The same people who determined what defines a "basic" level of disability insurance and unemployment were, and then provided them to you.  You currently have those, paid for with your tax dollars.  Do you feel like they are excessive?  Do you want to opt out of them?  Congress disagrees with you.  Do you feel like you are unfairly being asked to pay for your peers plans?  That's kind of the point of insurance.


Once again, no it is not.  True insurance is not a cost transfer system.  It is only a hedge against unlikely, but expensive, life events.  Annual checkups don't count, they are both predictable and not particularly expensive anyway.  And I already  pay for those through my taxes for the homeless, that's why free health clinics exist.  If your "basic" health plan only covered the truly unlikely events, that cannot reasonably be tied to lifestyle; such as most forms of cancer, but not lung cancer for the chronic smoker or skin cancer for the sun bathing addicts, we might have something to talk about.  But to anything that could be provided by a free clinic today, no.  I might commit to taxpayer funded birth control, but only as a condition of providing free health care, and of the type that does not depend upon the ongoing responsibility of the person receiving benefits.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 09, 2017, 11:54:10 PM


Second objection... If you are advocating abolishing HSAs, you can't also say that you are allowing plans that work for everyone.  I love my HSA, in part, because I allows me to actually become a risk pool of one, over my remaining lifetime instead of per calendar year.

I don't remember reading about the right to an HSA in the "Bill of Rights". ;)

Well, I don't remember reading about the right to social security payments at 65 either, so be careful what you might advocate abolishing!

In general I'm against all itemized deductions for health care. There should be no deductions for premiums, costs, HSAs etc. Such deductions almost always increase costs. I have said this before, I'm pretty much against most deductions.

I understand, and respect, your position.  I'm just saying that I don't agree, and in order to get your way, odds are high you are going to lose something you like as well.

Yes, there are things that I hugely benefit from like the 401k/IRA deductions, the health insurance premium deductions, the mortgage interest deductions, the reduced tax rates on capital gains and dividends. But, I'd rather have a larger standard deduction that benefits everyone and a plan that will significantly simplify the tax code. It is theoretical at this point, but I'm willing to take some of that pain. For the good of our country and the vast majority of its citizens, it is required to have a dialogue that results in coming up with a plan and scheme that benefits this majority.

Well, best of luck to you.  As for myself, I'm just going to try and enjoy the decline.
Title: Re: What comes after the ACA?
Post by: Lagom on January 10, 2017, 12:32:20 AM
For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything.  But it would be mixed in with everything else the government buys with your tax dollars.  No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes.  At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.

This is a key point. Of course the "taxes are theft" folks will still disagree on principle, but their principles are based on an ignorance of historical context, understanding of how the economy works, and/or empathy for others, so I'm not sure their opinions are particularly relevant.

Do you not proof read your posts first?  Or do you just not care how offensive you sound to those whose opinions you do not share?

Well, this is a fair objection, in some respects. I don't pretend to be tactful. The thing is that this is far from the first forum in which i have fought this particular fight. And it gets old. I'm sure those favoring your worldview feel the same. So to repeat myself yet again, the short version here is that the opportunity (which is unprecedented in human history) to be collectively able to have this conversation, is based in the history of the society in which we reside, which was built upon taxation of the resident populous. That we are all able to consider the possibility of FIRE is very much thanks to the fruits of those taxes. In this increasingly automated world, that it might still be possible to continue to grow the economy for the benefit of all is a direct result of what taxation has wrought. I do not claim that taxes are universally well implemented (quite the opposite), but it is absurd to claim they are theft when the reality is that they have enabled more wealth than would have otherwise been possible. I have little patience for people who deal in absolutes.
Title: Re: What comes after the ACA?
Post by: Metric Mouse on January 10, 2017, 01:19:36 AM
So we're arguing single payer is political unfeasible, but abolishing medicare is a cornerstone of this plan?

Though I can see something like this gaining support: "Just let the government pay for everyone's health insurance out of taxes."  Never mind that it would by necessity be cheaper to pay healthcare providers directly.
Title: Re: What comes after the ACA?
Post by: beltim on January 10, 2017, 01:51:00 AM
What percentage of my income does it cost?

That depends on your income, I suppose.  What percentage of your income does your healthcare currently cost?

I suppose the answer could be "zero" if you have no income and thus pay no taxes.  I think even homeless people deserve an annual checkup.  Maybe it will keep them out of emergency rooms.

For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything.  But it would be mixed in with everything else the government buys with your tax dollars.  No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes.  At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.

Back of the envelope calculation is it would roughly double taxes.  Total US spending on healthcare in 2015 was $3.2 trillion, of which the federal government already paid about $1 trillion, leaving $2.2 trillion.  Total taxes collected from individuals was about $2.5 trillion.
Or, roughly a 14% tax on all wages, without any deductions.

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf
http://www.cbpp.org/research/policy-basics-where-do-federal-tax-revenues-come-from
Title: Re: What comes after the ACA?
Post by: Metric Mouse on January 10, 2017, 01:54:01 AM
Or, roughly a 14% tax on all wages, without any deductions.

I would ha no problem voting for this. :D
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 10, 2017, 06:38:36 AM
For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything.  But it would be mixed in with everything else the government buys with your tax dollars.  No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes.  At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.

This is a key point. Of course the "taxes are theft" folks will still disagree on principle, but their principles are based on an ignorance of historical context, understanding of how the economy works, and/or empathy for others, so I'm not sure their opinions are particularly relevant.

Do you not proof read your posts first?  Or do you just not care how offensive you sound to those whose opinions you do not share?

Well, this is a fair objection, in some respects. I don't pretend to be tactful. The thing is that this is far from the first forum in which i have fought this particular fight. And it gets old. I'm sure those favoring your worldview feel the same. So to repeat myself yet again, the short version here is that the opportunity (which is unprecedented in human history) to be collectively able to have this conversation, is based in the history of the society in which we reside, which was built upon taxation of the resident populous. That we are all able to consider the possibility of FIRE is very much thanks to the fruits of those taxes. In this increasingly automated world, that it might still be possible to continue to grow the economy for the benefit of all is a direct result of what taxation has wrought. I do not claim that taxes are universally well implemented (quite the opposite), but it is absurd to claim they are theft when the reality is that they have enabled more wealth than would have otherwise been possible. I have little patience for people who deal in absolutes.

It's easy to talk about how stupid and dependent everyone else is when you first disabuse yourself of the notion that you live in a society.

"I got mine, Jack."

Seriously, Quidnon, government policy is pretty much how we make decisions about things that affect all of us. Participate or don't, but acting like you're somehow not in a society is just obnoxious. If everyone else was a unicorn of personal responsibility like you, then we would live in a free market utopia where nothing bad ever happens.

I think that's going to be my new band name, Unicorn of Personal Responsibility.
Title: Re: What comes after the ACA?
Post by: nereo on January 10, 2017, 08:01:45 AM
Quote
I think that's going to be my new band name, Unicorn of Personal Responsibility.

Punk band?
Title: Re: What comes after the ACA?
Post by: scantee on January 10, 2017, 08:11:16 AM
For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything.  But it would be mixed in with everything else the government buys with your tax dollars.  No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes.  At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.

This is a key point. Of course the "taxes are theft" folks will still disagree on principle, but their principles are based on an ignorance of historical context, understanding of how the economy works, and/or empathy for others, so I'm not sure their opinions are particularly relevant.

Do you not proof read your posts first?  Or do you just not care how offensive you sound to those whose opinions you do not share?

Quidnon, your posts about health care in this and other threads are full of meaningless hyperbole. Everything you disagree with is PROPAGANDA and health care a serious incursion on your FREEDOM. People here are (rightly, I think) interpreting your comments as nothing more than ridiculous histrionics and are poking fun at you because of it. From what I can tell, your main objection to the ACA is that it is more expensive for you personally than plans you had in the old private insurance market. That's actually a legitimate beef! You're probably going to get more traction with the argument "the ACA is simply too expensive for individuals like me" than trying to connect it to some grave threat to your personal autonomy and the stability of the republic.
Title: Re: What comes after the ACA?
Post by: jim555 on January 10, 2017, 08:14:27 AM
Somalia has a great health care system, FREEDOM baby!
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 10, 2017, 08:16:46 AM
Quote
I think that's going to be my new band name, Unicorn of Personal Responsibility.

Punk band?

I was thinking Ska. But it could work for punk too ...
Title: Re: What comes after the ACA?
Post by: EnjoyIt on January 10, 2017, 08:56:52 AM
No one talks about cost.  The cost of healthcare is more important than who will pay for it.  Cut the cost and almost everyone can afford it.  Only than can taxes cover those that can't.

Just out of curiosity for those that think healthcare should be free for all (paid by taxes)
1) Should people who continue to smoke despite multiple hospitalizations continue to get free care? Showing up in the hospital once or twice a month because they can't breath yet refuse to try and quit smoking?

2) Should smokers pay more money in taxes?  What about heavy drinkers and drug addicts? Should the American people subsidize someones poor choices and unhealthy lifestyles?

3) Should we continue free medical intervention and testing on those that are bedridden, confused, and can't comprehend their surroundings? No quality of life?

I ask because those items cost a huge percentage of the healthcare dollar.  I see no reason why those people can't get that care if they can afford it.  But I personally do not believe it should be paid by tax payer dollars.  BTW, I realize some of those are addictions, and we need to provide ample amounts of free addiction assistance programs if we are to cut people off from free health care.


Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 09:03:07 AM
2) Should smokers pay more money in taxes?  What about heavy drinkers and drug addicts? Should the American people subsidize someones poor choices and unhealthy lifestyles?

Just want to point out that they do pay more in taxes with every pack they buy, which makes me wonder where that money is currently going? That has to be a LOAD of money BTW at $1 per pack at the federal level, ~$15 billion per year, if you google the sales in the US per year.

http://taxfoundation.org/blog/how-high-are-cigarette-taxes-your-state
Title: Re: What comes after the ACA?
Post by: radram on January 10, 2017, 09:08:53 AM
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

I don't believe this statement.  One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record.  Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves.  For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.

Completely agree. It is not a RIGHT.

I do feel that there is SOMETHING there, but I can not describe it. Maybe moral obligation, but that does not sound right either. All I know is that if I see someone in distress, it just feels right to try to help. I feel better when I do, and sometimes feel like shit when I don't.

I believe one of the best achievements in mankind is the ability to feed its population. We do very well in the US. Even though there is struggle with the poor, there are very few that reach the level of undernourishment and starvation. Government, individuals, corporations, churches and non-profits all have some ownership in this achievement, and it does come with a price. Do people take advantage of that? Yup. It sucks. If that meant that others were suffering from starvation I would hope we would work more aggressively to prevent that from happening, either by going after the ones taking advantage, or working to provide more food. It feels like the right thing to do.

It feels to me that the ability to sustain and maintain a basic level of health services for all people in the US should be possible, and with advancement it is quickly rising to the level similar to feeding its people. This should include preventative care, treatment for minor health issues and some level of treatment for catastrophic care. I agree with you that calling all of this "insurance" is probably the wrong description, but that does not mean they need to be addressed separately. Maybe that would be the best way to do it, but it makes some sense to do so.

It should forever be a choice to provide health services to the entire nation, whereby the elected leaders can add or remove that service as they see fit, just like it is for social security, medicare, military, foodstamps etc. It does NOT need to remain each individuals choice to participate financially, just like it is not my right that I can say my taxes can not go to war or defense or a wall that some group in the future will demand that we "tear down this wall". I would like the US to choose yes on providing health services for all just as every other advanced nation does to varying levels. That might require making choices we are not yet prepared to make, including a shift in spending, or a rethinking of health in exchange for profit, or an increase in taxes.

It is my hope that our future selves look back to the time we did not provide health services to our own people with disdain.

I would like to add that Sol's idea has much promise for me, with maybe some sort of a combination of penalty for "bad bahavior" or discount for "good behavior". Devil in the details of course. Reasonable, rational, and everyone gets skin in the game. In other words, it has no chance :)
Title: Re: What comes after the ACA?
Post by: OurTown on January 10, 2017, 09:22:13 AM
Several people in this thread have mentioned that there is no way to make health insurance affordable to all Americans as long as healthcare costs are so high.  I think this is wrong.  There IS a way to give everyone affordable insurance without controlling costs at all.  Insurers and hospitals/doctors can continue to get rich, and everyone can have access to affordable care.  I think I've cracked the nut.

What secret sauce have I invented?  The key is in the definition of "affordable".  Just pay 100% of everyone's private health insurance premium with tax dollars. 

Think about this.  Taxes are already designed to be "affordable" to everyone.  They are progressive (for income tax, so the rich pay more) and they are also a flat tax (for OASDI, which everyone pays the same percentage regardless of income).  No one ever goes broke because of taxes.  If you have no income, you pay no taxes.  If you have lots of money, you pay lots of taxes but you still have lots of money.  In both cases, taxes are "affordable" to you.  Why can't health insurance work the same way?

The 100% covered premiums would have to be for basic services, of course, not cadillac plans.  Maybe make them similar to current subsidized silver plans, say 100% coverage for routine preventative care, $25 copays for other stuff, and $1k per person deductibles so everyone pays for their first basic care out of pocket.  People who want more than basic coverage could still buy it, if they can afford it.  Exclude cosmetic procedures.  Revoke HSAs.  Your doctor would bill your insurance company just like it does now, and your insurance company would bill Uncle Sam instead of you.  The private insurance industry would become just like the post office, a quasi-government for-profit corporation subject to federal oversight and regulation, that provides a uniformly available service for the common good and receives periodic bailouts when necessary and makes good money the rest of the time.

If you have employer-sponsored insurance, nothing would need to change.  The money your employer currently pays towards your insurance would get paid to Uncle Sam as taxes.  If you run a small business, you don't need to worry about providing healthcare to your employees if you don't want to.  If you are unemployed or retired, your health insurance is now covered just like your unemployment insurance and disability insurance are already covered under current law.

So this solutions obviously isn't a 100% free ride for everyone.  If Uncle Sam is paying all of this extra money for health insurance premiums, where is the money coming from?  Your taxes, of course.  You can either raise tax rates (either the progressive income tax brackets or the flat OASDI taxes or both, or other taxes) or you can cut spending.  Doesn't really matter.  The key is that taxes are always "affordable" by design, so we're piggy-backing on that system.  Theoretically, your savings from not buying your current insurance should cover your costs from higher taxes.

In either case, the government basically becomes the only end-consumer of health insurance.  They can negotiate rates with the private insurance companies, who can negotiate with providers, to bring long term costs under control.  Medicare already pays a fixed amount for MRIs, and that amount should be the MRI price for EVERYONE, not just old people.  Similar arguments apply for any other billable procedure.  They also get to ration care, for example by denying cosmetic surgery for old ladies who are vain or providing palliative care instead of invasive surgery for 90 year-olds with aggressive cancer.  If you are a billionaire 90 year-old with brain cancer, you can buy additional insurance or pay out of pocket, but even if you don't your basic care is covered just like it is for everyone else.

Everyone gets affordable health care!  You are covered, your rates are affordable to you, and no one will ever go medically bankrupt again!

There is no individual mandate!  You're not forced to buy anything.  The government is buying it for you, just like it buys national defense for you, because we all need it.

There is no denial for pre-existing conditions!  Everyone gets (reasonable) care regardless of health history.  And you can always buy more if you can afford it.

Health outcomes will improve!  Preventative care is free for everyone!  Here's your "how to quit smoking" pamphlet and free nicorette gum.

Emergency care is still available to everyone, but won't be the only care available to poor people!  There is no need to repeal EMTALA.

It's not single payer!  The insurance industry isn't nationalized, and they continue to exist as profitable private corporations.


I'm open to suggestions and criticisms of this plan.  There are clearly a thousand details to complicate the implementation, but the overarching idea of just raising taxes to pay for universally available private insurance seems like the only way to give everyone what they want.

This is a YUUUUUGE winner.  How do we convince the Republicans to run with this and think it was their idea?  Can you add in some random persecution of poor people, that might help.

The Republican congress sounds a lot like the Roman Senate in Mel Brooks' "History of the World Part One."  "FUCK THE POOR!"
Title: Re: What comes after the ACA?
Post by: protostache on January 10, 2017, 09:22:52 AM
No one talks about cost.  The cost of healthcare is more important than who will pay for it.  Cut the cost and almost everyone can afford it.  Only than can taxes cover those that can't.

Just out of curiosity for those that think healthcare should be free for all (paid by taxes)
1) Should people who continue to smoke despite multiple hospitalizations continue to get free care?

Yes.

Quote
2) Should smokers pay more money in taxes?

No.

Quote
3) Should we continue free medical intervention and testing on those that are bedridden, confused, and can't comprehend their surroundings? No quality of life?

This is entirely between the patient, the patient's family, and their doctors. Not you, not me, not the government.

These are not hard questions if you have even an ounce of compassion in your body.
Title: Re: What comes after the ACA?
Post by: bacchi on January 10, 2017, 09:36:37 AM
These are not hard questions if you have even an ounce of compassion in your body.

These types of questions have also been solved in numerous other countries around the world, including by our neighbors to the north and our closest allies (like Britain and Germany).

We're not figuring out logistics for a manned mission to Mars; this has been done before.
Title: Re: What comes after the ACA?
Post by: thenextguy on January 10, 2017, 09:44:10 AM
Just a counterpoint to those claiming the ACA has failed. More people than ever have just signed up for the exchanges.

http://www.cnbc.com/2017/01/10/obamacare-sign-ups-hit-more-than-11-million-nationally-up-slightly-over-last-year-as-gop-struggles-over-repeal-and-replace.html

It can use some tweaks, but it's definitely not collapsing if more people are signing up for it.
Title: Re: What comes after the ACA?
Post by: mm1970 on January 10, 2017, 09:49:44 AM
No one talks about cost.  The cost of healthcare is more important than who will pay for it.  Cut the cost and almost everyone can afford it.  Only than can taxes cover those that can't.

Just out of curiosity for those that think healthcare should be free for all (paid by taxes)
1) Should people who continue to smoke despite multiple hospitalizations continue to get free care? Showing up in the hospital once or twice a month because they can't breath yet refuse to try and quit smoking?

2) Should smokers pay more money in taxes?  What about heavy drinkers and drug addicts? Should the American people subsidize someones poor choices and unhealthy lifestyles?

3) Should we continue free medical intervention and testing on those that are bedridden, confused, and can't comprehend their surroundings? No quality of life?

I ask because those items cost a huge percentage of the healthcare dollar.  I see no reason why those people can't get that care if they can afford it.  But I personally do not believe it should be paid by tax payer dollars.  BTW, I realize some of those are addictions, and we need to provide ample amounts of free addiction assistance programs if we are to cut people off from free health care.
This is an interesting point, and bears research and statistics.  I can't speak for NOW, but I do remember reading years ago (a decade, maybe?) that smokers actually cost LESS than non-smokers (from a medical stand point) because they die earlier.

Someone else mentioned the taxes you pay on cigarettes too.  I'd want to see the math on that - amount spent on cigs (should the taxes simply go into a medical "pool"?), cost of healthcare to treat a smoker who dies earlier, not to mention costs of social security - do typical lifelong smokers die before they collect?  (Both my parents smoked.  My dad lived to be 81 and was on SS for 20 years, but only got a small amount.  My mother died only a few years after collecting SS.  They were divorced.)
Title: Re: What comes after the ACA?
Post by: golden1 on January 10, 2017, 09:54:27 AM
Quote
No one talks about cost.  The cost of healthcare is more important than who will pay for it.  Cut the cost and almost everyone can afford it.  Only than can taxes cover those that can't.

Just out of curiosity for those that think healthcare should be free for all (paid by taxes)
1) Should people who continue to smoke despite multiple hospitalizations continue to get free care? Showing up in the hospital once or twice a month because they can't breath yet refuse to try and quit smoking?

2) Should smokers pay more money in taxes?  What about heavy drinkers and drug addicts? Should the American people subsidize someones poor choices and unhealthy lifestyles?

3) Should we continue free medical intervention and testing on those that are bedridden, confused, and can't comprehend their surroundings? No quality of life?

I ask because those items cost a huge percentage of the healthcare dollar.  I see no reason why those people can't get that care if they can afford it.  But I personally do not believe it should be paid by tax payer dollars.  BTW, I realize some of those are addictions, and we need to provide ample amounts of free addiction assistance programs if we are to cut people off from free health care.

Smokers already pay more money in taxes.  I am blown away at how much smokers pay for a pack these days.  When I was a kid, my parents bought cigarettes for $30 a carton, now it's $20 a pack.

I don't beleive attacking addiction in a punitive way is effective, and the evidence is supporting that view.  Sure, make it anti-social, which worked for smoking, but don't criminalize it or tie someone's health care to it.  People don't make these decisions in a rational way.  People know that smoking will likely kill you, yet they still do it. 

I am all for mandatory end of life planning, but that got labelled as "death panels" so thats a non starter.  The majority of money spent on health care in your life will be spent in the last 6 months of it, which is just wasteful and usually stressful for everyone involved.   
Title: Re: What comes after the ACA?
Post by: rtrnow on January 10, 2017, 10:06:13 AM
No one talks about cost.  The cost of healthcare is more important than who will pay for it.  Cut the cost and almost everyone can afford it.  Only than can taxes cover those that can't.

Just out of curiosity for those that think healthcare should be free for all (paid by taxes)
1) Should people who continue to smoke despite multiple hospitalizations continue to get free care? Showing up in the hospital once or twice a month because they can't breath yet refuse to try and quit smoking?

2) Should smokers pay more money in taxes?  What about heavy drinkers and drug addicts? Should the American people subsidize someones poor choices and unhealthy lifestyles?

3) Should we continue free medical intervention and testing on those that are bedridden, confused, and can't comprehend their surroundings? No quality of life?

I ask because those items cost a huge percentage of the healthcare dollar.  I see no reason why those people can't get that care if they can afford it.  But I personally do not believe it should be paid by tax payer dollars.  BTW, I realize some of those are addictions, and we need to provide ample amounts of free addiction assistance programs if we are to cut people off from free health care.

1. yes
2. Both smokers and drinkers already pay more in taxes. If marijuana was legal and taxed a federal level that could be added to the list.
3. I think that has to be a individual/family decision. We could save tons by actually discussing end of life care in real terms. I assume almost no one really wants to live that life, but we often don't discuss wishes with our family and doctors don't have these discussions either. Perhaps just changing doctor training could solve this one.
Title: Re: What comes after the ACA?
Post by: webguy on January 10, 2017, 10:18:24 AM
It seems like the first logical step to fixing healthcare insurance is addressing the ridiculous prices that healthcare companies are charging. Lowering the cost of care then lowers the cost to the insurance company which lowers the cost for us. $450 for a 5 minute consultation with a "specialist" is beyond obsurd. Set restrictions on what companies can charge, or have insurance companies incentivize people to price shop for cheaper healthcare and suddenly the cost of care lowers and this entire mess gets sorted out.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 10:25:41 AM
Just a counterpoint to those claiming the ACA has failed. More people than ever have just signed up for the exchanges.

http://www.cnbc.com/2017/01/10/obamacare-sign-ups-hit-more-than-11-million-nationally-up-slightly-over-last-year-as-gop-struggles-over-repeal-and-replace.html

It can use some tweaks, but it's definitely not collapsing if more people are signing up for it.
I guess that depends on your definition of success... If by success you mean we are finally forcing every person to purchase health insurance, if they want it or not, and if not we are going to hit them with a fine(or tax, or what ever suits your legal description at the time to defend it), then yea you might call it a success.

But if success means its something financially sustainable, then that it is not... It has been a total and complete failure from any angle other than to funnel more money from your pocket into Washington DC.
Title: Re: What comes after the ACA?
Post by: Roland of Gilead on January 10, 2017, 10:26:34 AM
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.   Pregnant women are certainly a drain, especially if they have a history of premature births.  Perhaps we should charge them more?  Sounds fair right?
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 10:31:27 AM
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.   Pregnant women are certainly a drain, especially if they have a history of premature births.  Perhaps we should charge them more?  Sounds fair right?
I believe they already are.... from a health insurance perspective since they are more likely to need health care related services.

But why would you have a problem singling these people out for higher taxes? and not... lets say a single young adult? which is exactly what the ACA currently does. Are they not worth our compassion? Especially since it is probably the most difficult time in life financially.

Both are wrong in my opinion, but I don't get how the glove doesn't fit the other hand for supporter of the ACA.
Title: Re: What comes after the ACA?
Post by: scantee on January 10, 2017, 10:40:17 AM
It seems like the first logical step to fixing healthcare insurance is addressing the ridiculous prices that healthcare companies are charging. Lowering the cost of care then lowers the cost to the insurance company which lowers the cost for us. $450 for a 5 minute consultation with a "specialist" is beyond obsurd. Set restrictions on what companies can charge, or have insurance companies incentivize people to price shop for cheaper healthcare and suddenly the cost of care lowers and this entire mess gets sorted out.

Why do we expect for-profit health insurance companies to limit costs? Their goal is to maximize profits and they do that in part through ever-increasing costs. A health care system funded through a system of for-profit insurance providers is at odds with a goal of cost control.
Title: Re: What comes after the ACA?
Post by: protostache on January 10, 2017, 10:41:47 AM
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.   Pregnant women are certainly a drain, especially if they have a history of premature births.  Perhaps we should charge them more?  Sounds fair right?
But why would you have a problem singling these people out for higher taxes? and not... lets say a single young adult? which is exactly what the ACA currently does. Are they not worth our compassion? Especially since it is probably the most difficult time in life financially.

ACA gives subsidies to people so they can afford health insurance and it specifically allows cheaper catastrophic plans for young adults and lets them stay on their parents plans until they're 26. In states that didn't reject Medicaid expansion for entirely political reasons there should be no case where a poor single young adult is worse off under ACA than they were before, either because they qualify for subsidies, they're on their parent's plan, or they're able to get Medicaid.
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 10, 2017, 11:10:07 AM
I guess that depends on your definition of success... If by success you mean we are finally forcing every person to purchase health insurance, if they want it or not, and if not we are going to hit them with a fine(or tax, or what ever suits your legal description at the time to defend it), then yea you might call it a success.

But if success means its something financially sustainable, then that it is not... It has been a total and complete failure from any angle other than to funnel more money from your pocket into Washington DC.

Anyone who can guarantee zero insurance utilization for the duration of their life should be welcome to opt-out. For the rest of us, get in the fucking pool.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 11:15:07 AM
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.   Pregnant women are certainly a drain, especially if they have a history of premature births.  Perhaps we should charge them more?  Sounds fair right?
But why would you have a problem singling these people out for higher taxes? and not... lets say a single young adult? which is exactly what the ACA currently does. Are they not worth our compassion? Especially since it is probably the most difficult time in life financially.

ACA gives subsidies to people so they can afford health insurance and it specifically allows cheaper catastrophic plans for young adults and lets them stay on their parents plans until they're 26. In states that didn't reject Medicaid expansion for entirely political reasons there should be no case where a poor single young adult is worse off under ACA than they were before, either because they qualify for subsidies, they're on their parent's plan, or they're able to get Medicaid.

And what about those over 26 and don't qualify for subsidies? Do these people not deserve a right to choose if they should pay for something they don't need or want?
Title: Re: What comes after the ACA?
Post by: farmecologist on January 10, 2017, 11:21:22 AM
I guess that depends on your definition of success... If by success you mean we are finally forcing every person to purchase health insurance, if they want it or not, and if not we are going to hit them with a fine(or tax, or what ever suits your legal description at the time to defend it), then yea you might call it a success.

But if success means its something financially sustainable, then that it is not... It has been a total and complete failure from any angle other than to funnel more money from your pocket into Washington DC.

Anyone who can guarantee zero insurance utilization for the duration of their life should be welcome to opt-out. For the rest of us, get in the fucking pool.


Exactly..and obviously nobody can guarantee that.  I just love it when people use the "I'm healthy - I don't need insurance" bit.  That is just rationalization plain and simple.  It's just insane that anyone would think that way - ANYONE can get a major disease at any moment...regardless of how "healthy" you think you are.

Frankly, the very notion of insurance doesn't work if everyone doesn't pay in.  I'm not sure why people have a problem with the idea of this.  There are many other problems with our health care system ( or lack thereof ).  However, I'm not sure why there is ever any argument over the idea of the mandate.



Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 10, 2017, 11:23:49 AM
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.   Pregnant women are certainly a drain, especially if they have a history of premature births.  Perhaps we should charge them more?  Sounds fair right?
But why would you have a problem singling these people out for higher taxes? and not... lets say a single young adult? which is exactly what the ACA currently does. Are they not worth our compassion? Especially since it is probably the most difficult time in life financially.

ACA gives subsidies to people so they can afford health insurance and it specifically allows cheaper catastrophic plans for young adults and lets them stay on their parents plans until they're 26. In states that didn't reject Medicaid expansion for entirely political reasons there should be no case where a poor single young adult is worse off under ACA than they were before, either because they qualify for subsidies, they're on their parent's plan, or they're able to get Medicaid.

And what about those over 26 and don't qualify for subsidies? Do these people not deserve a right to choose if they should pay for something they don't need or want?

Do I get to choose whether or not my tax dollars goes to pay their ER bill when their break all their limbs heliskiing after spending all of their money on hookers and blow?
Title: Re: What comes after the ACA?
Post by: GuitarStv on January 10, 2017, 11:26:10 AM
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.

Actually, it should be cheaper for smokers and fat people.  They die quicker and because of this cost the health care system less . . . prolonging those last few years of life for healthy folk (and giving them years of treatment that they manage to survive) is really, really expensive.

http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html (http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html)
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 11:37:42 AM
Do I get to choose whether or not my tax dollars goes to pay their ER bill when their break all their limbs heliskiing after spending all of their money on hookers and blow?
These are Heliskiers, not rock stars, physical and mental fitness is important to them... They would blow their money on hookers and blow.... Common lets be sensible : )
Title: Re: What comes after the ACA?
Post by: protostache on January 10, 2017, 11:39:46 AM
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.   Pregnant women are certainly a drain, especially if they have a history of premature births.  Perhaps we should charge them more?  Sounds fair right?
But why would you have a problem singling these people out for higher taxes? and not... lets say a single young adult? which is exactly what the ACA currently does. Are they not worth our compassion? Especially since it is probably the most difficult time in life financially.

ACA gives subsidies to people so they can afford health insurance and it specifically allows cheaper catastrophic plans for young adults and lets them stay on their parents plans until they're 26. In states that didn't reject Medicaid expansion for entirely political reasons there should be no case where a poor single young adult is worse off under ACA than they were before, either because they qualify for subsidies, they're on their parent's plan, or they're able to get Medicaid.

And what about those over 26 and don't qualify for subsidies? Do these people not deserve a right to choose if they should pay for something they don't need or want?

If you're over 26, don't qualify for subsidies, and live in a Medicare expansion state than by definition you're making enough money to afford health insurance or you're covered by an employer plan.

And they have every right to choose to go without health insurance, in which case they should pay the penalty which helps to pay for if they actually do need to go to the ER and choose to skip out on the bill.
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 10, 2017, 12:00:16 PM
Do I get to choose whether or not my tax dollars goes to pay their ER bill when their break all their limbs heliskiing after spending all of their money on hookers and blow?
These are Heliskiers, not rock stars, physical and mental fitness is important to them... They would blow their money on hookers and blow.... Common lets be sensible : )

Helisnowboarders, then. ;-)
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 12:18:31 PM
If you're over 26, don't qualify for subsidies, and live in a Medicare expansion state than by definition you're making enough money to afford health insurance or you're covered by an employer plan.

And they have every right to choose to go without health insurance, in which case they should pay the penalty which helps to pay for if they actually do need to go to the ER and choose to skip out on the bill.
We talk all the time about how most people are literally straddled with debt and barely getting by, its their own fault, but in my opinion its not really fair to throw one more expense at them just because you think you know what is best for them.

Also, lets put thing in perspective a little. Everyone keeps talking about this "trip to the ER" like it is financially life ending. According to the Washington post and a few other sites, in 2013(sorry couldn't find a source for 2016), was around $1200.

https://www.washingtonpost.com/news/wonk/wp/2013/03/02/an-average-er-visit-costs-more-than-an-average-months-rent/?utm_term=.439bdb99ae9c

The last time I checked insurance prices for our family it was about $350 per month(this was at the time with employer sponsored, now it would be much higher). That means our family, for the same cost of coverage, could go to the ER 3.5 times. Or one visit per person, per year. If that $350 per month were put into a savings account for 10years (@2% interest)would be worth $46,453.10.....

In my opinion this does not make sense financially, odds of being in a life threatening car accident(which is probably most likely scenario) are pretty small, and $46k is pretty life changing for some.
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 10, 2017, 12:29:16 PM
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.   Pregnant women are certainly a drain, especially if they have a history of premature births.  Perhaps we should charge them more?  Sounds fair right?
But why would you have a problem singling these people out for higher taxes? and not... lets say a single young adult? which is exactly what the ACA currently does. Are they not worth our compassion? Especially since it is probably the most difficult time in life financially.

ACA gives subsidies to people so they can afford health insurance and it specifically allows cheaper catastrophic plans for young adults and lets them stay on their parents plans until they're 26. In states that didn't reject Medicaid expansion for entirely political reasons there should be no case where a poor single young adult is worse off under ACA than they were before, either because they qualify for subsidies, they're on their parent's plan, or they're able to get Medicaid.

And what about those over 26 and don't qualify for subsidies? Do these people not deserve a right to choose if they should pay for something they don't need or want?

Think of it differently - if you don't buy health insurance the tax penalty you pay is buying your trip to the ER when you need your life saved and you don't have regular insurance.
Title: Re: What comes after the ACA?
Post by: nereo on January 10, 2017, 12:34:22 PM

Also, lets put thing in perspective a little. Everyone keeps talking about this "trip to the ER" like it is financially life ending. According to the Washington post and a few other sites, in 2013(sorry couldn't find a source for 2016), was around $1200.


Just some clarification, the median cost for a trip to the ER may be 'only' a few thousand dollars, but that isn't what people are insuring against. Most visits to teh ER wind up being out-patient procedures - stitches or a sprain or viral infection that just has to run its course.
Depending on the locale, a single night in the ICU can cost $20k or more. In-patient costs can be between $3k-$5k/night

So while the median cost may be low, the real financial threat is when you need to be hospitalized for multiple days, like if you are in a bad car accident or puncture your spleen while running with scissors.

With insurance you aren't protecting against the routine, but rather the more unlikely extreme events that you otherwise couldn't afford.

*it's also important to note that most people say they can't afford even an unexpected $800 expense without going into debt.  Sad but true.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 12:48:36 PM
Think of it differently - if you don't buy health insurance the tax penalty you pay is buying your trip to the ER when you need your life saved and you don't have regular insurance.
Umm I don't think so, my debt doesn't magically go away because I paid my fee last year. I will still be on the hook for the bill, and will gratefully pay the bill since they saved my life. I would technically owe my existence to their awesome training that they paid good money for.

Besides, do you really think that forcing everyone to pay into a broken system is going fix everything? Would stop runaway costs? They don't say "more money, more problems" for nothing...and all things being equal, democrats allowed the most inefficient form of resource management to come in and take control of everything. My prediction is we are all going to continue to see rising healthcare costs, or a reduction in service or a reduction in quality.... Maybe even a little of each.
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 10, 2017, 01:04:47 PM
Think of it differently - if you don't buy health insurance the tax penalty you pay is buying your trip to the ER when you need your life saved and you don't have regular insurance.
Umm I don't think so, my debt doesn't magically go away because I paid my fee last year. I will still be on the hook for the bill, and will gratefully pay the bill since they saved my life. I would technically owe my existence to their awesome training that they paid good money for.

Besides, do you really think that forcing everyone to pay into a broken system is going fix everything? Would stop runaway costs? They don't say "more money, more problems" for nothing...and all things being equal, democrats allowed the most inefficient form of resource management to come in and take control of everything. My prediction is we are all going to continue to see rising healthcare costs, or a reduction in service or a reduction in quality.... Maybe even a little of each.

No - what I really think is that that this great, very affluent country, ought to be as progressive as others and make it possible for the humans who live here to get health care.  And I selfishly want to be able to buy it for myself.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 01:23:28 PM
No - what I really think is that that this great, very affluent country, ought to be as progressive as others and make it possible for the humans who live here to get health care.  And I selfishly want to be able to buy it for myself.

Well I wouldn't call you selfish for wanting that for yourself.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 10, 2017, 02:01:07 PM

With insurance you aren't protecting against the routine, but rather the more unlikely extreme events that you otherwise couldn't afford.


Yes!  Yes!  That's it exactly!  And that is my complaint with Obamacare.  It has regulated such a high minimum standard of benefits, in order to be called "health insurance" in any legal context, that I can no longer actually buy real insurance in this field; at least not without also paying a tax penalty for not having official health insurance.  I'm relatively healthy for my age, with no major issues; and I have enough money between my HSA and other funds that I could take quite a hard hit.  But without true catastrophic and/or hospitalization insurance, I cannot be certain that I could absorb any hit that life could throw at me, regardless of the odds that I'll be hit at all.  I should have the right to buy whatever insurance I believe is right for myself, and self-insure to whatever level I am comfortable with financially, without special tax consequences and without being compelled to support the choices of others.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 10, 2017, 02:20:06 PM
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.

Actually, it should be cheaper for smokers and fat people.  They die quicker and because of this cost the health care system less . . . prolonging those last few years of life for healthy folk (and giving them years of treatment that they manage to survive) is really, really expensive.

http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html (http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html)

This may actually be true, on a life cycle perspective, since the healthy tend to live longer and have more opportunity to rack up charges.  Even still, tis just proves the point that there are many valid ways to look at it, and that also means that there can never be a consensus on what the ideal public plan should look like.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 02:20:49 PM
I live in the Midwest and am confident that I don't need protection from the Russians or from ISIS.  Quidnon: what is your argument for why I should be paying for your protection?   
That is one of the actual legitimate roles of a government is to provide defense of its citizens.

Title: Re: What comes after the ACA?
Post by: sol on January 10, 2017, 02:25:36 PM

With insurance you aren't protecting against the routine, but rather the more unlikely extreme events that you otherwise couldn't afford.


Yes!  Yes!  That's it exactly!  And that is my complaint with Obamacare.  It has regulated such a high minimum standard of benefits, in order to be called "health insurance" in any legal context, that I can no longer actually buy real insurance in this field; at least not without also paying a tax penalty for not having official health insurance.  I'm relatively healthy for my age, with no major issues; and I have enough money between my HSA and other funds that I could take quite a hard hit.  But without true catastrophic and/or hospitalization insurance, I cannot be certain that I could absorb any hit that life could throw at me, regardless of the odds that I'll be hit at all.  I should have the right to buy whatever insurance I believe is right for myself, and self-insure to whatever level I am comfortable with financially, without special tax consequences and without being compelled to support the choices of others.

I am a real tough guy.  Nobody messes with me or tries to fight me.  Therefore, I should have the right to buy whatever [amount of defense protection from the federal government] I believe is right for myself, and [protect myself] to whatever level I am comfortable with financially, without special tax consequences and without being compelled to [pay for the protection of people who are weaker than me].

I live in the Midwest and am confident that I don't need protection from the Russians or from ISIS.  Quidnon: what is your argument for why I should be paying for your protection?   

This seems like a fun game, can I play?

I have a very secure job, and have almost no chance of being fired or needing to collect unemployment.  I should be able to buy the correct account of unemployment insurance that I think is right for me, without being compelled to pay for your unemployment insurance.  What is your argument for why I should be paying for your unemployment insurance?

Can I do your disability insurance next?  Same deal.

How about your old age insurance, aka social security? Same deal.

This whole argument is stupid, Q.  Congress has decided to provide these services to every American worker whether they think they need them or not.  They protect workers from catastrophic wipeout and they protect private insurer from adverse risk pools.  They are good for the country.  So is widely available affordable health insurance.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 10, 2017, 02:39:11 PM
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

I don't believe this statement.  One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record.  Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves.  For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.

Completely agree. It is not a RIGHT.

I do feel that there is SOMETHING there, but I can not describe it. Maybe moral obligation, but that does not sound right either. All I know is that if I see someone in distress, it just feels right to try to help. I feel better when I do, and sometimes feel like shit when I don't.


So help.  I can show you a dozen different ways that you can, personally, help others in need.  Some with an accompanying tax deduction, and some completely anonymously.  And I agree with the moral obligation to help, as that is literally written into the Christian teachings.  But I don't agree that a non-Christian is bound by that moral obligation, I don't believe that a taxpayer funded program satisfies that obligation, and I don't believe that there is only one way to do anything in a nation of over 300 million people.

Quote

It feels to me that the ability to sustain and maintain a basic level of health services for all people in the US should be possible,


Oh, it's certainly possible, depending upon the concept of "basic level of health services".  But it's not the place of the federal government to do this kind of thing, either for the states or instead of them.  And if it were, it would never work.  One size fits all programs don't ever fit all.  I'm a fine example of that.

Title: Re: What comes after the ACA?
Post by: GuitarStv on January 10, 2017, 02:42:34 PM
If you are going to single out smokers (I have never smoked in my life) then why not continue and single out obese people since they are a drain on the healthcare system.

Actually, it should be cheaper for smokers and fat people.  They die quicker and because of this cost the health care system less . . . prolonging those last few years of life for healthy folk (and giving them years of treatment that they manage to survive) is really, really expensive.

http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html (http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html)

This may actually be true, on a life cycle perspective, since the healthy tend to live longer and have more opportunity to rack up charges.  Even still, tis just proves the point that there are many valid ways to look at it, and that also means that there can never be a consensus on what the ideal public plan should look like.

There probably never will be a consensus.  (Here in Canada there's no consensus as to what the ideal role of government should be in health care.  I suspect you could find the same sort of argument going on in France, the UK, or anywhere else that public health care is provided.)  There are an awful lot of cases in life where waiting for a perfect solution will prevent you from accepting a good solution, to the detriment of all.



I live in the Midwest and am confident that I don't need protection from the Russians or from ISIS.  Quidnon: what is your argument for why I should be paying for your protection?   
That is one of the actual legitimate roles of a government is to provide defense of its citizens.

In your opinion.

In the opinion of many in this thread, one of the actual legitimate roles of a government is to provide health care for its citizens.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 10, 2017, 02:45:24 PM


Quidnon, your posts about health care in this and other threads are full of meaningless hyperbole. Everything you disagree with is PROPAGANDA and health care a serious incursion on your FREEDOM. People here are (rightly, I think) interpreting your comments as nothing more than ridiculous histrionics and are poking fun at you because of it. From what I can tell, your main objection to the ACA is that it is more expensive for you personally than plans you had in the old private insurance market. That's actually a legitimate beef! You're probably going to get more traction with the argument "the ACA is simply too expensive for individuals like me" than trying to connect it to some grave threat to your personal autonomy and the stability of the republic.

The loss of personal freedom and control of my own situation is a large part of my issues with the ACA, who are you to say that my complaints are illegitimate?
Title: Re: What comes after the ACA?
Post by: sol on January 10, 2017, 02:46:14 PM
One size fits all programs don't ever fit all.  I'm a fine example of that.

Why do they need to fit everyone perfectly?  The US government provided a ton of services to everyone, regardless of their individual needs.  In the past few posts you've heard about unemployment insurance, disability insurance, and national defense, all of which are provided to every American regardless of their individual need.  We could also talk about the CDC, which you don't need unless you have an infectious disease, or the EPA, which you don't need unless you are drinking contaminated water.

But you do!  You need all of those services, whether you realize it or not.  You benefit from the army, you benefit from disease control and clean water and from disability insurance, even if you're not currently consuming them, because they benefit everyone and make America stronger.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 10, 2017, 02:47:37 PM

Seriously, Quidnon, government policy is pretty much how we make decisions about things that affect all of us. Participate or don't, but acting like you're somehow not in a society is just obnoxious. If everyone else was a unicorn of personal responsibility like you, then we would live in a free market utopia where nothing bad ever happens.


Your health decisions should not affect me, nor should mine affect you.  This is not a business of the federal government.  Maybe of the state, but not the federal.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 02:48:49 PM
This whole argument is stupid, Q.  Congress has decided to provide these services to every American worker whether they think they need them or not.  They protect workers from catastrophic wipeout and they protect private insurer from adverse risk pools.  They are good for the country.  So is widely available affordable health insurance.

Only in the case of the ACA, congress didn't decide it as a governing body with consent of both sides, the democrats did it all by themselves as if it were a dictatorship.... In the same way that it is now going to be undone.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 02:50:08 PM
The loss of personal freedom and control of my own situation is a large part of my issues with the ACA, who are you to say that my complaints are illegitimate?
+1 and...

Your health decisions should not affect me, nor should mine affect you.  This is not a business of the federal government.  Maybe of the state, but not the federal.
+1
Title: Re: What comes after the ACA?
Post by: bacchi on January 10, 2017, 02:52:54 PM
This whole argument is stupid, Q.  Congress has decided to provide these services to every American worker whether they think they need them or not.  They protect workers from catastrophic wipeout and they protect private insurer from adverse risk pools.  They are good for the country.  So is widely available affordable health insurance.

Only in the case of the ACA, congress didn't decide it as a governing body with consent of both sides, the democrats did it all by themselves as if it were a dictatorship.... In the same way that it is now going to be undone.

For fuck's sake, a majority vote in a democratically elected Congress and signed by a democratically elected President is not a "dictatorship."

http://www.dictionary.com/browse/dictatorship
Title: Re: What comes after the ACA?
Post by: Knaak on January 10, 2017, 02:56:05 PM
I live in the Midwest and am confident that I don't need protection from the Russians or from ISIS.  Quidnon: what is your argument for why I should be paying for your protection?   
That is one of the actual legitimate roles of a government is to provide defense of its citizens.

To provide the defense of what for its citizens?  You mean, like, their health?

We can create the Department of Health Defense.  The department will provide citizens a defense against domestic (hereditary) and foreign diseases.  Just like the DoD, the DoHD can go on the offensive and provide preventative measures for its citizens.  We can even keep insurance companies (like sol mentioned earlier) and call them defense contractors.  We all know Republicans love giving taxpayer dollars to defense contractors, so the department will be well-funded.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 03:03:28 PM
We can create the Department of Health Defense.  The department will provide citizens a defense against domestic (hereditary) and foreign diseases.  Just like the DoD, the DoHD can go on the offensive and provide preventative measures for its citizens.  We can even keep insurance companies (like sol mentioned earlier) and call them defense contractors.  We all know Republicans love giving taxpayer dollars to defense contractors, so the department will be well-funded.

Lol that's funny : )
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 03:04:15 PM
For fuck's sake, a majority vote in a democratically elected Congress and signed by a democratically elected President is not a "dictatorship."

http://www.dictionary.com/browse/dictatorship

Yes I know it wasn't the correct word exactly, but you cant argue the whole thing wasn't a one side decision.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 10, 2017, 03:06:16 PM
For everyone else I suppose the answer would be "as high as your effective tax rate" which could be just about anything.  But it would be mixed in with everything else the government buys with your tax dollars.  No one asks "what percentage of my income does national defense cost" because our national defense is paid for out of our collective taxes, and there's no way to track where your specific tax dollars go after you pay taxes.  At best, we can say something like "16% of federal tax revenue is spent on national defense" and then you can multiply your individual tax burden by 16%.

This is a key point. Of course the "taxes are theft" folks will still disagree on principle, but their principles are based on an ignorance of historical context, understanding of how the economy works, and/or empathy for others, so I'm not sure their opinions are particularly relevant.

Do you not proof read your posts first?  Or do you just not care how offensive you sound to those whose opinions you do not share?

Well, this is a fair objection, in some respects. I don't pretend to be tactful. The thing is that this is far from the first forum in which i have fought this particular fight. And it gets old. I'm sure those favoring your worldview feel the same
It certainly does.
Quote
So to repeat myself yet again, the short version here is that the opportunity (which is unprecedented in human history) to be collectively able to have this conversation, is based in the history of the society in which we reside, which was built upon taxation of the resident populous.
This is not true.  Direct income taxes didn't start till 1914, and were widely regarded as theft by fiat before that.  This means that for the first half of the Industrial Revolution, the United States did not have any universal income tax system.  Your perspective on the value of taxation to support your preferred government policy is based upon a false premise, that governments solve social problems better than individuals or the free market is able to do so, and thus the imposition of the taxes necessary to support those programs are practical and legitimate.  I disagree.  So do many others, including Historians Thaddeus Russel & Tom Woods, and Economists Bob Murphy, Walter Williams and Walter Block.  These are the people that I listen to and trust, and you have to address their complaints as well as my own, in order to win me to your side.
Title: Re: What comes after the ACA?
Post by: Gin1984 on January 10, 2017, 03:09:31 PM
For fuck's sake, a majority vote in a democratically elected Congress and signed by a democratically elected President is not a "dictatorship."

http://www.dictionary.com/browse/dictatorship

Yes I know it wasn't the correct word exactly, but you cant argue the whole thing wasn't a one side decision.
Actually you can.  Because ACA is very much a compromise.  ACA is Romneycare expanded and was designed almost entirely by the heritage foundation.  The liberal way would have been single payer.   
Title: Re: What comes after the ACA?
Post by: sol on January 10, 2017, 03:09:50 PM
These are the people that I listen to and trust, and you have to address their complaints as well as my own, in order to win me to your side.

Fortunately for all of us, Congress doesn't have to operate by unanimous consent.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 03:14:59 PM
Actually you can.  Because ACA is very much a compromise.  ACA is Romneycare expanded and was designed almost entirely by the heritage foundation.  The liberal way would have been single payer.   
If were a compromise, then why did all 178 republicans and 34 democrats in congress vote against the bill?
Title: Re: What comes after the ACA?
Post by: rpr on January 10, 2017, 03:19:25 PM
For fuck's sake, a majority vote in a democratically elected Congress and signed by a democratically elected President is not a "dictatorship."

http://www.dictionary.com/browse/dictatorship

Yes I know it wasn't the correct word exactly, but you cant argue the whole thing wasn't a one side decision.

Obama and other democrats foolishly bent over backwards to  try and reach some compromise. But when you had the republicans deciding they would oppose anything Obama did on principle, there was no room.  At that time, one of their leaders was reputed to have said that they would do anything to make Obama a one term president.

FWIW, the Obamacare plan was based on Romneycare which was similar to the plan put forth by a conservative think tank. The republicans blindly opposed it because Obama. If the democrats really wanted no compromise, they would have gone for a single payer system.

The fact that they are trying to repeal it without providing any replacements must tell you something about their hatred. This is not based on any fundamental principles.  They have had the past 6+ years to come up with an alternate plan.

Number of Obamacare repeal votes in Congress -- 60
Number of Obamacare replacement votes in Congress -- ZERO.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 10, 2017, 03:20:29 PM

Seriously, Quidnon, government policy is pretty much how we make decisions about things that affect all of us. Participate or don't, but acting like you're somehow not in a society is just obnoxious. If everyone else was a unicorn of personal responsibility like you, then we would live in a free market utopia where nothing bad ever happens.


Your health decisions should not affect me, nor should mine affect you.  This is not a business of the federal government.  Maybe of the state, but not the federal.

So you have no problem if a bureaucrat with the state government knows the intimate details of your health?  Why?

Oh, I would & do.  But at least I have someone closer to my own situation to complain to.  It's no secret that politicos in Washington DC are too far removed from the people they officially represent, and that this leads to problems.  Additionally, my state officials are much more likely to share my own culture, upbringing and values; and are thus more likely to craft a state solution that is less objectionable to the citizens of the state than the federal version, which is almost guaranteed to upset a large portion of most of the states, which is exactly what happened.  It has been noted before that the ACA was modeled on a similar state program for Massachusetts, and that it worked well enough for them.  They can have it back, but if I lived in Massachusetts, I'd seriously consider moving, particularly after I retire.  To a warm state, with no state income taxes, and no or lower public health care requirements on what I must do or have.  Health care reform is a perfect example of the "many state experiments" in governance that was mentioned in the Federalist Papers (yes, many but not all of which I have read.  Have you?).  Let the people vote with their feet, as they already do.  The broken states lose both their economic base and their working age populations, as Illinois is currently doing; and high tax states lose their accumulated capital base, as they run off the retired population for more income friendly states, as California has been losing to Texas for years.   Yes, this sets up a "death spiral" of sorts that the loser states must address, or risk economic destruction.  But that is how it is supposed to work,  Illinois should already be making changes to make the state more attractive to those who are fleeing, or do something different to attract another crowd.
Title: Re: What comes after the ACA?
Post by: sol on January 10, 2017, 03:23:46 PM
Actually you can.  Because ACA is very much a compromise.  ACA is Romneycare expanded and was designed almost entirely by the heritage foundation.  The liberal way would have been single payer.   
If were a compromise, then why did all 178 republicans and 34 democrats in congress vote against the bill?

It was a compromise by a supermajority of elected representatives, regardless of their party affiliation.  It's not all about party.

If the KKK party was 100% opposed to the ACA, would you claim it was passed by dictatorship because their negligible minority in congress didn't get on board?  I wouldn't, fringe groups don't get to dictate policy.  Policy is set by the elected majority, following congressional rules, which is how we got the ACA and how we're going to lose it, with equal validity.

Elections have consequences.  America gets what it votes for (in congress, not so much in the president).
Title: Re: What comes after the ACA?
Post by: rpr on January 10, 2017, 03:29:59 PM

Elections have consequences.  America gets what it votes for (in congress, not so much in the president).

+1. Agree. People get the government they deserve.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 10, 2017, 03:31:13 PM
These are the people that I listen to and trust, and you have to address their complaints as well as my own, in order to win me to your side.

Fortunately for all of us, Congress doesn't have to operate by unanimous consent.

I wasn't talking about congress, but since you brought it up.  Congress, by design, is intended to represent the general will of the people.  Unlike the President, there is no electoral college to skew the outcomes (although there is gerry-mandering), so the make up of the US  congress, and overall the make up of the many state legislatures, should largely reflect the actual make up of the people.  You said in another time & thread that you thought that liberalism was losing the ideological fight.  Looking at the current make up of state legislatures and congress, I'd say that liberalism has already lost.  It's the forth quarter of the game, your team is down by 20 points, and your senior bench is either exhausted or already quit and left for the showers.  The ACA was unpopular with middle class Americans before, during and after it's time in congress; and was passed by using a parliamentary trick (that the Republicans are now using against the Democrats, with all irony intended I think) that didn't require any bi-partisan support, because they knew that they didn't have it.  For one moment in time, the Republicans were listening to their constituents.  Hopefully they are doing it again.
Title: Re: What comes after the ACA?
Post by: OurTown on January 10, 2017, 03:31:54 PM

Elections have consequences.  America gets what it votes for (in congress, not so much in the president).

+1. Agree. People get the government they deserve.

And they deserve the shit policies they are about to get.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 03:34:12 PM
Obama and other democrats foolishly bent over backwards to  try and reach some compromise. But when you had the republicans deciding they would oppose anything Obama did on principle, there was no room.  At that time, one of their leaders was reputed to have said that they would do anything to make Obama a one term president.

FWIW, the Obamacare plan was based on Romneycare which was similar to the plan put forth by a conservative think tank. The republicans blindly opposed it because Obama. If the democrats really wanted no compromise, they would have gone for a single payer system.

The fact that they are trying to repeal it without providing any replacements must tell you something about their hatred. This is not based on any fundamental principles.  They have had the past 6+ years to come up with an alternate plan.

Number of Obamacare repeal votes in Congress -- 60
Number of Obamacare replacement votes in Congress -- ZERO.
Well, I'm glad you feel that it is ok for a party to do whatever they please when they are in power without the consent of the other, because its about to happen again. The democrats really opened a pandoras box by doing what they did, you can keep thinking it was all a plot to discredit Obama, but I think we both know you would never get all republicans and 34 democrats to vote just for that purpose.... That's a pretty ridiculous argument.
Title: Re: What comes after the ACA?
Post by: rpr on January 10, 2017, 03:36:08 PM
Additionally, my state officials are much more likely to share my own culture, upbringing and values;  ...

Code for we don't like them liberal Coastal types :)
Title: Re: What comes after the ACA?
Post by: GuitarStv on January 10, 2017, 03:43:39 PM
We can create the Department of Health Defense.  The department will provide citizens a defense against domestic (hereditary) and foreign diseases.  Just like the DoD, the DoHD can go on the offensive and provide preventative measures for its citizens.  We can even keep insurance companies (like sol mentioned earlier) and call them defense contractors.  We all know Republicans love giving taxpayer dollars to defense contractors, so the department will be well-funded.

Lol that's funny : )

Would the DoHD be allowed to carry out drone immunization strikes against those who don't vaccinate?
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 03:45:15 PM
It was a compromise by a supermajorityof elected representatives, regardless of their party affiliation.  It's not all about party.
No it wasn't, a super majority is a 2/3 vote... It's final vote barely passed with a simple majority.

 
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 10, 2017, 03:46:34 PM
Additionally, my state officials are much more likely to share my own culture, upbringing and values;  ...

Code for we don't like them liberal Coastal types :)

Not code at all.  I'll say it outright, I've lived on the left coast, and the only thing I liked about it was the weather.  The cost of living was too high, and the taxes were a good portion of that; and the people are ignorant and self-absorbed.  And often rich enough that they suffer no noticeable consequences of their ignorance or attitude.  I have never lived on the East Coast, but I have a brother who lived in NYC for a time, and all he ever had to say about it was "Central Park was nice, but the rest of the city stank".  I'm pretty sure he intended that statement literally.  I have also lived in Chicago, didn't care for that city either.  I loved South Haven in Michigan, and would still consider retiring to that area, as I do love the lakes; but I would stay the hell away from Chicago and Detroit.  Maybe visit Chicago if I had business there, but not Detroit.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 03:51:34 PM
Code for we don't like them liberal Coastal types :)
Not when you pretend to think you know how to run other peoples lives better than they do through force with federal gov.....

Not really a coastal thing.... I really like some parts.
Title: Re: What comes after the ACA?
Post by: rpr on January 10, 2017, 03:52:50 PM

I wasn't talking about congress, but since you brought it up.  Congress, by design, is intended to represent the general will of the people.  Unlike the President, there is no electoral college to skew the outcomes (although there is gerry-mandering), so the make up of the US  congress, and overall the make up of the many state legislatures, should largely reflect the actual make up of the people.  You said in another time & thread that you thought that liberalism was losing the ideological fight.  Looking at the current make up of state legislatures and congress, I'd say that liberalism has already lost.  It's the forth quarter of the game, your team is down by 20 points, and your senior bench is either exhausted or already quit and left for the showers.  The ACA was unpopular with middle class Americans before, during and after it's time in congress; and was passed by using a parliamentary trick (that the Republicans are now using against the Democrats, with all irony intended I think) that didn't require any bi-partisan support, because they knew that they didn't have it.  For one moment in time, the Republicans were listening to their constituents.  Hopefully they are doing it again.

This is something that I do agree with you. Liberalism is certainly on the defensive. There has been a rightward tilt not just in this country but in the whole world. People everywhere are become more insular with more hatred towards outsiders. 
Title: Re: What comes after the ACA?
Post by: rpr on January 10, 2017, 03:54:02 PM
Code for we don't like them liberal Coastal types :)
Not when you pretend to think you know how to run other peoples lives better than they do through force with federal gov.....
And the republicans don't butt into how people should live their lives.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 10, 2017, 04:00:12 PM

I wasn't talking about congress, but since you brought it up.  Congress, by design, is intended to represent the general will of the people.  Unlike the President, there is no electoral college to skew the outcomes (although there is gerry-mandering), so the make up of the US  congress, and overall the make up of the many state legislatures, should largely reflect the actual make up of the people.  You said in another time & thread that you thought that liberalism was losing the ideological fight.  Looking at the current make up of state legislatures and congress, I'd say that liberalism has already lost.  It's the forth quarter of the game, your team is down by 20 points, and your senior bench is either exhausted or already quit and left for the showers.  The ACA was unpopular with middle class Americans before, during and after it's time in congress; and was passed by using a parliamentary trick (that the Republicans are now using against the Democrats, with all irony intended I think) that didn't require any bi-partisan support, because they knew that they didn't have it.  For one moment in time, the Republicans were listening to their constituents.  Hopefully they are doing it again.

This is something that I do agree with you. Liberalism is certainly on the defensive. There has been a rightward tilt not just in this country but in the whole world. People everywhere are become more insular with more hatred towards outsiders.

People have become more nationalistic, but you have no evidence to support the idea that they have become likely to "hate" on anyone.  There are enough economic or nationalistic reasons to oppose refugee immigration in Europe, for example, that resorting to accusations of hatred of any sort are unjustified. 

And the very fact that you were willing to write this statement displays your own prejudices against the motives of those who don't think like you do. 
Title: Re: What comes after the ACA?
Post by: rpr on January 10, 2017, 04:02:28 PM

People have become more nationalistic, but you have no evidence to support the idea that they have become likely to "hate" on anyone.  There are enough economic or nationalistic reasons to oppose refugee immigration in Europe, for example, that resorting to accusations of hatred of any sort are unjustified. 

And the very fact that you were willing to write this statement displays your own prejudices against the motives of those who don't think like you do.

And I imagined all of the Islamophobia coming from the Trump rallies.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 04:04:02 PM
This is something that I do agree with you. Liberalism is certainly on the defensive. There has been a rightward tilt not just in this country but in the whole world. People everywhere are become more insular with more hatred towards outsiders. 
I don't think it is towards all outsiders so much as it is the outsiders trying to change the way of life people are happy with.
Title: Re: What comes after the ACA?
Post by: sol on January 10, 2017, 04:05:11 PM
Code for we don't like them liberal Coastal types :)
Not when you pretend to think you know how to run other peoples lives better than they do through force with federal gov.....
And the republicans don't butt into how people should live their lives.

Unless you're a woman of reproductive age, then they literally penetrate your nethers by force.  Mitch McConnell will give you a transvaginal ultrasound and there's nothing you can do about it.

Or gay.  Or Muslim.  Or an immigrant.  Or gender non conforming.  In any of these cases, the republicans REALLY want to butt into your business.  But hey, at least they won't fine you if you use healthcare and try to avoid paying for it.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 10, 2017, 04:05:21 PM

People have become more nationalistic, but you have no evidence to support the idea that they have become likely to "hate" on anyone.  There are enough economic or nationalistic reasons to oppose refugee immigration in Europe, for example, that resorting to accusations of hatred of any sort are unjustified. 

And the very fact that you were willing to write this statement displays your own prejudices against the motives of those who don't think like you do.

And I imagined all of the Islamophobia coming from the Trump rallies.

Maybe not all of it, but definitely the majority of it.  Or perhaps more accurately, you didn't imagine it, but it was concocted by the media in opposition.  I have seen more than a few examples of racism portrayed on the media at a Trump rally turn out to be a Clinton supporter in character deliberately smearing the image of the people who turn out to the rally by seeking out the news media and portraying the most extreme stereotype that they could get away with.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 04:11:06 PM
And the republicans don't butt into how people should live their lives.
I would hope not, can you give an example?
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 04:14:03 PM
Or gay.  Or Muslim.  Or an immigrant.  Or gender non conforming.  In any of these cases, the republicans REALLY want to butt into your business.  But hey, at least they won't fine you if you use healthcare and try to avoid paying for it.

I'm sorry but can you point to a piece of legislation that specifically targets or denigrates any of those groups?

As far as I know, every person has the right, when they are born to the same freedoms in this country(assuming they are a US citizen).
Title: Re: What comes after the ACA?
Post by: sol on January 10, 2017, 04:21:11 PM
Or gay.  Or Muslim.  Or an immigrant.  Or gender non conforming.  In any of these cases, the republicans REALLY want to butt into your business.  But hey, at least they won't fine you if you use healthcare and try to avoid paying for it.

I'm sorry but can you point to a piece of legislation that specifically targets or denigrates any of those groups?

As far as I know, every person has the right, when they are born to the same freedoms in this country(assuming they are a US citizen).

Are you going to be one of those people that tells me segregated black and white drinking fountains aren't discriminatory because the "no coloreds" law applied to everyone equally?
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 04:26:26 PM
Or gay.  Or Muslim.  Or an immigrant.  Or gender non conforming.  In any of these cases, the republicans REALLY want to butt into your business.  But hey, at least they won't fine you if you use healthcare and try to avoid paying for it.

I'm sorry but can you point to a piece of legislation that specifically targets or denigrates any of those groups?

As far as I know, every person has the right, when they are born to the same freedoms in this country(assuming they are a US citizen).

Are you going to be one of those people that tells me segregated black and white drinking fountains aren't discriminatory because the "no coloreds" law applied to everyone equally?
Good example of what was an actual plight of a group and discrimination. Are there any current laws along those lines aimed at any of the minority groups you mentioned?
Title: Re: What comes after the ACA?
Post by: sol on January 10, 2017, 04:37:48 PM
Good example of what was an actual plight of a group and discrimination. Are there any current laws along those lines aimed at any of the minority groups you mentioned?

Forced transvaginal ultrasounds are just as discriminatory against women as segregated drinking fountains were against blacks.  I fear you're about to claim "men would also have to get transvaginal ultrasounds if they got pregnant and needed an abortion."  Before you do, please consider whether you think a discriminatory law (like no coloreds) is acceptable if applied to "everyone" while only possibly impacting the targeted group.
Title: Re: What comes after the ACA?
Post by: protostache on January 10, 2017, 04:52:56 PM
Or gay.  Or Muslim.  Or an immigrant.  Or gender non conforming.  In any of these cases, the republicans REALLY want to butt into your business.  But hey, at least they won't fine you if you use healthcare and try to avoid paying for it.

I'm sorry but can you point to a piece of legislation that specifically targets or denigrates any of those groups?

As far as I know, every person has the right, when they are born to the same freedoms in this country(assuming they are a US citizen).

Are you going to be one of those people that tells me segregated black and white drinking fountains aren't discriminatory because the "no coloreds" law applied to everyone equally?
Good example of what was an actual plight of a group and discrimination. Are there any current laws along those lines aimed at any of the minority groups you mentioned?

North Carolina famously passed HB2 last year which restricts people to using the bathroom corresponding to the gender on their birth certificate in government buildings. The effect of this bill is that non-gender-conforming people can't go to the DMV, they can't go to a courthouse, and they can't go to public school. Texas is in the process of passing a similar bill right now. A large number of states have passed discriminatory voter ID laws in the past few years that specifically target black and latino populations. Several states have the transvaginal unltrasound (a completely unnecessary painful procedure where the doctor rams a prod the size of a cucumber up the woman's vagainal canal) requirement that sol mentioned before women can pay out of pocket for their own damn abortion. In the past week or two Obama dismantled a Bush II era program for tracking Muslims. Indiana, home of our Vice President elect, has a "religious freedom" law that allows public businesses to not serve LGBTQ folks based solely on their gender or sexual identity.

Open your eyes and look around at what these communities are saying is happening to them and you'll see these and many other examples of rights being stripped from people who aren't white, male, cisgendered and heterosexual.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 10, 2017, 04:55:19 PM
Forced transvaginal ultrasounds are just as discriminatory against women as segregated drinking fountains were against blacks.  I fear you're about to claim "men would also have to get transvaginal ultrasounds if they got pregnant and needed an abortion."  Before you do, please consider whether you think a discriminatory law (like no coloreds) is acceptable if applied to "everyone" while only possibly impacting the targeted group.
On that I'm not sure where I fall, on one hand you have an innocent life that has already been created and is possibly going to be killed, and on the other you have a person that due to whatever circumstances may not be able to deal with or provide for that human life, or possibly was impregnated under force.... That is truly a personal decision and what I think or feel is not important for that woman. I don't think there should be the requirement, but if someone came to me and asked, I would advise them to do the ultra sound.

The intent of that law is to give that life that has been created its best chance at survival. I get the intent, but I don't agree with the law... So I guess you got me on that one.
Title: Re: What comes after the ACA?
Post by: protostache on January 10, 2017, 05:00:55 PM
Forced transvaginal ultrasounds are just as discriminatory against women as segregated drinking fountains were against blacks.  I fear you're about to claim "men would also have to get transvaginal ultrasounds if they got pregnant and needed an abortion."  Before you do, please consider whether you think a discriminatory law (like no coloreds) is acceptable if applied to "everyone" while only possibly impacting the targeted group.
On that I'm not sure where I fall, on one hand you have an innocent life that has already been created and is possibly going to be killed, and on the other you have a person that due to whatever circumstances may not be able to deal with or provide for that human life, or possibly was impregnated under force.... That is truly a personal decision and what I think or feel is not important for that woman. I don't think there should be the requirement, but if someone came to me and asked, I would advise them to do the ultra sound.

The intent of that law is to give that life that has been created its best chance at survival. I get the intent, but I don't agree with the law... So I guess you got me on that one.

You're wrong. The intent of the bill is to force doctors to shame and intimidate women out of having a legal medical procedure. Full stop.
Title: Re: What comes after the ACA?
Post by: sol on January 10, 2017, 05:06:56 PM
if someone came to me and asked, I would advise them to do the ultra sound.

What you or I would advise for that person isn't necessarily the same as what you or I want our government to enforce by law.  I would advise you to quit smoking and exercise more, but I don't want congress to make a law about it.

Same deal on bathroom bills, Muslim registries, immigration parole, and all of the others already mentioned here.  What I think about it isn't the same as what I want congress to pass laws about.  Nobody's opinion on these issues needs to be enforced by new federal regulation.

Damn republicans always getting up in peoples business.
Title: Re: What comes after the ACA?
Post by: Gin1984 on January 10, 2017, 05:10:03 PM
Forced transvaginal ultrasounds are just as discriminatory against women as segregated drinking fountains were against blacks.  I fear you're about to claim "men would also have to get transvaginal ultrasounds if they got pregnant and needed an abortion."  Before you do, please consider whether you think a discriminatory law (like no coloreds) is acceptable if applied to "everyone" while only possibly impacting the targeted group.
On that I'm not sure where I fall, on one hand you have an innocent life that has already been created and is possibly going to be killed, and on the other you have a person that due to whatever circumstances may not be able to deal with or provide for that human life, or possibly was impregnated under force.... That is truly a personal decision and what I think or feel is not important for that woman. I don't think there should be the requirement, but if someone came to me and asked, I would advise them to do the ultra sound.

The intent of that law is to give that life that has been created its best chance at survival. I get the intent, but I don't agree with the law... So I guess you got me on that one.
There is no evidence that assaulting a woman with a transvaginal ultrasound wand decreases abortion.  Would you like something forced in your anus against your wishes so that you can have a necessary, legal medical procedure? 

Sent from my SPH-L710 using Tapatalk

Title: Re: What comes after the ACA?
Post by: rpr on January 10, 2017, 06:03:28 PM
The Repeal and Replace drama has just begun in Washington. In this episode

-- According to the President elect, it should happen next week.
-- A republican senator says that we shouldn't take the President elect literally (really?)
-- As usual, the Senate Majority leader weasels out of answering any questions
-- Five republican senators want the deadline extended to March
-- Speaker Ryan says it will only happen in the coming months

Stay tuned for  the next episode. It may happen as early as 3 AM eastern if a tweet arrives. ;)
Title: Re: What comes after the ACA?
Post by: radram on January 10, 2017, 06:49:41 PM
Access to health care is a basic human right.
I don't think all the people in power in this country believe this statement.

I don't believe this statement.  One of the fundamental ideas of a "basic human right" is that they are ancient, as in recognized as true (by some group, not everyone) for as long as humanity can record.  Another fundamental idea of a "basic human right" is that other people don't have to do anything, but instead are morally bound not to prevent the human in question from doing something for themselves.  For example, I have a basic human right to life, and no one has a right to take my life away from me; where a "right" to healthcare would require someone else provide that service to me.

So no, you don't have a right to healthcare.

Completely agree. It is not a RIGHT.

I do feel that there is SOMETHING there, but I can not describe it. Maybe moral obligation, but that does not sound right either. All I know is that if I see someone in distress, it just feels right to try to help. I feel better when I do, and sometimes feel like shit when I don't.


So help.  I can show you a dozen different ways that you can, personally, help others in need.  Some with an accompanying tax deduction, and some completely anonymously.  And I agree with the moral obligation to help, as that is literally written into the Christian teachings.  But I don't agree that a non-Christian is bound by that moral obligation, I don't believe that a taxpayer funded program satisfies that obligation, and I don't believe that there is only one way to do anything in a nation of over 300 million people.

Quote

It feels to me that the ability to sustain and maintain a basic level of health services for all people in the US should be possible,


Oh, it's certainly possible, depending upon the concept of "basic level of health services".  But it's not the place of the federal government to do this kind of thing, either for the states or instead of them.  And if it were, it would never work.  One size fits all programs don't ever fit all.  I'm a fine example of that.

But I AM a non-christian.
And what do you mean it would never work. We are the LAST advanced nation to fail at this.
Title: Re: What comes after the ACA?
Post by: sol on January 10, 2017, 07:49:05 PM
It was a compromise by a supermajorityof elected representatives, regardless of their party affiliation.  It's not all about party.
No it wasn't, a super majority is a 2/3 vote... It's final vote barely passed with a simple majority.

You are mistaken, twice.

The ACA was passed by a vote of 60 to 39.  The 60 vote threshhold is the filibuster-proof supermajority the Senate rules require, and is definitely NOT "barely a simple majority."  It's 3/5, which is what the Senate defines as a supermajority.  It was then passed by the House with 257 out of 435 reps.  Which is technically just shy of a supermajority, at 59.1% but is still definitely NOT "barely a simple majority".

I guess you're free to define the word "supermajority" to mean something different, but unless the Senate agrees with you your opinion will still be wrong.

I should also point out, for the people who like to claim that the ACA was passed without any Republican support, that the 60th vote came from a Republican (Arlen Specter, R-PA) who switched his party affiliation just for this reason.
Title: Re: What comes after the ACA?
Post by: jim555 on January 10, 2017, 07:58:24 PM
The Repeal and Replace drama has just begun in Washington. In this episode

-- According to the President elect, it should happen next week.
-- A republican senator says that we shouldn't take the President elect literally (really?)
-- As usual, the Senate Majority leader weasels out of answering any questions
-- Five republican senators want the deadline extended to March
-- Speaker Ryan says it will only happen in the coming months

Stay tuned for  the next episode. It may happen as early as 3 AM eastern if a tweet arrives. ;)
Since I am using the ACA I think it really sucks the way they are leaving everyone up in the air.  I don't know if I will even be able to get any insurance at all (pre-existing conditions) once this all settles out.  They should have had their new plan thought out and ready to go.  Millions are being hung out to worry by these a-holes.
Title: Re: What comes after the ACA?
Post by: rpr on January 10, 2017, 08:11:25 PM
All these current republicans who complain about the individual mandate should know that it was first proposed by The Heritage Foundation which is a conservative think tank. Furthermore, it had lots of support from prominent republicans including Bob Dole, Lincoln Chafee. Heck, even Orrin Hatch supported it.

I don't get the Dems. They move towards accepting some conservative ideas and suddenly the goalposts are moved. What's the point? Obama does share some of the blame as well.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 10, 2017, 08:14:09 PM


But I AM a non-christian.


So you shouldn't be compelled to support Christians either.

Quote
And what do you mean it would never work. We are the LAST advanced nation to fail at this.

We are not like other nations, either.  We are a nation of states, literally a nation of nations.  Notice that while European nations all have some form of mixed or single payer system, each one has it's own version.  Many are alike, but they still have differences, and they are administrated by the state or local governments; not the EU.  We have a variety of regional cultures in the US, a national plan will never make enough people in enough states to survive.  And this is the outcome.  The same will be true with anything the Republicans replace it with, if it's not something that is state optional or can be opt-ed out as an individual.
Title: Re: What comes after the ACA?
Post by: sol on January 10, 2017, 08:15:45 PM
Obama does share some of the blame as well.

I think Obama may be the one Democrat who bears the least responsibility.  He didn't write the law.  He didn't sponsor the legislation, he didn't even campaign on it.  He had almost nothing to do with the creation of the law that now informally bears his name, other than that he didn't veto it once Congress had passed it.
Title: Re: What comes after the ACA?
Post by: Paul der Krake on January 10, 2017, 08:31:35 PM
We are not like other nations, either.  We are a nation of states, literally a nation of nations.  Notice that while European nations all have some form of mixed or single payer system, each one has it's own version.  Many are alike, but they still have differences, and they are administrated by the state or local governments; not the EU.  We have a variety of regional cultures in the US, a national plan will never make enough people in enough states to survive.  And this is the outcome.  The same will be true with anything the Republicans replace it with, if it's not something that is state optional or can be opt-ed out as an individual.
The EU is a supranational construct. The United States is one nation. Comparing the two is silly.

The US has some regional differences, but by and large quite uniform. People speak the same language, watch the same TV shows, learn roughly the same things in school, buy things from the same national corporations, and consume health services the same way (extremely poorly). Your average Floridian is immensely closer to your average South Dakotan or Alaskan than a Frenchman to a Spaniard or a Greek.

State differences are vastly overrated.
Title: Re: What comes after the ACA?
Post by: rpr on January 10, 2017, 08:36:02 PM
Obama does share some of the blame as well.

I think Obama may be the one Democrat who bears the least responsibility.  He didn't write the law.  He didn't sponsor the legislation, he didn't even campaign on it.  He had almost nothing to do with the creation of the law that now informally bears his name, other than that he didn't veto it once Congress had passed it.

Sol -- I don't think that is true. There were lots of back and forth between Rahm Emmanuel and Nancy Pelosi.
Title: Re: What comes after the ACA?
Post by: badassprof on January 10, 2017, 09:18:03 PM

Elections have consequences.  America gets what it votes for (in congress, not so much in the president).

+1. Agree. People get the government they deserve.

Unless, of course, we're talking about the jerry-rigged congress. Not much that can be done to change the makeup of congress  in at least the next 10 years. See David Daley's _Rat F**ked_ for more on that subject.
Title: Re: What comes after the ACA?
Post by: sol on January 10, 2017, 09:29:43 PM
Obama does share some of the blame as well.

I think Obama may be the one Democrat who bears the least responsibility.  He didn't write the law.  He didn't sponsor the legislation, he didn't even campaign on it.  He had almost nothing to do with the creation of the law that now informally bears his name, other than that he didn't veto it once Congress had passed it.

Sol -- I don't think that is true. There were lots of back and forth between Rahm Emmanuel and Nancy Pelosi.

Are either of those people named Barack Obama? 
Title: Re: What comes after the ACA?
Post by: Metric Mouse on January 10, 2017, 09:48:44 PM
All these current republicans who complain about the individual mandate should know that it was first proposed by The Heritage Foundation which is a conservative think tank. Furthermore, it had lots of support from prominent republicans including Bob Dole, Lincoln Chafee. Heck, even Orrin Hatch supported it.

I don't get the Dems. They move towards accepting some conservative ideas and suddenly the goalposts are moved. What's the point? Obama does share some of the blame as well.

What does it matter, at this point, anyway? The individual mandate is a terrible idea, and only tacked on because it is the only way to make this untenable system sorta hold together for longer than a moment. Just because conservatives are able to ensure terrible ideas are executed in the best way possible doesn't mean that their terrible ideas should be supported.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 10, 2017, 10:54:09 PM
We are not like other nations, either.  We are a nation of states, literally a nation of nations.  Notice that while European nations all have some form of mixed or single payer system, each one has it's own version.  Many are alike, but they still have differences, and they are administrated by the state or local governments; not the EU.  We have a variety of regional cultures in the US, a national plan will never make enough people in enough states to survive.  And this is the outcome.  The same will be true with anything the Republicans replace it with, if it's not something that is state optional or can be opt-ed out as an individual.
The EU is a supranational construct. The United States is one nation. Comparing the two is silly.
The men who showed up at the first continental congress regarded themselves as representatives of free and independent states, and created the first "supranational construct" in the world, at least the first that didn't come to be by imperial conquest.  You can think of the US as a single nation, but that doesn't make it true.  I've been a member of a manufacturing union for decades, and they like to pretend that we all think and act with a like mind, in solidarity; pretending it is so is still a useful idea sometimes, but that is still not true either.  We still have distinct borders, and up until much more recently than one might imagine, border disputes.  We have, if not unique, independent bodies of law between states; and even distinctions about the colonial foundations of some of that state law.  We are what the EU could be in several generations, if it somehow manages to not break apart first.  We are, in effect, what the EU government, currently seated in Brussels, aspires to be.  It's a pity, really, that they are too European to succeed.

Quote
The US has some regional differences, but by and large quite uniform. People speak the same language, watch the same TV shows, learn roughly the same things in school, buy things from the same national corporations, and consume health services the same way (extremely poorly). Your average Floridian is immensely closer to your average South Dakotan or Alaskan than a Frenchman to a Spaniard or a Greek.

State differences are vastly overrated.

Overrated perhaps, but still there.  And yes, the vast majority of us do speak English and share a common cultural background; and perhaps more importantly, a common legal background.  This is one reason the EU is doomed to failure, no common language and no common legal or cultural background.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 10, 2017, 10:57:02 PM
All these current republicans who complain about the individual mandate should know that it was first proposed by The Heritage Foundation which is a conservative think tank. Furthermore, it had lots of support from prominent republicans including Bob Dole, Lincoln Chafee. Heck, even Orrin Hatch supported it.

There is not a single name in there that I could consider a conservative.  And I think that it's a bit of a stretch to claim that The Heritage Foundation is  actually conservative.  In any case, I wouldn't have liked the idea any better from a Republican, particularly from Romney.  So the source doesn't matter too much to me.
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 11, 2017, 04:59:30 AM
We are not like other nations, either.  We are a nation of states, literally a nation of nations.  Notice that while European nations all have some form of mixed or single payer system, each one has it's own version.  Many are alike, but they still have differences, and they are administrated by the state or local governments; not the EU.  We have a variety of regional cultures in the US, a national plan will never make enough people in enough states to survive.  And this is the outcome.  The same will be true with anything the Republicans replace it with, if it's not something that is state optional or can be opt-ed out as an individual.
The EU is a supranational construct. The United States is one nation. Comparing the two is silly.
The men who showed up at the first continental congress regarded themselves as representatives of free and independent states, and created the first "supranational construct" in the world, at least the first that didn't come to be by imperial conquest.  You can think of the US as a single nation, but that doesn't make it true.  I've been a member of a manufacturing union for decades, and they like to pretend that we all think and act with a like mind, in solidarity; pretending it is so is still a useful idea sometimes, but that is still not true either.  We still have distinct borders, and up until much more recently than one might imagine, border disputes.  We have, if not unique, independent bodies of law between states; and even distinctions about the colonial foundations of some of that state law.  We are what the EU could be in several generations, if it somehow manages to not break apart first.  We are, in effect, what the EU government, currently seated in Brussels, aspires to be.  It's a pity, really, that they are too European to succeed.

Quote
The US has some regional differences, but by and large quite uniform. People speak the same language, watch the same TV shows, learn roughly the same things in school, buy things from the same national corporations, and consume health services the same way (extremely poorly). Your average Floridian is immensely closer to your average South Dakotan or Alaskan than a Frenchman to a Spaniard or a Greek.

State differences are vastly overrated.

Overrated perhaps, but still there.  And yes, the vast majority of us do speak English and share a common cultural background; and perhaps more importantly, a common legal background.  This is one reason the EU is doomed to failure, no common language and no common legal or cultural background.

Quindon - you speak your opinion as if were fact.  Really - it is just your opinion.

The following is my opinion.

Being part of a society has its costs.  We all pay for the public school system whether we use it or not.  We all pay for TSA whether we ever get on a plane or leave a port.  I could go on and on.  We are one nation of individuals.  Every other nation in the world close to our stature provides its citizens with health care.  I get it that you don't want to pay for everyone else to have some minimal healthcare - but personally - I'd rather pay for that then another carrier to protect some other part of the world.  But most of all - I'll support both.   You simply sound mean spirited and selfish - and maybe you are not - but that is how you come across to me.  I highly doubt our forefathers would have rejected the idea of a measure to provide the country's citizens with a simple measure of  wellbeing in the form of minimal health care.

You are not smarter nor wiser than everyone (or maybe anyone) here - no matter how forceful your rhetoric.  I am now to the point where this is my last ever post on MMM regarding the ACA, because I guess our country is so divided at a fundamental level the civil, respectful discourse on the issues of the wellbeing of all of its citizens is now beyond reach. 

I will say what I said in the beginning, whether you believe it or not, i could not get insurance at any cost before the ACA due to an operable and curable condition.  (I know you don't believe this - you've told so many people who conveyed this to you on a number of occasions - but you are just simply wrong.) I want three things. 

1.) I want every citizen in this country of any income level to have access to health care because it is better for all of us if they do and because I am a socially conscious human.
2.) I want to be able to purchase a high deductible health plan.  I don't mind paying my typical annual expenses on my own.  But if I come down with a disease or fall while hiking - I want to be able to get treatment without having to spend our entire NW on it.
3.) I've paid into medicare for over 35 years.  I want it to be around in mostly its present form for me and all of the others that have paid into it.   

Those are three simple things.  And one day, Quidon, when you are not so young, and life has thrown you a curve ball or two, you might see that there is some wisdom in what I am saying.
Title: Re: What comes after the ACA?
Post by: Gin1984 on January 11, 2017, 06:05:55 AM
The Repeal and Replace drama has just begun in Washington. In this episode

-- According to the President elect, it should happen next week.
-- A republican senator says that we shouldn't take the President elect literally (really?)
-- As usual, the Senate Majority leader weasels out of answering any questions
-- Five republican senators want the deadline extended to March
-- Speaker Ryan says it will only happen in the coming months

Stay tuned for  the next episode. It may happen as early as 3 AM eastern if a tweet arrives. ;)
Since I am using the ACA I think it really sucks the way they are leaving everyone up in the air.  I don't know if I will even be able to get any insurance at all (pre-existing conditions) once this all settles out.  They should have had their new plan thought out and ready to go. Millions are being hung out to worry by these a-holes.
They had six years to make a new plan, and nothing.  And the reason for this is the ACA IS their plan, with a few compromises to make it better for the lower/middle classes.  They won't replace it.
Title: Re: What comes after the ACA?
Post by: nereo on January 11, 2017, 06:23:03 AM
The Repeal and Replace drama has just begun in Washington. In this episode

-- According to the President elect, it should happen next week.
-- A republican senator says that we shouldn't take the President elect literally (really?)
-- As usual, the Senate Majority leader weasels out of answering any questions
-- Five republican senators want the deadline extended to March
-- Speaker Ryan says it will only happen in the coming months

Stay tuned for  the next episode. It may happen as early as 3 AM eastern if a tweet arrives. ;)
Since I am using the ACA I think it really sucks the way they are leaving everyone up in the air.  I don't know if I will even be able to get any insurance at all (pre-existing conditions) once this all settles out.  They should have had their new plan thought out and ready to go. Millions are being hung out to worry by these a-holes.

They had six years to make a new plan, and nothing.  And the reason for this is the ACA IS their plan, with a few compromises to make it better for the lower/middle classes.  They won't replace it.

My bet is they'll keep large sections of it, eliminate the mandate and cost-controls, ignore the increased cost (added to the deficit), declare victory and campaign on having finally "destroyed disastrous Obamacare (even though it's major provisions are still basically there, so don't worry!)"
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 11, 2017, 06:26:01 AM
Forced transvaginal ultrasounds are just as discriminatory against women as segregated drinking fountains were against blacks.  I fear you're about to claim "men would also have to get transvaginal ultrasounds if they got pregnant and needed an abortion."  Before you do, please consider whether you think a discriminatory law (like no coloreds) is acceptable if applied to "everyone" while only possibly impacting the targeted group.
On that I'm not sure where I fall, on one hand you have an innocent life that has already been created and is possibly going to be killed, and on the other you have a person that due to whatever circumstances may not be able to deal with or provide for that human life, or possibly was impregnated under force.... That is truly a personal decision and what I think or feel is not important for that woman. I don't think there should be the requirement, but if someone came to me and asked, I would advise them to do the ultra sound.

The intent of that law is to give that life that has been created its best chance at survival. I get the intent, but I don't agree with the law... So I guess you got me on that one.

Thank you for your informed medical opinion.

Whether or not a human person needs any diagnostic or procedure, invasive or otherwise, is between the patient and their doctor. There is absolutely no medical reason to do transvaginal ultrasound on a patient seeking to terminate a pregnancy. Invasive ultrasound isn't risk-free, and doing it unnecessarily violates medical ethics.

Your opinion that life starts at conception is completely irrelevant, medically and scientifically speaking. You don't want your tax dollars paying for abortions? Fine, but don't get in the way of private money paying for them.
Title: Re: What comes after the ACA?
Post by: protostache on January 11, 2017, 06:31:32 AM
The Repeal and Replace drama has just begun in Washington. In this episode

-- According to the President elect, it should happen next week.
-- A republican senator says that we shouldn't take the President elect literally (really?)
-- As usual, the Senate Majority leader weasels out of answering any questions
-- Five republican senators want the deadline extended to March
-- Speaker Ryan says it will only happen in the coming months

Stay tuned for  the next episode. It may happen as early as 3 AM eastern if a tweet arrives. ;)
Since I am using the ACA I think it really sucks the way they are leaving everyone up in the air.  I don't know if I will even be able to get any insurance at all (pre-existing conditions) once this all settles out.  They should have had their new plan thought out and ready to go. Millions are being hung out to worry by these a-holes.

They had six years to make a new plan, and nothing.  And the reason for this is the ACA IS their plan, with a few compromises to make it better for the lower/middle classes.  They won't replace it.

My bet is they'll keep large sections of it, eliminate the mandate and cost-controls, ignore the increased cost (added to the deficit), declare victory and campaign on having finally "destroyed disastrous Obamacare (even though it's major provisions are still basically there, so don't worry!)"

I think (mostly hope) that enough GOP congress members realize that the mandate is vital to preventing a death spiral to prevent it getting repealed. It's the third leg of the tripod. Without it no plan relying on private insurers can stand.
Title: Re: What comes after the ACA?
Post by: Gin1984 on January 11, 2017, 06:33:11 AM
The Repeal and Replace drama has just begun in Washington. In this episode

-- According to the President elect, it should happen next week.
-- A republican senator says that we shouldn't take the President elect literally (really?)
-- As usual, the Senate Majority leader weasels out of answering any questions
-- Five republican senators want the deadline extended to March
-- Speaker Ryan says it will only happen in the coming months

Stay tuned for  the next episode. It may happen as early as 3 AM eastern if a tweet arrives. ;)
Since I am using the ACA I think it really sucks the way they are leaving everyone up in the air.  I don't know if I will even be able to get any insurance at all (pre-existing conditions) once this all settles out.  They should have had their new plan thought out and ready to go. Millions are being hung out to worry by these a-holes.

They had six years to make a new plan, and nothing.  And the reason for this is the ACA IS their plan, with a few compromises to make it better for the lower/middle classes.  They won't replace it.

My bet is they'll keep large sections of it, eliminate the mandate and cost-controls, ignore the increased cost (added to the deficit), declare victory and campaign on having finally "destroyed disastrous Obamacare (even though it's major provisions are still basically there, so don't worry!)"

I think (mostly hope) that enough GOP congress members realize that the mandate is vital to preventing a death spiral to prevent it getting repealed. It's the third leg of the tripod. Without it no plan relying on private insurers can stand.
I think they do.  So if they remove it, they have more evidence on how terrible Obamacare is and then they can repeal without replacing (because again, they have nothing to replace with).
Title: Re: What comes after the ACA?
Post by: golden1 on January 11, 2017, 06:46:12 AM
Quote
My bet is they'll keep large sections of it, eliminate the mandate and cost-controls, ignore the increased cost (added to the deficit), declare victory and campaign on having finally "destroyed disastrous Obamacare (even though it's major provisions are still basically there, so don't worry!)"

Yep, they will rely on Trump to rebrand Obamacare into "Trumpcare".  They will leave it mostly untouched, or do a symbolic repeal and replace just to make their constituency get the warm fuzzies.   Then they will institute something similar and call it a victory.  And people will fall for it. 

The only way universal healthcare will work is if we hold it as a fundamental right and value that we should care for the health of our citizens, but most conservatives only really care about "real Americans" that look and act like them. 




Title: Re: What comes after the ACA?
Post by: coppertop on January 11, 2017, 07:33:26 AM

With insurance you aren't protecting against the routine, but rather the more unlikely extreme events that you otherwise couldn't afford.


Yes!  Yes!  That's it exactly!  And that is my complaint with Obamacare.  It has regulated such a high minimum standard of benefits, in order to be called "health insurance" in any legal context, that I can no longer actually buy real insurance in this field; at least not without also paying a tax penalty for not having official health insurance.  I'm relatively healthy for my age, with no major issues; and I have enough money between my HSA and other funds that I could take quite a hard hit.  But without true catastrophic and/or hospitalization insurance, I cannot be certain that I could absorb any hit that life could throw at me, regardless of the odds that I'll be hit at all.  I should have the right to buy whatever insurance I believe is right for myself, and self-insure to whatever level I am comfortable with financially, without special tax consequences and without being compelled to support the choices of others.

However, I am reminded of a lowly paid employee we used to have here, who claimed he couldn't afford our employer-sponsored health insurance, whose wife had a stroke and since they had no coverage, I had to fill out papers for him to receive medical assistance.  YOU may have the funds to take care of yourself should you have a catastrophic event, but you are not typical.  Most people would not be able to pay for it if they had no insurance and would either go bankrupt or lose their homes and other assets in order to pay the whopping medical bills they were not prepared for. 
Title: Re: What comes after the ACA?
Post by: Gin1984 on January 11, 2017, 07:54:44 AM

With insurance you aren't protecting against the routine, but rather the more unlikely extreme events that you otherwise couldn't afford.


Yes!  Yes!  That's it exactly!  And that is my complaint with Obamacare.  It has regulated such a high minimum standard of benefits, in order to be called "health insurance" in any legal context, that I can no longer actually buy real insurance in this field; at least not without also paying a tax penalty for not having official health insurance.  I'm relatively healthy for my age, with no major issues; and I have enough money between my HSA and other funds that I could take quite a hard hit.  But without true catastrophic and/or hospitalization insurance, I cannot be certain that I could absorb any hit that life could throw at me, regardless of the odds that I'll be hit at all.  I should have the right to buy whatever insurance I believe is right for myself, and self-insure to whatever level I am comfortable with financially, without special tax consequences and without being compelled to support the choices of others.

However, I am reminded of a lowly paid employee we used to have here, who claimed he couldn't afford our employer-sponsored health insurance, whose wife had a stroke and since they had no coverage, I had to fill out papers for him to receive medical assistance.  YOU may have the funds to take care of yourself should you have a catastrophic event, but you are not typical.  Most people would not be able to pay for it if they had no insurance and would either go bankrupt or lose their homes and other assets in order to pay the whopping medical bills they were not prepared for.
I doubt he has it either, my bet is he does not realize the full cost especially if it puts you out of work for a few months.  Because it is not the initial visit, it is the costs of dealing with the long term damage.  My husband had a motorcycle accident (and was insanely lucky).  Beyond the over $30,000 of medical care he got the first night, he was bed ridden for over 6 months.  That is with a lucky accident.  And he was sent home because he did not have insurance.  If I, with my current insurance, had the same accident, I'd be in the hospital for longer.  And likely it would have caught an issue that caused my husband pain and surgery later.  Which overall cost more.
Title: Re: What comes after the ACA?
Post by: nereo on January 11, 2017, 08:01:21 AM
Sorry to hear about your husband, Gin - has he recovered since the accident?
Title: Re: What comes after the ACA?
Post by: Gin1984 on January 11, 2017, 08:06:02 AM
Sorry to hear about your husband, Gin - has he recovered since the accident?
Except for one thing that does require treatment occasionally and will end up with surgery later, yes.  He was insanely lucky.  If the motorcycle had landed an inch and half to the left he would have been paralyzed because his spinal cord would be severed.  And the worse part was that he had insurance weeks prior but aged out of his parent's plan and had not gotten anything else because he thought he'd was young and healthy.  Ironically because he left the hospital early due to no insurance, they missed the secondary issue and because he paid for the treatment out of pocket he was eligible for private insurance at a great rate a couple years after and me, who just locked my trapezius during college could get NOTHING for ANY price.   
Title: Re: What comes after the ACA?
Post by: nereo on January 11, 2017, 08:14:01 AM

With insurance you aren't protecting against the routine, but rather the more unlikely extreme events that you otherwise couldn't afford.


Yes!  Yes!  That's it exactly!  And that is my complaint with Obamacare.  It has regulated such a high minimum standard of benefits, in order to be called "health insurance" in any legal context, that I can no longer actually buy real insurance in this field; at least not without also paying a tax penalty for not having official health insurance.  I'm relatively healthy for my age, with no major issues; and I have enough money between my HSA and other funds that I could take quite a hard hit.  But without true catastrophic and/or hospitalization insurance, I cannot be certain that I could absorb any hit that life could throw at me, regardless of the odds that I'll be hit at all.  I should have the right to buy whatever insurance I believe is right for myself, and self-insure to whatever level I am comfortable with financially, without special tax consequences and without being compelled to support the choices of others.

You've taken my quote out of context, Quidnon?. I was responding to your claim that the median emergency visit was (in 2013) about $1,200 - and therefore a trip to the ER is not a financial doomsday. My point was that you don't insure against the median event, but the extremes.
As an example, take car insurance. I'm certain most accidents are minor fender-benders with no injuries and cosmetic damage.  Yet I carry insurance not to cover these likely events (which I could easily do out of pocket) but for the more rare but exponentially more costly major injury/accidents.  Like with the ACA, car insurance covers a wide range of things including damaging property, emergency transport, salary compensation, etc.  All of these are unlikely to be needed by me individually, but will be used across the pool of people who ride in cars. 

I would not characterize the ACA as having an incredibly high minimum standard of benefits.  It doesn't cover a wide range of things, including dental and vision, and my unofficial survey of people I know indicate that most of them have both teeth and eyes. The requirements are fairly low overall for a population. What you seem to be objecting to is that you as an individual are required to have coverage for things that you are unlikely to use. Laws, however, are concerned with the population at large.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 11, 2017, 08:56:32 AM
Forced transvaginal ultrasounds are just as discriminatory against women as segregated drinking fountains were against blacks.  I fear you're about to claim "men would also have to get transvaginal ultrasounds if they got pregnant and needed an abortion."  Before you do, please consider whether you think a discriminatory law (like no coloreds) is acceptable if applied to "everyone" while only possibly impacting the targeted group.
On that I'm not sure where I fall, on one hand you have an innocent life that has already been created and is possibly going to be killed, and on the other you have a person that due to whatever circumstances may not be able to deal with or provide for that human life, or possibly was impregnated under force.... That is truly a personal decision and what I think or feel is not important for that woman. I don't think there should be the requirement, but if someone came to me and asked, I would advise them to do the ultra sound.

The intent of that law is to give that life that has been created its best chance at survival. I get the intent, but I don't agree with the law... So I guess you got me on that one.

Thank you for your informed medical opinion.

Whether or not a human person needs any diagnostic or procedure, invasive or otherwise, is between the patient and their doctor. There is absolutely no medical reason to do transvaginal ultrasound on a patient seeking to terminate a pregnancy. Invasive ultrasound isn't risk-free, and doing it unnecessarily violates medical ethics.

Your opinion that life starts at conception is completely irrelevant, medically and scientifically speaking. You don't want your tax dollars paying for abortions? Fine, but don't get in the way of private money paying for them.

You obviously passed right over the previous sentence where I stated, That is truly a personal decision and what I think or feel is not important for that woman. I don't think there should be the requirement"....

I don't understand why you and few others feel they need to be so one sided, I'm a person over here(just like you), not some republican hack and I don't agree with everything republicans do. Are their any democrats that can admit this as well?

Title: Re: What comes after the ACA?
Post by: Gin1984 on January 11, 2017, 09:07:23 AM
Forced transvaginal ultrasounds are just as discriminatory against women as segregated drinking fountains were against blacks.  I fear you're about to claim "men would also have to get transvaginal ultrasounds if they got pregnant and needed an abortion."  Before you do, please consider whether you think a discriminatory law (like no coloreds) is acceptable if applied to "everyone" while only possibly impacting the targeted group.
On that I'm not sure where I fall, on one hand you have an innocent life that has already been created and is possibly going to be killed, and on the other you have a person that due to whatever circumstances may not be able to deal with or provide for that human life, or possibly was impregnated under force.... That is truly a personal decision and what I think or feel is not important for that woman. I don't think there should be the requirement, but if someone came to me and asked, I would advise them to do the ultra sound.

The intent of that law is to give that life that has been created its best chance at survival. I get the intent, but I don't agree with the law... So I guess you got me on that one.

Thank you for your informed medical opinion.

Whether or not a human person needs any diagnostic or procedure, invasive or otherwise, is between the patient and their doctor. There is absolutely no medical reason to do transvaginal ultrasound on a patient seeking to terminate a pregnancy. Invasive ultrasound isn't risk-free, and doing it unnecessarily violates medical ethics.

Your opinion that life starts at conception is completely irrelevant, medically and scientifically speaking. You don't want your tax dollars paying for abortions? Fine, but don't get in the way of private money paying for them.

You obviously passed right over the previous sentence where I stated, That is truly a personal decision and what I think or feel is not important for that woman. I don't think there should be the requirement"....

I don't understand why you and few others feel they need to be so one sided, I'm a person over here(just like you), not some republican hack and I don't agree with everything republicans do. Are their any democrats that can admit this as well?
Most if not all democrats do.  See ACA as an example.  Many democrats feel and felt that it did not go far enough and we should have single payer.  I think I'd buy that more if I EVER saw GOP members actually call out their reps.  I don't see that.  I see that in conversations, well I don't agree with X.  But you voted for that as acceptable.  That is still an issue.
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 11, 2017, 09:38:27 AM
Forced transvaginal ultrasounds are just as discriminatory against women as segregated drinking fountains were against blacks.  I fear you're about to claim "men would also have to get transvaginal ultrasounds if they got pregnant and needed an abortion."  Before you do, please consider whether you think a discriminatory law (like no coloreds) is acceptable if applied to "everyone" while only possibly impacting the targeted group.
On that I'm not sure where I fall, on one hand you have an innocent life that has already been created and is possibly going to be killed, and on the other you have a person that due to whatever circumstances may not be able to deal with or provide for that human life, or possibly was impregnated under force.... That is truly a personal decision and what I think or feel is not important for that woman. I don't think there should be the requirement, but if someone came to me and asked, I would advise them to do the ultra sound.

The intent of that law is to give that life that has been created its best chance at survival. I get the intent, but I don't agree with the law... So I guess you got me on that one.

Thank you for your informed medical opinion.

Whether or not a human person needs any diagnostic or procedure, invasive or otherwise, is between the patient and their doctor. There is absolutely no medical reason to do transvaginal ultrasound on a patient seeking to terminate a pregnancy. Invasive ultrasound isn't risk-free, and doing it unnecessarily violates medical ethics.

Your opinion that life starts at conception is completely irrelevant, medically and scientifically speaking. You don't want your tax dollars paying for abortions? Fine, but don't get in the way of private money paying for them.

You obviously passed right over the previous sentence where I stated, That is truly a personal decision and what I think or feel is not important for that woman. I don't think there should be the requirement"....

I don't understand why you and few others feel they need to be so one sided, I'm a person over here(just like you), not some republican hack and I don't agree with everything republicans do. Are their any democrats that can admit this as well?

No I didn't pass over it. Putting a disclaimer at the top, then saying "I think she should get the ultrasound" doesn't absolve you. The ultrasound is a bad idea independent of your abortion opinion. It's like saying, "He clearly has a broken neck, but let's get some CSF to be sure." Just because it's a diagnostic in the general area we're talking about doesn't mean the test is a good idea.

It's an unnecessary procedure, and it's unethical. I'm being one-sided because there's the side with medical ethics and science, and then there's the side advocating (and legislating) unnecessary medical procedures for other human people based on their feelings about a fetus, which is not a human person at this stage of development.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 11, 2017, 02:43:49 PM

With insurance you aren't protecting against the routine, but rather the more unlikely extreme events that you otherwise couldn't afford.


Yes!  Yes!  That's it exactly!  And that is my complaint with Obamacare.  It has regulated such a high minimum standard of benefits, in order to be called "health insurance" in any legal context, that I can no longer actually buy real insurance in this field; at least not without also paying a tax penalty for not having official health insurance.  I'm relatively healthy for my age, with no major issues; and I have enough money between my HSA and other funds that I could take quite a hard hit.  But without true catastrophic and/or hospitalization insurance, I cannot be certain that I could absorb any hit that life could throw at me, regardless of the odds that I'll be hit at all.  I should have the right to buy whatever insurance I believe is right for myself, and self-insure to whatever level I am comfortable with financially, without special tax consequences and without being compelled to support the choices of others.

You've taken my quote out of context, Quidnon?. I was responding to your claim that the median emergency visit was (in 2013) about $1,200 - and therefore a trip to the ER is not a financial doomsday.

Did I?  Well, that's interesting, particularly since you just attributed a claim or quote to me that I did not make.  I do not have an opinion on the average cost of an ER trip, and I don't consider it particularly important anyway.

Quote
My point was that you don't insure against the median event, but the extremes.
As an example, take car insurance. I'm certain most accidents are minor fender-benders with no injuries and cosmetic damage.  Yet I carry insurance not to cover these likely events (which I could easily do out of pocket) but for the more rare but exponentially more costly major injury/accidents.
And I was agreeing with you, so I don't think that I was taking your quote out of context.

Quote
  Like with the ACA, car insurance covers a wide range of things including damaging property, emergency transport, salary compensation, etc.  All of these are unlikely to be needed by me individually, but will be used across the pool of people who ride in cars. 

Comprehensive insurance does, but it doesn't exist to protect you, it exists to protect the provider of your car loan from you.  So the part that is insurance for your direct benefit is the liability portion; which exists to protect you from a catastrophic loss due to harm you might cause to other drivers.  You can get comprehensive auto insurance on your paid for car as well, but it doesn't make sense unless your vehicle is particularly valuable or rare.  Not exactly a apples to apples comparison, since you are expected to pay the premiums on the insurance that protects your loan company's underwritten asset, the loan. 

Quote
I would not characterize the ACA as having an incredibly high minimum standard of benefits.  It doesn't cover a wide range of things, including dental and vision, and my unofficial survey of people I know indicate that most of them have both teeth and eyes. The requirements are fairly low overall for a population. What you seem to be objecting to is that you as an individual are required to have coverage for things that you are unlikely to use. Laws, however, are concerned with the population at large.

That's just one objection, but yes.  I'm unlikely to require a free mammogram, and it's discriminatory to me to force me to pay the premium that would pay for that.  I find it amazing that insurance companies can't manage to turn a profit under these conditions, even with the extra regulatory burdens.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 11, 2017, 02:50:27 PM

With insurance you aren't protecting against the routine, but rather the more unlikely extreme events that you otherwise couldn't afford.


Yes!  Yes!  That's it exactly!  And that is my complaint with Obamacare.  It has regulated such a high minimum standard of benefits, in order to be called "health insurance" in any legal context, that I can no longer actually buy real insurance in this field; at least not without also paying a tax penalty for not having official health insurance.  I'm relatively healthy for my age, with no major issues; and I have enough money between my HSA and other funds that I could take quite a hard hit.  But without true catastrophic and/or hospitalization insurance, I cannot be certain that I could absorb any hit that life could throw at me, regardless of the odds that I'll be hit at all.  I should have the right to buy whatever insurance I believe is right for myself, and self-insure to whatever level I am comfortable with financially, without special tax consequences and without being compelled to support the choices of others.

However, I am reminded of a lowly paid employee we used to have here, who claimed he couldn't afford our employer-sponsored health insurance, whose wife had a stroke and since they had no coverage, I had to fill out papers for him to receive medical assistance.  YOU may have the funds to take care of yourself should you have a catastrophic event, but you are not typical.  Most people would not be able to pay for it if they had no insurance and would either go bankrupt or lose their homes and other assets in order to pay the whopping medical bills they were not prepared for.

Of course I'm not typical.  That's an argument for what?  Because I'm not typical, I have to pay more for insurance than I believe that I require, because you know better than I?  Because I'm both lucky and I planned better than most?  I am aware that I'm not typical, but I don't consider that to be cause to force me to pay for more than I require and tax me more in order to subsidize the problems of other people.
Title: Re: What comes after the ACA?
Post by: nereo on January 11, 2017, 04:11:49 PM
My apologies Quidnon? - it was actually Greenback who made the original statement about the median ER visit being 'only' $1200 and how that wasn't a financial death sentence.  That was sloppy thread-following of me.
I do maintain that it's appropriate for both laws and insurance to pertain to what the group needs as opposed to the individual.  As a male I'm unlikely to need a mammogram but then again my wife is (i hope) unlikely to need a prostate exam. No one needs everything, but it is useful at the population level.
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 11, 2017, 04:38:43 PM
My apologies Quidnon? - it was actually Greenback who made the original statement about the median ER visit being 'only' $1200 and how that wasn't a financial death sentence.  That was sloppy thread-following of me.
I do maintain that it's appropriate for both laws and insurance to pertain to what the group needs as opposed to the individual.  As a male I'm unlikely to need a mammogram but then again my wife is (i hope) unlikely to need a prostate exam. No one needs everything, but it is useful at the population level.

That's debatable, and obviously I disagree.  I think that regulated "free" services (because we all know there is no such thing as free) sets up some unpredictable, and often negative, incentives.  To start with, it encourages over use of such services, even if there is a limit.  Because there is no evidence, as an example, that an annual checkup is ideal.  My own doctor, whom I pay in cash, has admitted to me that for most healthy people annually is too often; perhaps 18 to 24 months; but then every 12 months is likely not often enough for monitoring a known chronic problem, or for most over about age 65.  But that is just one example, because I think that most people would be better off if all of society expected them to pay for the regular and moderately common or cheap services needed, and no one had an expectation that they would be able to avoid those smaller, regular expenses; because the insurance part (that limits risk of extreme circumstances) would be much cheaper and much more accessible for the majority.  It's similar to a right to food, I don't believe in that either.  It's not important that it is necessary to life, or that it costs more money for quality, you don't have a right to it just because you are alive and need it.
Title: Re: What comes after the ACA?
Post by: RentSeeking on January 11, 2017, 09:31:41 PM
And I think that it's a bit of a stretch to claim that The Heritage Foundation is  actually conservative.

This is almost, but not quite, as hilarious as Rex Tillerson claiming under oath today that he is "not aware of anything the fossil fuel industry gets that [he] would characterize as a subsidy."
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 11, 2017, 11:02:01 PM
And I think that it's a bit of a stretch to claim that The Heritage Foundation is  actually conservative.

This is almost, but not quite, as hilarious as Rex Tillerson claiming under oath today that he is "not aware of anything the fossil fuel industry gets that [he] would characterize as a subsidy."

Well, I'm the self-identified, non-Republican, conservative here; and I don't consider them conservative.  More neo-con-ish.
Title: Re: What comes after the ACA?
Post by: nereo on January 12, 2017, 05:36:05 AM

That's debatable, and obviously I disagree.  I think that regulated "free" services (because we all know there is no such thing as free) sets up some unpredictable, and often negative, incentives.  To start with, it encourages over use of such services, even if there is a limit.  Because there is no evidence, as an example, that an annual checkup is ideal.  My own doctor, whom I pay in cash, has admitted to me that for most healthy people annually is too often; perhaps 18 to 24 months; but then every 12 months is likely not often enough for monitoring a known chronic problem, or for most over about age 65.  But that is just one example, because I think that most people would be better off if all of society expected them to pay for the regular and moderately common or cheap services needed, and no one had an expectation that they would be able to avoid those smaller, regular expenses; because the insurance part (that limits risk of extreme circumstances) would be much cheaper and much more accessible for the majority.  It's similar to a right to food, I don't believe in that either.  It's not important that it is necessary to life, or that it costs more money for quality, you don't have a right to it just because you are alive and need it.

Yes, we seem to disagree, and that's ok.  Sometimes rational people won't see eye-to-eye on certain issues. My take is that a society has a moral obligation to take care of its people, and the wealthier the society the more obligation it has. Whether that's considered an 'unalienable right' I suppose we could debate, but I think its something we *should* do regardless.
However, I've lived for the past several years in a place that has mandatory single-payer health care, and I see how it can go wrong adn I do see some of the problems you describe (namely overuse). My FIL (a physician in New England) likes to say that if htye just started charging $5 for parking it would eliminate many of the unnecessary visits by those that have zero co-pay. Similarly I would support a program that  allowed for annual checkups but charged a nominal sum (say $15 per visit, but $0 if you were unemployed/underemployed). Regarding frequency, it's true that many healthy individuals do not need a checkup every year, but others with chronic conditions need more frequent visits; such decisions should be between the patient and doctor, not legislation.
Such are my opinons - we may never agree but that's where I'm coming from.

Title: Re: What comes after the ACA?
Post by: rtrnow on January 12, 2017, 06:41:02 AM
And I think that it's a bit of a stretch to claim that The Heritage Foundation is  actually conservative.

This is almost, but not quite, as hilarious as Rex Tillerson claiming under oath today that he is "not aware of anything the fossil fuel industry gets that [he] would characterize as a subsidy."

Well, I'm the self-identified, non-Republican, conservative here; and I don't consider them conservative.  More neo-con-ish.

You also posted a link to thenewamerican. So you obviously don't know how to evaluate an actual news source.
Title: Re: What comes after the ACA?
Post by: farmecologist on January 12, 2017, 07:56:55 AM
No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 
Title: Re: What comes after the ACA?
Post by: nereo on January 12, 2017, 08:05:59 AM
No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   
Worth noting that the Supreme Court recognized that health care is unique insofar that virtually no one can avoid it over the course of his or her life.
Title: Re: What comes after the ACA?
Post by: coppertop on January 12, 2017, 08:15:24 AM
No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

Not to mention an accident that happens in a flash.  Last spring, I decided to walk to the bank (for work) on a beautiful day.  On my way back into the building, the toe of my shoe hit the step and sent me sprawling.  My humerus was fractured, and I required surgery, with a stabilizer and screws.  Many follow-ups, plus physical therapy, were required.  Because I was on a work errand and the accident happened on premises, I was covered under workers' comp, thank God.  I have no idea how much that whole thing cost, but I'm sure it was a tremendous amount of money.  I have a high-deductible plan - $5,000 plus additional coinsurance of $1,850, all on me.  Had I fallen on my own time, I'd have had to pay that out myself.  You never know what surprises life has in store.
Title: Re: What comes after the ACA?
Post by: GuitarStv on January 12, 2017, 08:43:06 AM
No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

Not to mention an accident that happens in a flash.  Last spring, I decided to walk to the bank (for work) on a beautiful day.  On my way back into the building, the toe of my shoe hit the step and sent me sprawling.  My humerus was fractured, and I required surgery, with a stabilizer and screws.  Many follow-ups, plus physical therapy, were required.  Because I was on a work errand and the accident happened on premises, I was covered under workers' comp, thank God.  I have no idea how much that whole thing cost, but I'm sure it was a tremendous amount of money.  I have a high-deductible plan - $5,000 plus additional coinsurance of $1,850, all on me.  Had I fallen on my own time, I'd have had to pay that out myself.  You never know what surprises life has in store.

Last December my best friend collapsed out of the blue and went to the ER.  He's 36, not a heavy drinker, in good shape (plays soccer and works out regularly), doesn't smoke, and has no family history of disease.  Turns out he had stage 4 lung cancer.  We live in Canada, so I don't know what the cost of a month and a half in intensive care, several ambulance rides, multiple surgeries, home care with an oxygen tank and daily O2 readings, radiation therapy, and the piles upon piles of pills would have cost him in total.

At the moment he is mostly stabilized and is on some trial experimental drugs.  Those pills cost just under 100,000$ a month, (I know because they're experimental and are not covered by Canada's health care plan).  He will likely be on them for the rest of his life.  Medical expenses are real, and they can hit anybody.
Title: Re: What comes after the ACA?
Post by: boarder42 on January 12, 2017, 08:51:18 AM
No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

Not to mention an accident that happens in a flash.  Last spring, I decided to walk to the bank (for work) on a beautiful day.  On my way back into the building, the toe of my shoe hit the step and sent me sprawling.  My humerus was fractured, and I required surgery, with a stabilizer and screws.  Many follow-ups, plus physical therapy, were required.  Because I was on a work errand and the accident happened on premises, I was covered under workers' comp, thank God.  I have no idea how much that whole thing cost, but I'm sure it was a tremendous amount of money.  I have a high-deductible plan - $5,000 plus additional coinsurance of $1,850, all on me.  Had I fallen on my own time, I'd have had to pay that out myself.  You never know what surprises life has in store.

Yes and that is the arguemnt quindon etc are making ... i should have a right to choose to be on a high deductible plan - 6850 is a drop in the bucket to those of us around here who are saving properly.  if you have your HSA that 6850 is really only 40% of that or 4110 out of pocket using those funds. 

i think pre existing conditions should be covered but i also think we each have a right to choose to be on catostrophic plans basically like homeowners insurance.  i dont need insurance against 5k dollar issues i need insurance against 100k dollar issues. 

Yes the avg american doesnt save and invest like us folk around here, and most americans carry low deductible home insurance etc.

covering people is an issue but the biggest issue still is cost transparency.  You can shop for an ER by being prepared.  Just like with work insurance you know which hospitals are in your network by you.  the same thought could be applied to finding the best service lowest cost ER by you if costs were presented open for everyone to see ahead of time you could know which hosipital you'd like to use in an ER event.
Title: Re: What comes after the ACA?
Post by: boarder42 on January 12, 2017, 08:57:35 AM
No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

Not to mention an accident that happens in a flash.  Last spring, I decided to walk to the bank (for work) on a beautiful day.  On my way back into the building, the toe of my shoe hit the step and sent me sprawling.  My humerus was fractured, and I required surgery, with a stabilizer and screws.  Many follow-ups, plus physical therapy, were required.  Because I was on a work errand and the accident happened on premises, I was covered under workers' comp, thank God.  I have no idea how much that whole thing cost, but I'm sure it was a tremendous amount of money.  I have a high-deductible plan - $5,000 plus additional coinsurance of $1,850, all on me.  Had I fallen on my own time, I'd have had to pay that out myself.  You never know what surprises life has in store.

Last December my best friend collapsed out of the blue and went to the ER.  He's 36, not a heavy drinker, in good shape (plays soccer and works out regularly), doesn't smoke, and has no family history of disease.  Turns out he had stage 4 lung cancer.  We live in Canada, so I don't know what the cost of a month and a half in intensive care, several ambulance rides, multiple surgeries, home care with an oxygen tank and daily O2 readings, radiation therapy, and the piles upon piles of pills would have cost him in total.

At the moment he is mostly stabilized and is on some trial experimental drugs.  Those pills cost just under 100,000$ a month, (I know because they're experimental and are not covered by Canada's health care plan).  He will likely be on them for the rest of his life.  Medical expenses are real, and they can hit anybody.

So here is an example of the rich funding the poor. 

these are trial and experimental drugs some company has invested a lot of time and energy coming up with. 10 years ago your friend may have died.  Think of this like a tesla costing 130k can everyone buy that no is everyone entitled to it no.  but the model 3 will be rolling off assembly lines this year and in 5 years the general public can afford it. 

We cant save everyone with the latest and greatest most expensive technology that has been created right when it comes out.  future generations will benefit.  just like we have from great reduction and many helathcare system improvements of those who came before us.
Title: Re: What comes after the ACA?
Post by: nereo on January 12, 2017, 09:10:47 AM

covering people is an issue but the biggest issue still is cost transparency.  You can shop for an ER by being prepared.  Just like with work insurance you know which hospitals are in your network by you.  the same thought could be applied to finding the best service lowest cost ER by you if costs were presented open for everyone to see ahead of time you could know which hosipital you'd like to use in an ER event.

I agree that transparency is a very big issue.  So too is the extreme differences in cost for similar services. 
But almost by definition an ER visit will be unplanned.  Certainly you can inquire ahead of time about various costs at different facilities, but you don't always get to choose in the moment and the almost infinite permutations of emergencies makes it virtually impossible to know where you should go in advance.  Will it be a punctured lung or a bypass? Stroke or pneumonia? You need to know the treatment first before choosing the best ER, and even a physician can't determination until there's a thorough examination and preliminary tests are run. Compounding this is that you'll never know *where* you will be when you need care.

Its never sat well with me that a common procedure, like taking x-rays and setting a simple fracture can vary by 3x or more between facilities less than 20 miles apart. Medicaid has tried to deal with this for decades by having a reimbursement schedule for every proceedure hey can think of (there are literally thousands and all involve using the correct coding), but it's ornerous and ultimately results in certain hospitals losing money on certain proceedures, while others turn a profit.. all of which is completely unknown to the patients and even to most doctors.
Title: Re: What comes after the ACA?
Post by: Rezdent on January 12, 2017, 09:46:10 AM

covering people is an issue but the biggest issue still is cost transparency.  You can shop for an ER by being prepared.  Just like with work insurance you know which hospitals are in your network by you.  the same thought could be applied to finding the best service lowest cost ER by you if costs were presented open for everyone to see ahead of time you could know which hosipital you'd like to use in an ER event.

I agree that transparency is a very big issue.  So too is the extreme differences in cost for similar services. 
But almost by definition an ER visit will be unplanned.  Certainly you can inquire ahead of time about various costs at different facilities, but you don't always get to choose in the moment and the almost infinite permutations of emergencies makes it virtually impossible to know where you should go in advance.  Will it be a punctured lung or a bypass? Stroke or pneumonia? You need to know the treatment first before choosing the best ER, and even a physician can't determination until there's a thorough examination and preliminary tests are run. Compounding this is that you'll never know *where* you will be when you need care.

Its never sat well with me that a common procedure, like taking x-rays and setting a simple fracture can vary by 3x or more between facilities less than 20 miles apart. Medicaid has tried to deal with this for decades by having a reimbursement schedule for every proceedure hey can think of (there are literally thousands and all involve using the correct coding), but it's ornerous and ultimately results in certain hospitals losing money on certain proceedures, while others turn a profit.. all of which is completely unknown to the patients and even to most doctors.

+1

We absolutely need transparency.  We also need some regulation for those situations where transparency can't help.

ER visits are one place where you could identify a choice and not get it for any of various reasons.  You could be unconscious, or the paramedics might not agree with you, or that ER is full...

I had a neck injury.  Strapped to a Backboard, neck brace and Styrofoam stabilizer shoved in my mouth.
The paramedics transported me to their ER choice even while acknowledging they understood my requests through that foam for a different ER.  They told me no, not hospital Y; they were taking me to hospital X, and I just needed to relax and be quiet because my blood pressure appeared to be going up really fast.
Ha! Just choose an ER...


Title: Re: What comes after the ACA?
Post by: CBnCO on January 12, 2017, 09:46:45 AM
I always find the healthcare debate fascinating. First, I think we all have the responsibility to take care of ourselves. Exercise, eating healthy, etc. In fact, I think we should start, instead of with arguing over the price of pharmaceuticals, with health and nutrition education in schools. It really should be one of the most important subjects in the public curriculum. Not one of the proposals I've seen allocates increased spending to health education; so, instead, most get their health education from Mountain Dew and Doritos commercials.

Further, it's not like the Earth is hurting for people. In fact, we are pretty much wreaking havoc on the planet and really shouldn't aspire to increase our populations. I've also seen somewhere that we spend around 50% of our healthcare dollars on "end of life care" and maybe this is something we should consider. I'm thinking we get people educated on how to be healthy, we unhook terminal patients from machines and pills and give them palliative care, and sprinkle in some market based competition and we would see significant improvements. Unfortunately, this is not a debate about what's best for the people, the country, the environment; but, one between the pharmas, insurance companies, politicians, hospitals, etc..in essence $$$..I'm off the eat a salad and do some push-ups!
Title: Re: What comes after the ACA?
Post by: Gin1984 on January 12, 2017, 09:47:17 AM
No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

Not to mention an accident that happens in a flash.  Last spring, I decided to walk to the bank (for work) on a beautiful day.  On my way back into the building, the toe of my shoe hit the step and sent me sprawling.  My humerus was fractured, and I required surgery, with a stabilizer and screws.  Many follow-ups, plus physical therapy, were required.  Because I was on a work errand and the accident happened on premises, I was covered under workers' comp, thank God.  I have no idea how much that whole thing cost, but I'm sure it was a tremendous amount of money.  I have a high-deductible plan - $5,000 plus additional coinsurance of $1,850, all on me.  Had I fallen on my own time, I'd have had to pay that out myself.  You never know what surprises life has in store.

Yes and that is the arguemnt quindon etc are making ... i should have a right to choose to be on a high deductible plan - 6850 is a drop in the bucket to those of us around here who are saving properly.  if you have your HSA that 6850 is really only 40% of that or 4110 out of pocket using those funds. 

i think pre existing conditions should be covered but i also think we each have a right to choose to be on catostrophic plans basically like homeowners insurance.  i dont need insurance against 5k dollar issues i need insurance against 100k dollar issues. 

Yes the avg american doesnt save and invest like us folk around here, and most americans carry low deductible home insurance etc.

covering people is an issue but the biggest issue still is cost transparency. You can shop for an ER by being prepared. Just like with work insurance you know which hospitals are in your network by you.  the same thought could be applied to finding the best service lowest cost ER by you if costs were presented open for everyone to see ahead of time you could know which hosipital you'd like to use in an ER event.
LOL, tried that, did not work.  No one could tell me the cost of procedure I wanted.  Hell, no one could tell me the cost a blood draw.
Title: Re: What comes after the ACA?
Post by: The Happy Philosopher on January 12, 2017, 09:49:19 AM
No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 
Yes, and health care expenses are extremely varied and unpredictable. You can't really know whether your health care costs will be 40k or 5million over your life time. It's easy to be cavalier about health care when you are healthy.
Title: Re: What comes after the ACA?
Post by: The Happy Philosopher on January 12, 2017, 09:57:38 AM
There is this misconception that only people that eat poorly or smoke/drink whatever are the only ones that get sick. Yes, medical costs will tend to be higher in populations that live unhealthy lifestyles, but there are plenty of people who do everything right and still get very sick.

Also, end of life care is a bit more nuanced. Much money is spent on EOLC, but the problem is you don't always know who is going to have a good outcome. If you knew who was going to die anyways with or without care decisions would be easier. That said there is a lot of money that is wasted at the end. To solve that problem though we have to venture into 'death panel' territory and you saw how that went from a political standpoint. We could save a lot of money by changing our societal attitude towards death though. Right now we save all life at any cost to the system.

I always find the healthcare debate fascinating. First, I think we all have the responsibility to take care of ourselves. Exercise, eating healthy, etc. In fact, I think we should start, instead of with arguing over the price of pharmaceuticals, with health and nutrition education in schools. It really should be one of the most important subjects in the public curriculum. Not one of the proposals I've seen allocates increased spending to health education; so, instead, most get their health education from Mountain Dew and Doritos commercials.

Further, it's not like the Earth is hurting for people. In fact, we are pretty much wreaking havoc on the planet and really shouldn't aspire to increase our populations. I've also seen somewhere that we spend around 50% of our healthcare dollars on "end of life care" and maybe this is something we should consider. I'm thinking we get people educated on how to be healthy, we unhook terminal patients from machines and pills and give them palliative care, and sprinkle in some market based competition and we would see significant improvements. Unfortunately, this is not a debate about what's best for the people, the country, the environment; but, one between the pharmas, insurance companies, politicians, hospitals, etc..in essence $$$..I'm off the eat a salad and do some push-ups!
Title: Re: What comes after the ACA?
Post by: thenextguy on January 12, 2017, 09:58:12 AM
And I think that it's a bit of a stretch to claim that The Heritage Foundation is  actually conservative.

This is almost, but not quite, as hilarious as Rex Tillerson claiming under oath today that he is "not aware of anything the fossil fuel industry gets that [he] would characterize as a subsidy."

Well, I'm the self-identified, non-Republican, conservative here; and I don't consider them conservative.  More neo-con-ish.

Even if one were to acknowledge The Heritage Foundation as more neoconservative rather than conservative, it's largely irrelevant to this discussion. The two camps are largely identical on domestic policy. The differences are found in foreign policy.
Title: Re: What comes after the ACA?
Post by: bacchi on January 12, 2017, 10:05:37 AM
You can shop for an ER by being prepared.
LOL, tried that, did not work.  No one could tell me the cost of procedure I wanted.  Hell, no one could tell me the cost a blood draw.

And the hospital can't tell you who will be on duty the night of your future accident or whether the doctors on call are in your network, even if we ignore whether you're even conscious to tell the medics, "Only Central ER! Not Southwest ER; they're too expensive." I guess the cost-conscious person can wear a medical bracelet with an ordering of ERs:

"Take me to an ER in order:
1) Central ER
2) North ER
3) General ER
4) Southwest ER"

Picking out an ER ahead of time as a solution to rising health care costs is laughable.
Title: Re: What comes after the ACA?
Post by: Greenback Reproduction Specialist on January 12, 2017, 10:21:43 AM
LOL, tried that, did not work.  No one could tell me the cost of procedure I wanted.  Hell, no one could tell me the cost a blood draw.
I struggle with this everytime I go to a dr or dentist.... I tell them up front I will not pay for something unless they tell me up front how much it will cost... Very frustrating, and I have walked out a couple times to find somewhere else to go. But I have found a few places around town that will give me the costs upfront before doing the work.

I don't think it is fair to do the work, and then be like "oh by the way it cost $x and you now owe us that"
Title: Re: What comes after the ACA?
Post by: sol on January 12, 2017, 10:49:20 AM
I'm trying really hard to listen and learn here.  I understand that people have a wide diversity of opinions about health care and health insurance.

But virtually every objection I have heard in this thread basically boils down to some variation of "you are going to die because you have no money to pay me to make you better" and I cannot fathom how anyone could think that is a moral or ethical position to support.

When your house is on fire, the fire department doesn't stop to ask which political party you belong to.  When you call 911, the operator does not ask what tax bracket you are in.  Food banks don't turn you away just because you are black or brown.  Can we all agree that would be wrong?

I believe that everyone deserves some basic level of healthcare.  It is good for our society to have a healthy population.  I don't care how much money you make, or what you personally pay for that care, because I believe it should be available to everyone, just like 911 is available to everyone, whether you use it or not and whether you pay for it or not.  Our society is better off having 911, and a fire department, and food banks, universally available to everyone at all times, than we would be without those things.  They are part of what makes America great. 

I think basic healthcare is in the same category, and should be paid for the same way.
Title: Re: What comes after the ACA?
Post by: nereo on January 12, 2017, 10:51:47 AM

And the hospital can't tell you who will be on duty the night of your future accident or whether the doctors on call are in your network, even if we ignore whether you're even conscious to tell the medics, "Only Central ER! Not Southwest ER; they're too expensive." I guess the cost-conscious person can wear a medical bracelet with an ordering of ERs:

"Take me to an ER in order:
1) Central ER
2) North ER
3) General ER
4) Southwest ER"

Picking out an ER ahead of time as a solution to rising health care costs is laughable.
I think it would have to be even more detailed, something like:
Take me an ER in order
1) Central ER, except...
2) North ER for all strokes and neurological problems or:
3) General ER if an MRI is required or:
4) Southwest ER if you suspect poisioning.
exception 1: If there are multiple lacerations and radiology is required then North would be preferable to Central unless the lacerations are minor
exception 2: If my car is totaled and I require outpatient procedures with follow-ups take me to Southwest b/c they are near public transit
exception 3: NEVER General if this is cancer-related, their oncology department is under state review for errors
exception 4:....

Quote
I don't think it is fair to do the work, and then be like "oh by the way it cost $x and you now owe us that"
I agree.  Unfortunately the price isn't even known to the doctors/nurses treating you in most cases, and the reimbursement rate for the procedure will be different depending on whether you have medicaid, private insurance, state-sponsored health insurance or if you pay out of pocket.  So the price is never the price.
It's bizarre, and should be fixed.
Title: Re: What comes after the ACA?
Post by: nereo on January 12, 2017, 10:54:37 AM

I think basic healthcare is in the same category, and should be paid for the same way.
I'm with you Sol - I think a society should strive towards providing basic health services for its people as it does a basic level of safety (police, fire, military), shelter, education and nurishment.

Often the programs which provide these services can be improve, but they should always exist.
Title: Re: What comes after the ACA?
Post by: boarder42 on January 12, 2017, 11:06:24 AM
No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

Not to mention an accident that happens in a flash.  Last spring, I decided to walk to the bank (for work) on a beautiful day.  On my way back into the building, the toe of my shoe hit the step and sent me sprawling.  My humerus was fractured, and I required surgery, with a stabilizer and screws.  Many follow-ups, plus physical therapy, were required.  Because I was on a work errand and the accident happened on premises, I was covered under workers' comp, thank God.  I have no idea how much that whole thing cost, but I'm sure it was a tremendous amount of money.  I have a high-deductible plan - $5,000 plus additional coinsurance of $1,850, all on me.  Had I fallen on my own time, I'd have had to pay that out myself.  You never know what surprises life has in store.

Yes and that is the arguemnt quindon etc are making ... i should have a right to choose to be on a high deductible plan - 6850 is a drop in the bucket to those of us around here who are saving properly.  if you have your HSA that 6850 is really only 40% of that or 4110 out of pocket using those funds. 

i think pre existing conditions should be covered but i also think we each have a right to choose to be on catostrophic plans basically like homeowners insurance.  i dont need insurance against 5k dollar issues i need insurance against 100k dollar issues. 

Yes the avg american doesnt save and invest like us folk around here, and most americans carry low deductible home insurance etc.

covering people is an issue but the biggest issue still is cost transparency. You can shop for an ER by being prepared. Just like with work insurance you know which hospitals are in your network by you.  the same thought could be applied to finding the best service lowest cost ER by you if costs were presented open for everyone to see ahead of time you could know which hosipital you'd like to use in an ER event.
LOL, tried that, did not work.  No one could tell me the cost of procedure I wanted.  Hell, no one could tell me the cost a blood draw.

Thats my point on the transparency part.  i was saying IF we had transparency you could do that
Title: Re: What comes after the ACA?
Post by: boarder42 on January 12, 2017, 11:08:45 AM
You can shop for an ER by being prepared.
LOL, tried that, did not work.  No one could tell me the cost of procedure I wanted.  Hell, no one could tell me the cost a blood draw.

And the hospital can't tell you who will be on duty the night of your future accident or whether the doctors on call are in your network, even if we ignore whether you're even conscious to tell the medics, "Only Central ER! Not Southwest ER; they're too expensive." I guess the cost-conscious person can wear a medical bracelet with an ordering of ERs:

"Take me to an ER in order:
1) Central ER
2) North ER
3) General ER
4) Southwest ER"

Picking out an ER ahead of time as a solution to rising health care costs is laughable.

that quote was taken out of context and is assuming we have full transparency.. and guess what if we had it prices would normalize and it wouldnt matter.
Title: Re: What comes after the ACA?
Post by: protostache on January 12, 2017, 11:09:49 AM
No offense to anyone but I honestly get a good laugh out of some of the comments here.  It's almost as if people think a chronic condition will never happen to them..the classic "it only happens to those other people" attitude.   Well I have bad news for you...millions of people every year develop chronic conditions that are then reclassified as "pre-existing" conditions ( diabetes is a prime example ).  These chronic conditions can come out of nowhere, are very expensive, and can easily wipe a person's savings out.  I find it mind boggling that some of you are willing to take that risk.  I also guarantee that minds change extremely fast once a person or someone in the family develops one of these conditions.  I have seen it happen many times.   



 

Not to mention an accident that happens in a flash.  Last spring, I decided to walk to the bank (for work) on a beautiful day.  On my way back into the building, the toe of my shoe hit the step and sent me sprawling.  My humerus was fractured, and I required surgery, with a stabilizer and screws.  Many follow-ups, plus physical therapy, were required.  Because I was on a work errand and the accident happened on premises, I was covered under workers' comp, thank God.  I have no idea how much that whole thing cost, but I'm sure it was a tremendous amount of money.  I have a high-deductible plan - $5,000 plus additional coinsurance of $1,850, all on me.  Had I fallen on my own time, I'd have had to pay that out myself.  You never know what surprises life has in store.

Yes and that is the arguemnt quindon etc are making ... i should have a right to choose to be on a high deductible plan - 6850 is a drop in the bucket to those of us around here who are saving properly.  if you have your HSA that 6850 is really only 40% of that or 4110 out of pocket using those funds. 

i think pre existing conditions should be covered but i also think we each have a right to choose to be on catostrophic plans basically like homeowners insurance.  i dont need insurance against 5k dollar issues i need insurance against 100k dollar issues. 

Yes the avg american doesnt save and invest like us folk around here, and most americans carry low deductible home insurance etc.

covering people is an issue but the biggest issue still is cost transparency. You can shop for an ER by being prepared. Just like with work insurance you know which hospitals are in your network by you.  the same thought could be applied to finding the best service lowest cost ER by you if costs were presented open for everyone to see ahead of time you could know which hosipital you'd like to use in an ER event.
LOL, tried that, did not work.  No one could tell me the cost of procedure I wanted.  Hell, no one could tell me the cost a blood draw.


Thats my point on the transparency part.  i was saying IF we had transparency you could do that

But wouldn't it be better for all of us if nobody needed to?
Title: Re: What comes after the ACA?
Post by: boarder42 on January 12, 2017, 11:17:31 AM
I'm trying really hard to listen and learn here.  I understand that people have a wide diversity of opinions about health care and health insurance.

But virtually every objection I have heard in this thread basically boils down to some variation of "you are going to die because you have no money to pay me to make you better" and I cannot fathom how anyone could think that is a moral or ethical position to support.

When your house is on fire, the fire department doesn't stop to ask which political party you belong to.  When you call 911, the operator does not ask what tax bracket you are in.  Food banks don't turn you away just because you are black or brown.  Can we all agree that would be wrong?

I believe that everyone deserves some basic level of healthcare.  It is good for our society to have a healthy population.  I don't care how much money you make, or what you personally pay for that care, because I believe it should be available to everyone, just like 911 is available to everyone, whether you use it or not and whether you pay for it or not.  Our society is better off having 911, and a fire department, and food banks, universally available to everyone at all times, than we would be without those things.  They are part of what makes America great. 

I think basic healthcare is in the same category, and should be paid for the same way.

the difference esp. in some of the posts here are that police and fire technology for the most part have stayed the same and arent new or highly costly.  When a new tech as GStv mentioned above comes out how do you determine who gets the treatment.  it cant be everyone it cost something to develop that and someone has to pay the cost for it.  This isnt the same as my house is burning down we are constantly advancing treatments and cures.  you're equating things that arent 100% relatable. 

When you say basic ok - someone has to decide what that basic need is - does it cover cancer maybe maybe not what level of coverage does it offer.  These services all cost money. So when we decide basic is xyz and then tax people for it, you'll still have rich people that can afford the better treatments receiving better care and staying alive b/c they have money.  But defining basic care and people bringing up experimental drug prices are in 2 completely different ballparks or even planets.  Drug companies have to profit its how capitalism works. 
Title: Re: What comes after the ACA?
Post by: protostache on January 12, 2017, 11:26:21 AM
I'm trying really hard to listen and learn here.  I understand that people have a wide diversity of opinions about health care and health insurance.

But virtually every objection I have heard in this thread basically boils down to some variation of "you are going to die because you have no money to pay me to make you better" and I cannot fathom how anyone could think that is a moral or ethical position to support.

When your house is on fire, the fire department doesn't stop to ask which political party you belong to.  When you call 911, the operator does not ask what tax bracket you are in.  Food banks don't turn you away just because you are black or brown.  Can we all agree that would be wrong?

I believe that everyone deserves some basic level of healthcare.  It is good for our society to have a healthy population.  I don't care how much money you make, or what you personally pay for that care, because I believe it should be available to everyone, just like 911 is available to everyone, whether you use it or not and whether you pay for it or not.  Our society is better off having 911, and a fire department, and food banks, universally available to everyone at all times, than we would be without those things.  They are part of what makes America great. 

I think basic healthcare is in the same category, and should be paid for the same way.

the difference esp. in some of the posts here are that police and fire technology for the most part have stayed the same and arent new or highly costly.  When a new tech as GStv mentioned above comes out how do you determine who gets the treatment.  it cant be everyone it cost something to develop that and someone has to pay the cost for it.  This isnt the same as my house is burning down we are constantly advancing treatments and cures.  you're equating things that arent 100% relatable. 

When you say basic ok - someone has to decide what that basic need is - does it cover cancer maybe maybe not what level of coverage does it offer.  These services all cost money. So when we decide basic is xyz and then tax people for it, you'll still have rich people that can afford the better treatments receiving better care and staying alive b/c they have money.  But defining basic care and people bringing up experimental drug prices are in 2 completely different ballparks or even planets.  Drug companies have to profit its how capitalism works.

So lets have that conversation. I posit we start wth the ACA-defined minimum guarantees and a silver level plan. That seems basic to me. No dental, no vision, limited prescription coverage (maybe just if you're admitted), limited access to private hospital rooms. A minimal copay for doctor visits ($5) and a small deductible that can be waived based on income. If you want Rx, better hospital rooms, etc you can pay for extra.
Title: Re: What comes after the ACA?
Post by: sol on January 12, 2017, 11:34:09 AM
So lets have that conversation. I posit we start wth the ACA-defined minimum guarantees and a silver level plan. That seems basic to me.

That's certainly one place to start.  Another good option is to define basic care as the level of care that we currently provide through one of our three existing single payer systems (Medicaid, Medicare, and Tricare). 

This is a problem we have already solved three times, so I'm not too worried about solving it again.  I agree it is a decision that had to be made, I just don't think it's that hard.
Title: Re: What comes after the ACA?
Post by: nereo on January 12, 2017, 12:02:24 PM

the difference esp. in some of the posts here are that police and fire technology for the most part have stayed the same and arent new or highly costly.  When a new tech as GStv mentioned above comes out how do you determine who gets the treatment.  it cant be everyone it cost something to develop that and someone has to pay the cost for it.  This isnt the same as my house is burning down we are constantly advancing treatments and cures.  you're equating things that arent 100% relatable. 

When you say basic ok - someone has to decide what that basic need is - does it cover cancer maybe maybe not what level of coverage does it offer.  These services all cost money. So when we decide basic is xyz and then tax people for it, you'll still have rich people that can afford the better treatments receiving better care and staying alive b/c they have money.  But defining basic care and people bringing up experimental drug prices are in 2 completely different ballparks or even planets.  Drug companies have to profit its how capitalism works.

I actually think the analogy between a society providing security (police, fire, military) and basic health services still hold up.  Advances in all have come with very large increases in cost; Police use aircraft, camera networks and advanced weaponry and armor.  Still to there's a constant dialog about how much 'basic' service should be; how many uniformed officers do we want per city block?  what is an acceptable response time?

A public discussion about what the appropriate levels of service is appropriate, but unfortunately something we haven't really done. The way our health-care system has evolved (predominately work-place sponsored) most people are completely ignorant about how much it actually costs. A former co-worked of mine was upset that her monthly co-pay for her state-sponsored family health care plan was increasing from $48 to around $100, but didn't have a clue that her work paid the other $600/mo. Few realize that the same procedure might bill at 30-50% less if you are part of a plan vs paying out of pocket.
Title: Re: What comes after the ACA?
Post by: little_brown_dog on January 12, 2017, 12:16:59 PM
I'm trying really hard to listen and learn here.  I understand that people have a wide diversity of opinions about health care and health insurance.

But virtually every objection I have heard in this thread basically boils down to some variation of "you are going to die because you have no money to pay me to make you better" and I cannot fathom how anyone could think that is a moral or ethical position to support.

When your house is on fire, the fire department doesn't stop to ask which political party you belong to.  When you call 911, the operator does not ask what tax bracket you are in.  Food banks don't turn you away just because you are black or brown.  Can we all agree that would be wrong?

I believe that everyone deserves some basic level of healthcare.  It is good for our society to have a healthy population.  I don't care how much money you make, or what you personally pay for that care, because I believe it should be available to everyone, just like 911 is available to everyone, whether you use it or not and whether you pay for it or not.  Our society is better off having 911, and a fire department, and food banks, universally available to everyone at all times, than we would be without those things.  They are part of what makes America great. 

I think basic healthcare is in the same category, and should be paid for the same way.

Yes…at the very least, universal strong preventative healthcare and common treatments like antibiotic regimens…

Preventative care is  the most critical type of care for population health (vaccines, prenatal/postnatal care, pediatric appointments, basic screenings, etc) and it is what often keeps minor problems from ballooning into more deadly and more costly ones – both at an individual level and population level. Take vaccines…yes it is costly to pay for them for everyone, but far less costly than what would happen if the entire nation was being constantly slammed by epidemics that take millions out of work, put thousands or millions in the hospital, and oh yeah…kill people…most often babies and other innocents.

ACA for all of its faults, had one huge benefit, and that was the provision of preventative care for swaths of the population. Prenatal and postnatal care was well covered. Under ACA all my prenatal appointments were covered…didn’t pay for any of them…including the standard screening like the oral glucose test for gest diabetes and strep b screen (vital as infection can cause devastating illness that can kill newborns within days). Same goes for my follow up appointment and all of the well baby visits. Inadequate prenatal care is one of the key factors responsible for poor US maternal and newborn outcomes compared to other developed nations. And you guessed it, poor health outcomes mean more medical costs overall....for everyone.

Repubs love to act like the party of family values, but how is that possible when they do crap like this? They prance around acting like they love the unborn as they literally plot to take away said unborns’ checkups. Doing so sends medical costs soaring as more women and babies require more intensive care to manage the damage caused by skipping appointments and forgoing routine screening/management. And of course these women cant pay thousands in medical bills, so the system eats the cost. It’s the definition of insanity. What is even more shocking is that large numbers of Americans actually think this is totally logical….
Title: Re: What comes after the ACA?
Post by: RangerOne on January 12, 2017, 12:18:13 PM
Agreed that most peoples understanding of their own insurance is pitiful. But to be somewhat fair it is pretty complicated and difficult to grasp all the finer points.

Whether a $1200 ER visit is catastrophic for some one really depends. For most of us on this site a few thousand dollars for an emergency is pretty easily absorbed if that means we can keep our yearly insurance costs down. But for many people more than $1000 dollars means a monthly payment plan.

What annoys me about the current Republican approach to the ACA is that it seems pretty clear they are only interest in the political capital gained by shitting on it and getting it repealed or modified, as others have said so they can declare victory and win a partisan battle against the Democrats. I don't see them presenting a really comprehensive alternative being presented. There are some good disparate ideas being floated but if we are months away from gutting the new laws, you would think they would want to present a road map for how a new system should try to operate. That does not appear to be happening.
Title: Re: What comes after the ACA?
Post by: waltworks on January 12, 2017, 12:23:03 PM
I bet everyone could agree on killing the preferential tax treatment for benefits, right? It's objectively a dumb idea from both liberal and conservative perspectives. Getting healthcare/insurance through work means that nobody sees the actual cost of healthcare, and that it's hard for creative people to strike out on their own because buying their own health care is dramatically more expensive.

-W
Title: Re: What comes after the ACA?
Post by: RangerOne on January 12, 2017, 12:25:42 PM
...
As an example, take car insurance. I'm certain most accidents are minor fender-benders with no injuries and cosmetic damage....

I don't know if you have taken a recent model car to a shop lately but the age of a fender bender costing you $600 dollars out of pocket seems long gone. I recently took in my 2013 Hyundai Sonata for a parking lot hit and run. It is our nice family car so cosmetics still mean something to me.

Basically someone crunched a small part of our bumper behind the rear wheel. Caving in maybe like a soccer ball sized dent, but functionally no real damage.

Parts and paint cost maybe like $80 for the repair. But the man hours to fix the dent cost over $2000 and took nearly a full week of work by an approved AAA repair vendor... From what I have read newer vehicles, due to the use of modern body materials, aren't able to undergo many of the same simple quick fixes that cars pre and early 2000 era used to be able to get. Fender benders have gotten pretty damn expensive.

I could pay $2000 cash to fix something like this, but it is one hell of a price to pay for a cosmetic fix over random uncontrollable damage occasionally incurred in city living wiht assholes.
Title: Re: What comes after the ACA?
Post by: RangerOne on January 12, 2017, 12:34:29 PM
I bet everyone could agree on killing the preferential tax treatment for benefits, right? It's objectively a dumb idea from both liberal and conservative perspectives. Getting healthcare/insurance through work means that nobody sees the actual cost of healthcare, and that it's hard for creative people to strike out on their own because buying their own health care is dramatically more expensive.

-W

Which preferential tax treatment are you referring to?

I agree most people don't have any comprehension of what decent health coverage costs until you have to pay it yourself or someone shows you... The Bluecross family plan our work signs us up for cost me $200 a month plus HSA contributions. Similar plans, with worse terms, cost $1600 a month a premiums alone if you are buying it on your own. Good health coverage is really a drastic portion of your working income when you have to compare owning a business or being an independent contractor versus working for a big company.

Most of the independent contractors I knew would band together to buy more affordable health care as groups can negotiate better rates. But they still have to deal with the full rate that many of us don't see.
Title: Re: What comes after the ACA?
Post by: waltworks on January 12, 2017, 12:56:38 PM
Which preferential tax treatment are you referring to?

Employers do not pay FICA on benefits paid to employees - that's a ~8% savings off the top. It's also the case that the employer can deduct any benefits paid out as a business expense - but the employee can do no such thing if they obtain insurance on their own.

Hence the incentive is for employers to pay as much as possible in the form of benefits, and as little as possible in salary, in many cases.

-W
Title: Re: What comes after the ACA?
Post by: nereo on January 12, 2017, 01:05:59 PM
...
As an example, take car insurance. I'm certain most accidents are minor fender-benders with no injuries and cosmetic damage....

I don't know if you have taken a recent model car to a shop lately but the age of a fender bender costing you $600 dollars out of pocket seems long gone. I recently took in my 2013 Hyundai Sonata for a parking lot hit and run. It is our nice family car so cosmetics still mean something to me.

Basically someone crunched a small part of our bumper behind the rear wheel. Caving in maybe like a soccer ball sized dent, but functionally no real damage.

Parts and paint cost maybe like $80 for the repair. But the man hours to fix the dent cost over $2000 and took nearly a full week of work by an approved AAA repair vendor... From what I have read newer vehicles, due to the use of modern body materials, aren't able to undergo many of the same simple quick fixes that cars pre and early 2000 era used to be able to get. Fender benders have gotten pretty damn expensive.

I could pay $2000 cash to fix something like this, but it is one hell of a price to pay for a cosmetic fix over random uncontrollable damage occasionally incurred in city living wiht assholes.
I don't dispute what you say, but I don't see how it invalidates my point. The majority of accidents are non-injury fender benders.  Certainly in late-model cars they can cost a few grand to fix should you want to.
My point was that the majority of accidents (even at ~$2k) are not the true reason to be insured.  It's the less common but more severe accidents that can be orders of magnitude more costly, like multiple-car injury accidents.
All of this was an analogy to another poster's comment about the median ER visit cost being ~$1,200, and how that wasn't exactly a financial catastrophy, so why the need for insurance? 
Title: Re: What comes after the ACA?
Post by: MayDay on January 12, 2017, 01:31:06 PM
I don't understand what is being required as coverage under the ACA that people oppose and think is too fancy.

Someone mentioned mammograms.  Is it because they are a man?  Do they think I should get a discount since I don't need prostrate checks?  Do they think prostrate exams are cheaper, and thus men should pay less?  Should we divide out all gender-specific medical costs and charge different premiums based on gender? 

The logic boggles me. 
Title: Re: What comes after the ACA?
Post by: mathlete on January 12, 2017, 01:43:06 PM
I don't understand what is being required as coverage under the ACA that people oppose and think is too fancy.

Someone mentioned mammograms.  Is it because they are a man?  Do they think I should get a discount since I don't need prostrate checks?  Do they think prostrate exams are cheaper, and thus men should pay less?  Should we divide out all gender-specific medical costs and charge different premiums based on gender? 

The logic boggles me.

Someone could oppose the mandate based on the minimum actuarial value rather than the required covered benefits.

Perhaps this person is wealthy and healthy and carries only a critical illness indemnity plan or some other stop loss kind of product. They pay for what little regular health care they receive out of pocket and if something really bad happens, insurance covers it.

If that person wanted to do the same strategy under ACA, they'd have to pay the tax.

I would consider this to be a legitimate gripe with ACA.

Of course, I don't know how many people this actually describes vs. people who don't carry insurance b/c they think they're invincible but in reality they're a $10K bill away from medical bankruptcy.
Title: Re: What comes after the ACA?
Post by: protostache on January 12, 2017, 01:53:34 PM
I don't understand what is being required as coverage under the ACA that people oppose and think is too fancy.

Someone mentioned mammograms.  Is it because they are a man?  Do they think I should get a discount since I don't need prostrate checks?  Do they think prostrate exams are cheaper, and thus men should pay less?  Should we divide out all gender-specific medical costs and charge different premiums based on gender? 

The logic boggles me.

Someone could oppose the mandate based on the minimum actuarial value rather than the required covered benefits.

Perhaps this person is wealthy and healthy and carries only a critical illness indemnity plan or some other stop loss kind of product. They pay for what little regular health care they receive out of pocket and if something really bad happens, insurance covers it.

If that person wanted to do the same strategy under ACA, they'd have to pay the tax.

I would consider this to be a legitimate gripe with ACA.

Of course, I don't know how many people this actually describes vs. people who don't carry insurance b/c they think they're invincible but in reality they're a $10K bill away from medical bankruptcy.

You think someone wealthy enough to legitimately use that strategy cares at all about a $700 fine? Please. It's extremely unlikely they would be paying it anyway because nobody in that situation is getting a tax refund.
Title: Re: What comes after the ACA?
Post by: Metric Mouse on January 12, 2017, 02:02:59 PM

I think basic healthcare is in the same category, and should be paid for the same way.
I'm with you Sol - I think a society should strive towards providing basic health services for its people as it does a basic level of safety (police, fire, military), shelter, education and nurishment.

Often the programs which provide these services can be improve, but they should always exist.

I think most people would agree on this. (One of)the issues with the ACA is that it doesn't provide health care, just health insurance. Universal health care would be great; universal health insurance is a very poor substitute, especially considering the cost.
Title: Re: What comes after the ACA?
Post by: v8rx7guy on January 12, 2017, 02:04:18 PM

I think basic healthcare is in the same category, and should be paid for the same way.
I'm with you Sol - I think a society should strive towards providing basic health services for its people as it does a basic level of safety (police, fire, military), shelter, education and nurishment.

Often the programs which provide these services can be improve, but they should always exist.

I think most people would agree on this. (One of)the issues with the ACA is that it doesn't provide health care, just health insurance. Universal health care would be great; universal health insurance is a very poor substitute, especially considering the cost.

That's a really good point, hadn't thought of that distinction before.
Title: Re: What comes after the ACA?
Post by: rpr on January 12, 2017, 02:10:07 PM
I think most people would agree on this. (One of)the issues with the ACA is that it doesn't provide health care, just health insurance. Universal health care would be great; universal health insurance is a very poor substitute, especially considering the cost.
I wholeheartedly agree with what you say. However, given the current political anti-government atmosphere prevailing in this country, universal health insurance is the best that we can hope for. It is certainly better than the alternative of no health insurance thus no health care.
Title: Re: What comes after the ACA?
Post by: EfficientN on January 12, 2017, 02:18:37 PM
I don't understand what is being required as coverage under the ACA that people oppose and think is too fancy.

Someone mentioned mammograms.  Is it because they are a man?  Do they think I should get a discount since I don't need prostrate checks?  Do they think prostrate exams are cheaper, and thus men should pay less?  Should we divide out all gender-specific medical costs and charge different premiums based on gender? 

The logic boggles me.

Someone could oppose the mandate based on the minimum actuarial value rather than the required covered benefits.

Perhaps this person is wealthy and healthy and carries only a critical illness indemnity plan or some other stop loss kind of product. They pay for what little regular health care they receive out of pocket and if something really bad happens, insurance covers it.

If that person wanted to do the same strategy under ACA, they'd have to pay the tax.

I would consider this to be a legitimate gripe with ACA.

Of course, I don't know how many people this actually describes vs. people who don't carry insurance b/c they think they're invincible but in reality they're a $10K bill away from medical bankruptcy.

Wait, isn't what you're describing just a High-Deductible Health Care Plan? Those are freely available and even come with generous HSA tax incentives.
Title: Re: What comes after the ACA?
Post by: mathlete on January 12, 2017, 02:24:15 PM
You think someone wealthy enough to legitimately use that strategy cares at all about a $700 fine? Please. It's extremely unlikely they would be paying it anyway because nobody in that situation is getting a tax refund.

You pay the maximum of the set penalty and a percentage of your income, all the way up to the cost of a Bronze AV plan. So it can be a lot higher than $695. For a sufficiently high income, you're basically forced onto a bronze plan.

Besides, you don't need to be that rich to have your options of cost-cutting limited by ACA.

I receive employer coverage so this is moot for me, but if I didn't have employer coverage, but made a similar income and had similar savings to what I do now, I would opt for a very high out of pocket max plan. I'm a young and healthy guy with enough savings to cover lots of healthcare costs. This strategy is hampered by such a plan possibly not meeting the minimum AV. I'd be discouraged from doing this b/c of the penalty.
Title: Re: What comes after the ACA?
Post by: mathlete on January 12, 2017, 02:33:57 PM
Wait, isn't what you're describing just a High-Deductible Health Care Plan? Those are freely available and even come with generous HSA tax incentives.

A high deductible plan is one way to do it. Critical illness plans like I mentioned are another.

Even with high deductible plans though, under ACA, you're really limited by how "high" the high deductible can be.

In order to qualify as a QHP (plan that will get you out of paying the penalty), a plan has to meet certain limits. One limit is on the out-of-pocket max. Deductible can't be higher than the OOP max so your deductible is capped at $7,150 for individuals.

Title: Re: What comes after the ACA?
Post by: protostache on January 12, 2017, 02:57:55 PM
You think someone wealthy enough to legitimately use that strategy cares at all about a $700 fine? Please. It's extremely unlikely they would be paying it anyway because nobody in that situation is getting a tax refund.

You pay the maximum of the set penalty and a percentage of your income, all the way up to the cost of a Bronze AV plan. So it can be a lot higher than $695. For a sufficiently high income, you're basically forced onto a bronze plan.

Besides, you don't need to be that rich to have your options of cost-cutting limited by ACA.

I receive employer coverage so this is moot for me, but if I didn't have employer coverage, but made a similar income and had similar savings to what I do now, I would opt for a very high out of pocket max plan. I'm a young and healthy guy with enough savings to cover lots of healthcare costs. This strategy is hampered by such a plan possibly not meeting the minimum AV. I'd be discouraged from doing this b/c of the penalty.

I didn't know it applied like that. Good info.

That said, the number of people this affects is maaaaybe 1% of the population on the outside, right? There just aren't that many people that actually have the financial wherewithal to self insure things a non-QHP indemnity plan doesn't cover. Public policy needs to account for most of the people most of the time. It shouldn't be catering to the top.
Title: Re: What comes after the ACA?
Post by: RangerOne on January 12, 2017, 03:35:31 PM
Which preferential tax treatment are you referring to?

Employers do not pay FICA on benefits paid to employees - that's a ~8% savings off the top. It's also the case that the employer can deduct any benefits paid out as a business expense - but the employee can do no such thing if they obtain insurance on their own.

Hence the incentive is for employers to pay as much as possible in the form of benefits, and as little as possible in salary, in many cases.

-W

Hm okay that is kind of what I assumed you were getting at though I don't have the perspective of the employer end to understand why you think that tax incentive is harmful.

It sounds like you are suggesting that having big companies disproportionately encourage through tax breaks to pay untenable health care premiums is driving up prices which would otherwise be lower if it were left entirely to individual families to pay for.

That is an interesting notion I hadn't considered. Have you seen any research that shows this is happening? Maybe this is based on personal experience from helping make such decisions?

I don't get the impression from larger companies and employment groups like Tri-net, based the raw cost of their health care plans and the portion they pay for, that they find it desirable to spend as much money as possible on health insurance. Many appear to be going the opposite direction. There are many large companies trying to shift plans over to HDHP over standard plans primarily because they cost them less.

Its not like you can pay an employee in a competitive market half what your competitors are by arguing the other half is covered by an overpriced health plan that is more than you need. Competition among employers should keep the total package prices in line. You can certainly argue that your offer is better because you offer better more valuable health care than a competitor but there is a definite limit on how effective that argument will be based on many other market factors beyond tax incentives.
Title: Re: What comes after the ACA?
Post by: RangerOne on January 12, 2017, 04:02:55 PM
...
As an example, take car insurance. I'm certain most accidents are minor fender-benders with no injuries and cosmetic damage....

I don't know if you have taken a recent model car to a shop lately but the age of a fender bender costing you $600 dollars out of pocket seems long gone. I recently took in my 2013 Hyundai Sonata for a parking lot hit and run. It is our nice family car so cosmetics still mean something to me.

Basically someone crunched a small part of our bumper behind the rear wheel. Caving in maybe like a soccer ball sized dent, but functionally no real damage.

Parts and paint cost maybe like $80 for the repair. But the man hours to fix the dent cost over $2000 and took nearly a full week of work by an approved AAA repair vendor... From what I have read newer vehicles, due to the use of modern body materials, aren't able to undergo many of the same simple quick fixes that cars pre and early 2000 era used to be able to get. Fender benders have gotten pretty damn expensive.

I could pay $2000 cash to fix something like this, but it is one hell of a price to pay for a cosmetic fix over random uncontrollable damage occasionally incurred in city living wiht assholes.
I don't dispute what you say, but I don't see how it invalidates my point. The majority of accidents are non-injury fender benders.  Certainly in late-model cars they can cost a few grand to fix should you want to.
My point was that the majority of accidents (even at ~$2k) are not the true reason to be insured.  It's the less common but more severe accidents that can be orders of magnitude more costly, like multiple-car injury accidents.
All of this was an analogy to another poster's comment about the median ER visit cost being ~$1,200, and how that wasn't exactly a financial catastrophy, so why the need for insurance?

Thats true I suppose discussing real numbers doesn't make your point invalid.

I think what you are stating is one way of looking at what insurance is. But I don't think that is how most people think when they buy insurance.

What I think actually happens is you buy insurance to set a threshold that says, I can afford to risk losing X amount of cash each year without any lingering adverse effects. And I am willing to pay Y fixed cost per year to make sure I never go over Y+X in any given year.

You aren't really shopping for insurance thinking about the 1 in a million chance you will be hospitalized for a major issue for plow your car into a pack of Teslas.

What you are doing is trying to control your budget by setting a maximum yearly cost you will incur by always paying a fixed insurance cost. This allows you hopefully to be able to say that with regards to something like yearly health costs, you are equally comfortable paying the minimum and maximum each year. Without insurance there would be almost no way to have this kind of certainty.

I don't know maybe I am saying the same thing. Maybe there is not a difference between talking about being insured for catastrophe and being insured to set tolerable max and min cost on your health.
Title: Re: What comes after the ACA?
Post by: waltworks on January 12, 2017, 04:29:56 PM
Don't get me wrong, Ranger - the employer still wants to spend as little as possible on health insurance, of course. But it costs them less to spend $10k on health insurance for an employee than it does to pay them $10k in salary. That's the issue here.

It's also the case that most employees don't see or know how much their employer is spending on health insurance for them (until they try to go on COBRA and get a rude shock...) so there is a price transparency issue here as well.

Essentially, decoupling health care from employment should be a goal for basically everyone regardless of political persuasion. Even simply applying FICA to all compensation would do that pretty quickly and a true market for individual insurance could develop.

-W
Title: Re: What comes after the ACA?
Post by: jim555 on January 12, 2017, 04:39:57 PM
Don't worry it will be wonderful and so much cheaper!  How?  Magic!
Title: Re: What comes after the ACA?
Post by: protostache on January 12, 2017, 04:40:41 PM
So... does anyone know what comes after the ACA?   I sure don't. All this talk of black boxes during the election -- Hillary's emails; Trumps tax returns -- but the replacement for Obamacare (if there is one) seems to be pretty boxlike, itself.

No. Nobody knows. There seem to be three competing "plans", only one of which is at all fleshed out. Paul Ryan's A Better Way has the most detail. The incoming secretary of Health and Human Services has another plan but it's really just sort of a sketch. PEOTUS Trump has said "better, cheaper" but that's the most detail he's provided.
Title: Re: What comes after the ACA?
Post by: nereo on January 12, 2017, 05:09:41 PM
So... does anyone know what comes after the ACA?   I sure don't. All this talk of black boxes during the election -- Hillary's emails; Trumps tax returns -- but the replacement for Obamacare (if there is one) seems to be pretty boxlike, itself.

No. Nobody knows. There seem to be three competing "plans", only one of which is at all fleshed out. Paul Ryan's A Better Way has the most detail. The incoming secretary of Health and Human Services has another plan but it's really just sort of a sketch. PEOTUS Trump has said "better, cheaper" but that's the most detail he's provided.
For Trump you forgot the "fantastic" part of his detailed plan.

Re: Ryan's plan... is that seriously what it's called (A Better Way)?  Did no one think that through??  I mean, I get that they are immediately trying to suggest that it's better than Obamacare, but what happens if it actually goes through?  For the foreseeable future people are political hacks are going to be saying "is this really 'A Better Way'" and "there's got to be "A Better Way"".  Why not just label is the "Independently Tested Standardized Universal Care & Karma Statute?"??
Title: Re: What comes after the ACA?
Post by: protostache on January 12, 2017, 05:37:22 PM
So... does anyone know what comes after the ACA?   I sure don't. All this talk of black boxes during the election -- Hillary's emails; Trumps tax returns -- but the replacement for Obamacare (if there is one) seems to be pretty boxlike, itself.

No. Nobody knows. There seem to be three competing "plans", only one of which is at all fleshed out. Paul Ryan's A Better Way has the most detail. The incoming secretary of Health and Human Services has another plan but it's really just sort of a sketch. PEOTUS Trump has said "better, cheaper" but that's the most detail he's provided.
For Trump you forgot the "fantastic" part of his detailed plan.

Re: Ryan's plan... is that seriously what it's called (A Better Way)?  Did no one think that through??  I mean, I get that they are immediately trying to suggest that it's better than Obamacare, but what happens if it actually goes through?  For the foreseeable future people are political hacks are going to be saying "is this really 'A Better Way'" and "there's got to be "A Better Way"".  Why not just label is the "Independently Tested Standardized Universal Care & Karma Statute?"??

Yep. It even has a slick marketing website: http://abetterway.speaker.gov (http://abetterway.speaker.gov). Keep in mind this is Ryan's comprehensive plan for A Better America so it includes things like A Better Medicare (gotten rid of) and A Better Social Security (also gone).
Title: Re: What comes after the ACA?
Post by: nereo on January 12, 2017, 05:42:11 PM
So... does anyone know what comes after the ACA?   I sure don't. All this talk of black boxes during the election -- Hillary's emails; Trumps tax returns -- but the replacement for Obamacare (if there is one) seems to be pretty boxlike, itself.

No. Nobody knows. There seem to be three competing "plans", only one of which is at all fleshed out. Paul Ryan's A Better Way has the most detail. The incoming secretary of Health and Human Services has another plan but it's really just sort of a sketch. PEOTUS Trump has said "better, cheaper" but that's the most detail he's provided.
For Trump you forgot the "fantastic" part of his detailed plan.

Re: Ryan's plan... is that seriously what it's called (A Better Way)?  Did no one think that through??  I mean, I get that they are immediately trying to suggest that it's better than Obamacare, but what happens if it actually goes through?  For the foreseeable future people are political hacks are going to be saying "is this really 'A Better Way'" and "there's got to be "A Better Way"".  Why not just label is the "Independently Tested Standardized Universal Care & Karma Statute?"??

Yep. It even has a slick marketing website: http://abetterway.speaker.gov (http://abetterway.speaker.gov). Keep in mind this is Ryan's comprehensive plan for A Better America so it includes things like A Better Medicare (gotten rid of) and A Better Social Security (also gone).
so.... most of the "better" things are already gone? 
how sad.
Title: Re: What comes after the ACA?
Post by: brooklynguy on January 12, 2017, 05:45:15 PM
But it costs them less to spend $10k on health insurance for an employee than it does to pay them $10k in salary.

Not exactly -- the cost to the employer is the same, but, for the employee, the compensation received in the form of employer-paid health insurance premiums is exempt from taxes (while the compensation received in the form of cash salary, of course, is not).  In other words, it costs the employer less to spend a given amount on health insurance for an employee than it it would cost to provide the employee with an equivalent amount of salary on after-tax basis from the employee's perspective.  But the point still stands.
Title: Re: What comes after the ACA?
Post by: protostache on January 12, 2017, 05:48:37 PM
But it costs them less to spend $10k on health insurance for an employee than it does to pay them $10k in salary.

Not exactly -- the cost to the employer is the same, but, for the employee, the compensation received in the form of employer-paid health insurance premiums is exempt from taxes (while the compensation received in the form of cash salary, of course, is not).  In other words, it costs the employer less to spend a given amount on health insurance for an employee than it it would cost to provide the employee with an equivalent amount of salary on after-tax basis from the employee's perspective.  But the point still stands.

Plus the employer half of payroll tax. One could argue that's part of compensation, I suppose.
Title: Re: What comes after the ACA?
Post by: nereo on January 12, 2017, 06:03:19 PM
But it costs them less to spend $10k on health insurance for an employee than it does to pay them $10k in salary.

Not exactly -- the cost to the employer is the same, but, for the employee, the compensation received in the form of employer-paid health insurance premiums is exempt from taxes (while the compensation received in the form of cash salary, of course, is not).  In other words, it costs the employer less to spend a given amount on health insurance for an employee than it it would cost to provide the employee with an equivalent amount of salary on after-tax basis from the employee's perspective.  But the point still stands.

Exactly, and I think this is an example of an unexpected runaway effect. We wanted to encourage employers to provide benefits for their workers, so we made it preferable for companies to provide health insurance over increased pay.  Unanticipated result - people stopped recognizing what their health care premiums actually cost, and it created barriers to leaving (I don't want to lose my health care!) Insurance companies got savvy and started bargaining for better prices, which alternatively meant that self-insured people had to pay more for the same treatment. Now whenever people become unemployed they are unprepared to pay their own insurance. "$15,000/year for a low-deductable family plan? that's outrageous!" - maybe, but it's about what your health insurance cost all along...
Title: Re: What comes after the ACA?
Post by: protostache on January 12, 2017, 06:14:38 PM
But it costs them less to spend $10k on health insurance for an employee than it does to pay them $10k in salary.

Not exactly -- the cost to the employer is the same, but, for the employee, the compensation received in the form of employer-paid health insurance premiums is exempt from taxes (while the compensation received in the form of cash salary, of course, is not).  In other words, it costs the employer less to spend a given amount on health insurance for an employee than it it would cost to provide the employee with an equivalent amount of salary on after-tax basis from the employee's perspective.  But the point still stands.

Exactly, and I think this is an example of an unexpected runaway effect. We wanted to encourage employers to provide benefits for their workers, so we made it preferable for companies to provide health insurance over increased pay.  Unanticipated result - people stopped recognizing what their health care premiums actually cost, and it created barriers to leaving (I don't want to lose my health care!) Insurance companies got savvy and started bargaining for better prices, which alternatively meant that self-insured people had to pay more for the same treatment. Now whenever people become unemployed they are unprepared to pay their own insurance. "$5,000/year for a low-deductable family plan? that's outrageous!" - maybe, but it's about what your health insurance cost all along...

I don't think society encouraged it. Companies couldn't raise wages after WWII so they started offering insane fringe benefits instead, which they then wrote off their taxes as expenses. Company provided health insurance is a legacy from that era.

Also $5,000 for a low deductible family plan? That's outrageous...ly low. The low deductible plans in Michigan this year were on the order of $18k this year.
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 12, 2017, 06:15:38 PM
I don't get the impression from larger companies and employment groups like Tri-net, based the raw cost of their health care plans and the portion they pay for, that they find it desirable to spend as much money as possible on health insurance. Many appear to be going the opposite direction. There are many large companies trying to shift plans over to HDHP over standard plans primarily because they cost them less.

Its not like you can pay an employee in a competitive market half what your competitors are by arguing the other half is covered by an overpriced health plan that is more than you need. Competition among employers should keep the total package prices in line. You can certainly argue that your offer is better because you offer better more valuable health care than a competitor but there is a definite limit on how effective that argument will be based on many other market factors beyond tax incentives.

Because many employers have figured out they can shift the cost burden to employees without giving them the corresponding bump in pay they would hypothetically see instead of healthcare subsidies.
Title: Re: What comes after the ACA?
Post by: thenextguy on January 12, 2017, 06:23:40 PM
So... does anyone know what comes after the ACA?   I sure don't. All this talk of black boxes during the election -- Hillary's emails; Trumps tax returns -- but the replacement for Obamacare (if there is one) seems to be pretty boxlike, itself.

I have no idea. But Donald Trump says it'll be "terrific!"
Title: Re: What comes after the ACA?
Post by: Quidnon? on January 12, 2017, 06:33:34 PM
So... does anyone know what comes after the ACA?   I sure don't. All this talk of black boxes during the election -- Hillary's emails; Trumps tax returns -- but the replacement for Obamacare (if there is one) seems to be pretty boxlike, itself.

I have no idea. But Donald Trump says it'll be "terrific!"

I believe that is a mis-quote.  Trump said it was going to be "Yuge!"
Title: Re: What comes after the ACA?
Post by: rpr on January 12, 2017, 06:45:01 PM
So... does anyone know what comes after the ACA?   I sure don't. All this talk of black boxes during the election -- Hillary's emails; Trumps tax returns -- but the replacement for Obamacare (if there is one) seems to be pretty boxlike, itself.

I have no idea. But Donald Trump says it'll be "terrific!"

I believe that is a mis-quote.  Trump said it was going to be "Yuge!"
Quidnon? -- good one :)
Title: Re: What comes after the ACA?
Post by: nereo on January 12, 2017, 06:56:36 PM
But it costs them less to spend $10k on health insurance for an employee than it does to pay them $10k in salary.

Not exactly -- the cost to the employer is the same, but, for the employee, the compensation received in the form of employer-paid health insurance premiums is exempt from taxes (while the compensation received in the form of cash salary, of course, is not).  In other words, it costs the employer less to spend a given amount on health insurance for an employee than it it would cost to provide the employee with an equivalent amount of salary on after-tax basis from the employee's perspective.  But the point still stands.

Exactly, and I think this is an example of an unexpected runaway effect. We wanted to encourage employers to provide benefits for their workers, so we made it preferable for companies to provide health insurance over increased pay.  Unanticipated result - people stopped recognizing what their health care premiums actually cost, and it created barriers to leaving (I don't want to lose my health care!) Insurance companies got savvy and started bargaining for better prices, which alternatively meant that self-insured people had to pay more for the same treatment. Now whenever people become unemployed they are unprepared to pay their own insurance. "$5,000/year for a low-deductable family plan? that's outrageous!" - maybe, but it's about what your health insurance cost all along...

I don't think society encouraged it. Companies couldn't raise wages after WWII so they started offering insane fringe benefits instead, which they then wrote off their taxes as expenses. Company provided health insurance is a legacy from that era.

Also $5,000 for a low deductible family plan? That's outrageous...ly low. The low deductible plans in Michigan this year were on the order of $18k this year.

What I meant by 'encouraged' was exacly that - through the tax code.  I don't think it was ever intended to turn out this way (hence the 'unexpected consequences') but our tax code encouraged employers to offer health care in lieu of bigger paychecks which started this cycle of people being dependent on their employer-sponsored health care and not understanding the total cost.

oh - i meant for it to be "$15,000" - that was a typo, thanks for the catch.
Title: Re: What comes after the ACA?
Post by: Monkey Uncle on January 13, 2017, 04:27:22 AM
Don't get me wrong, Ranger - the employer still wants to spend as little as possible on health insurance, of course. But it costs them less to spend $10k on health insurance for an employee than it does to pay them $10k in salary. That's the issue here.

It's also the case that most employees don't see or know how much their employer is spending on health insurance for them (until they try to go on COBRA and get a rude shock...) so there is a price transparency issue here as well.

Essentially, decoupling health care from employment should be a goal for basically everyone regardless of political persuasion. Even simply applying FICA to all compensation would do that pretty quickly and a true market for individual insurance could develop.

-W

Yeah, I never understood why the ACA included the mandate for employers over a certain size to provide insurance for their employees.  If you want the exchanges to succeed, you should try to give them as many customers as possible, rather than making it even more likely that all of the low-risk customers get insurance through some source other than the exchanges.  I presume that the eventual Republican replacement will not include an employer mandate, which might actually be a step in the right direction toward a viable individual insurance market (although it will be disruptive in the short term when a bunch of people lose their employer-provided health insurance).
Title: Re: What comes after the ACA?
Post by: mm1970 on January 13, 2017, 10:10:45 AM
I don't understand what is being required as coverage under the ACA that people oppose and think is too fancy.

Someone mentioned mammograms.  Is it because they are a man?  Do they think I should get a discount since I don't need prostrate checks?  Do they think prostrate exams are cheaper, and thus men should pay less?  Should we divide out all gender-specific medical costs and charge different premiums based on gender? 

The logic boggles me.

Someone could oppose the mandate based on the minimum actuarial value rather than the required covered benefits.

Perhaps this person is wealthy and healthy and carries only a critical illness indemnity plan or some other stop loss kind of product. They pay for what little regular health care they receive out of pocket and if something really bad happens, insurance covers it.

If that person wanted to do the same strategy under ACA, they'd have to pay the tax.

I would consider this to be a legitimate gripe with ACA.

Of course, I don't know how many people this actually describes vs. people who don't carry insurance b/c they think they're invincible but in reality they're a $10K bill away from medical bankruptcy.

You think someone wealthy enough to legitimately use that strategy cares at all about a $700 fine? Please. It's extremely unlikely they would be paying it anyway because nobody in that situation is getting a tax refund.
Well, no but I think there might be just a basic philosophical difference in the point of insurance.

When I was a kid (back in the dark ages), we didn't have insurance for much of the time.  However, it was expected that you paid for your doctors and dentist appointments.  Now the good and bad on that:
Good: you budgeted for this.  Paying for your own medical care came before cable TV, eating out, computers, new clothing, vacations, etc.  (some of these items were just coming out when I was growing up)
Bad: during lean times, you went to the dentist every 2-3 years and the doctor less frequently than that.  Teeth are very important and dental hygiene is really important to health.

So it was expected that you covered the basics, and insurance (if you had it), covered the big stuff.  (I had to have surgery twice when I was 12, no insurance, my parents paid that off for 5 years).


Now, other philosophy: an ounce of prevention is worth a pound of cure.
For whatever reason, people don't go to the doctor when they are ailing.  For some (even people my age), they would get mad at a copay for an annual exam.  The whole cost sharing thing was an affront, and these are upper middle class people.
For others, they just can't afford it.  A $25 copay?  No money for that.  So the problems are left to get worse.  Infections.  Bad teeth.  High cholesterol.  Pre-diabetes.  Wait long enough and you have very very expensive, bad problems.

The good thing about the ACA is that preventive things are fully covered.  So if it really does result in people going to the doctor, getting diagnosed, and fixing things before they get worse, then it is worth it in the long run.

For me, I fall in a gray area.  I totally understand the point of expecting people to use insurance for catastrophic things only.  On the other hand, insurance companies suck and deny deny deny - I really don't think people should die because they cannot afford insurance and treatment, and I also don't think people should be bankrupted due to health / medical issues (I also believe we spend too much on treatment.)

Title: Re: What comes after the ACA?
Post by: Helvegen on January 13, 2017, 01:35:35 PM
It's also the case that most employees don't see or know how much their employer is spending on health insurance for them (until they try to go on COBRA and get a rude shock...) so there is a price transparency issue here as well.

I work for megacorp and every year, they send out information sheets detailing how much they pay for their share of employee benefits. Their share of my HDHP coverage is $21k. Then you add on what I pay, about another $3k, so $24k a year in family plan coverage. Yeah, not affording that on my own.
Title: Re: What comes after the ACA?
Post by: rpr on January 13, 2017, 02:41:29 PM
It's also the case that most employees don't see or know how much their employer is spending on health insurance for them (until they try to go on COBRA and get a rude shock...) so there is a price transparency issue here as well.

I work for megacorp and every year, they send out information sheets detailing how much they pay for their share of employee benefits. Their share of my HDHP coverage is $21k. Then you add on what I pay, about another $3k, so $24k a year in family plan coverage. Yeah, not affording that on my own.

In addition:

If this was not tax deductible, you would be paying 6K/year in federal taxes assuming 25% tax bracket. Most people with employer health insurance don't realize the tax break (or subsidy) they are getting from the government.
Title: Re: What comes after the ACA?
Post by: realDonaldTrump on January 15, 2017, 04:56:18 AM
Short answer is: "Something Terrific"
Title: Re: What comes after the ACA?
Post by: GuitarStv on January 15, 2017, 08:38:46 AM
Short answer is: "Something Terrific"

I suspect people would be less concerned if the long answer differed in any way from the short answer.
Title: Re: What comes after the ACA?
Post by: AllTheLights on January 15, 2017, 08:49:27 AM
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.
Title: Re: What comes after the ACA?
Post by: realDonaldTrump on January 15, 2017, 09:00:34 AM

I suspect people would be less concerned if the long answer differed in any way from the short answer.

The long answer is it will be disaster for poor people (many of them Trump voters).  But it will take to those Rednecks 1-2 years to realize that they voted against their own interest.

Donald Trump is very smart — just ask him — so he’s a quick learner.
Title: Re: What comes after the ACA?
Post by: GuitarStv on January 15, 2017, 09:05:37 AM
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

Hyper-individualism and the myth of personal exceptionalism appear to be very heavily sold to the average American, and I believe that they act as roadblocks to viewing the question the way the rest of the world does.
Title: Re: What comes after the ACA?
Post by: nereo on January 15, 2017, 09:30:18 AM
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

I agree partly with GuitarStv that the concept of total universal healthcare is anathema to most Americans.  For starters, it's socialism, something that a great percentage of our current population grew up to fear and hate.  Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.  YOu can hear that in the way we talk about the government; it's rarely "OUR government is making it harder for small businesses to succeed" - instead it's "THE government (often just "Washington" is against US small business owners".  Even though we are supposedly a government of the people, for the people and by the people we've never fully trusted our elected officials.

FInally there's great concern about financing other people's health care costs, especially those that make poor life decisions. I'll say this is a concern I share in Canada, where people who are overweight, smoke and don't excercise get the same access to health care that I do. With (usually) zero out of pocket cost to everyone the healthy use less than the sick.

THen of course there's the free-market capitalism mentality that permeates US society and runs something like this: why should someone who's worked hard to be very successful be treated the same as a deadbeat slacker when they go to the go to doctors?  In that context, shouldn't having more and paying more result in better/faster/more comfortable service?

Personal thoughts: I think both the Canadian-provincial and US health care systems have a lot of room for improvement.
Title: Re: What comes after the ACA?
Post by: Roland of Gilead on January 15, 2017, 07:36:39 PM

FInally there's great concern about financing other people's health care costs, especially those that make poor life decisions. I'll say this is a concern I share in Canada, where people who are overweight, smoke and don't excercise get the same access to health care that I do. With (usually) zero out of pocket cost to everyone the healthy use less than the sick.


I feel kind of the same way about people who make poor education choices.  Women's studies in college instead of a good solid engineering degree.   They then can't pay back their student loans because there actually was no demand for their field of study.

People make bad choices.
Title: Re: What comes after the ACA?
Post by: waltworks on January 15, 2017, 07:39:45 PM

FInally there's great concern about financing other people's health care costs, especially those that make poor life decisions. I'll say this is a concern I share in Canada, where people who are overweight, smoke and don't excercise get the same access to health care that I do. With (usually) zero out of pocket cost to everyone the healthy use less than the sick.


I feel kind of the same way about people who make poor education choices.  Women's studies in college instead of a good solid engineering degree.   They then can't pay back their student loans because there actually was no demand for their field of study.

People make bad choices.

Actually most of the student loan defaults are from folks who dropped out - and of those, most are in 2-year/associates programs. It's really not the Swarthmore underwater feminist basket weaving kids - they just end up getting a real job and do fine and eventually pay off the loans.

-W
Title: Re: What comes after the ACA?
Post by: Metric Mouse on January 15, 2017, 10:55:24 PM
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

No one's really presented a workable, affordable plan for moving towards this. And it would probably require cutting several popular programs (as it would replace them) of medicare and medicaid, which causes many people to oppose it.

Title: Re: What comes after the ACA?
Post by: jim555 on January 16, 2017, 05:23:59 AM
If the ACA is defunded but the law remains on the books, then most people would qualify for a hardship exemption due to unaffordability.  The ACA catastrophic plans would then become an option.  This seems like the most likely outcome.  There will be no replacement since they do not have the votes for one.  They will do a delayed defunding.

Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 16, 2017, 05:43:31 AM
Something that just came up in a WaPo article, which I had forgotten. Back in the good old days, pregnancy was widely considered a preexisting condition. Not pregnancy as in "are you currently pregnant?" But pregnancy as in "have you ever, in your life, been pregnant?"

Yes. Let's go back to that. Sounds reasonable.
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 05:55:50 AM
Something that just came up in a WaPo article, that I had forgotten. Back in the good old days, pregnancy was widely considered a preexisting condition. Not pregnancy as in "are you currently pregnant?" But pregnancy as in "have you ever, in your life, been pregnant?"

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

Yeah... the ACA is filled with problems, but what it replaced in 2006 was far worse. I'd respect opponents a lot more if they'd just admit that.  Then the decision could be either
1) the ACA was a first attempt, but it's so big/cumbersome that we should write an entirely new law
2) the ACA's faults can be fixed by numerous 'patches'

Framed that way I can see merit for option #1.... but that involves first admitting the ACA was an improvement over our previous system. Instead, it's been made out to be the devil's spawn.
Title: Re: What comes after the ACA?
Post by: Iplawyer on January 16, 2017, 07:12:39 AM
Something that just came up in a WaPo article, which I had forgotten. Back in the good old days, pregnancy was widely considered a preexisting condition. Not pregnancy as in "are you currently pregnant?" But pregnancy as in "have you ever, in your life, been pregnant?"

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

And before the ACA women only bore the cost of pregnancy when buying health insurance - not the men that were an integral part of it.  So insurance was far more expensive for women than men and impossible to get once pregnant.  Yay - let's have women go nine months with no prenatal care and birth a baby in the emergency room. As a society - just like society pays for primary and secondary education - can't we agree that all of us should pay for insurance for a pregnant woman? 
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 16, 2017, 07:50:54 AM
Something that just came up in a WaPo article, which I had forgotten. Back in the good old days, pregnancy was widely considered a preexisting condition. Not pregnancy as in "are you currently pregnant?" But pregnancy as in "have you ever, in your life, been pregnant?"

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

And before the ACA women only bore the cost of pregnancy when buying health insurance - not the men that were an integral part of it.  So insurance was far more expensive for women than men and impossible to get once pregnant.  Yay - let's have women go nine months with no prenatal care and birth a baby in the emergency room. As a society - just like society pays for primary and secondary education - can't we agree that all of us should pay for insurance for a pregnant woman?

The kicker is that we're all paying for it anyway, regardless of the insurance situation. Woman has a baby in the ER with no insurance and no assets? Guess who's bill just got a little bit higher? If it's a non-profit hospital, they get to count any "bad debt" as "community benefit" for the IRS, even after putting the patient into collections/bankruptcy.

The care is generally happening one way or another, but acting like we aren't paying for it (or aren't going to pay for it) is just asinine. We need to move past it, and develop something sustainable that doesn't involve dicking over poor people.
Title: Re: What comes after the ACA?
Post by: EscapeVelocity2020 on January 16, 2017, 07:53:42 AM
Something that just came up in a WaPo article, which I had forgotten. Back in the good old days, pregnancy was widely considered a preexisting condition. Not pregnancy as in "are you currently pregnant?" But pregnancy as in "have you ever, in your life, been pregnant?"

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

And before the ACA women only bore the cost of pregnancy when buying health insurance - not the men that were an integral part of it.  So insurance was far more expensive for women than men and impossible to get once pregnant.  Yay - let's have women go nine months with no prenatal care and birth a baby in the emergency room. As a society - just like society pays for primary and secondary education - can't we agree that all of us should pay for insurance for a pregnant woman?

The kicker is that we're all paying for it anyway, regardless of the insurance situation. Woman has a baby in the ER with no insurance and no assets? Guess who's bill just got a little bit higher? If it's a non-profit hospital, they get to count any "bad debt" as "community benefit" for the IRS, even after putting the patient into collections/bankruptcy.

The care is generally happening one way or another, but acting like we aren't paying for it (or aren't going to pay for it) is just asinine. We need to move past it, and develop something sustainable that doesn't involve dicking over poor people.

Amen brother, or, I guess I should say +1.  I would only add that it disproportionately affects the 'middle class' as opposed to being a problem for the 1%. 
Title: Re: What comes after the ACA?
Post by: packlawyer04 on January 16, 2017, 08:43:53 AM
There is still no plan anywhere to comprehensively address medical costs so there is still no solution that works (ACA or any other plan put forth to date from republicans).

Nobody wants to address the difficult questions.  Just like other problems, keep kicking the can down the road.
Title: Re: What comes after the ACA?
Post by: packlawyer04 on January 16, 2017, 08:48:10 AM
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category. The current major entitlement programs the government runs are running out of money and are rampant with fraud and waste.  The U.S. currently has a universal healthcare model, the V.A. We all see how that is working....
Title: Re: What comes after the ACA?
Post by: sol on January 16, 2017, 09:07:35 AM
The U.S. currently has a universal healthcare model, the V.A. We all see how that is working....

Technically we have three different single payer systems.  Medicaid, Medicare, and Tricare. I agree that they do not all work equally well, but I would argue that all three of them are better than what we had before the ACA.
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 09:08:05 AM
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category.
Your response basically confirms my point. In other countries the citizens have a different view about which (private for-profits or the government) will be the most effective. The levels of waste, abuse, corruption etc. for either depend on the laws, oversight, and competition available.
Title: Re: What comes after the ACA?
Post by: infogoon on January 16, 2017, 09:16:11 AM
To provide the defense of what for its citizens?  You mean, like, their health?

It's fucking amazing that there are people in this country more scared of ISIS than they are of cancer.
Title: Re: What comes after the ACA?
Post by: protostache on January 16, 2017, 09:31:53 AM
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category. The current major entitlement programs the government runs are running out of money and are rampant with fraud and waste.  The U.S. currently has a universal healthcare model, the V.A. We all see how that is working....

Please elaborate and cite your sources.
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 09:47:06 AM
interesting article out today commenting on DJT's pledge of 'insurance for everybody'.
 (https://www.washingtonpost.com/politics/trump-vows-insurance-for-everybody-in-obamacare-replacement-plan/2017/01/15/5f2b1e18-db5d-11e6-ad42-f3375f271c9c_story.html?hpid=hp_hp-top-table-main_trump-interview-822pm%3Ahomepage%2Fstory&utm_term=.8f1877f83141)
tl/dr: Trump's setting the bar pretty high by promising coverage for everyone that's 'much less expensive and much better' with 'much lower deductibles'. He says it will not have cuts to Medicare.
Curious to see how this could happen without costing a fortune and requiring some sort of coersion/mandate to get everyone to participate.
Title: Re: What comes after the ACA?
Post by: packlawyer04 on January 16, 2017, 09:52:16 AM
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category. The current major entitlement programs the government runs are running out of money and are rampant with fraud and waste.  The U.S. currently has a universal healthcare model, the V.A. We all see how that is working....

Please elaborate and cite your sources.

LOL. Our major entitlement programs are not going to be able to pay out what they said they would pretty soon. Social Security, Medicaire, Medicaid, etc.
Title: Re: What comes after the ACA?
Post by: packlawyer04 on January 16, 2017, 09:56:11 AM
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category.
Your response basically confirms my point. In other countries the citizens have a different view about which (private for-profits or the government) will be the most effective. The levels of waste, abuse, corruption etc. for either depend on the laws, oversight, and competition available.

And most other countries (European single payer is often discussed) are the size of a state in the United States.  I would agree that states are more efficient than federal government. And local government is more efficient that state government.  On down the line.  Which is why the guys who founded this country left most powers with the states.
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 09:59:57 AM
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category. The current major entitlement programs the government runs are running out of money and are rampant with fraud and waste.  The U.S. currently has a universal healthcare model, the V.A. We all see how that is working....

Please elaborate and cite your sources.

LOL. Our major entitlement programs are not going to be able to pay out what they said they would pretty soon. Social Security, Medicaire, Medicaid, etc.

Sounds like fear tactics to me.  Let's take SS for an example: currently its running a surplus forecasted to continue until 2019, at which point it'll start drawing from the trust fund.  Under the SST's most conservative model, the fund will be able to pay out full benefits until 2034.  Afterwards, it will be able to pay out at least 79% of proposed benefits for the full 75 year time frame required by law.

Not exactly "pretty soon" in my view, nor even definite.  These models are concervative to begin with and small adjustments and/or better revenue could ensure they never happen.
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 16, 2017, 10:01:07 AM
interesting article out today commenting on DJT's pledge of 'insurance for everybody'.
 (https://www.washingtonpost.com/politics/trump-vows-insurance-for-everybody-in-obamacare-replacement-plan/2017/01/15/5f2b1e18-db5d-11e6-ad42-f3375f271c9c_story.html?hpid=hp_hp-top-table-main_trump-interview-822pm%3Ahomepage%2Fstory&utm_term=.8f1877f83141)
tl/dr: Trump's setting the bar pretty high by promising coverage for everyone that's 'much less expensive and much better' with 'much lower deductibles'. He says it will not have cuts to Medicare.
Curious to see how this could happen without costing a fortune and requiring some sort of coersion/mandate to get everyone to participate.

What the what? He's literally suggesting that low-to-moderate income people are going to get bigger subsidies. I seriously hope they're not just going to deficit spend this one ...
Title: Re: What comes after the ACA?
Post by: packlawyer04 on January 16, 2017, 10:03:03 AM
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category. The current major entitlement programs the government runs are running out of money and are rampant with fraud and waste.  The U.S. currently has a universal healthcare model, the V.A. We all see how that is working....

Please elaborate and cite your sources.

LOL. Our major entitlement programs are not going to be able to pay out what they said they would pretty soon. Social Security, Medicaire, Medicaid, etc.

Sounds like fear tactics to me.  Let's take SS for an example: currently its running a surplus forecasted to continue until 2019, at which point it'll start drawing from the trust fund.  Under the SST's most conservative model, the fund will be able to pay out full benefits until 2034.  Afterwards, it will be able to pay out at least 79% of proposed benefits for the full 75 year time frame required by law.

Not exactly "pretty soon" in my view, nor even definite.  These models are concervative to begin with and small adjustments and/or better revenue could ensure they never happen.

What scare tactic. You jut admitted it is not going to be able to meet its requirements.  2034 is soon to me.  Less than 20 years.  I'm 35. If someone is 65 now, yeah, you probably don't really care very much.
Title: Re: What comes after the ACA?
Post by: sol on January 16, 2017, 10:03:30 AM
tl/dr: Trump's setting the bar pretty high by promising coverage for everyone that's 'much less expensive and much better' with 'much lower deductibles'.

Well, the easy way to do that is to raise deductibles.  Insurance premiums gets pretty cheap if everyone has a $20k deductible and gets zero coverage until they spend that much out of pocket in a calendar year.

This sort of plan is usually cheaper for young healthy people, because they just don't go to the doctor.  They get no preventative care at all.  Unfortunately it's not cheaper overall for society, because lots of cheaply preventable problems go untreated until that person shows up at the ER with gangrenous feet.

One way to fix that problem (that the ACA tried, so maybe Republicans hate it) is to make preventative care 100% covered even on high deductible plans.  Like you get one physical per year for free, but if that physical finds anything wrong you are going to be on the hook to pay for it.  Ditto for 100% coverage of twice per year routine dental cleanings, but not any dental work (fillings are 100% out of pocket).  The problem with this plan is that it doesn't really keep costs down if you're paying for the first care and the last care but not the middle care, and it incentivizes people who need routine care to avoid getting it, so that they don't incur any cost for cavities or arthritis drugs or whatever. 

But the high deductible and free preventative care model works well for some people, including my family.  We're on a plan that leans that direction, and it is cheaper for us as long as we avoid any major medical catastrophes, and it will be slightly more expensive than our traditional insurance the first year one of my kids breaks a bone.  As a high income family, we also get way more benefit out of the HSA than do most people because our tax bracket is so high, so I expect Republicans to expand the HSA contribution limits as another tax break for rich people like me. 
Title: Re: What comes after the ACA?
Post by: bacchi on January 16, 2017, 10:03:56 AM
Something that just came up in a WaPo article, which I had forgotten. Back in the good old days, pregnancy was widely considered a preexisting condition. Not pregnancy as in "are you currently pregnant?" But pregnancy as in "have you ever, in your life, been pregnant?"

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

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

Too many head colds was grounds for denial.

Those were the good ol' days. America! Fuck yeah!
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 10:07:19 AM
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category.
Your response basically confirms my point. In other countries the citizens have a different view about which (private for-profits or the government) will be the most effective. The levels of waste, abuse, corruption etc. for either depend on the laws, oversight, and competition available.

And most other countries (European single payer is often discussed) are the size of a state in the United States.  I would agree that states are more efficient than federal government. And local government is more efficient that state government.  On down the line.  Which is why the guys who founded this country left most powers with the states.
I'm not sure what this has to do with the topic at hand. I made no comment about the efficency of state or local governments; I'm merely trying to explain to non-Americans why there is so much resistance in the US to universal federal health care.  Certainly some will argue that economies of scale favor larger interactions.
Also "the guys who founded this country" also didn't envision a country this large and complex, nor corporations that have the powers and wealth that they do today.
Perhaps that argues for increased local level government, perhaps not - doesn't seem to fit this sub-thread though.
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 10:10:02 AM
tl/dr: Trump's setting the bar pretty high by promising coverage for everyone that's 'much less expensive and much better' with 'much lower deductibles'.

Well, the easy way to do that is to raise deductibles.  Insurance premiums gets pretty cheap if everyone has a $20k deductible and gets zero coverage until they spend that much out of pocket in a calendar year. (snip)


Yeah, except DJT is proposing better & cheaper coverage for everyone "with much lower deductables".
Like many of his promises, I don't see how this is even remotely possible.  To borrow an industry phrase; you can have high quality, fast and cheap, but you only get to pick two.
Title: Re: What comes after the ACA?
Post by: Wexler on January 16, 2017, 10:11:36 AM
interesting article out today commenting on DJT's pledge of 'insurance for everybody'.
 (https://www.washingtonpost.com/politics/trump-vows-insurance-for-everybody-in-obamacare-replacement-plan/2017/01/15/5f2b1e18-db5d-11e6-ad42-f3375f271c9c_story.html?hpid=hp_hp-top-table-main_trump-interview-822pm%3Ahomepage%2Fstory&utm_term=.8f1877f83141)
tl/dr: Trump's setting the bar pretty high by promising coverage for everyone that's 'much less expensive and much better' with 'much lower deductibles'. He says it will not have cuts to Medicare.
Curious to see how this could happen without costing a fortune and requiring some sort of coersion/mandate to get everyone to participate.

Hard to say, because it's not like anyone (including Trump himself) believes anything he says or holds himself to things he said 5 minutes ago.  However, he did complain about drug prices being too high and that he should get to negotiate them.  So...maybe he'll pit himself against the pharmaceutical industry?  It would be hugely popular with everyone except pharmaceutical executives and, you know, the entire Republican congress.  Remember when they passed a law that Medicare wasn't allowed to negotiate drug prices?  For him to act outside of that would require legislative action, and that seems like a non-starter.
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 10:14:44 AM

What scare tactic. You jut admitted it is not going to be able to meet its requirements.  2034 is soon to me.  Less than 20 years.  I'm 35. If someone is 65 now, yeah, you probably don't really care very much.
No... I'm not the one doing the analysis here, it's the SS Trustees. You were the one saying "very soon;" my argument is that 19 years is not 'pretty soon' especially when the shortfall is about 20% under the most conservative model.
under most scenarios it will be even longer nad with less of a shortfall, and this is assuming we do nothing for the next two decades.
Title: Re: What comes after the ACA?
Post by: Metric Mouse on January 16, 2017, 10:16:56 AM
To provide the defense of what for its citizens?  You mean, like, their health?

It's fucking amazing that there are people in this country more scared of ISIS than they are of cancer.

There are also people more scared of assault rifles than they are of their car... what's the point?
Title: Re: What comes after the ACA?
Post by: packlawyer04 on January 16, 2017, 10:21:06 AM
Wouldn't it just be better if you had universal healthcare?  As a non-American, this whole thing seems like such a strange debate.

 Also, people from the US generally are more skeptical of their government than in most other countries, and there's a widely held belief that anything the government undertakes will be inefficient, wasteful, cumbersome and slow, especially compared to private enterprise.


I wouldn't put that in belief category. More factual category.
Your response basically confirms my point. In other countries the citizens have a different view about which (private for-profits or the government) will be the most effective. The levels of waste, abuse, corruption etc. for either depend on the laws, oversight, and competition available.

And most other countries (European single payer is often discussed) are the size of a state in the United States.  I would agree that states are more efficient than federal government. And local government is more efficient that state government.  On down the line.  Which is why the guys who founded this country left most powers with the states.
I'm not sure what this has to do with the topic at hand. I made no comment about the efficency of state or local governments; I'm merely trying to explain to non-Americans why there is so much resistance in the US to universal federal health care.  Certainly some will argue that economies of scale favor larger interactions.
Also "the guys who founded this country" also didn't envision a country this large and complex, nor corporations that have the powers and wealth that they do today.
Perhaps that argues for increased local level government, perhaps not - doesn't seem to fit this sub-thread though.

Because smaller European countries who are often pointed to as the example of what the U.S. should implement, are simply that, very small countries. Implementing a governmental program to a country that is primarily of the same race and genetic background (Nordic countries) and the size of Virginia or Ohio is a whole other ball game than implementing a single payer system in a country like the United States. See the VA. That is what it has to do with this topic.

It is the reason smaller companies generally have less waste than larger companies. The larger something is, the harder it is to manage and control.

I'm not sitting here claiming we have some great healthcare system pre-ACA. The system was broken. The system is still broken. I'm upset that nobody actually wants to address the problems but instead simply play the move around who is paying for what game.

I'll wait to see what Trump comes up with but I don't see how he has put together a plan for the the comprehensive changes that would need to be implemented on such short notice.
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 10:27:48 AM

Because smaller European countries who are often pointed to as the example of what the U.S. should implement, are simply that, very small countries. Implementing a governmental program to a country that is primarily of the same race and genetic background (Nordic countries) and the size of Virginia or Ohio is a whole other ball game than implementing a single payer system in a country like the United States. See the VA. That is what it has to do with this topic.

It is the reason smaller companies generally have less waste than larger companies. The larger something is, the harder it is to manage and control.

I'm not sitting here claiming we have some great healthcare system pre-ACA. The system was broken. The system is still broken. I'm upset that nobody actually wants to address the problems but instead simply play the move around who is paying for what game.
Fair enough - but I'm not arguing any of these points.
Someone asked why Americans were resistant to universal health care, and I provided my reasoning to why many ideologically disagree with that concept.  A subset of my explanation was that many Americans assume a governmental system will be more wasteful, etc.  You took that portion and re-stated it as fact.

I'm honestly not sure what in my argument you are disagreeing with or why - if anything you seem to be saying that these perceptions are facts.  I wasn't providing an opinion about whether they are true or not because the validity isn't important to the original question about why many in the US resist universal coverage programs.
Title: Re: What comes after the ACA?
Post by: bacchi on January 16, 2017, 10:33:09 AM
I'm not sitting here claiming we have some great healthcare system pre-ACA. The system was broken. The system is still broken. I'm upset that nobody actually wants to address the problems but instead simply play the move around who is paying for what game.

What are the real problems and the solutions? I'll start.

Problems:
1) Everything costs a lot.
2) We're unhealthy.
3) End of life care is yuge for some people.

Solutions:
1) Regulate costs.
2) Promote healthy living. How?
3) Death panels (95 year olds don't get heart-lung transplants)?

Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 10:45:51 AM
I'm not sitting here claiming we have some great healthcare system pre-ACA. The system was broken. The system is still broken. I'm upset that nobody actually wants to address the problems but instead simply play the move around who is paying for what game.

What are the real problems and the solutions? I'll start.


Modifying what Bacchi wrote...
Problems:
1) Health Care costs more in the US than most other countries
2) We're unhealthy.
3) End of life care is yuge for some people.
4) Too many people don't have coverage and/or won't be able to afford coverage without assistance
5) ER visits by uninsured billed to hospitals which never collect

Solutions:
1) Regulate costs.
more preventative medicine, including vaccines and health care during developmental years. Reduce over-treatment/tests which is largely an effort to cover one's ass or appease patients. Control costs of prescription drugs. Reduce overprescription of drugs in first place.
2) Promote healthy living. How?
dunno...hard to control without infringing on individual rights or the free market.
3) Death panels (95 year olds don't get heart-lung transplants)?
We need a paradigm shift on how the elderly are cared for, including more personal responsibility for family members and keeping the elderly engaged in the community vs walling them off to die expensive protracted deaths in assisted senior living stations. 'Right to die" needs to be available for terminally ill patients.  Mostly though better health in your 60s will ensure MUCH cheaper health adn better quality of life in your 70s/80s/90s.
4) extend a minimum level of coverage for everyone which includes annual checkups & vaccines.
5) dunno - but reducing the use of ERs for medical treatment (detecting/treating before it becomes a serious problem) also seems like a 'win-win', and gets back to some level of coverage for everyone.
Title: Re: What comes after the ACA?
Post by: GuitarStv on January 16, 2017, 10:53:18 AM
Quote
2) Promote healthy living. How?
dunno...hard to control without infringing on individual rights or the free market.

Why not have a revenue neutral tax added to stuff that's bad for you?  Cigarettes, booze, refined sugar products, processed meats . . . these types of products get taxed.  Fresh fruit and vegetables, birth control devices / pharmaceuticals,  these types of products are subsidized by the tax.  This way you leverage the power of the free market in a socially constructive manner.
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 10:58:37 AM
Quote
2) Promote healthy living. How?
dunno...hard to control without infringing on individual rights or the free market.

Why not have a revenue neutral tax added to stuff that's bad for you?  Cigarettes, booze, refined sugar products, processed meats . . . these types of products get taxed.  Fresh fruit and vegetables, birth control devices / pharmaceuticals,  these types of products are subsidized by the tax.  This way you leverage the power of the free market in a socially constructive manner.

To some extent this is already being done - there are taxes on cigarettes/cigars/tobacco, and in most places non-processed groceries have no sales tax.  Some places have started taxes and limitations on sodas and other sugary drinks (like NYC).  Personally I think this is one weapon we should use, but tehy alone probably won't do the trick.
One argument against is that it's monkeying with 'free-trade' and that people ought to be free to make their own decisions. 
Also, these taxes have had some effect but it's far from perfect, as evidenced by the number of overweight and obese in both the US and Canada.
My guess is people would still buy super-grande double-caramel frappachinnos at 900 calories every morning even if we instilled a $1 tax/drink on them.

ETA:
I don't want the government deciding what's bad for me.
This is a pervasive and legitimate concern for many.
Title: Re: What comes after the ACA?
Post by: Schaefer Light on January 16, 2017, 10:59:28 AM
Quote
2) Promote healthy living. How?
dunno...hard to control without infringing on individual rights or the free market.

Why not have a revenue neutral tax added to stuff that's bad for you?  Cigarettes, booze, refined sugar products, processed meats . . . these types of products get taxed.  Fresh fruit and vegetables, birth control devices / pharmaceuticals,  these types of products are subsidized by the tax.  This way you leverage the power of the free market in a socially constructive manner.

I don't want the government deciding what's bad for me.
Title: Re: What comes after the ACA?
Post by: bacchi on January 16, 2017, 11:05:30 AM
Quote
2) Promote healthy living. How?
dunno...hard to control without infringing on individual rights or the free market.

Why not have a revenue neutral tax added to stuff that's bad for you?  Cigarettes, booze, refined sugar products, processed meats . . . these types of products get taxed.  Fresh fruit and vegetables, birth control devices / pharmaceuticals,  these types of products are subsidized by the tax.  This way you leverage the power of the free market in a socially constructive manner.

To some extent this is already being done - there are taxes on cigarettes/cigars/tobacco, and in most places non-processed groceries have no sales tax.  Some places have started taxes and limitations on sodas and other sugary drinks (like NYC).  Personally I think this is one weapon we should use, but tehy alone probably won't do the trick.
One argument against is that it's monkeying with 'free-trade' and that people ought to be free to make their own decisions. 
Also, these taxes have had some effect but it's far from perfect, as evidenced by the number of overweight and obese in both the US and Canada.
My guess is people would still buy super-grande double-caramel frappachinnos at 900 calories every morning even if we instilled a $1 tax/drink on them.

The $1 tax can be used to support the health care system treating the obese.

It's actually more of a libertarian solution than not. Those who want to eat like shit can eat like shit but aren't passing their health costs on to others.
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 11:09:59 AM

The $1 tax can be used to support the health care system treating the obese.

It's actually more of a libertarian solution than not. Those who want to eat like shit can eat like shit but aren't passing their health costs on to others.

Sure, but how do we get past the fungibility of money concept? Raise a bunch of money for health-care through taxes on cigs and sugary drinks and within a few years other funding for health care will be diverted to schools or roads or higher-speed internet access.
Title: Re: What comes after the ACA?
Post by: GuitarStv on January 16, 2017, 11:11:40 AM

The $1 tax can be used to support the health care system treating the obese.

It's actually more of a libertarian solution than not. Those who want to eat like shit can eat like shit but aren't passing their health costs on to others.

Sure, but how do we get past the fungibility of money concept? Raise a bunch of money for health-care through taxes on cigs and sugary drinks and within a few years other funding for health care will be diverted to schools or roads or higher-speed internet access.

Revenue neutrality is an important concept for such a tax to allay these types of fears.
Title: Re: What comes after the ACA?
Post by: accolay on January 16, 2017, 11:14:06 AM
Which is why the guys who founded this country left most powers with the states.
I disagree that is why the Founders left power or "most power" to states.

Because smaller European countries who are often pointed to as the example of what the U.S. should implement, are simply that, very small countries. Implementing a governmental program to a country that is primarily of the same race and genetic background (Nordic countries) and the size of Virginia or Ohio is a whole other ball game than implementing a single payer system in a country like the United States. See the VA. That is what it has to do with this topic.

It is the reason smaller companies generally have less waste than larger companies. The larger something is, the harder it is to manage and control.
I don't understand this argument.

Quote from: packlawyer04
I'm not sitting here claiming we have some great healthcare system pre-ACA. The system was broken. The system is still broken. I'm upset that nobody actually wants to address the problems but instead simply play the move around who is paying for what game.
A lot of the ACA tried to address these problems and control costs. Healthcare in our country can have good outcomes, but overall stats are shit in the United States. I didn't understand arguments for our Great American Healthcare System (since Canadians were coming here for treatment or whatever) because it was never that great. I'll argue that instead of our system being broken, we had no system.

Getting rid of the system that attempted to fix things and replacing it with nothing is not a good idea. (just by saying that it's going to be the best is not a plan). And over the last seven eight years it's been a waste of time. Instead, why not attempt to fix the problems with the current system? Unfortunately for those that hate the individual mandate, there can be no system without that. There is no logical argument for having a working or good system without the individual mandate. People are going to have to contribute to the pool. Just like taxes.
Title: Re: What comes after the ACA?
Post by: sol on January 16, 2017, 11:18:07 AM
Unfortunately for those that hate the individual mandate, there can be no system without that.

I've already proposed at least one solution to give everyone affordable health insurance, without an individual mandate, while keeping private insurance companies, back on page 4 of this thread (http://forum.mrmoneymustache.com/welcome-to-the-forum/what-comes-after-the-aca/msg1372352/#msg1372352).

Title: Re: What comes after the ACA?
Post by: accolay on January 16, 2017, 11:20:42 AM
I don't want the government deciding what's bad for me.

We'll then I'll fucking tell you: Cigarettes, too much alcohol, too much sugar are bad for you. Everything in moderation. Eat vegetables and fruits. Exercise.
Title: Re: What comes after the ACA?
Post by: accolay on January 16, 2017, 11:24:11 AM
Unfortunately for those that hate the individual mandate, there can be no system without that.

I've already proposed at least one solution to give everyone affordable health insurance, without an individual mandate, while keeping private insurance companies, back on page 4 of this thread (http://forum.mrmoneymustache.com/welcome-to-the-forum/what-comes-after-the-aca/msg1372352/#msg1372352).

Sol, this is America. Extra taxes because it will benefit us? That's Socialism!
Title: Re: What comes after the ACA?
Post by: Gal2016 on January 16, 2017, 11:33:09 AM
Do people really not understand the waste inherent in providing healthcare on such a grand scale as would be implemented in the US?  Seriously?  We're the 3rd most populous country (after China and India).  Canada has a population a little less than California.  The rest of the European nations that are touted as being oh so great with their universal healthcare have a markedly non-diverse population (only one cultural norm, there) and their populations are roughly the size of a midwestern state (ie Ohio).  You really don't understand the nuances and difficulties that would be inherent in providing "universal healthcare" for a country as large and as diverse as ours?  Whose mantra has long been "personal freedom" and "capitalism"?  Nowhere else in the world are you going to find the economic and social mobility that is found in the US -- and that's because of the the individual freedoms we all enjoy (with very few social or regulatory expectations) along with states' rights (which are awesome and really the only reason that it's worth being a part of this country).

Unless people wise-up, there will be no working solution.  You can't pretend that we're a small European country who embraced socialism (at least, in part) a few hundred years ago and who's population is homogeneous.
Title: Re: What comes after the ACA?
Post by: sol on January 16, 2017, 11:34:27 AM
Unfortunately for those that hate the individual mandate, there can be no system without that.

I've already proposed at least one solution to give everyone affordable health insurance, without an individual mandate, while keeping private insurance companies, back on page 4 of this thread (http://forum.mrmoneymustache.com/welcome-to-the-forum/what-comes-after-the-aca/msg1372352/#msg1372352).

Sol, this is America. Extra taxes because it will benefit us? That's Socialism!

Even if the extra taxes you might pay are less than you're currently paying for health insurance which you wouldn't need to buy anymore?

Besides, the way Republicans are talking I'm not sure they really care about balanced budgets anymore.  They could fund the whole thing with deficit spending up front, then worry about phasing in the taxes over the next ten years.  Or maybe cancel a trillion dollar war to help pay for it?
Title: Re: What comes after the ACA?
Post by: packlawyer04 on January 16, 2017, 11:38:42 AM
Do people really not understand the waste inherent in providing healthcare on such a grand scale as would be implemented in the US?  Seriously?  We're the 3rd most populous country (after China and India).  Canada has a population a little less than California.  The rest of the European nations that are touted as being oh so great with their universal healthcare have a markedly non-diverse population (only one cultural norm, there) and their populations are roughly the size of a midwestern state (ie Ohio).  You really don't understand the nuances and difficulties that would be inherent in providing "universal healthcare" for a country as large and as diverse as ours?  Whose mantra has long been "personal freedom" and "capitalism"?  Nowhere else in the world are you going to find the economic and social mobility that is found in the US -- and that's because of the the individual freedoms we all enjoy (with very few social or regulatory expectations) along with states' rights (which are awesome and really the only reason that it's worth being a part of this country).

Unless people wise-up, there will be no working solution.  You can't pretend that we're a small European country who embraced socialism (at least, in part) a few hundred years ago and who's population is homogeneous.

As I have said before, one doesn't have to guess or envision what it would look like. We already have it, the VA. We all know the problems there and that is on a small scale compared to every citizen.  Talk about the claims of "republicans just want to repeal Obamacare and let people die on the streets." Vets died waiting for care at the VA.

Nobody needs to wake up. Some in this country want to have a tax, regulatory and overall system similar to our European brethren.  I think they are crazy, but you are not going to change their view. Fortunately, they are still the minority.
Title: Re: What comes after the ACA?
Post by: Lagom on January 16, 2017, 11:45:46 AM
Do people really not understand the waste inherent in providing healthcare on such a grand scale as would be implemented in the US?  Seriously?  We're the 3rd most populous country (after China and India).  Canada has a population a little less than California.  The rest of the European nations that are touted as being oh so great with their universal healthcare have a markedly non-diverse population (only one cultural norm, there) and their populations are roughly the size of a midwestern state (ie Ohio).  You really don't understand the nuances and difficulties that would be inherent in providing "universal healthcare" for a country as large and as diverse as ours?  Whose mantra has long been "personal freedom" and "capitalism"?  Nowhere else in the world are you going to find the economic and social mobility that is found in the US -- and that's because of the the individual freedoms we all enjoy (with very few social or regulatory expectations) along with states' rights (which are awesome and really the only reason that it's worth being a part of this country).

Unless people wise-up, there will be no working solution.  You can't pretend that we're a small European country who embraced socialism (at least, in part) a few hundred years ago and who's population is homogeneous.

As I have said before, one doesn't have to guess or envision what it would look like. We already have it, the VA. We all know the problems there and that is on a small scale compared to every citizen.  Talk about the claims of "republicans just want to repeal Obamacare and let people die on the streets." Vets died waiting for care at the VA.

This is an extremely disingenuous argument. The VA is but one example of a domestic single payer system, as Sol has noted repeatedly. As you say, it's also at a very small scale, comparable to national healthcare systems in other small countries, which several posters have argued is an integral part of their success. Thus the VA itself might be poorly executed (although I need more info to be convinced of that. Anyone have a good source here?) but it's ridiculous to claim that disproves the entire concept of single payer.
Title: Re: What comes after the ACA?
Post by: sol on January 16, 2017, 11:47:38 AM
As I have said before, one doesn't have to guess or envision what it would look like. We already have it, the VA. We all know the problems there and that is on a small scale compared to every citizen.  Talk about the claims of "republicans just want to repeal Obamacare and let people die on the streets." Vets died waiting for care at the VA.

Do you NOT READ the responses to your own posts (http://forum.mrmoneymustache.com/welcome-to-the-forum/what-comes-after-the-aca/msg1383994/#msg1383994)?

Ask anyone in the military whether they would rather have free lifetime health coverage through the VA or be forced to buy insurance on the private individual market.  Go ahead, I'll wait.

And you've complete ignored the other two single-payer systems in America, Medicaid and Medicare.  Medicare in particular is wildly popular, nationwide, despite all of these complaints about how American is too big for it to work.
Title: Re: What comes after the ACA?
Post by: waltworks on January 16, 2017, 11:51:07 AM
Do people really not understand the waste inherent in providing healthcare on such a grand scale as would be implemented in the US?  Seriously?  We're the 3rd most populous country (after China and India).  Canada has a population a little less than California.  The rest of the European nations that are touted as being oh so great with their universal healthcare have a markedly non-diverse population (only one cultural norm, there) and their populations are roughly the size of a midwestern state (ie Ohio).  You really don't understand the nuances and difficulties that would be inherent in providing "universal healthcare" for a country as large and as diverse as ours?  Whose mantra has long been "personal freedom" and "capitalism"?  Nowhere else in the world are you going to find the economic and social mobility that is found in the US -- and that's because of the the individual freedoms we all enjoy (with very few social or regulatory expectations) along with states' rights (which are awesome and really the only reason that it's worth being a part of this country).

Unless people wise-up, there will be no working solution.  You can't pretend that we're a small European country who embraced socialism (at least, in part) a few hundred years ago and who's population is homogeneous.

What specific problems do you mean? I mean, you get treated the same for lung cancer (in theory) whether you're of Norwegian origin or African or whatever. There are some subtle differences (sickle cell anemia, some genetic stuff that exists in small populations) but it's not like we're treating vastly different things - these are all people. What about the size of the country makes health care hard to deliver?

If I go to the doctor for an infected toe in Louisiana or in Utah, what sort of problems would I/we run into if both doctors were part of the same large system? I mean, specific problems that would result in my treatment being really expensive or ineffective or both?

I mean, people generally like Medicare, which covers the whole country and is an enormous thing. It works. It could probably work better, but so could Aetna or BC/BS.

-Walt
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 11:52:05 AM
Do people really not understand the waste inherent in providing healthcare on such a grand scale as would be implemented in the US?  Seriously?  We're the 3rd most populous country (after China and India).  Canada has a population a little less than California.  The rest of the European nations that are touted as being oh so great with their universal healthcare have a markedly non-diverse population (only one cultural norm, there) and their populations are roughly the size of a midwestern state (ie Ohio).  You really don't understand the nuances and difficulties that would be inherent in providing "universal healthcare" for a country as large and as diverse as ours?  Whose mantra has long been "personal freedom" and "capitalism"?  Nowhere else in the world are you going to find the economic and social mobility that is found in the US -- and that's because of the the individual freedoms we all enjoy (with very few social or regulatory expectations) along with states' rights (which are awesome and really the only reason that it's worth being a part of this country).

Unless people wise-up, there will be no working solution.  You can't pretend that we're a small European country who embraced socialism (at least, in part) a few hundred years ago and who's population is homogeneous.

As I have said before, one doesn't have to guess or envision what it would look like. We already have it, the VA.

I don't agree that the VA is necessarily a harbinger of what health care must look like, or even a good example to compare it to.  The VA is tasked with treating a very select subset of the population that's has as high-risk occupations as you can get and is burdened by a very high number of chronic and sometimes catastrophic injuries. Its members can leave the service but are still covered for many years afterwards (sometimes for their entire lives). Unlike most any other proposed system it's funding source doesn't come primarily from the people it's treating, but from an outside group (namely non-military citizens), so it becomes a political football.
While federal in nature, the VA's membership pool is relatively small - a few million active plus several million retired but still under care.

There is no apples-to-apples comparison, but one could look at state-mandated health care systems, or other federal systems (including our own medicare) and learn from them what works and what doesn't work.
Title: Re: What comes after the ACA?
Post by: packlawyer04 on January 16, 2017, 11:55:00 AM
As I have said before, one doesn't have to guess or envision what it would look like. We already have it, the VA. We all know the problems there and that is on a small scale compared to every citizen.  Talk about the claims of "republicans just want to repeal Obamacare and let people die on the streets." Vets died waiting for care at the VA.

Do you NOT READ the responses to your own posts (http://forum.mrmoneymustache.com/welcome-to-the-forum/what-comes-after-the-aca/msg1383994/#msg1383994)?

Ask anyone in the military whether they would rather have free lifetime health coverage through the VA or be forced to buy insurance on the private individual market.  Go ahead, I'll wait.

And you've complete ignored the other two single-payer systems in America, Medicaid and Medicare.  Medicare in particular is wildly popular, nationwide, despite all of these complaints about how American is too big for it to work.

Look, I get it. You guys like big government. Why not just have states pass these great plans. Then if you want it, move to the state. I'm sure the West Coast will be littered with states that pass it. Have fun, enjoy it. Leave the rest of us alone to die sitting outside hospitals.
Title: Re: What comes after the ACA?
Post by: RangerOne on January 16, 2017, 11:58:30 AM
You know who also is a large country that has simpler healthcare than us, fucking Russia... They are about half our size, yet we have about 18x the GDP...

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

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

Title: Re: What comes after the ACA?
Post by: accolay on January 16, 2017, 11:59:27 AM
Unfortunately for those that hate the individual mandate, there can be no system without that.

I've already proposed at least one solution to give everyone affordable health insurance, without an individual mandate, while keeping private insurance companies, back on page 4 of this thread (http://forum.mrmoneymustache.com/welcome-to-the-forum/what-comes-after-the-aca/msg1372352/#msg1372352).

Sol, this is America. Extra taxes because it will benefit us? That's Socialism!

Even if the extra taxes you might pay are less than you're currently paying for health insurance which you wouldn't need to buy anymore?

Besides, the way Republicans are talking I'm not sure they really care about balanced budgets anymore.  They could fund the whole thing with deficit spending up front, then worry about phasing in the taxes over the next ten years.  Or maybe cancel a trillion dollar war to help pay for it?

I was kidding about the socialism and taxes. Honestly I pay about 45 bucks a month for both health and dental. 30$ copay out of network, $0 if I go to the care system where I work.

Did Republicans ever care about balanced budgets or was it another issue talking point to get the grumpy old men of America riled up?

Cancel a war? Are you kidding? That's great for the economy!®
Title: Re: What comes after the ACA?
Post by: Metric Mouse on January 16, 2017, 12:05:45 PM
Did Republicans ever care about balanced budgets or was it another issue talking point to get the grumpy old men of America riled up?

Cancel a war? Are you kidding? That's great for the economy!®

While I can't actually speak for the republican party, I imagine they do care about balanced budgets. But like politicians across the spectrum, they are willing to spend money to help the people in their districts (which is what they were elected for). So there are complex, conflicting interests, across both political parties, which is why the federal debt has been increasing massively.
Title: Re: What comes after the ACA?
Post by: accolay on January 16, 2017, 12:06:22 PM
Look, I get it. You guys like big government.

What does this mean to you? I have never understood the talking point. Please, I'm honestly interested in your take on what Big Government means and why it applies to only some areas of government and not to others?
Title: Re: What comes after the ACA?
Post by: sol on January 16, 2017, 12:09:06 PM
Honestly I pay about 45 bucks a month for both health and dental.

How much does your employer pay for that coverage?  Would you rather have that much money added to your paycheck, and have your tax rate go up? 

In theory, the only people who wouldn't come out ahead in this deal are the super wealthy.  And those folks will still be super wealthy, even with slightly higher tax rates.
Title: Re: What comes after the ACA?
Post by: waltworks on January 16, 2017, 12:14:57 PM
Everyone likes big government. They just like different parts. I'd rather spend more of my tax money on keeping people healthy than on big new whiz-bang fighter jets. If you feel that the world is a very threatening place, you might feel the opposite way, I guess.

-W
Title: Re: What comes after the ACA?
Post by: RangerOne on January 16, 2017, 12:16:06 PM
Lets also not forget that a large part of the Republican rallying cry against the ACA has just been partisan rhetoric design to help win elections against Democrats by drumming up sentiment against the law.

The ACA is the perfect opportunity to do this because absolutely some people have seen their premiums go way up, and the cost of insurance is as always has been disgusting. So all the attention on health care is the perfect opportunity to make people upset and stir passions.

I am not saying the Repubs are uniquely disgusting for doing this I am just noting that most of the "repeal the ACA" rallying cry is political theater.

The reality is the Repubs know that tweaking healthcare is a hornets nest filled with pitfalls open for their political opponents to jump on. They also know while their base may be happy to hate the ACA and side with them now, the opposite effect is likely to occur if they if they do a true repeal and start letting insurance companies boot millions sick people off of their insurance plans. The Repubs and Dems are all pretty cowardly about going after a system like Medicare, Social Security or now the ACA in a transparent way because they know if their cuts could hurt them in the next election.

So they will keep railing against the ACA, and at some point after enough tweaking has occurred the news outlets and the Repubs will declare that they have repealed the ACA, but the reality will be that we have remnant pieces of it floating trying to keep certain things like pre-existing condition coverage with a bunch of new confusing rules added in. What we end up with will be better for some and worse for others, but they will declare some form of political victory against the ACA and maybe re-brand it.
Title: Re: What comes after the ACA?
Post by: accolay on January 16, 2017, 12:17:05 PM
Honestly I pay about 45 bucks a month for both health and dental.

How much does your employer pay for that coverage?  Would you rather have that much money added to your paycheck, and have your tax rate go up? 

Yeah. For the record, I'm not too worried about my taxes going up a bit if it benefits the country as a whole and definitely not worried about increasing taxes for the wealthy.
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 16, 2017, 12:23:33 PM
Honestly I pay about 45 bucks a month for both health and dental.

How much does your employer pay for that coverage?  Would you rather have that much money added to your paycheck, and have your tax rate go up? 

In theory, the only people who wouldn't come out ahead in this deal are the super wealthy.  And those folks will still be super wealthy, even with slightly higher tax rates.

I think people who work at hospitals would probably end up a little worse off, mostly because our health plans are insanely good, and there's little to no profit motive for a health system covering its own people (especially if it's 501c3). On the whole, I'm willing to accept that trade-off for a better macro system. For one thing, it gives non-clinical workers like me more employment options outside of healthcare. Currently, most employers would have to pull up to my house with a dump truck full of money for me to jump ship (and I'm not particularly well-paid).
Title: Re: What comes after the ACA?
Post by: RangerOne on January 16, 2017, 12:25:04 PM
Did Republicans ever care about balanced budgets or was it another issue talking point to get the grumpy old men of America riled up?

Cancel a war? Are you kidding? That's great for the economy!®

While I can't actually speak for the republican party, I imagine they do care about balanced budgets. But like politicians across the spectrum, they are willing to spend money to help the people in their districts (which is what they were elected for). So there are complex, conflicting interests, across both political parties, which is why the federal debt has been increasing massively.

I am not sure that is the case. It may be popular to attack the opposing sides plans to expand spending in an area you don't approve of with ideal talk about balancing the budget. But things seem to be the opposite with every President in my short lifetime.

The last major opportunity the Repubs had to "balance the budget" was when Bush took office after Clinton. Clinton having raised some taxes left Repubs with a surplus of cash. The new administration could have easily pay down a bit of the deficit and attempted to continue to run in a surplus. Instead they passed budgets that put us back into a deficit. I don't recall Obama ever running a surplus.

Conservatives may be for balancing the budget but the Repubs and Dems rarely chose to run a balanced budget for long before the desire to spend more money on their respective private interests takes over. Repubs do tend to make cuts, but they also increase spending in other areas like defense and decrease taxes/revenues in ways that aren't helpful to most of us.
Title: Re: What comes after the ACA?
Post by: bacchi on January 16, 2017, 12:42:28 PM
Look, I get it. You guys like big government. Why not just have states pass these great plans. Then if you want it, move to the state. I'm sure the West Coast will be littered with states that pass it. Have fun, enjoy it. Leave the rest of us alone to die sitting outside hospitals.

Why not make it more local, like at the city or county level? States are hugely inefficient.

The problem is that would it create a death spiral in those states that provided universal care. This could be ameliorated somewhat by cutting the funding to the moocher states but the costs would eventually catch up.

Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 12:54:01 PM

Look, I get it. You guys like big government. Why not just have states pass these great plans. Then if you want it, move to the state. I'm sure the West Coast will be littered with states that pass it. Have fun, enjoy it. Leave the rest of us alone to die sitting outside hospitals.

I certainly would not count myself in the camp of people who "like big government."  I'd favor seeing the size and scope of the government shrink a fair bit at a gradual rate, but of course the devil is in the details. I'd rather we not spend money on the military like we have over the past 15 years. I'd like us to step-up educational spending, particularly at the university level before more of our universiteis fall out of the "top 100 in the world" rankings. Our infrastructure needs investment dollars, but I don't think the solution should always be bigger, newer roads.

Also - not sure how the west coast (currrently composed of just California, Oregon and Washington) could be "littered with states that pass [state healthcare]." If your argument is that smaller entities are more efficient than larger ones, many of the southern states should be as well (or even better) equipped to run their own state healthcare systems.
Title: Re: What comes after the ACA?
Post by: bacchi on January 16, 2017, 12:59:58 PM
Also - not sure how the west coast (currrently composed of just California, Oregon and Washington) could be "littered with states that pass [state healthcare]." If your argument is that smaller entities are more efficient than larger ones, many of the southern states should be as well (or even better) equipped to run their own state healthcare systems.

I think he was implying that those states wouldn't pass their own state-run healthcare system because of freedom.
Title: Re: What comes after the ACA?
Post by: sol on January 16, 2017, 01:01:38 PM
Everyone likes big government. They just like different parts.

It's okay to admit that we ALL like big government.  Even the most conservative among us recognize that the US military is superior to every alternative on the planet.  It is a lumbering behemoth, hugely inefficient and wasteful, and yet it enjoys bipartisan support for the sole reason that it is better than the privately-operated alternative, despite all of its flaws.  Highlighting those flaws doesn't change the fact that is still better than the alternative.

It is more efficient than the private alternative, because it pays less to its staff.  It is more effective than the private alternative, because it has access to classified information and technologies that are not publicly available.  It is more accountable than the private alternative, because it reports directly to our elected officials and is backed by the full credit of the US economy.  When I try to envision a private company doing the job of the US armed forces, I have nightmares about Bond villains.

The same reasoning applies to lots of other "big government" programs, like the CDC and the FCC and a thousand other agencies with acronyms.  Lots of people complain about "big government" but they really like having beef without any e. coli in it, and functional internet/radio/tv, and widely available vaccines and outbreak response teams.  The interstate highway system is universally better than any state highway system.  The post office provides service to places that UPS and FedEx don't go.  And Medicare is enormously successful at providing affordable health insurance to the elderly, and could easily be expanded just by lowering the eligibility age.
Title: Re: What comes after the ACA?
Post by: SuperMex on January 16, 2017, 01:03:05 PM
I have lived in Germany for the last 5 years I often here arguments about the need to have socialized medicine. The problem is Americans have to decide if they want to pay European tax rates for socialized benefits or not.

Germany individual income tax rates, 2016

Tax %   Tax Base (EUR)
0           Up to 8,652
14%           8,653-53,665
42%           53,666-254,446
45%           254,447 and over

Plus 5.5% solidarity tax, 7.5% Health tax plus an equal tax to the employer, 8-9% church tax.

19% flat vat tax on almost all purchases, TV tax, radio tax, dog tax, road tax, and a ton I haven't thought of.

Plus Physicians make 20-30% what a U.S. physician makes and you get worse access to care and it is no frills care. After you have a surgery they roll you into the hall and leave you with your family to recover, 2-3 patients to a room, there is a cost benifits analysis on care when you are older.
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 01:07:08 PM
I have lived in Germany for the last 5 years I often here arguments about the need to have socialized medicine. The problem is Americans have to decide if they want to pay European tax rates for socialized benefits or not.

Thanks to Trump, we won't have to!  Coverage for all Americans that's going to be 'much better, much cheaper, [with]... much smaller deductibles!'
It's almost like magic!
Title: Re: What comes after the ACA?
Post by: waltworks on January 16, 2017, 01:09:28 PM
I have lived in Germany for the last 5 years I often here arguments about the need to have socialized medicine. The problem is Americans have to decide if they want to pay European tax rates for socialized benefits or not.

Germany individual income tax rates, 2016

Tax %   Tax Base (EUR)
0           Up to 8,652
14%           8,653-53,665
42%           53,666-254,446
45%           254,447 and over

Plus 5.5% solidarity tax, 7.5% Health tax plus an equal tax to the employer, 8-9% church tax.

19% flat vat tax on almost all purchases, TV tax, radio tax, dog tax, road tax, and a ton I haven't thought of.

Plus Physicians make 20-30% what a U.S. physician makes and you get worse access to care and it is no frills care. After you have a surgery they roll you into the hall and leave you with your family to recover, 2-3 patients to a room, there is a cost benifits analysis on care when you are older.

Sounds great to me.

As an aside, wtf is up with people wanting to stay at the Ritz when they go in for some routine surgery? I don't want a fancy hospital room, I want my damn ACL or hernia or whatever competently fixed and then as long as I'm not in danger of dying, yes, send me the fuck home or let me sit in the hall and dick around on my computer or whatever. And if I'm 90 and need a new heart, yes, I should have to pay out of pocket, because that's ridiculous.

-W
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 16, 2017, 01:10:27 PM
Honestly I pay about 45 bucks a month for both health and dental.

How much does your employer pay for that coverage?  Would you rather have that much money added to your paycheck, and have your tax rate go up? 

In theory, the only people who wouldn't come out ahead in this deal are the super wealthy.  And those folks will still be super wealthy, even with slightly higher tax rates.

FWIW, my hospital employer Family I plan (2-3 dependents) annual costs:
$2993.90 Employee cost
$8957.00 Employer contribution

In-network care is covered 100%, $35 specialist copay, $100 ER copay (waived if you're admitted), reasonable Rx coverage. My premium is discounted 30% because we participate in the wellness program.
Title: Re: What comes after the ACA?
Post by: jim555 on January 16, 2017, 01:13:54 PM
I have lived in Germany for the last 5 years I often here arguments about the need to have socialized medicine. The problem is Americans have to decide if they want to pay European tax rates for socialized benefits or not.

Thanks to Trump, we won't have to!  Coverage for all Americans that's going to be 'much better, much cheaper, [with]... much smaller deductibles!'
It's almost like magic!
Today he was saying he would have insurance for everybody and lower deductibles.  Sounds great!  Trumpcare is awesome.
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 01:15:04 PM


As an aside, wtf is up with people wanting to stay at the Ritz when they go in for some routine surgery? I don't want a fancy hospital room, I want my damn ACL or hernia or whatever competently fixed and then as long as I'm not in danger of dying, yes, send me the fuck home or let me sit in the hall and dick around on my computer or whatever. And if I'm 90 and need a new heart, yes, I should have to pay out of pocket, because that's ridiculous.

-W

Oh, this brings up another point to add to the earlier discussion - shifting more procedures to outpatient drastically reduces costs. We have a history and custom in the US to try to keep patients in hospitals much longer than other countries, and often much longer than is optimal. Surgery, stabilize and send them home (with follow-up care) and we'd save a lot.
Title: Re: What comes after the ACA?
Post by: NoStacheOhio on January 16, 2017, 01:17:12 PM


As an aside, wtf is up with people wanting to stay at the Ritz when they go in for some routine surgery? I don't want a fancy hospital room, I want my damn ACL or hernia or whatever competently fixed and then as long as I'm not in danger of dying, yes, send me the fuck home or let me sit in the hall and dick around on my computer or whatever. And if I'm 90 and need a new heart, yes, I should have to pay out of pocket, because that's ridiculous.

-W

Oh, this brings up another point to add to the earlier discussion - shifting more procedures to outpatient drastically reduces costs. We have a history and custom in the US to try to keep patients in hospitals much longer than other countries, and often much longer than is optimal. Surgery, stabilize and send them home (with follow-up care) and we'd save a lot.

Funny that you mention it, because my department was just working on a piece to explain to international patients (Saudi Arabia in particular) why we weren't going to keep them for six months.
Title: Re: What comes after the ACA?
Post by: accolay on January 16, 2017, 01:19:54 PM
Sounds great to me.

As an aside, wtf is up with people wanting to stay at the Ritz when they go in for some routine surgery? I don't want a fancy hospital room, I want my damn ACL or hernia or whatever competently fixed and then as long as I'm not in danger of dying, yes, send me the fuck home or let me sit in the hall and dick around on my computer or whatever. And if I'm 90 and need a new heart, yes, I should have to pay out of pocket, because that's ridiculous.

-W

In my experience people want the Hilton, but only want to pay for the HoJo. People don't know what things cost, like they're stuck in 1980s pricing or something.
Title: Re: What comes after the ACA?
Post by: Schaefer Light on January 16, 2017, 01:31:13 PM
I have lived in Germany for the last 5 years I often here arguments about the need to have socialized medicine. The problem is Americans have to decide if they want to pay European tax rates for socialized benefits or not.

Germany individual income tax rates, 2016

Tax %   Tax Base (EUR)
0           Up to 8,652
14%           8,653-53,665
42%           53,666-254,446
45%           254,447 and over

Plus 5.5% solidarity tax, 7.5% Health tax plus an equal tax to the employer, 8-9% church tax.

19% flat vat tax on almost all purchases, TV tax, radio tax, dog tax, road tax, and a ton I haven't thought of.

Plus Physicians make 20-30% what a U.S. physician makes and you get worse access to care and it is no frills care. After you have a surgery they roll you into the hall and leave you with your family to recover, 2-3 patients to a room, there is a cost benifits analysis on care when you are older.

I'll take the American health care system over what you've just described any day.
Title: Re: What comes after the ACA?
Post by: Lorna2287 on January 16, 2017, 01:36:17 PM
7.  Loosen the cost controls on age-related premium pricing, so that old people will pay more for insurance.

The ACA caps the ratio of max to min premiums at 3:1, so that old folks can never pay more than 300% as much as young healthy folks pay.  The GOP plan wants to change this ratio to 5:1, effectively transferring the cost of coverage away from the young and onto the old.  The GOP thinks all of you poor old folks can suck it, apparently.

It has been several years since I read articles about this, but IIRC, the actual healthcare costs are a 6:1 ratio and most states had a cap at 5:1 pre-ACA.  This means our old plans already had the youngest age band subsidizing the oldest age band.  When the ACA went into effect it capped the max at a 3:1 ratio.  This is forcing the youngest group to pay an extra 75% over what their costs really are so the oldest group can get a discount.  Considering the Boomers never had to pay that extra amount when they were younger, they are now getting one hell of a deal.

The Democrats think all of you young folks can suck it, apparently.

Disclaimer:  I'm not a Republican and I'm in favor of single payer.  I just wanted to point out the 3:1 ratio really fucked over young people.

Just to clear up some misconceptions. I work in public health and have advocated for the ACA since the beginning. I have a personal investment in it too since my daughter is a two-time childhood cancer survivor and faces an uninsurable future without the ACA. Unlike 99.9% of the people who speak with absolute authority about something they know nothing about, I’ve read the ACA from beginning to end and have worked on programs funded by the ACA. I keep trying to explain to people that the current crappy version of the ACA with the health exchanges was a Republican idea in the first place. Obama and health care reform activists wanted a public option but couldn’t make that happen due to Republican obstructionism, so they turned to The Massachusetts model (“RomneyCare”...has everyone conveniently forgotten that?!) So the ACA, in its current iteration, IS a Republican program. But the Republicans with their extreme partisanship love to blame any failures of the ACA on the Democrats and take credit for any success. Please be careful when assigning blame.
Title: Re: What comes after the ACA?
Post by: GuitarStv on January 16, 2017, 01:38:03 PM


As an aside, wtf is up with people wanting to stay at the Ritz when they go in for some routine surgery? I don't want a fancy hospital room, I want my damn ACL or hernia or whatever competently fixed and then as long as I'm not in danger of dying, yes, send me the fuck home or let me sit in the hall and dick around on my computer or whatever. And if I'm 90 and need a new heart, yes, I should have to pay out of pocket, because that's ridiculous.

-W

Oh, this brings up another point to add to the earlier discussion - shifting more procedures to outpatient drastically reduces costs. We have a history and custom in the US to try to keep patients in hospitals much longer than other countries, and often much longer than is optimal. Surgery, stabilize and send them home (with follow-up care) and we'd save a lot.

Related side note . . . a couple years ago I was rushing to do some work in the garden early in the morning and managed to slice my right index finger very deeply.  Cleaned the wound, bandaged it up, went on my way to my job.  It was painful but everything seemed fine.  That night I woke up in excruciating pain, noticed bright red streaks on my arms going from where my cut was up my arm, and decided that I needed to go to the ER.

The ER figured out that I had developed blood poisoning.  The stuck me on an IV cocktail of ultra powerful antibiotics and I spent the night there.  The next day I was feeling fine aside from a little throbbing in my hand.  They told me I needed to stay on IV antibiotics for at least a week . . . which really bummed me out that I'd be a prisoner in the hospital.  BUT - then they told me that they had an outpatient program.  I could recover at home, they would show me how/when to swap the IV bags and send a nurse over every day to make sure I was doing everything right.  So that's what I did.

My experience is that it's infinitely better to recover at home where you're comfortable (and it's just a bonus that I managed to save our health care system some cash).
Title: Re: What comes after the ACA?
Post by: Schaefer Light on January 16, 2017, 01:40:00 PM
7.  Loosen the cost controls on age-related premium pricing, so that old people will pay more for insurance.

The ACA caps the ratio of max to min premiums at 3:1, so that old folks can never pay more than 300% as much as young healthy folks pay.  The GOP plan wants to change this ratio to 5:1, effectively transferring the cost of coverage away from the young and onto the old.  The GOP thinks all of you poor old folks can suck it, apparently.

It has been several years since I read articles about this, but IIRC, the actual healthcare costs are a 6:1 ratio and most states had a cap at 5:1 pre-ACA.  This means our old plans already had the youngest age band subsidizing the oldest age band.  When the ACA went into effect it capped the max at a 3:1 ratio.  This is forcing the youngest group to pay an extra 75% over what their costs really are so the oldest group can get a discount.  Considering the Boomers never had to pay that extra amount when they were younger, they are now getting one hell of a deal.

The Democrats think all of you young folks can suck it, apparently.

Disclaimer:  I'm not a Republican and I'm in favor of single payer.  I just wanted to point out the 3:1 ratio really fucked over young people.

Just to clear up some misconceptions. I work in public health and have advocated for the ACA since the beginning. I have a personal investment in it too since my daughter is a two-time childhood cancer survivor and faces an uninsurable future without the ACA. Unlike 99.9% of the people who speak with absolute authority about something they know nothing about, I’ve read the ACA from beginning to end and have worked on programs funded by the ACA. I keep trying to explain to people that the current crappy version of the ACA with the health exchanges was a Republican idea in the first place. Obama and health care reform activists wanted a public option but couldn’t make that happen due to Republican obstructionism, so they turned to The Massachusetts model (“RomneyCare”...has everyone conveniently forgotten that?!) So the ACA, in its current iteration, IS a Republican program. But the Republicans with their extreme partisanship love to blame any failures of the ACA on the Democrats and take credit for any success. Please be careful when assigning blame.

And how many Republicans voted for the ACA?
Title: Re: What comes after the ACA?
Post by: accolay on January 16, 2017, 01:45:48 PM
My experience is that it's infinitely better to recover at home where you're comfortable (and it's just a bonus that I managed to save our health care system some cash).

This has been studied. There is a sweet spot for hospital stay, don't remember if it's tailored to specific illness. If I recall three days is the magic number. Less or more than that is associated with worse outcomes. I'll find cold hard fact if I have time.
Title: Re: What comes after the ACA?
Post by: Schaefer Light on January 16, 2017, 01:45:48 PM
I don't want the government deciding what's bad for me.

We'll then I'll fucking tell you: Cigarettes, too much alcohol, too much sugar are bad for you. Everything in moderation. Eat vegetables and fruits. Exercise.

I get that.  What I don't want is the government deciding some items get a "sin" tax while others do not.  If one beer a day is okay from a health perspective, then why can't I buy one beer a day without paying any extra tax?  And why is there no extra tax on a cheeseburger at McDonald's?  Surely a cheeseburger per day is worse for me than a beer per day.
Title: Re: What comes after the ACA?
Post by: bacchi on January 16, 2017, 01:47:06 PM
I have lived in Germany for the last 5 years I often here arguments about the need to have socialized medicine. The problem is Americans have to decide if they want to pay European tax rates for socialized benefits or not.

Americans already pay for it! In fact, we pay more per capita for health care than any other country.

Quote
Plus Physicians make 20-30% what a U.S. physician makes

No, they don't. PCPs make $185k in the US and $131k in Germany. That's 1/3 less, not 1/3 of.

Stop spreading FUD.
Title: Re: What comes after the ACA?
Post by: boarder42 on January 16, 2017, 01:48:15 PM
7.  Loosen the cost controls on age-related premium pricing, so that old people will pay more for insurance.

The ACA caps the ratio of max to min premiums at 3:1, so that old folks can never pay more than 300% as much as young healthy folks pay.  The GOP plan wants to change this ratio to 5:1, effectively transferring the cost of coverage away from the young and onto the old.  The GOP thinks all of you poor old folks can suck it, apparently.

It has been several years since I read articles about this, but IIRC, the actual healthcare costs are a 6:1 ratio and most states had a cap at 5:1 pre-ACA.  This means our old plans already had the youngest age band subsidizing the oldest age band.  When the ACA went into effect it capped the max at a 3:1 ratio.  This is forcing the youngest group to pay an extra 75% over what their costs really are so the oldest group can get a discount.  Considering the Boomers never had to pay that extra amount when they were younger, they are now getting one hell of a deal.

The Democrats think all of you young folks can suck it, apparently.

Disclaimer:  I'm not a Republican and I'm in favor of single payer.  I just wanted to point out the 3:1 ratio really fucked over young people.

Just to clear up some misconceptions. I work in public health and have advocated for the ACA since the beginning. I have a personal investment in it too since my daughter is a two-time childhood cancer survivor and faces an uninsurable future without the ACA. Unlike 99.9% of the people who speak with absolute authority about something they know nothing about, I’ve read the ACA from beginning to end and have worked on programs funded by the ACA. I keep trying to explain to people that the current crappy version of the ACA with the health exchanges was a Republican idea in the first place. Obama and health care reform activists wanted a public option but couldn’t make that happen due to Republican obstructionism, so they turned to The Massachusetts model (“RomneyCare”...has everyone conveniently forgotten that?!) So the ACA, in its current iteration, IS a Republican program. But the Republicans with their extreme partisanship love to blame any failures of the ACA on the Democrats and take credit for any success. Please be careful when assigning blame.

And how many Republicans voted for the ACA?

haha 0... hard to stick it to the "republicans" as their plan when they didnt vote for it... they could have passed whatever they chose to.
Title: Re: What comes after the ACA?
Post by: sol on January 16, 2017, 01:48:15 PM
At least one!

Arlen Specter, lifelong Republican from PA, changed his party affiliation specifically for the purpose of giving Democrats a 60 vote filibuster-proof supermajority in the Senate, so that they could pass the ACA.

There were also a whole bunch of Republicans working on subcommittees that drafted the ACA, who not only wrote the text but also then attached amendments.  In the end, they were compelled to vote against the law they helped create by Republican leadership, mostly because Mitch McConnell had a raging hard-on for undermining Obama's agenda in every possible way, democracy be damned.

So let's review.  Republicans came up with the idea.  Republicans pased it in MA and really liked it.  Republicans introduced the idea to Congress, where Democrats actually agreed with them that something needed to change, and in the interest of getting changes passed they agreed to try the Republican's idea that seemed to be working really well in MA.  Republicans helped write the new law, including passing amendments to make it better.  Some Republicans even voted for the final bill, along with a supermajority of our elected officials.  Obama declined to veto it, and it was thus named "Obamacare" and now Republicans hated it with the heat of a thousand suns.
Title: Re: What comes after the ACA?
Post by: bacchi on January 16, 2017, 01:53:11 PM
I don't want the government deciding what's bad for me.

We'll then I'll fucking tell you: Cigarettes, too much alcohol, too much sugar are bad for you. Everything in moderation. Eat vegetables and fruits. Exercise.

I get that.  What I don't want is the government deciding some items get a "sin" tax while others do not.  If one beer a day is okay from a health perspective, then why can't I buy one beer a day without paying any extra tax?  And why is there no extra tax on a cheeseburger at McDonald's?  Surely a cheeseburger per day is worse for me than a beer per day.

Cheeseburgers should have a sin tax.

I see your point. What do you propose, then? What's the free market solution? Because right now, the healthy all pay for people who don't exercise and who eat 3 cheeseburgers/day. It's also one of the major reasons that our health costs are so high. Is the free market solution "nothing"?
Title: Re: What comes after the ACA?
Post by: SuperMex on January 16, 2017, 01:57:10 PM
Average Salary for People with Jobs as Physicians / Doctors


People with Jobs as Physicians / Doctors Median Salary by Job
Job
National Salary Data
€0   €50K   €100K   €150K
Physician / Doctor, General Practice
21 salaries
€39,866               
Physician / Doctor, Internal Medicine
13 salaries
€50,083   
Family Physician / Doctor
8 salaries
€50,829   
Physician / Doctor, Neurologist
8 salaries
€60,000   
Physician / Doctor, Radiologist
7 salaries
€39,600   
Physician / Doctor, Plastic Surgeon
6 salaries
€103,846   
Physician / Doctor, Oncologist
4 salaries
€65,000   
Country: Germany | Currency: EUR | Updated: 2 Jan 2017 | Individuals Reporting: 81


People with Jobs as Physicians / Doctors Median Salary by Job
Job
National Salary Data
$0   $100K   $200K   $300K
Family Physician / Doctor
1133 salaries
$167,468               
Physician / Doctor, Internal Medicine
1091 salaries
$181,831   
Physician / Doctor, General Practice
686 salaries
$135,133   
Physician / Doctor, Emergency Room (ER)
551 salaries
$208,256   
Physician / Doctor, Radiologist
460 salaries
$286,989   
Physician / Doctor, Neurologist
364 salaries
$201,899   
Obstetrician / Gynecologist (OB/GYN)
322 salaries
$204,951   
Country: United States | Currency: USD | Updated: 7 Jan 2017 | Individuals Reporting: 7,075
Title: Re: What comes after the ACA?
Post by: accolay on January 16, 2017, 01:59:47 PM
I don't want the government deciding what's bad for me.

We'll then I'll fucking tell you: Cigarettes, too much alcohol, too much sugar are bad for you. Everything in moderation. Eat vegetables and fruits. Exercise.

I get that.  What I don't want is the government deciding some items get a "sin" tax while others do not.  If one beer a day is okay from a health perspective, then why can't I buy one beer a day without paying any extra tax?  And why is there no extra tax on a cheeseburger at McDonald's?  Surely a cheeseburger per day is worse for me than a beer per day.

I don't know. I wont put a moral equivalence on it all, and I suppose some people have a "food addiction" but I'd bet without even looking up numbers that problems with cigarettes and alcohol cost us more than obesity, and obesity costs a lot. Unsure of stats on car crashes from eating cheeseburgers and driving though.

Some cities have a sugary drink tax. Before we tax cheese burgers though, maybe we should just ditch some agriculture subsidies and stop artificial pricing.
Title: Re: What comes after the ACA?
Post by: bacchi on January 16, 2017, 02:01:45 PM
Country: Germany | Currency: EUR | Updated: 2 Jan 2017 | Individuals Reporting: 81

Seriously?
Title: Re: What comes after the ACA?
Post by: SuperMex on January 16, 2017, 02:05:38 PM
OK how about this Bacchi I'll get several German physicians I know to give me their annual pay report and I'll black out their name. If they make more than 33% of what the average U.S. physician makes with similar qualifications you win.

I'll bet you $10,000 are you in?????
Title: Re: What comes after the ACA?
Post by: bacchi on January 16, 2017, 02:11:05 PM
OK how about this Bacchi I'll get several German physicians I know to give me their annual pay report and I'll black out their name. If they make more than 33% of what the average U.S. physician makes with similar qualifications you win.

I'll bet you $10,000 are you in?????

Seriously? Dude, it's not about one physician; it's about the median. Throwing out "this guy I know" means squat.

There is, admittedly, a Euro-USD conversion issue. The Euro used to be much stronger.
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 02:12:47 PM


I see your point. What do you propose, then? What's the free market solution? Because right now, the healthy all pay for people who don't exercise and who eat 3 cheeseburgers/day. It's also one of the major reasons that our health costs are so high. Is the free market solution "nothing"?

One proposal I'd make is to focus less on taxing individual items and instead levy some sort of penalty on individuals who aren't healthy.  Overweight? you pay more.  Obese? you pay more still.  Maybe people will start taking their health more seriously if there's more of a financial penalty* instead of, you know, just an increased risk of dying and having a poor quality of life.

*yeah, in some regards this is already done by charging smokers and drinkers a higher premium.  And the ADA will probably fight tooth and nail to keep "obesety" from being monitarily penalized.
Title: Re: What comes after the ACA?
Post by: bacchi on January 16, 2017, 02:15:59 PM


I see your point. What do you propose, then? What's the free market solution? Because right now, the healthy all pay for people who don't exercise and who eat 3 cheeseburgers/day. It's also one of the major reasons that our health costs are so high. Is the free market solution "nothing"?

One proposal I'd make is to focus less on taxing individual items and instead levy some sort of penalty on individuals who aren't healthy.  Overweight? you pay more.  Obese? you pay more still.  Maybe people will start taking their health more seriously if there's more of a financial penalty* instead of, you know, just an increased risk of dying and having a poor quality of life.

*yeah, in some regards this is already done by charging smokers and drinkers a higher premium.  And the ADA will probably fight tooth and nail to keep "obesety" from being monitarily penalized.

That makes sense. It doesn't help those who can't afford it, though. If ya can't afford $200/month, you can't afford $250/month when you're obese and still poor.
Title: Re: What comes after the ACA?
Post by: SuperMex on January 16, 2017, 02:17:02 PM
that 123K you quoted is pre-tax after tax you are looking at mid 50's in Germany if you are lucky.
Title: Re: What comes after the ACA?
Post by: Monkey Uncle on January 16, 2017, 02:18:59 PM
Plus 5.5% solidarity tax, 7.5% Health tax plus an equal tax to the employer, 8-9% church tax.

Church tax?  WTF?  Most Germans don't even believe in god any more...
Title: Re: What comes after the ACA?
Post by: bacchi on January 16, 2017, 02:19:53 PM
that 123K you quoted is pre-tax after tax you are looking at mid 50's in Germany if you are lucky.

True, it is pre-tax and their taxes are high.
Title: Re: What comes after the ACA?
Post by: Monkey Uncle on January 16, 2017, 02:20:22 PM
So let's review.  Republicans came up with the idea.  Republicans pased it in MA and really liked it.  Republicans introduced the idea to Congress, where Democrats actually agreed with them that something needed to change, and in the interest of getting changes passed they agreed to try the Republican's idea that seemed to be working really well in MA.  Republicans helped write the new law, including passing amendments to make it better.  Some Republicans even voted for the final bill, along with a supermajority of our elected officials.  Obama declined to veto it, and it was thus named "Obamacare" and now Republicans hated it with the heat of a thousand suns.

Seriously, you ought to write copy for late-night comedians.  You'd clean up.
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 02:22:35 PM
that 123K you quoted is pre-tax after tax you are looking at mid 50's in Germany if you are lucky.
well that's sort of the thing here... Germany has high taxes and a corresponding high level of services.  In the US you have lower taxes and less services.
Both have their advantages depending on the case and personal preference, but it's not fair to compare post-tax salaries unless you also consider what post-tax services one recieves (or would have to pay for).
Title: Re: What comes after the ACA?
Post by: SuperMex on January 16, 2017, 02:22:58 PM
I have 31 German employees only two are Church goers yet they all pay Church tax. I asked them why that is and they said the process is so onerous to get out of it that almost no one does it.
Title: Re: What comes after the ACA?
Post by: sol on January 16, 2017, 02:23:10 PM
interesting article out today commenting on DJT's pledge of 'insurance for everybody'.
 (https://www.washingtonpost.com/politics/trump-vows-insurance-for-everybody-in-obamacare-replacement-plan/2017/01/15/5f2b1e18-db5d-11e6-ad42-f3375f271c9c_story.html?hpid=hp_hp-top-table-main_trump-interview-822pm%3Ahomepage%2Fstory&utm_term=.8f1877f83141)
tl/dr: Trump's setting the bar pretty high by promising coverage for everyone that's 'much less expensive and much better' with 'much lower deductibles'. He says it will not have cuts to Medicare.
Curious to see how this could happen without costing a fortune and requiring some sort of coersion/mandate to get everyone to participate.

That whole article is a mess of contradictions. 

Trump is promising lower premiums AND lower deductibles, and I don't see any way to do that without
    A)  making insurance crappy, so it doesn't pay for anything, or
    B)  using federal dollars to subsidize insurance companies.  This is what the ACA is already doing. 

Trump is promising "insurance for everybody" and said "There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”   This suggests to me he is either going to offer health care providers (not insurers) federal subsidies for providing emergency medical care to uninsured people, or he is going to increase health insurance subsidies to poor people (which seems contrary to his previous plans to decrease subsidies to the poor and increase subsidies to the elderly).

Trump is promising that nobody who gained access under the ACA will lose coverage.  This seems like an easy fix, just grandfather everyone in and then reinstate the exclusion of people with pre-existing conditions going forward.  He could truthfully claim that no one lost coverage when they repealed the ACA, without the burden of having to provide insurance to any newly sick people. 

Trump is promising not to cut Medicare.  Yay, I guess?  This isn't really surprising because lots of GOP voters are elderly and use Medicare.  What he is doing instead is cutting MedicAID.  Very few young, poor, or disabled people are GOP voters, after all, so the party doesn't lose much by screwing those folks over.



Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 02:23:51 PM
So let's review.  Republicans came up with the idea.  Republicans pased it in MA and really liked it.  Republicans introduced the idea to Congress, where Democrats actually agreed with them that something needed to change, and in the interest of getting changes passed they agreed to try the Republican's idea that seemed to be working really well in MA.  Republicans helped write the new law, including passing amendments to make it better.  Some Republicans even voted for the final bill, along with a supermajority of our elected officials.  Obama declined to veto it, and it was thus named "Obamacare" and now Republicans hated it with the heat of a thousand suns.

Seriously, you ought to write copy for late-night comedians.  You'd clean up.

Reading some of Sol's posts, the voice of John Oliver occasionally takes over in my head...
Title: Re: What comes after the ACA?
Post by: waltworks on January 16, 2017, 02:26:12 PM
SuperMex, you need to back up your numbers. You are digging yourself a quick credibility hole.

I will eat my hat if German physicians (GPs, no cherrypicking plastic surgeons or something) make 33% of what US physicians do.

I'm assuming you googled this and misinterpreted the NPR quote at the top of the results page:
http://www.npr.org/templates/story/story.php?storyId=91931036
"In some parts of Germany, doctors are going on strike over what they get paid. It's not that German doctors live in poverty. The average German primary-care doctor makes around $123,000 a year before taxes. That's about one-third less than the U.S. average."

That means they make 66% of what a US physician does, not 33%.

-W
Title: Re: What comes after the ACA?
Post by: SuperMex on January 16, 2017, 02:27:01 PM
Nereo I totally agree and that was my point Americans have to come to terms with which they prefer.

However politicians saying they are going to give you something for free is total bull.

Title: Re: What comes after the ACA?
Post by: bacchi on January 16, 2017, 02:28:15 PM
I'm assuming you googled this and misinterpreted the NPR quote at the top of the results page:
http://www.npr.org/templates/story/story.php?storyId=91931036


An interesting part of that story,

Quote
On top of that, administrative costs are almost 50 percent lower. That's not because the German health system is simple and streamlined. With its employer-based system, multiple insurers and ever-changing rules, German health care is as complicated in many ways as the U.S. system. But administration is much simpler because nearly everybody gets the same benefits, payment rates are uniform and virtually everybody is covered.
Title: Re: What comes after the ACA?
Post by: SuperMex on January 16, 2017, 02:29:28 PM
your right if you are counting pre-tax wages and don't take into account the difference in taxes.
Title: Re: What comes after the ACA?
Post by: nereo on January 16, 2017, 02:37:13 PM
Nereo I totally agree and that was my point Americans have to come to terms with which they prefer.

However politicians saying they are going to give you something for free is total bull.

I agree on both points emboldened above.
In general the US population sucks at understanding their level of service is tied to the amount we pay.  A stupidly large percentage of people seem to think we can increase services while decreasing taxes, all while paying down the deficit.
Partly I blame this drum-beat of "fraud and waste are to blame for everything!" as well as "increased growth will more than make up for loss in tax revenue when we cut taxes."
Title: Re: What comes after the ACA?
Post by: waltworks on January 16, 2017, 02:38:51 PM
your right if you are counting pre-tax wages and don't take into account the difference in taxes.

At $180k income (roughly) a US single doctor not doing any clever tax-avoidance (ie pretax retirement/health accounts) would pay (roughly) $70k in total taxes (state taxes vary a lot, but that's probably close). So $110k.

German taxes on $123k would break down as roughly:
First $8k = $0
Next $45k = $8k
Last $70k = $29k

The Euro is close enough to the dollar right now that I'm just going to ignore doing any careful converting back and forth.

That leaves us with a total compensation after income tax of about $86k. Even if you tack on some of the other taxes you mention (which I know nothing about) you are not going to get to $55k after tax, let alone ~$36k (which would be one third of US after-tax money).

You may have misunderstood how marginal tax rates work.

-W
Title: Re: What comes after the ACA?