Author Topic: What comes after the ACA?  (Read 773339 times)

AdrianC

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Re: What comes after the ACA?
« Reply #3200 on: July 19, 2017, 08:08:08 AM »
You should really take advantage of that free colonoscopy, it could save your life.
I just did (on Monday). All clear. Come back in ten years.

My uncle just two years older than me died of colon cancer. It's totally worth the minor discomfort to get peace of mind/early diagnosis.

On topic: since the ACA our deductibles are a bit higher (we run high deductibles on all our insurance since we can afford to "self-insure" that portion). Premiums have tripled. Some of the increase is us getting older, some is to pay for increased benefits to us, some is to pay for increased benefits to others in our risk pool. I'm OK with all that.

I vote (did vote) to keep and strengthen the ACA. My reps have vowed (and voted) to repeal it. We still don't know how this will play out.

Mr. Green

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Re: What comes after the ACA?
« Reply #3201 on: July 19, 2017, 08:09:44 AM »
I am reading they will do a clean repeal vote next week.  I thought they said that it already died yesterday.  Guess they want to get the loss on record.
All this winning is wearing me out.  Where is that big beautiful see through solar powered wall?
Yes, McConnell wants to get a vote on record even though 3 Republican senators have already stated they will not vote for a clean repeal.

Mr. Green

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Re: What comes after the ACA?
« Reply #3202 on: July 19, 2017, 08:15:07 AM »
I was reading something this morning and it made me realize how poor of a strategy it is for Republicans to "let Obamacare fail" because it's not just one big marketplace. There are quite a number of markets (more than half I think?) where the exchanges are in no danger of failing and probably never will. The other markets that are having trouble tend to be more rural areas, which were President Trump's sweet spot during the election. I would think the vitriol would really kick into high gear as those folks are left with no options and have to watch other areas continue to operate just fine.

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Re: What comes after the ACA?
« Reply #3203 on: July 19, 2017, 08:29:49 AM »
All this discussion about the ACA and the actual ACA only covers about 7 million of the
320 million people in the US. (0.3%) a few million of those had insurance before the ACA and either it no longer qualified or with the subsidy the ACA was cheaper so they switched.
 There are another 10 million that were put onto Medicaid, because they were below the income threshold to qualify for the ACA.
 Seems like a massive social eruption for such a small part of the population.
 Could it be because the ACA legislation cause a huge increase in the cost of health insurance?

 
You seem to think that only the exchanges are covered under the ACA. It affects your insurance even if you are covered through your employment.

Could it be you don't understand the disruption because you don't understand ACA?

Oh I understand the ACA affected my non-ACA, non-employer, non-government policy. I'm self employed, I pay for my families policy. I had just got comfortable with the cost of my families health insurance cost after raising my deductible to $10,000* and getting my premium down to $4,512 a year. This was two years before the ACA regulations went into effect.
 In 2010 I had a 7.7% increase, in 2011 I had a 8.1% increase, then came the ACA reg's in 2012, I got a whooping 19.4% increase, 2013 it was a 21% increase and in 2014 it was 18.8% increase. That's a 72% increase in 3 years.
 But, I got these forced benefits 'cough' because of the ACA.
 I got a 'free' physical each year, (but notice it wasn't free, I paid way more for it with the premium increase.)
  I also got my $5,000,000 lifetime cap increased to unlimited. (is it right to force society to pay more tham $5,000,000 to keep me alive?)
 I get a 'free' Colonoscopy every 5 years.
 I got increased coverage for drug rehab.
I got a little more coverage for mental healthcare.
 All of those extras have saved me about $250 in doctor fees over those 5 years,
but I have paid an additional $17,070 in premium.
 I'll admit some of that $17k was because I got older.

*$10,000 deductible. I raised my deductible from $2,500 to $10,000, the lowered my premium from $9,900 to $4,512, people said I was crazy with that high deductible plan, but notice when the ACA came out most families have $12,600 deductible.
 Notice in 17 months the premium savings, paid for my $10k deductible. Plus With my high deductible plan I could deduct and HSA plan from my taxes.

Is it right to only allow the ludicrously wealthy to live?

If you're a Republican, then the answer is YES, because they think poor people are morally inferior.

BTDretire

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Re: What comes after the ACA?
« Reply #3204 on: July 19, 2017, 08:41:58 AM »

Is it right to only allow the ludicrously wealthy to live?

  Define ludicrously wealthy!
Does it matter to you how they got their wealth.
Oh! was I wrong to say their wealth, rather than their plunder?
Just trying to understand where your stand.

katsiki

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Re: What comes after the ACA?
« Reply #3205 on: July 19, 2017, 09:56:29 AM »

If you're a Republican, then the answer is YES, because they think poor people are morally inferior.

You're painting with a broad brush there...  Not all republicans are the same.

protostache

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Re: What comes after the ACA?
« Reply #3206 on: July 19, 2017, 10:39:30 AM »

If you're a Republican, then the answer is YES, because they think poor people are morally inferior.

You're painting with a broad brush there...  Not all republicans are the same.

Then the republicans that don't think that need to elect better representatives to local, state, and federal government, because all evidence suggests that the Republican elected representatives by and large don't care about how poor people are treated by the government.

nereo

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Re: What comes after the ACA?
« Reply #3207 on: July 19, 2017, 11:35:12 AM »
Well said Moustaches.

Adding: One big problem with the ACA (Affordable Care Act) is that its name is a misnomer.  Its primary function was to reduce the number of uninsured and increase the level of healthcare available by eliminating lifetime caps, increasing coverages and requiring more essential benefits.  To that end it did a very good job.  It took only perfunctory measures to make healthcare more affordable.  Critics have long hammered the law on rising premiums. 

Problem is, healthcare premiums were rising well above inflation long before the ACA, and apples-to-apples comparisons are exceedingly difficult because one must account not only for all the things which are covered (even if not used by an individual) as well as what costs would have been in 2017 had the ACA not ever existed.  As with anything this large, there will certainly be individual winners and losers.

sol

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Re: What comes after the ACA?
« Reply #3208 on: July 19, 2017, 11:45:18 AM »
Adding: One big problem with the ACA (Affordable Care Act) is that its name is a misnomer.

How do you feel about the Senate bill called the Better Care Reconciliation Act depriving 22 million Americans of their health insurance in order to fund tax breaks for rich people?

Is it really "better" care if it covers less, costs more, and is available to fewer people?  Maybe they meant "better" for rich people who want to pay fewer taxes?

shenlong55

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Re: What comes after the ACA?
« Reply #3209 on: July 19, 2017, 11:56:16 AM »

If you're a Republican, then the answer is YES, because they think poor people are morally inferior.

You're painting with a broad brush there...  Not all republicans are the same.

I think you were being sarcastic, but if you don't like republicans policy, it's better to try to understand their thinking than to cast them as villainous cartoon characters.

Republicans don't hate poor people and want to punish them, they believe that the majority of poor people are able bodied and can get out of their situation if they work harder.  So they don't like it when the government gives them free things and incentivizes them to get trapped into poverty because the government benefits are worth more than a job.  They also believe that cutting taxes on the rich and/or businesses benefits rich AND poor people as the money saved can be invested into new jobs or new equipment.  I agree with this stand point on some level as a mustachian that worked hard, saved, and invested.

He didn't say that republicans hate poor people (which I'm sure they don't), he said they think poor people are morally inferior.  Which is pretty much what you just said in the bold part.  Saying that the majority of poor people are able bodied and could get out of their situation if they wanted to is a moral judgement when you believe that hard work is a moral characteristic.
« Last Edit: July 19, 2017, 11:58:18 AM by shenlong55 »

nereo

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Re: What comes after the ACA?
« Reply #3210 on: July 19, 2017, 12:05:41 PM »
Adding: One big problem with the ACA (Affordable Care Act) is that its name is a misnomer.

How do you feel about the Senate bill called the Better Care Reconciliation Act depriving 22 million Americans of their health insurance in order to fund tax breaks for rich people?


I think many bills (and SuperPAC) names are laughably absurd relative to what they do.  Yeah on the face of it I support "Better Care"  - who wouldn't? - but as you noted the Senate bill did not provide better care for anyone; only better tax returns for rich people and lower premiums for young healthy people as long as they stayed that way. The Patriot Act did the exact opposite of what the original US colonial patriots fought against - governmental control of our daily lives with little oversight.  "Rebuilding America Now" sounds nice - our infrastructure and schools could certainly use a lot of attention after decades of neglect - but that's a super PAC that spent most of its money running brutal attack ads in the 2016 campaign and little to any actually rebuilding anything.

Back to the ACA - I think the bill was a very big net improvement over what came before. But putting "Affordable" as the first word has left it wide open to (often nefarious) attacks about how it's not really affordable. Had it been called the "Increasing Care Act for Really Everyone" (I-CARE) I think the criticisms from moderates would be much different.  Many wrongly interpret the bill as something designed to reduce premiums, instead of something designed primarily to increase both the numebr and the amount of everyone's coverage.


DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3211 on: July 19, 2017, 12:19:31 PM »
Yes the ACA subsidies need to be expanded and include more upper middle class incomes since health insurance became more expensive as a result of the changes the law required. These changes were needed.

runewell

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Re: What comes after the ACA?
« Reply #3212 on: July 19, 2017, 12:27:20 PM »
In order to be "let down" the expectation of cooperation has to exist first. Since that was never there in the first place, being let down is a misnomer.

The cooperation might not have been there in the first place, but that doesn't mean that an expectation of cooperation couldn't exist. 
So, it's not a misnomer.

shenlong55

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Re: What comes after the ACA?
« Reply #3213 on: July 19, 2017, 12:31:36 PM »

If you're a Republican, then the answer is YES, because they think poor people are morally inferior.

You're painting with a broad brush there...  Not all republicans are the same.

I think you were being sarcastic, but if you don't like republicans policy, it's better to try to understand their thinking than to cast them as villainous cartoon characters.

Republicans don't hate poor people and want to punish them, they believe that the majority of poor people are able bodied and can get out of their situation if they work harder.  So they don't like it when the government gives them free things and incentivizes them to get trapped into poverty because the government benefits are worth more than a job.  They also believe that cutting taxes on the rich and/or businesses benefits rich AND poor people as the money saved can be invested into new jobs or new equipment.  I agree with this stand point on some level as a mustachian that worked hard, saved, and invested.

He didn't say that republicans hate poor people (which I'm sure they don't), he said they think poor people are morally inferior.  Which is pretty much what you just said in the bold part.  Saying that the majority of poor people are able bodied and could get out of their situation if they wanted to is a moral judgement when you believe that hard work is a moral characteristic.

That's an interesting spin on the republican talking point, that they come from a religious perspective in that hard work is more spiritually beneficial.  That may be how social conservatives think but that's not how I think about it.  I'm more of a fiscal conservative, socially liberal, centrist that could be considered a moderate democrat or a moderate republican.  From my perspective, hard work is important but obviously not the only critical success factor.  You need some luck and you also need to be doing work that has some value in the marketplace.  Some of my high school friends work really hard but chose to pursue an acting career with low prospects.  I do think these type of people have chosen their lot in life by picking a career that is super difficult to win at, while others who chose to major in business, etc. are able to work hard and obtain success.

It's not even necessarily a religious thing.  People generally equate success with being a good person, because why would we reward bad people after all.  They also believe that hard work is how you become successful (pull yourself up by the bootstraps!).  So if successful people are good people and to be successful you have to work hard, then if you don't work hard you must be a bad person, right?

runewell

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Re: What comes after the ACA?
« Reply #3214 on: July 19, 2017, 12:32:52 PM »
People want affordable comprehensive healthcare, and in this country right now we mostly deliver that via private insurance.

hahahahaha good one

Quote
The ACA is a workable system of compromises that mostly delivers what it promised. Fixing the flaws (mostly caused by Republicsn ratfucking) is not a hard thing to do, but it takes compromise and discussion and effort.

The flaw in ACA was pretending that open enrollment and no preexising conditions wouldn't cost anything which was complete and utter fiction.

runewell

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Re: What comes after the ACA?
« Reply #3215 on: July 19, 2017, 12:35:52 PM »
Is it right to only allow the ludicrously wealthy to live?
Do all those without health insurance bear no absolutely blame for their choices and situation?

nereo

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Re: What comes after the ACA?
« Reply #3216 on: July 19, 2017, 12:36:59 PM »
In order to be "let down" the expectation of cooperation has to exist first. Since that was never there in the first place, being let down is a misnomer.

The cooperation might not have been there in the first place, but that doesn't mean that an expectation of cooperation couldn't exist. 
So, it's not a misnomer.

Why would there be an expectation of cooperation when the stated goal was to repeal what they had done?

No - I do not believe that there was ever an expectation of cooperation from either side. It was stated pretty plainly that the GOP was going to do this in spite of the Dems.  Many even went so far as to proclaim that they had a voter 'mandate' to undo this legislation.

R - "I'm going to tear down your house"

D- "I don't want you to tear down my house - I worked hard to build it.  Its not perfect, but i still like it."

R- "Dammit, why aren't you cooperating with me to tear down your house you don't want torn down!"

Um... no.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3217 on: July 19, 2017, 12:38:40 PM »
Is it right to only allow the ludicrously wealthy to live?
Do all those without health insurance bear no absolutely blame for their choices and situation?

There should be no choice, you have to get health insurance. At least the ACA recognized this issue.

Mr. Green

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Re: What comes after the ACA?
« Reply #3218 on: July 19, 2017, 12:47:40 PM »
In order to be "let down" the expectation of cooperation has to exist first. Since that was never there in the first place, being let down is a misnomer.

The cooperation might not have been there in the first place, but that doesn't mean that an expectation of cooperation couldn't exist. 
So, it's not a misnomer.

Why would there be an expectation of cooperation when the stated goal was to repeal what they had done?

No - I do not believe that there was ever an expectation of cooperation from either side. It was stated pretty plainly that the GOP was going to do this in spite of the Dems.  Many even went so far as to proclaim that they had a voter 'mandate' to undo this legislation.

R - "I'm going to tear down your house"

D- "I don't want you to tear down my house - I worked hard to build it.  Its not perfect, but i still like it."

R- "Dammit, why aren't you cooperating with me to tear down your house you don't want torn down!"

Um... no.
You must have been really let down because you honestly expected that guy to help you tear down his own house.

Mr. Green

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Re: What comes after the ACA?
« Reply #3219 on: July 19, 2017, 12:49:36 PM »
Is it right to only allow the ludicrously wealthy to live?
Do all those without health insurance bear no absolutely blame for their choices and situation?
That would depend on whether it was a choice. I'm not one to believe that a child at birth made a decision about how it wanted its heart to be formed while it was a fetus. There are plenty of situations that are not choice based at all. We can't even make the claim that being obese is a direct cause of heart disease there have been autopsies on obese people showing no signs of heart disease and autopsies on healthy people that do show heart disease. We simply don't know the science behind how our bodies work well enough to have an informed opinion about 90% of how we function and what ails us. Our current understanding of the human body is that the world is flat and ships will fall off the edge if they sail too close. Don't mistake ignorance for choice. Though there are certainly cases where choice is at play.
« Last Edit: July 19, 2017, 12:57:06 PM by Mr. Green »

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3220 on: July 19, 2017, 12:52:29 PM »
And yet we're all working so hard right now cause we're sick of working hard.

nereo

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Re: What comes after the ACA?
« Reply #3221 on: July 19, 2017, 12:57:05 PM »
Well the zombie bill gets up again...

DJT just challenged senators to delay their summer recess and resume their efforts.  "We are very close" he said.

runewell

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Re: What comes after the ACA?
« Reply #3222 on: July 19, 2017, 02:03:40 PM »

This is a great point.  All of the republican talking points about personal responsibility break down when you hear how stupid they sound when they claim that maternity care shouldn't be an essential benefit in all health insurance plans. "I'm a 55 year old male who doesn't want children, why should I get maternity care?" Just think about the implications of that statement.  He is saying that lifesaving procedures for premature babies should only be paid for by people of child bearing age who want children, which would cause the premiums to absolutely skyrocket for that group.

Well theoretically the 55-yr old male is right.  Why should be pay more for coverage he has no chance of using?
Perhaps the system could be changed so that there is no coverage for pregnancies. 
People who get pregnant then pay a one-time charge of $10,000 (or whatever) to coverage the procedure and any complications?
The premiums should go up for that group since they are the ones that are going to cause all the expense.  I've had my two kids and joined club V so I can confidently opt out of this cost.

In insurance ratemaking, social considerations always arise.  Theoretically a family with 10 children incurs more costs than 2 children, but I don't think they rate for it.  At some point they must figure that a family with 10 children isn't going to handle that expense well, so it gets subsidized.  But perhaps if people had to pay the explicitly pay a fee for childbirth coverage maybe it would change peoples' mindset somehow rather than having everyone always pay a little.
« Last Edit: July 19, 2017, 02:06:32 PM by runewell »

mm1970

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Re: What comes after the ACA?
« Reply #3223 on: July 19, 2017, 02:06:31 PM »

This is a great point.  All of the republican talking points about personal responsibility break down when you hear how stupid they sound when they claim that maternity care shouldn't be an essential benefit in all health insurance plans. "I'm a 55 year old male who doesn't want children, why should I get maternity care?" Just think about the implications of that statement.  He is saying that lifesaving procedures for premature babies should only be paid for by people of child bearing age who want children, which would cause the premiums to absolutely skyrocket for that group.

Well theoretically the 55-yr old male is right.  Why should be pay more for coverage he has no chance of using?
Perhaps the system could be changed so that there is no coverage for pregnancies. 
People who get pregnant then pay a one-time charge of $10,000 (or whatever) to coverage the procedure and any complications?
The premiums should go up for that group is they are the ones that are going to cause all the expense.  I've had my two kids and joined club V so I can confidently opt out of this cost.

Well, then we need to add a whole host of other things that aren't covered.  Like Viagra, prostate cancer, and ... well I can go on and on I suppose.

No babies = fewer people to pay taxes.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3224 on: July 19, 2017, 02:09:29 PM »

This is a great point.  All of the republican talking points about personal responsibility break down when you hear how stupid they sound when they claim that maternity care shouldn't be an essential benefit in all health insurance plans. "I'm a 55 year old male who doesn't want children, why should I get maternity care?" Just think about the implications of that statement.  He is saying that lifesaving procedures for premature babies should only be paid for by people of child bearing age who want children, which would cause the premiums to absolutely skyrocket for that group.

Well theoretically the 55-yr old male is right.  Why should be pay more for coverage he has no chance of using?
Perhaps the system could be changed so that there is no coverage for pregnancies. 
People who get pregnant then pay a one-time charge of $10,000 (or whatever) to coverage the procedure and any complications?
The premiums should go up for that group since they are the ones that are going to cause all the expense.  I've had my two kids and joined club V so I can confidently opt out of this cost.

In insurance ratemaking, social considerations always arise.  Theoretically a family with 10 children incurs more costs than 2 children, but I don't think they rate for it.  At some point they must figure that a family with 10 children isn't going to handle that expense well, so it gets subsidized.  But perhaps if people had to pay the explicitly pay a fee for childbirth coverage maybe it would change peoples' mindset somehow rather than having everyone always pay a little.

I'm not totally unsympathetic with your point about the unusual scenario of the 10 child family.
Nonetheless, you can say any issue needs to have a special up pricing added, whether it's a pregnancy, a decision to go hand-gliding, not being a vegetarian, etc.
This is untenable, and we're better off just spreading the risk around among everyone.

runewell

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Re: What comes after the ACA?
« Reply #3225 on: July 19, 2017, 02:11:41 PM »
I agree with that, working hard is an american moral imperative

I'm not convinced that Americans work hard.  Some do, many do not.

runewell

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Re: What comes after the ACA?
« Reply #3226 on: July 19, 2017, 02:17:23 PM »
I'm not totally unsympathetic with your point about the unusual scenario of the 10 child family.
Nonetheless, you can say any issue needs to have a special up pricing added, whether it's a pregnancy, a decision to go hand-gliding, not being a vegetarian, etc.
This is untenable, and we're better off just spreading the risk around among everyone.

I did not say this.  Pregnancy is a very common occurrence, and the cost of the procedure and the complications can be easily priced.  Hang-gliding would be impossible to rate for, and vegetarian might have potential but could never be enforced effectively. 

The big problem is, what happens when mom-to-be shows up in the delivery room and doesn't have pregnancy insurance? 

jim555

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Re: What comes after the ACA?
« Reply #3227 on: July 19, 2017, 02:57:25 PM »
Well the zombie bill gets up again...

DJT just challenged senators to delay their summer recess and resume their efforts.  "We are very close" he said.
The fail train just keeps delivering the fail.  Where is that great plan DJT was on about in the campaign?

OurTown

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Re: What comes after the ACA?
« Reply #3228 on: July 19, 2017, 03:05:29 PM »
Well the zombie bill gets up again...

DJT just challenged senators to delay their summer recess and resume their efforts.  "We are very close" he said.
The fail train just keeps delivering the fail.  Where is that great plan DJT was on about in the campaign?

They haven't translated it from the original Russian yet.

nereo

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Re: What comes after the ACA?
« Reply #3229 on: July 19, 2017, 03:57:32 PM »
CBO findings:  a whopping 32MM people would be uninsured by 2026 under the senate's current plan.
DJT still wants to resurrect this blood-sucker? 

sol

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Re: What comes after the ACA?
« Reply #3230 on: July 19, 2017, 04:05:49 PM »
CBO findings:  a whopping 32MM people would be uninsured by 2026 under the senate's current plan.
DJT still wants to resurrect this blood-sucker?

It's a farce.  They can't pass a clean repeal under reconciliation anyway.  We passed it with 60 votes, and they need 60 to repeal it.

Exflyboy

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Re: What comes after the ACA?
« Reply #3231 on: July 19, 2017, 04:13:46 PM »
CBO findings:  a whopping 32MM people would be uninsured by 2026 under the senate's current plan.
DJT still wants to resurrect this blood-sucker?

It's a farce.  They can't pass a clean repeal under reconciliation anyway.  We passed it with 60 votes, and they need 60 to repeal it.

I can't believe the PRESIDENT OF THE UNITED STATES is a complete fucking idiot!.. What the hell?

nereo

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Re: What comes after the ACA?
« Reply #3232 on: July 19, 2017, 04:26:18 PM »
CBO findings:  a whopping 32MM people would be uninsured by 2026 under the senate's current plan.
DJT still wants to resurrect this blood-sucker?

It's a farce.  They can't pass a clean repeal under reconciliation anyway.  We passed it with 60 votes, and they need 60 to repeal it.

Are you sure?  I thought the hope was that - because it reduces the deficit (by $473B over 10y) - it could be passed with a simple majority. I know the senate parliamentarian is/was supposed to make a ruling, but I'm not sure where that stands now...

rocketpj

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Re: What comes after the ACA?
« Reply #3233 on: July 19, 2017, 04:33:39 PM »
It seems to be a political nonstarter in the US, but is there any realistic way to get from the bizarre position of defending the mediocre at best ACA from attacks and towards some kind of single-payer system in the US?

The evidence is pretty much uncontrovertible that single payer health care is better for people and businesses (aside from some specialized HMO types, obviously).  But it seems that evidence is only a minor player in the political dramas of the US these days.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3234 on: July 19, 2017, 04:39:11 PM »
CBO findings:  a whopping 32MM people would be uninsured by 2026 under the senate's current plan.
DJT still wants to resurrect this blood-sucker?

It's a farce.  They can't pass a clean repeal under reconciliation anyway.  We passed it with 60 votes, and they need 60 to repeal it.

Are you sure?  I thought the hope was that - because it reduces the deficit (by $473B over 10y) - it could be passed with a simple majority. I know the senate parliamentarian is/was supposed to make a ruling, but I'm not sure where that stands now...

You're right Nereo but not sure of all the exact rules. The ACA would remain but some things about it could be changed by a simple majority vote. To actually vote the entire ACA void I think would require a 60 vote to avoid filibuster.
Nonetheless, the news media seems to report that a repeal just require 50 votes, and the Republicans don't have 50, three women Republican senators have already announced they would vote against repeal that doesn't include an acceptable replace option.

The question then becomes, what happens in rural counties where there is no health insurer that will participate in the ACA exchange - therefore no subsidies for health insurance for the middle and working class people. I think Ohio is in this predicament.

nereo

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Re: What comes after the ACA?
« Reply #3235 on: July 19, 2017, 04:48:20 PM »
It seems to be a political nonstarter in the US, but is there any realistic way to get from the bizarre position of defending the mediocre at best ACA from attacks and towards some kind of single-payer system in the US?

The evidence is pretty much uncontrovertible that single payer health care is better for people and businesses (aside from some specialized HMO types, obviously).  But it seems that evidence is only a minor player in the political dramas of the US these days.

I'm not sure I was agree that the evidence is 'uncontrovertible' [sic].  A lot depends on what you are measuring and what you value. I've gone from an employer-sponsored health care program pre-ACA to one post-ACA to the individual marketplace to (currently) the Quebec health care system. Without a doubt I'd say the level of care I receive and the attention I receive from my doctors here is less than what I received previously.  Of course there are some very good things - namely that almost everyone has coverage and far fewer people go broke due to medical issues.  Other things, like access to care in rural areas - seems just as bad here (i.e. "not better", but also not worse) than in similar areas in the US.

As for how we could get to single-payer - read back over the thread; it's been discussed at length, with some decent suggestions along the way.


DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3236 on: July 19, 2017, 05:27:31 PM »

Wow, by some measures, previously war-torn Rwanda, has better health care then we do in the US

In Health Care, Republicans Could Learn From Rwanda
https://nyti.ms/2vypbxY

teen persuasion

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Re: What comes after the ACA?
« Reply #3237 on: July 20, 2017, 05:22:01 AM »
Bill is dead for at least a week.

McCain had eye surgery for a blood clot and will not vote this week.

Does anyone else find it ironic that a medical procedure is what stalled a healthcare bill?
And now McCain is fighting cancer.    http://www.bostonglobe.com/news/nation/2017/07/19/senator-mccain-diagnosed-with-aggressive-type-brain-cancer/RYsMryuxcLQnml9mJC2q7O/story.html 

Expensive health issues only happen to other people, who make poor choices, right Congress?

beltim

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Re: What comes after the ACA?
« Reply #3238 on: July 20, 2017, 06:45:33 AM »
It seems to be a political nonstarter in the US, but is there any realistic way to get from the bizarre position of defending the mediocre at best ACA from attacks and towards some kind of single-payer system in the US?

The evidence is pretty much uncontrovertible that single payer health care is better for people and businesses (aside from some specialized HMO types, obviously).  But it seems that evidence is only a minor player in the political dramas of the US these days.

I'm not sure I was agree that the evidence is 'uncontrovertible' [sic].  A lot depends on what you are measuring and what you value. I've gone from an employer-sponsored health care program pre-ACA to one post-ACA to the individual marketplace to (currently) the Quebec health care system. Without a doubt I'd say the level of care I receive and the attention I receive from my doctors here is less than what I received previously.  Of course there are some very good things - namely that almost everyone has coverage and far fewer people go broke due to medical issues.  Other things, like access to care in rural areas - seems just as bad here (i.e. "not better", but also not worse) than in similar areas in the US.

As for how we could get to single-payer - read back over the thread; it's been discussed at length, with some decent suggestions along the way.

I agree with nereo.  Rocketpj, please provide some evidence for your statement.

Here, I'll start with some evidence that shows that single payor systems are not the world's best: http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror
This report shows that the top-ranked healthcare system (UK) is not just a single payer, but a fully government-run system.  The second best healthcare system (Switzerland) is not a single payer, but is in fact pretty close to the ACA (everyone must purchase health insurance on their own, subsidies are available for those whose incomes are too low to afford insurance).

frugalecon

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Re: What comes after the ACA?
« Reply #3239 on: July 20, 2017, 07:05:40 AM »

This is a great point.  All of the republican talking points about personal responsibility break down when you hear how stupid they sound when they claim that maternity care shouldn't be an essential benefit in all health insurance plans. "I'm a 55 year old male who doesn't want children, why should I get maternity care?" Just think about the implications of that statement.  He is saying that lifesaving procedures for premature babies should only be paid for by people of child bearing age who want children, which would cause the premiums to absolutely skyrocket for that group.

Well theoretically the 55-yr old male is right.  Why should be pay more for coverage he has no chance of using?
Perhaps the system could be changed so that there is no coverage for pregnancies. 
People who get pregnant then pay a one-time charge of $10,000 (or whatever) to coverage the procedure and any complications?
The premiums should go up for that group since they are the ones that are going to cause all the expense.  I've had my two kids and joined club V so I can confidently opt out of this cost.

In insurance ratemaking, social considerations always arise.  Theoretically a family with 10 children incurs more costs than 2 children, but I don't think they rate for it.  At some point they must figure that a family with 10 children isn't going to handle that expense well, so it gets subsidized.  But perhaps if people had to pay the explicitly pay a fee for childbirth coverage maybe it would change peoples' mindset somehow rather than having everyone always pay a little.

The 55 year old male was not dropped by a stork, he presumably was born once and benefited from his mother having health insurance.  Not too mention, he benefits from his daughters, nieces, nephews, grandchildren, and friends having coverage.  If you think it should just be every man for himself, why not just ban insurance altogether and we can go back to caveman times.

In your system where pregnancy isn't covered, $10,000 would be woefully inadequate.  That's what it costs now to have a baby when you have insurance negotiated rates and have a C-section with no complications!  And under your system would your insurance cover the prenatal visits to the doctor, blood tests, sonograms, etc or would that be out of pocket too?  It doesn't make any sense.  Either women will need to be ultra rich in order to have a child, or they will cheap out on their prenatal visits and their will be more birth defects and deaths, or hospitals won't be able to bear the costs and will stop performing births.   

It always shocks me when people make completely selfish statements like this.  We are a part of a civilized society here and we need to support each other.  Women of child bearing age get covered for pregnancy, while 55 year old men get covered for prostate cancer.  I have several friends who had premature babies - I can't imagine telling them I am pissed off that my premiums are higher so that we can cover your 2 pound baby as he fights for his life due to lung and heart problems.

Sol, my approach to these kinds of questions is "How would I want the system to be set up before I know what my particular life circumstances will be, i.e., when I am just a boozy idea in some amorous young people's minds?" I think this is also a good approach to questions of taxation. If I didn't know whether I would be born rich or poor or somewhere in between, what kind of tax system would make sense? It is a difficult mental calculus, but I think it is worth trying.

JustGettingStarted1980

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Re: What comes after the ACA?
« Reply #3240 on: July 20, 2017, 09:30:23 AM »


Sol, my approach to these kinds of questions is "How would I want the system to be set up before I know what my particular life circumstances will be, i.e., when I am just a boozy idea in some amorous young people's minds?" I think this is also a good approach to questions of taxation. If I didn't know whether I would be born rich or poor or somewhere in between, what kind of tax system would make sense? It is a difficult mental calculus, but I think it is worth trying.
[/quote]

Look up the "Veil of Ignorance", that's what you're talking about.

runewell

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Re: What comes after the ACA?
« Reply #3241 on: July 20, 2017, 09:34:29 AM »
The 55 year old male was not dropped by a stork, he presumably was born once and benefited from his mother having health insurance.  Not too mention, he benefits from his daughters, nieces, nephews, grandchildren, and friends having coverage.  If you think it should just be every man for himself, why not just ban insurance altogether and we can go back to caveman times.
But the parents of the 55-year old were both responsible for his birth and the ones who by far receive the greatest benefit of having him.   I benefit from having a boss I can ask questions to, but I don't go writing his mom thank you notes for having him.

In your system where pregnancy isn't covered, $10,000 would be woefully inadequate.  That's what it costs now to have a baby when you have insurance negotiated rates and have a C-section with no complications!  And under your system would your insurance cover the prenatal visits to the doctor, blood tests, sonograms, etc or would that be out of pocket too?  It doesn't make any sense.  Either women will need to be ultra rich in order to have a child, or they will cheap out on their prenatal visits and their will be more birth defects and deaths, or hospitals won't be able to bear the costs and will stop performing births.   


I didn't say $10K was the right number.  Perhaps if people were required to save up for the bill they would be more cost-conscious.  Lower-cost birthing clinics could open up as a competitive alternative.  You can pay $15,000 for the traditional hospital visit with your own room, or $5,000 for a semi-private room in a no-frills location.  What's it going to be?  One of the main reasons healthcare is so expensive is because the system doesn't lend itself well to competitive market pricing.  The milk at target has finally gotten lower ($1.48) to compete with the Aldi that opened two years ago.  Without competition we would be paying more for milk.  Same idea goes for childbirth; if there isn't a good non-luxury option, we will always overpay for luxury.

It always shocks me when people make completely selfish statements like this.  We are a part of a civilized society here and we need to support each other.  Women of child bearing age get covered for pregnancy, while 55 year old men get covered for prostate cancer.  I have several friends who had premature babies - I can't imagine telling them I am pissed off that my premiums are higher so that we can cover your 2 pound baby as he fights for his life due to lung and heart problems.

Who's being selfish?  The person who doesn't want to pay for someone else's childbirth, or the person who wants everyone to subsidize it?  As for the prostate cancer comment that doesn't even seem like a poor comparison.   

geekette

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Re: What comes after the ACA?
« Reply #3242 on: July 20, 2017, 09:47:12 AM »
The difference between a low cost birth and a high cost birth isn't the fancy room.

runewell

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Re: What comes after the ACA?
« Reply #3243 on: July 20, 2017, 09:54:03 AM »
The difference between a low cost birth and a high cost birth isn't the fancy room.
The main difference (apart from emergency treatment) is going to be labor vs C-section and whether an epidural is used.  There are a number of considerations that would need to be factored in. 

nereo

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Re: What comes after the ACA?
« Reply #3244 on: July 20, 2017, 10:38:53 AM »
The difference between a low cost birth and a high cost birth isn't the fancy room.
The main difference (apart from emergency treatment) is going to be labor vs C-section and whether an epidural is used.  There are a number of considerations that would need to be factored in.
#1 - there are many more factors than just C-section & epidural which add significant cost
#2 - many of these costs cannot be 'planned ahead.' Everyone hopes for an easy, low-cost pregnancy. Only some wind up getting it.
#3 - as stated at least a dozen times upthread, you cannot count on 'market forces' and 'consumer choice' to do much for lowering prices precisely because people cannot anticipate the care they need and plan accordingly (see #2). Trained doctors can't even anticipate which services will be needed and when.
 

radram

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Re: What comes after the ACA?
« Reply #3245 on: July 20, 2017, 11:09:28 AM »
  The milk at target has finally gotten lower ($1.48) to compete with the Aldi that opened two years ago.  Without competition we would be paying more for milk.  Same idea goes for childbirth; if there isn't a good non-luxury option, we will always overpay for luxury.

I find it interesting you used milk prices for your analogy. You do realize it costs more than $1.48 to produce 1 gallon of milk don't you? Why do you think it is that you can buy milk for less than it costs to produce it?

 Are you suggesting subsidizing healthcare prices in order to allow procedures to be performed below cost while still allowing to be profitable?

One byproduct of this relationship (with milk, anyway) is the requirement to be a bigger farm in order to survive, creating less competition. It sounds as though your example counters your goal of increased competition.

runewell

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Re: What comes after the ACA?
« Reply #3246 on: July 20, 2017, 11:19:37 AM »
And the american health system does not have the capability to provide firm prices ahead of time for having a baby given the uncertainty of what could happen. 

It most certainly does have the capability, or could implement it without too much trouble if there was an incentive to.  The point is not the charge for every single pill and piece of gauze.  There are zillions of babies born every year so that the insurance company can know that it should pay $X on average for a regular delivery and $Y for a C-section.  Or it could weight those together and charge $Z for coverage regardless of delivery method.  They would also be able to calculate an additional amount $W for ICU & emergencies.

I am going to get my car looked at today.  If I need a new axle, the repairman will be able to quote me $400 or whatever without too much trouble.  If I get my roof fixed i can get an estimate for that also.  Why is health insurance so different? Why is the cost is rarely discussed and until the bill arrives?  Do I really want to spend $110 on a doctor visit?  Maybe someone else will do it for $90.  But that doesn't happen; the instead the insurance company proposes to pay $110 this year instead of $108 last year, and the healthcare system goes about its business generating revenue.

It always shocks me when people make completely selfish statements like this.  We are a part of a civilized society here and we need to support each other.  Women of child bearing age get covered for pregnancy, while 55 year old men get covered for prostate cancer.  I have several friends who had premature babies - I can't imagine telling them I am pissed off that my premiums are higher so that we can cover your 2 pound baby as he fights for his life due to lung and heart problems.
Who's being selfish?  The person who doesn't want to pay for someone else's childbirth, or the person who wants everyone to subsidize it?  As for the prostate cancer comment that doesn't even seem like a poor comparison.   

You don't need to subsidize the birth of children - you can do this by not having health insurance and paying the penalty.  But if you want the benefits of health insurance, you can't have your cake and eat it too.
[/quote]

Mr. Green

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Re: What comes after the ACA?
« Reply #3247 on: July 20, 2017, 11:27:25 AM »
It always shocks me when people make completely selfish statements like this.  We are a part of a civilized society here and we need to support each other.  Women of child bearing age get covered for pregnancy, while 55 year old men get covered for prostate cancer.  I have several friends who had premature babies - I can't imagine telling them I am pissed off that my premiums are higher so that we can cover your 2 pound baby as he fights for his life due to lung and heart problems.

Who's being selfish?  The person who doesn't want to pay for someone else's childbirth, or the person who wants everyone to subsidize it?  As for the prostate cancer comment that doesn't even seem like a poor comparison.   
This argument is really a non-starter. We could apply the same logic to everything else. I shouldn't pay taxes for roads I don't drive on or schools for the kids I don't have. I shouldn't pay for the library I don't use. A civilization simply doesn't work that way. There are certain things that we have come to expect from each other based on our values. We value health so the expectation should exist that getting medical care isn't a privilege. It's the same reason our collective attitude isn't to have the cashier in the school lunch line look at the poor kid with an empty tray and say, "Fuck you, kid! Go chew on a napkin."

sol

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Re: What comes after the ACA?
« Reply #3248 on: July 20, 2017, 11:36:45 AM »
Yesterday Trump claimed his proposal to allow insurance to be sold across state lines (which is ALREADY legal) would lower premiums "60 to 70 percent" below what they currently are under the ACA.  What what?

This is like claiming we could all see 70% stock market gains if only US corporations were allowed to operate overseas.  Not only do they already do that, it's totally unrelated to delivering on the promise you are making.  I don't think you understand how these things are related.

Every time he opens his mouth to talk about health care, I get the impression he understands it less than my 11 year old daughter.  Everyone in congress musty be rolling their eyes as they try to do the hard work of identifying serious solutions while grandpa goes off on another stupid tangent.

At this point Trump is just a rubber stamp for whatever congress comes up with.  He has no power, no influence, nothing to contribute.  He would be an empty chair in the executive branch if he wasn't also denigrating the office by appearing to be so corrupt.  Putin must be disappointed that his pet turned out to be so impotent.

protostache

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Re: What comes after the ACA?
« Reply #3249 on: July 20, 2017, 11:42:42 AM »
Yesterday Trump claimed his proposal to allow insurance to be sold across state lines (which is ALREADY legal) would lower premiums "60 to 70 percent" below what they currently are under the ACA.  What what?

This is like claiming we could all see 70% stock market gains if only US corporations were allowed to operate overseas.  Not only do they already do that, it's totally unrelated to delivering on the promise you are making.  I don't think you understand how these things are related.

Every time he opens his mouth to talk about health care, I get the impression he understands it less than my 11 year old daughter.  Everyone in congress musty be rolling their eyes as they try to do the hard work of identifying serious solutions while grandpa goes off on another stupid tangent.

At this point Trump is just a rubber stamp for whatever congress comes up with.  He has no power, no influence, nothing to contribute.  He would be an empty chair in the executive branch if he wasn't also denigrating the office by appearing to be so corrupt.  Putin must be disappointed that his pet turned out to be so impotent.

Veering waaaaay off topic, but Putin never cared about having a puppet. Putin's singular goal is to increase Russia's relative power and importance in the world and his chosen strategy is to sow discord and disorder everywhere else. We saw this with Brexit and various elections in Europe including Germany, Belgium, and France, and we saw it in the 2016 US elections. Trump wanting to be buddy-buddy with Putin at this point is all on Trump's side because he thinks maybe it'll help him wipe out some of his debt.