What comes after the ACA?

[mm1970]

It's fairly well established in the MMM community that giving (or worse, lending) money to family members is generally a bad idea, as they'll come to depend on it. Helping people is not always a good thing and does create dependence. How is that hard to grasp?

Difference being that not giving a few thousand or whatever to family won't cause them to die because they can't afford cancer treatments but cutting Medicaid or backdoor evisceration of protections for pre-exisiting conditions does.  Many studies show that it's X # of deaths per Y # of uninsured.  Or is that fake news? 

Just admit that many of you right wingers just don't give a shit about people, you don't care if people die.   Fucking sociopaths.

They care a lot about fetuses though!

But really, I do have a LOT of conservative family members.  A LOT.  And ... they sort of don't care if people die.  I don't mean that in a "cold-hearted" way, but more of a practical way.

You know we've touched on this in several threads, but not sure if we've really delved deeply into it.

Aside from the cost of care being high and the need to cut it, there's the practical aspect and the caring aspect
- babies born early that spend a lot of time in the NICU cost a lot of money
- many of them have life-long problems that cost a lot of money, both health-wise and education wise
- babies born with fetal alcohol syndrome, or with other birth defects like down syndrome, or genetic disorders - they cost money.  To care for medically, and to educate.
- people get cancer.  Cancer treatment is expensive.
- people get diabetes, sometimes kids get Type 1, treatment is expensive
- people get old and sick.  And end of life care is expensive, and sometimes you need it for a very long time
- people will spend an inordinate amount of money, time, effort, to keep someone alive
- we don't allow euthanasia.  What if someone would rather die peacefully than live on machines for years, or die by refusing to eat?
- young people die because they get sick and don't have insurance and aren't able to get care

So, where do you draw the line?  I've got friends in Canada and Europe and the UK where they get care.  Yes, their taxes are high.  But they don't generally go broke due to medical issues.

In the US, we are such "individuals"... honestly, a lot of my conservative family members are practical.  People die.  They get that.  My cousin died of a leg infection.  Sometimes your baby is born too early and they die.  Sometimes you get cancer, and your church has a spaghetti dinner and a pancake breakfast (or 3) because your insurance sucks, or you don't have it at all.  But then you can't afford to finish chemo, so you die.  Sometimes you get old, and you cannot afford a home.  You don't want to go in one anyway.  So a few friends and family members may help you out, come by, bring dinner.  But in the end, you are living alone, you have an aneurysm burst and you die (my dad).

It's complicated, especially when you are talking millions of dollars.  I saw a quote yesterday "by having a lifetime cap on insurance, you are telling someone that they aren't worth any more money to keep alive".  Which sounds harsh.  And it is.  A preemie can hit that in months, and that preemie can go on to grow up and get a job and pay taxes.  On the other hand, that preemie might require a lifetime of specialized care in a special home, and that can run even higher.

[Roland of Gilead]

"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality.  Who needs reality when you have fear.  Just an FYI, our hospital system treats about 20% of its patient who are uninsured and no pay.

Ok, kill 22 million people might be quite an exaggeration.   If you make someone who is financially struggling but ineligible for medicaid wait six months to get insurance after they discover a lump in their breast, you have effectively killed them.   In a perfect world we would all be engineers with $150K+ salaries but in the real world you need someone to clean your linens in your hotel room and make sure the toilet there is not too dirty.   Sometimes those people choose slightly wrong choices instead of medical insurance.   It is a bit of a different choice than one of us choosing to fly coach instead of business class on a two week trip to Paris.

[protostache]

Why do republicans put so much time and money into pro-life efforts and then try and kill 22 million people?

It doesn't make any logical sense.

Because in their minds, once you are an adult, you can earn enough to live or else die. They don't see health care as a right.

"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality.  Who needs reality when you have fear.  Just an FYI, our hospital system treats about 20% of its patient who are uninsured and no pay.

If we were really serious about making healthcare affordable we would be yelling at our congress people to allow CMS to negotiate on medication purchases.  We would be pushing to decrease law suit liabilities from big pharma and minimize the regulatory burden the FDA imposes so that we can have less expensive drugs.  US has a much more stringent drug approval process as compared to European countries.  We would be pushing our congress people to demand educating the public on death with dignity. We would push to decrease the regulatory burden and unnecessary personnel involved in the delivery of healthcare. But no, we just clamor about who will pay the bill.

We all pay in some form or another except the very very poor who still qualify for medicaid.  And even they suffer because only so many providers are willing to accept the piss poor reimbursement of medicaid.  But hey, at least we can comfortably say we did not kill 22 million people.

You're not wrong!

But this argument is like saying we should campaign our government representatives for a better sprinkler and alarm system while half of them are filing up the kerosene tanks on their flamethrowers. Yes, cost control is extremely important and we should fight for it, but let's make sure nobody burns the building down first.

[Inaya]

It's fairly well established in the MMM community that giving (or worse, lending) money to family members is generally a bad idea, as they'll come to depend on it. Helping people is not always a good thing and does create dependence. How is that hard to grasp?

Difference being that not giving a few thousand or whatever to family won't cause them to die because they can't afford cancer treatments but cutting Medicaid or backdoor evisceration of protections for pre-exisiting conditions does.  Many studies show that it's X # of deaths per Y # of uninsured.  Or is that fake news? 

Just admit that many of you right wingers just don't give a shit about people, you don't care if people die.   Fucking sociopaths.

They care a lot about fetuses though!

But really, I do have a LOT of conservative family members.  A LOT.  And ... they sort of don't care if people die.  I don't mean that in a "cold-hearted" way, but more of a practical way.

You know we've touched on this in several threads, but not sure if we've really delved deeply into it.

Aside from the cost of care being high and the need to cut it, there's the practical aspect and the caring aspect
- babies born early that spend a lot of time in the NICU cost a lot of money
- many of them have life-long problems that cost a lot of money, both health-wise and education wise
- babies born with fetal alcohol syndrome, or with other birth defects like down syndrome, or genetic disorders - they cost money.  To care for medically, and to educate.
- people get cancer.  Cancer treatment is expensive.
- people get diabetes, sometimes kids get Type 1, treatment is expensive
- people get old and sick.  And end of life care is expensive, and sometimes you need it for a very long time
- people will spend an inordinate amount of money, time, effort, to keep someone alive
- we don't allow euthanasia.  What if someone would rather die peacefully than live on machines for years, or die by refusing to eat?
- young people die because they get sick and don't have insurance and aren't able to get care

So, where do you draw the line?

At birth, apparently. Since they're willing to fight so impractically hard to save the fetus--no matter the cost (physical, financial, emotional) to the mother---which will then inevitably end up being one or more of the bullets on this list.

[sol]

"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality. 

Okay, let me offer you some reality.

22 million people will lose access to primary care within the first ten years, and then approximately that many more after that.  Not all of those peole are going to die from lack of healthcare, but SOME of them certainly will.

Some of them will contract fatal diseases, and go undiagnosed until it is too late.  Some of them will have horrible accidents and be maimed for life because they could not afford the surgeries and rehab that they need.  Some of them will fail to get lifestyle intervention that could have saved then from diabetes or skin cancer.  Some mothers and babies will die during childbirth because they had home births with complications instead of trained hospital staff with proper equipment.

It won't be 22 million deaths, but it absolutely WILL be tens of thousands, and maybe hundreds of thousands, of needless and preventable deaths and disfigurements and the only thing that republicans have to do to save them all is... nothing.  Just do nothing.  Just don't strip healthcare access away from millions of people.  Just leave it alone.  Just don't be cruel.

Is that so hard?  Then we can talk about the good republican ideas for how to improve things.  Yes, let's do a better job controlling costs.  Yes, let's figure out how to make insurance more affordable, and fix the subsidy cliffs, and prop up the market in rural areas.  But before we start working on making it better, can we please stop trying to make it worse?

The republican healthcare bill will kill people.  That is not exaggeration. 

[chasesfish]

How do I unfollow a topic so its not showing up as new replies to my posts?  Y'all have gone way off the rails from the original discussion

[nereo]

How do I unfollow a topic so its not showing up as new replies to my posts?  Y'all have gone way off the rails from the original discussion

The only way you can do this is to delete all of the posts you have made in that thread.

Yeah... we need an 'unfollow' link but in previous discussions its apparently not a simple fix.

[protostache]

McConnell delayed the vote until after the 4th. Wants to make revisions and get another CBO score.

[Roland of Gilead]

McConnell delayed the vote until after the 4th. Wants to make revisions and get another CBO score.

Probably so Trump can fire all of the current CBO people.

[nereo]

McConnell delayed the vote until after the 4th. Wants to make revisions and get another CBO score.

I'll chalk this up as good news.  The Senate is supposed to be a deliberative legislative body.  Everything Mitch has been doing seemed designed to try to thwart that as much as possible. Now we can collectively spend the next few days carefully examining this bill.  Everything I've read thus far suggests its horrible, and this hiatus ought to give time for more people to see its warts.

I'm curious though - how many times can they tweak the bill and wait for a new CBO score and have it actually help their cause?

[jim555]

Every version gets worse.  Not enough pain in this one.

[protostache]

Probably so Trump can fire all of the current CBO people.

Congress (the collected House and Senate) fund and control the Congressional Budget Office because they're part of the Legislative branch. The Executive branch headed by Trump has zero control over the CBO.

I'll chalk this up as good news.  The Senate is supposed to be a deliberative legislative body.  Everything Mitch has been doing seemed designed to try to thwart that as much as possible. Now we can collectively spend the next few days carefully examining this bill.  Everything I've read thus far suggests its horrible, and this hiatus ought to give time for more people to see its warts.

I'm curious though - how many times can they tweak the bill and wait for a new CBO score and have it actually help their cause?

As many as they want, but remember they need to also go through the debt ceiling gauntlet again and actually do the tax changes they all ran on and pass a FY2018 budget, all before the midterm election season starts early next year. That's why this healthcare stuff has been so rushed, because the GOP has an excruciatingly short window of time to get everything done in the order they want to do it while they still have full control of the government.

[nereo]

Probably so Trump can fire all of the current CBO people.

Congress (the collected House and Senate) fund and control the Congressional Budget Office because they're part of the Legislative branch. The Executive branch headed by Trump has zero control over the CBO.

I'll chalk this up as good news.  The Senate is supposed to be a deliberative legislative body.  Everything Mitch has been doing seemed designed to try to thwart that as much as possible. Now we can collectively spend the next few days carefully examining this bill.  Everything I've read thus far suggests its horrible, and this hiatus ought to give time for more people to see its warts.

I'm curious though - how many times can they tweak the bill and wait for a new CBO score and have it actually help their cause?

As many as they want, but remember they need to also go through the debt ceiling gauntlet again and actually do the tax changes they all ran on and pass a FY2018 budget, all before the midterm election season starts early next year. That's why this healthcare stuff has been so rushed, because the GOP has an excruciatingly short window of time to get everything done in the order they want to do it while they still have full control of the government.

Sorry I wasn't more clear - my question wasn't about how many times htey can legally do this (infinite) but rather my own musing about whether tweaking the bill over and over again will result in a harder enviornment to get it passed.
In other words - what's the political cost of tweaking and waiting for a new score.  My guess is that resistence will harden and conceptions will be formed (fairly or not) much as they did with the ACA.

[Jrr85]

"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality. 

Okay, let me offer you some reality.

22 million people will lose access to primary care within the first ten years, and then approximately that many more after that.  Not all of those peole are going to die from lack of healthcare, but SOME of them certainly will.

Some of them will contract fatal diseases, and go undiagnosed until it is too late.  Some of them will have horrible accidents and be maimed for life because they could not afford the surgeries and rehab that they need.  Some of them will fail to get lifestyle intervention that could have saved then from diabetes or skin cancer.  Some mothers and babies will die during childbirth because they had home births with complications instead of trained hospital staff with proper equipment.

It won't be 22 million deaths, but it absolutely WILL be tens of thousands, and maybe hundreds of thousands, of needless and preventable deaths and disfigurements and the only thing that republicans have to do to save them all is... nothing.  Just do nothing.  Just don't strip healthcare access away from millions of people.  Just leave it alone.  Just don't be cruel.

Is that so hard?  Then we can talk about the good republican ideas for how to improve things.  Yes, let's do a better job controlling costs.  Yes, let's figure out how to make insurance more affordable, and fix the subsidy cliffs, and prop up the market in rural areas.  But before we start working on making it better, can we please stop trying to make it worse?

The republican healthcare bill will kill people.  That is not exaggeration.

You realize the vast majority of the reduction in number of insured people the CBO projects are not people that are going to have their health insurance stripped away from them, but people that choose not to be insured because they are no longer subject to the individual mandate.  That may not be good policy, but it's certainly not equivalent to killing people. 

[DavidAnnArbor]

"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality.  Who needs reality when you have fear.  Just an FYI, our hospital system treats about 20% of its patient who are uninsured and no pay.

If we were really serious about making healthcare affordable we would be yelling at our congress people to allow CMS to negotiate on medication purchases.  We would be pushing to decrease law suit liabilities from big pharma and minimize the regulatory burden the FDA imposes so that we can have less expensive drugs.  US has a much more stringent drug approval process as compared to European countries.  We would be pushing our congress people to demand educating the public on death with dignity. We would push to decrease the regulatory burden and unnecessary personnel involved in the delivery of healthcare. But no, we just clamor about who will pay the bill.

We all pay in some form or another except the very very poor who still qualify for medicaid.  And even they suffer because only so many providers are willing to accept the piss poor reimbursement of medicaid.  But hey, at least we can comfortably say we did not kill 22 million people.

Or maybe hospitals have to learn how to be more efficient and pay the medical doctor specialists less and learn to appreciate the Medicaid reimbursement rates which were increased thanks to Obamacare/ACA.

Doctors and staff can wash their hands more often and not spread infections inside the hospital.

Cardiologists shouldn't be doing so many stress tests to bilk Medicare.

[Gin1984]

"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality. 

Okay, let me offer you some reality.

22 million people will lose access to primary care within the first ten years, and then approximately that many more after that.  Not all of those peole are going to die from lack of healthcare, but SOME of them certainly will.

Some of them will contract fatal diseases, and go undiagnosed until it is too late.  Some of them will have horrible accidents and be maimed for life because they could not afford the surgeries and rehab that they need.  Some of them will fail to get lifestyle intervention that could have saved then from diabetes or skin cancer.  Some mothers and babies will die during childbirth because they had home births with complications instead of trained hospital staff with proper equipment.

It won't be 22 million deaths, but it absolutely WILL be tens of thousands, and maybe hundreds of thousands, of needless and preventable deaths and disfigurements and the only thing that republicans have to do to save them all is... nothing.  Just do nothing.  Just don't strip healthcare access away from millions of people.  Just leave it alone.  Just don't be cruel.

Is that so hard?  Then we can talk about the good republican ideas for how to improve things.  Yes, let's do a better job controlling costs.  Yes, let's figure out how to make insurance more affordable, and fix the subsidy cliffs, and prop up the market in rural areas.  But before we start working on making it better, can we please stop trying to make it worse?

The republican healthcare bill will kill people.  That is not exaggeration.

You realize the vast majority of the reduction in number of insured people the CBO projects are not people that are going to have their health insurance stripped away from them, but people that choose not to be insured because they are no longer subject to the individual mandate.  That may not be good policy, but it's certainly not equivalent to killing people.

Or people who can't afford insurance or lose insurance and can't get it back because the new law will keep them from having insurance for six months.  But, yes, we should just assume those people are not the majority....

[sol]

You realize the vast majority of the reduction in number of insured people the CBO projects are not people that are going to have their health insurance stripped away from them, but people that choose not to be insured because they are no longer subject to the individual mandate.  That may not be good policy, but it's certainly not equivalent to killing people.

You obviously haven't read the CBO report.  It says 7 million fewer people insured through the individual market, and 15 million people who would have their current Medicaid coverage stripped away by the republican health care plan (in the first 10 years, and then even more after that).

And even if you wanted to only count the 15 million who would have their health care forcibly taken away by the republicans, and not the 7 million for whom insurance would be made unaffordable by the republicans, that's still tens of thousands of totally avoidable senseless deaths.  That blood would be on the party's hands for generations to come.

And let's not forget the reasoning behind this cruelty.  They could avoid all of that misery and death by just sitting on their hands and letting the ACA continue to function as-is (nevermind fixing/improving it), but they won't.  Because billionaires need tax cuts!  Republicans are actively pursuing all of that needless death and suffering in order to fund tax cuts for the wealthiest Americans.  Tens of thousands of poor women and children would die needless deaths, but the top 0.1% of Americans would get an average of $197,350 each back from the government.  That's what the republican party is proposing with this bill.

[Cassie]

The whole thing makes me sick. Even if you have a ton of $ saved and insurance often you end up broke from cancer that keeps coming back, a nursing home stay, etc.  What we need is Medicare for everyone.  Everyone deserves decent health insurance. When I was young most full time jobs came  with health insurance. That ship sailed a long time ago.  I can barely stand to watch the news anymore.

[Exflyboy]

The whole thing makes me sick. Even if you have a ton of $ saved and insurance often you end up broke from cancer that keeps coming back, a nursing home stay, etc.  What we need is Medicare for everyone.  Everyone deserves decent health insurance. When I was young most full time jobs came  with health insurance. That ship sailed a long time ago.  I can barely stand to watch the news anymore.

This does ask the Question what do you mean by a "Ton of $"?.. if you have $1m+ does this hold true?

Not trying to pick a fight here.. I come from the UK (our single payer works very well) so you can imagine I am no fan of the US HC system.

So assuming one gets the cancer treatment pre-approved by the insurance company then in theory your costs for each year are limited by the max out of pocket.

I'm sure there are a number of things on your bill that suddenly won't be covered.. so add say $10k for those items.

Is this not true???

[wenchsenior]

"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality. 

Okay, let me offer you some reality.

22 million people will lose access to primary care within the first ten years, and then approximately that many more after that.  Not all of those peole are going to die from lack of healthcare, but SOME of them certainly will.

Some of them will contract fatal diseases, and go undiagnosed until it is too late.  Some of them will have horrible accidents and be maimed for life because they could not afford the surgeries and rehab that they need.  Some of them will fail to get lifestyle intervention that could have saved then from diabetes or skin cancer.  Some mothers and babies will die during childbirth because they had home births with complications instead of trained hospital staff with proper equipment.

It won't be 22 million deaths, but it absolutely WILL be tens of thousands, and maybe hundreds of thousands, of needless and preventable deaths and disfigurements and the only thing that republicans have to do to save them all is... nothing.  Just do nothing.  Just don't strip healthcare access away from millions of people.  Just leave it alone.  Just don't be cruel.

Is that so hard?  Then we can talk about the good republican ideas for how to improve things.  Yes, let's do a better job controlling costs.  Yes, let's figure out how to make insurance more affordable, and fix the subsidy cliffs, and prop up the market in rural areas.  But before we start working on making it better, can we please stop trying to make it worse?

The republican healthcare bill will kill people.  That is not exaggeration.

You realize the vast majority of the reduction in number of insured people the CBO projects are not people that are going to have their health insurance stripped away from them, but people that choose not to be insured because they are no longer subject to the individual mandate.  That may not be good policy, but it's certainly not equivalent to killing people.

Oh, please do tell us where you got this bit of data from?  Paul Ryan's bs talking points?

[the_fixer]

Can we stop with all of the theatrics already?

I really would like to hear about what is happening but this BS is getting an it over the top with the everyone on the right wants everyone to die except except rich people and fetuses.

Keep fighting along party lines, that is what they want you to do because as long as you are focused on that you will not be focused on them.

[wenchsenior]

Can we stop with all of the theatrics already?

I really would like to hear about what is happening but this BS is getting an it over the top with the everyone on the right wants everyone to die except except rich people and fetuses.

Keep fighting along party lines, that is what they want you to do because as long as you are focused on that you will not be focused on them.

Heh. I can multitask.  I'm on top of what Congress is up to nearly all the time, even when they are doing boring stuff.

[wenchsenior]

The whole thing makes me sick. Even if you have a ton of $ saved and insurance often you end up broke from cancer that keeps coming back, a nursing home stay, etc.  What we need is Medicare for everyone.  Everyone deserves decent health insurance. When I was young most full time jobs came  with health insurance. That ship sailed a long time ago.  I can barely stand to watch the news anymore.

This does ask the Question what do you mean by a "Ton of $"?.. if you have $1m+ does this hold true?

Not trying to pick a fight here.. I come from the UK (our single payer works very well) so you can imagine I am no fan of the US HC system.

So assuming one gets the cancer treatment pre-approved by the insurance company then in theory your costs for each year are limited by the max out of pocket.

I'm sure there are a number of things on your bill that suddenly won't be covered.. so add say $10k for those items.

Is this not true???

This is true currently, under the ACA, which does not allow caps to spending by the health insurance companies. So as long as you pay your premiums and meet your deductible (which can be very substantial...a legit problem with the ACA in some markets), your cancer treatment would be covered with no cap.  However, under the proposed GOP bill, premiums and deductibles will go up (at least for the first few years, after  which the GOP believes competition would drive rates down) and the quality of the plan will drop. So people will have to pay more for worse insurance.

In addition, this legislation proposes that states can opt out of current restrictions on plans that are offered. So they could theoretically start offering plans with lifetime caps (could be blown through by cancer) or maximum annual caps, etc. Also, this could allow backdoor methods of dropping coverage for preexisting conditions. So insurance companies would be required to offer SOME sort of insurance to a cancer sufferer, but not necessarily insurance that covered chemo.

[sol]

Can we stop with all of the theatrics already?

I really would like to hear about what is happening but this BS is getting an it over the top with the everyone on the right wants everyone to die except except rich people and fetuses.

Keep fighting along party lines, that is what they want you to do because as long as you are focused on that you will not be focused on them.

This really shouldn't be a party issue.  It's a bad bill, in virtually every respect.  It makes insurance more expensive, it covers fewer people, and it makes that coverage less useful, all without actually repealing Obamacare.  It breaks every campaign promise Trump made about healthcare.

What it does do is reduce federal spending on healthcare.  Unfortunately, it just replaces it with federal spending on tax refunds for rich people.

[Cassie]

Exfly: some good friends of mine had health insurance but his wife got cancer 8 times through 12 years and he got it twice. They had a paid for house, money saved and jobs. Eventually she could no longer work so had to go on SSDI.  They both died last year in early 60's without a penny to their names and she was in a nursing home on Medicaid. They had so many medical bills that eventually took equity out of their home to pay them and finally sold it and rented a tiny place. In the end they sold everything they had when he was dying and she went into a home because he was too sick to care for her and she by then had developed dementia.

[Exflyboy]

Cassie.. I wonder if they had treatments that were pre-approved by the insurance company? I too have friends in a similar situation but it turns out they agreed to care for her breast cancer suggested by her Dr without getting pre-approval.. Guess what?.. It wasn't covered and cost them $100k.

So I'm wondering if your friends were in a similar situation? Also, prior to the ACA you could be kicked off your insurance and then no one would touch you because of the pre-existing condition clause. But currently they can't do that.

So I'm at a loss as to (under current law) how you can be charged much more than the max OOP number listed on your plan?

As for us if we got stung with a $100k bill then I'm on the first flight back to the UK!

[wenchsenior]

It's fairly well established in the MMM community that giving (or worse, lending) money to family members is generally a bad idea, as they'll come to depend on it. Helping people is not always a good thing and does create dependence. How is that hard to grasp?

Difference being that not giving a few thousand or whatever to family won't cause them to die because they can't afford cancer treatments but cutting Medicaid or backdoor evisceration of protections for pre-exisiting conditions does.  Many studies show that it's X # of deaths per Y # of uninsured.  Or is that fake news? 

Just admit that many of you right wingers just don't give a shit about people, you don't care if people die.   Fucking sociopaths.

They care a lot about fetuses though!

But really, I do have a LOT of conservative family members.  A LOT.  And ... they sort of don't care if people die.  I don't mean that in a "cold-hearted" way, but more of a practical way.

You know we've touched on this in several threads, but not sure if we've really delved deeply into it.

Aside from the cost of care being high and the need to cut it, there's the practical aspect and the caring aspect
- babies born early that spend a lot of time in the NICU cost a lot of money
- many of them have life-long problems that cost a lot of money, both health-wise and education wise
- babies born with fetal alcohol syndrome, or with other birth defects like down syndrome, or genetic disorders - they cost money.  To care for medically, and to educate.
- people get cancer.  Cancer treatment is expensive.
- people get diabetes, sometimes kids get Type 1, treatment is expensive
- people get old and sick.  And end of life care is expensive, and sometimes you need it for a very long time
- people will spend an inordinate amount of money, time, effort, to keep someone alive
- we don't allow euthanasia.  What if someone would rather die peacefully than live on machines for years, or die by refusing to eat?
- young people die because they get sick and don't have insurance and aren't able to get care

So, where do you draw the line?  I've got friends in Canada and Europe and the UK where they get care.  Yes, their taxes are high.  But they don't generally go broke due to medical issues.

In the US, we are such "individuals"... honestly, a lot of my conservative family members are practical.  People die.  They get that.  My cousin died of a leg infection.  Sometimes your baby is born too early and they die.  Sometimes you get cancer, and your church has a spaghetti dinner and a pancake breakfast (or 3) because your insurance sucks, or you don't have it at all.  But then you can't afford to finish chemo, so you die.  Sometimes you get old, and you cannot afford a home.  You don't want to go in one anyway.  So a few friends and family members may help you out, come by, bring dinner.  But in the end, you are living alone, you have an aneurysm burst and you die (my dad).

It's complicated, especially when you are talking millions of dollars.  I saw a quote yesterday "by having a lifetime cap on insurance, you are telling someone that they aren't worth any more money to keep alive".  Which sounds harsh.  And it is.  A preemie can hit that in months, and that preemie can go on to grow up and get a job and pay taxes.  On the other hand, that preemie might require a lifetime of specialized care in a special home, and that can run even higher.

Oooo, oooo, so the post above where I was wrestling with the oddness of my father and  his family and their super conservative mindest that views poor people as too stupid to earn proper livings and too irresponsible to make smart choices like buy health insurance?  So...guess who never bothered to buy health insurance in his twenties, when his wife was pregnant with their first child (me)? And guess who ended up being an emergency c-section preemie who required intensive care for 2 weeks? Me!  And guess who got away with not having hundreds of thousands of dollars in bills that he couldn't possibly pay on his salary by the skin of his teeth? My dad. But HOW, you ask? By buying full coverage health insurance AFTER the emergency delivery...from his own father...because one of the two businesses  my dad's family owned was INSURANCE!!!  So handy... Extreme nepotism for the win!

Now, this did teach my father a lesson about never going without health insurance. But it NEVER made him more compassionate or understanding toward any OTHER person who went without insurance out of carelessness, thoughtlessness, or poverty and suffered financially or physically because of it. Those people just deserved whatever they got.   

[Cassie]

All their treatments were approved. She had 8 different surgeries and 8 different rounds of chemo. This happened from 1998 and they just died last year. Also most of those years she was too sick to work and then developed dementia from all the metal that is in chemo. He worked until a year before he died. They were never kicked off their insurance. I think one thing that hurt so much financially ws that they lost her income and she got SSDI that was about 1700/month. Then as he got older he got laid-off and at one point had to work as a security guard. But in the past 5 years before he died worked his way up in the company and had a good job.  They actually were not bitter and valued their lives more then $ but I think it is super sad the way it turned out.  AFter he died I was her guardian and when her care level went up the home charge double their rent. I ran out of her $ fast then and she qualified for Medicaid.

[wenchsenior]

Cassie.. I wonder if they had treatments that were pre-approved by the insurance company? I too have friends in a similar situation but it turns out they agreed to care for her breast cancer suggested by her Dr without getting pre-approval.. Guess what?.. It wasn't covered and cost them $100k.

So I'm wondering if your friends were in a similar situation? Also, prior to the ACA you could be kicked off your insurance and then no one would touch you because of the pre-existing condition clause. But currently they can't do that.

So I'm at a loss as to (under current law) how you can be charged much more than the max OOP number listed on your plan?

As for us if we got stung with a $100k bill then I'm on the first flight back to the UK!

I am not sure you can be under current law, though there might be weird loopholes somewhere. The point was, pre ACA, as you note, there were hardly any rules about this.  You could easily be bankrupted by medical bills.  And if the GOP passes something similar to their current bill, things will be very similar to how they were pre ACA except with the additional cuts to Medicaid, even fewer poor people will be covered than pre-ACA.

[Cassie]

Also when she got dementia and her cancer came back we did not treat it because doing so would be cruel.

[Exflyboy]

I am very sorry for you're loss, but glad you were there to help them Cassie.

[mm1970]

Also when she got dementia and her cancer came back we did not treat it because doing so would be cruel.

My FIL opted to do that with his mother in her 90s when her cancer came back.  But man, she suffered for a couple of years after that.  I think he partially regrets his decision.  If he'd known she was going to live, and be in that much pain, for that long - he might have opted to treat her.  It's so tricky.

[GuitarStv]

Why do republicans put so much time and money into pro-life efforts and then try and kill 22 million people?

It doesn't make any logical sense.

It does when you realize that pro-life is a misnomer.  Republicans are pro-punishment, and view children as punishment for sexual indiscretions.

[nereo]

Whether through luck or skill, Sol's prediction that GOP Senators would leave only in mass seems to be correct - immediately after the vote was postponed 5 more senators expressed unwillingness to support the bill without further debate and analysis.   WaPo counts 5 opposed and 5 'leaning-no'

Looks like we'll spend the 4th with campaign-style blitz from both sides. More details are starting to emerge as people get past the initial talking points and into the weeds.
 ALterations of the current Senate bill seem almost certain. I'm counting on some blatant mis-representation of the next CBO score - if the next one says only 19MM will lose health insurance the talking point will be "three million more will gain insurance" (not mentioning that number is compared to a bill which could not pass).

[ReadySetMillionaire]

I haven't dipped my toe into this thread because it's painfully clear to me that a lot of people posting in this thread know far more about healthcare than I do.

Yet I have one single question, which I'm hoping can start an informative dialogue: what do you guys think of banning employers offering healthcare as a benefit?

To my simple mind, the employment-based model of healthcare is the single biggest problem with our healthcare system. It removes the true cost from the consumer, it does not make any sense (employers don't pay for other insurance), it creates gaps in coverage if people get laid off (which then contributes to the pre-existing conditions issue), and it actually discourages entrepreneurship. I myself have thought long and hard about starting my own solo practice, but healthcare costs are a golden handcuff that I can't seem to shake.

Put simply, I think getting rid of the employment-based healthcare system would be the single best first step we can take, because it would create a true private versus public competition.

Thoughts?

[Roland of Gilead]

It doesn't have to be a straight ban, just start taxing employer provided healthcare as compensation.

If my employer paid my home owner or car insurance I would expect to be taxed on that.

[brooklynguy]

McConnell's backing down from his bluff to force a vote this week come hell or high water means the repeal efforts remain alive and strong.  The speculation that he would have moved forward with a vote destined to fail in order to "show the electorate a body" and move on to other issues on the agenda turns out to have been smoke and mirrors.  Successfully threading the need across all GOP factions might appear to be getting more difficult, but the effort is still underway.  I wouldn't be surprised if we see a repeat of the House process, where a little delay and some incremental changes to make the bill even worse ultimately result in passage (but I also wouldn't be surprised if GOP infighting ultimately proves insurmountable).  One thing is clear:  the longer this uncertainty lasts, the worse off our current health insurance system will become.

[nereo]

Yet I have one single question, which I'm hoping can start an informative dialogue: what do you guys think of banning employers offering healthcare as a benefit?

To my simple mind, the employment-based model of healthcare is the single biggest problem with our healthcare system (snip)

I would wholeheartedly support such a plan.  Problem is, particularly under the current climate it would be politically impractical, if not impossible. it would involve not just revamping our health care, but our entire tax code simultaneously (and we can't seem to do either in isolation, so together it seems like fantasy).  You're absoltuely right that it shields consumers from the true cost of hteir insurance, plus it makes employees beholden to their jobs.  About 20+ pages ago I mentioned how in ~2010 the enormous CalPERS (California State Employees) shifted their networks and premiums a bunch of my friends were irate that their family healthcare costs went from $80/mo to about $140 ("a 50% increase!! Thanks Obama!!").  Few realized that CalPERS continued to cover >90% of their health insurance, and that even $140/mo was dirt cheap for a family of 4.

I've heard pundits from both sides comment that if we were to really start over from scratch we'd never choose a model where the employer supplied ~2/3 of our health insurance. If we started taxing employer-provided healthcare as Roland suggests, employers would drop their healh plans like a flaming bag of poo - the only reason large corporations do this is because they can 'save' ~35¢ per dollar on corporate taxes.

[Inaya]

Yet I have one single question, which I'm hoping can start an informative dialogue: what do you guys think of banning employers offering healthcare as a benefit?

To my simple mind, the employment-based model of healthcare is the single biggest problem with our healthcare system (snip)

I would wholeheartedly support such a plan.  Problem is, particularly under the current climate it would be politically impractical, if not impossible.

More impractical/impossible than single-payer?

[protostache]

I've heard pundits from both sides comment that if we were to really start over from scratch we'd never choose a model where the employer supplied ~2/3 of our health insurance. If we started taxing employer-provided healthcare as Roland suggests, employers would drop their healh plans like a flaming bag of poo - the only reason large corporations do this is because they can 'save' ~35¢ per dollar on corporate taxes.

Well, that and ACA mandates that any business with more than 50 employees has to provide health insurance for their full time employees. This PDF report explains how it works and how the penalties work on page 4, but it basically amounts to $2,260 per full time employee that doesn't have insurance.

[nancyjnelson]

To my simple mind, the employment-based model of healthcare is the single biggest problem with our healthcare system. It removes the true cost from the consumer, it does not make any sense (employers don't pay for other insurance), it creates gaps in coverage if people get laid off (which then contributes to the pre-existing conditions issue), and it actually discourages entrepreneurship. I myself have thought long and hard about starting my own solo practice, but healthcare costs are a golden handcuff that I can't seem to shake.

Put simply, I think getting rid of the employment-based healthcare system would be the single best first step we can take, because it would create a true private versus public competition.

I agree with this 100%.  A system that links health care coverage to full-time employment at medium-to-large firms (yes, some part-time positions and some tiny businesses do come with health care, but they are in the minority) does discourage entrepreneurship - and favors the bigger, already-established companies.  Health care coverage linked to employment harms the free market by preventing small companies from being able to attract the best candidates - thus limiting their growth - and keeps employees working at firms under disagreeable conditions (bad supervisor, too-long commute, not challenging, negative work environment, etc), thus wrongly rewarding these mediocre firms and their practices.

Taking it a step further, I would like to point out how the U.S. economic system is devolving into a sort of neo-feudalism, with the financial system increasingly rigged in favor of those who are already rich and powerful, and increasingly limited regarding the opportunities it offers to those who are not.  And if you replace laws chaining people to the land with medical coverage and educational debt chaining people to jobs with established companies, we are all serfs.  (Yes, I know there are many, many exceptions, but I am talking in broad brushstrokes here.)  But a discussion of this issue should happen on another thread.

The system, as it now stands, props up the status quo and makes people dependent on the current economic structure.  And this, my friends, is why MMM, FI and FU money is so important!








   

[nereo]

Yet I have one single question, which I'm hoping can start an informative dialogue: what do you guys think of banning employers offering healthcare as a benefit?

To my simple mind, the employment-based model of healthcare is the single biggest problem with our healthcare system (snip)

I would wholeheartedly support such a plan.  Problem is, particularly under the current climate it would be politically impractical, if not impossible.

More impractical/impossible than single-payer?

I actually think that a single-payer system is the only way we could get there, but it would mean simultaneously eliminating such health-insurance giants as Unitedhealth, Wellpoint, Kaiser and Aetnia.  Don't expect those to go quietly into the night...

Because of this legacy/inertia its hard for me to see how the US will ever get to a single-payer system, and I say this as someone who's from the US but has lived under two such systems (which have both advantages and disadvantages, and isn't a cure-all to all teh problems of the US system regardless). Large corporations have been incentivized to provide health-care through favorable taxation for decades. huge for-profit corporations exist that would be harmed if we went to single payer. There's incredible disconnect between cost of care/cost-of-insurance and what people find reasonable to spend on healthcare.  And of course as EnjoyIt keeps pointing out, we spend more per-capita on healthcare than any other country, and we're not the sort to take massive tax increases to pay for our current system (even though we already pay for it in various forms).

[DavidAnnArbor]

To my simple mind, the employment-based model of healthcare is the single biggest problem with our healthcare system. It removes the true cost from the consumer, it does not make any sense (employers don't pay for other insurance), it creates gaps in coverage if people get laid off (which then contributes to the pre-existing conditions issue), and it actually discourages entrepreneurship. I myself have thought long and hard about starting my own solo practice, but healthcare costs are a golden handcuff that I can't seem to shake.

Put simply, I think getting rid of the employment-based healthcare system would be the single best first step we can take, because it would create a true private versus public competition.

I agree with this 100%.  A system that links health care coverage to full-time employment at medium-to-large firms (yes, some part-time positions and some tiny businesses do come with health care, but they are in the minority) does discourage entrepreneurship - and favors the bigger, already-established companies.  Health care coverage linked to employment harms the free market by preventing small companies from being able to attract the best candidates - thus limiting their growth - and keeps employees working at firms under disagreeable conditions (bad supervisor, too-long commute, not challenging, negative work environment, etc), thus wrongly rewarding these mediocre firms and their practices.

Taking it a step further, I would like to point out how the U.S. economic system is devolving into a sort of neo-feudalism, with the financial system increasingly rigged in favor of those who are already rich and powerful, and increasingly limited regarding the opportunities it offers to those who are not.  And if you replace laws chaining people to the land with medical coverage and educational debt chaining people to jobs with established companies, we are all serfs.  (Yes, I know there are many, many exceptions, but I am talking in broad brushstrokes here.)  But a discussion of this issue should happen on another thread.

The system, as it now stands, props up the status quo and makes people dependent on the current economic structure.  And this, my friends, is why MMM, FI and FU money is so important!

And to add another data point in support of this hypothesis, employers make employees sign these overly broad non-compete clauses. So if you are an engineer or other occupations, and you leave your job, you're not allowed to work in your field for 2 years.

http://www.jsonline.com/story/opinion/blogs/real-time/2017/03/01/ties-bind-squeezing-wisconsins-economy/98546082/

[nereo]

I've heard pundits from both sides comment that if we were to really start over from scratch we'd never choose a model where the employer supplied ~2/3 of our health insurance. If we started taxing employer-provided healthcare as Roland suggests, employers would drop their healh plans like a flaming bag of poo - the only reason large corporations do this is because they can 'save' ~35¢ per dollar on corporate taxes.

Well, that and ACA mandates that any business with more than 50 employees has to provide health insurance for their full time employees. This PDF report explains how it works and how the penalties work on page 4, but it basically amounts to $2,260 per full time employee that doesn't have insurance.

Yeah... I knew this would come up, but I was speaking about the much longer time-scale of US health insurance.  Even before the ACA roughly 2/3rds of americans were covered under an employer-sponsored health insurance program. While the ACA did mandate more companies to offer health-care insurance, the % of Americans who get their insurance through their employer has remained basically steady.  Going into the weeds with this the driver seems to be the broader shift in more contract employees, though its also absoltuely true that smaller companies offer health insruance now which didn't pre-ACA.

[jim555]

Single-payer system in the US?  Lets get real.  Never going to happen.

The Republicans are discovering something - Ayn Rand meets reality.  Gut Medicaid, creates BIG problems for the states.  Who controls most of the states?  Republicans.  The idealogical dimwits in the House are not seeing the bigger picture, taking a huge dump in your own yard means you yourselves have to clean it up.  Senators WILL be hearing it from their Governors.  You can talk a lot to your base, but when the rubber meets the road and your policies create havoc you will have no one to blame but yourselves.  Are they smart enough to see this is political suicide?  People will not put up with granny being put on skid row and left to die or their Social Security and Medicare being ruined.

[Inaya]

Single-payer system in the US?  Lets get real.  Never going to happen.

The Republicans are discovering something - Ayn Rand meets reality.  Gut Medicaid, creates BIG problems for the states.  Who controls most of the states?  Republicans.  The idealogical dimwits in the House are not seeing the bigger picture, taking a huge dump in your own yard means you yourselves have to clean it up.  Senators WILL be hearing it from their Governors.  You can talk a lot to your base, but when the rubber meets the road and your policies create havoc you will have no one to blame but yourselves.  Are they smart enough to see this is political suicide?  People will not put up with granny being put on skid row and left to die or their Social Security and Medicare being ruined.

The most confusing thing about this is they are directly threatening older Americans. People who have always been their staunchest supporters. What do they hope to gain that will outweigh this support?

[dividendman]

Single-payer system in the US?  Lets get real.  Never going to happen.

The Republicans are discovering something - Ayn Rand meets reality.  Gut Medicaid, creates BIG problems for the states.  Who controls most of the states?  Republicans.  The idealogical dimwits in the House are not seeing the bigger picture, taking a huge dump in your own yard means you yourselves have to clean it up.  Senators WILL be hearing it from their Governors.  You can talk a lot to your base, but when the rubber meets the road and your policies create havoc you will have no one to blame but yourselves.  Are they smart enough to see this is political suicide?  People will not put up with granny being put on skid row and left to die or their Social Security and Medicare being ruined.

The most confusing thing about this is they are directly threatening older Americans. People who have always been their staunchest supporters. What do they hope to gain that will outweigh this support?

It doesn't matter. They're going to vote republican regardless of what happens and blame any hardship caused by government policies on the democrats even if the republicans control both their statehouses, the governors mansion, the congress, the white house and the supreme court.

It's how religious mania works  - you believe what you believe, fuck all of those "facts".

[Paul der Krake]

Single-payer system in the US?  Lets get real.  Never going to happen.

The Republicans are discovering something - Ayn Rand meets reality.  Gut Medicaid, creates BIG problems for the states.  Who controls most of the states?  Republicans.  The idealogical dimwits in the House are not seeing the bigger picture, taking a huge dump in your own yard means you yourselves have to clean it up.  Senators WILL be hearing it from their Governors.  You can talk a lot to your base, but when the rubber meets the road and your policies create havoc you will have no one to blame but yourselves.  Are they smart enough to see this is political suicide?  People will not put up with granny being put on skid row and left to die or their Social Security and Medicare being ruined.

Medicaid spends on two groups: poor people, and old people's hospices.

I'd wager that red states can gut the first one with almost no political consequences. It's the latter that they will have to tread on eggshells, and my guess is that they won't dare touch it. There is a good chunk of people who don't realize that Grandma is kept alive by Medicaid, but when they do, you can rest assured they will suddenly think the program is their hard earned birthright.

Seriously, who the fuck thought it was a good idea to have to programs that were guaranteed to be hotly debated have almost the same name.

[sol]

Single-payer system in the US?  Lets get real.  Never going to happen.

I think there might be a legitimate path to single payer in the US, now that unregulated healthcare was a disaster and conservatives then shit all over their own public/private hybrid solution.

It needs to be gradual, and to phase in over time.  We might start by lowering the Medicare age and raising the Medicaid qualification limit, in little bits every year.

It needs to be minimal, so that those huge corporations still have a role to play and we don't just dismantle 1/6 of the economy.  That means reducing the benefits, so that no one goes medically bankrupt but most people will still want to buy supplemental insurance.

It needs to be fiscally responsible, which probably means repealing the employer exemption and instituting a new oasdi tax.  This will be regressive enough that rich people don't mind, but the care would mostly benefit the poor so I'm okay with it.

It needs strong cost controls.  If Medicaid/Medicare negotiated together nationwide, they could dictate prices on the basic services they covered.  This is the secret sauce that every other western democracy uses to control healthcare costs.  It works, and we should join theparty.

And we would need a lot of morning talk show messaging to convince conservatives this is good for them.  Is your state struggling with opioid addiction?  Uncle Sam is going to offer you free treatment programs and Hollywood liberals are going to pay for it.  Do you crave individual freedom?  This plan ends the Obamacare mandate, breaks the shackles of employer coverage, and unleashes America's entrepreneurial spirit.  Are you an evangelical or compassionate conservative?  This plan reaches out to the neediest among us, without creating dependency or incentivizing laziness. 

We're not there yet, but I think it's a lot less far fetched than it was just a few short years ago.

[nereo]

Single-payer system in the US?  Lets get real.  Never going to happen.

The Republicans are discovering something - Ayn Rand meets reality.  Gut Medicaid, creates BIG problems for the states.  Who controls most of the states?  Republicans.  The idealogical dimwits in the House are not seeing the bigger picture, taking a huge dump in your own yard means you yourselves have to clean it up.  Senators WILL be hearing it from their Governors.  You can talk a lot to your base, but when the rubber meets the road and your policies create havoc you will have no one to blame but yourselves.  Are they smart enough to see this is political suicide?  People will not put up with granny being put on skid row and left to die or their Social Security and Medicare being ruined.

The most confusing thing about this is they are directly threatening older Americans. People who have always been their staunchest supporters. What do they hope to gain that will outweigh this support?

The freedom caucus + Rand see the rising costs of entitlement as an existential crisis to the United States.  In their eyes we cannot raise taxes, and failing to do this our government will be unable to do anything in the decades ahead besides pay out medical & SS UNLESS we cut back these programs and shift the responsibilites more onto individuals.

As for the political calculations, I'll bet many of htem think that lifelong GOPers are too set in their ways to ever change to 'the other side' (they might be right) and the one demographic this could actually help is the very affluent, who tend to be older white people.  The reduction in taxes these people might see could more than pay for the increased cost of insurance.