Author Topic: What comes after the ACA?  (Read 820477 times)

EnjoyIt

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Re: What comes after the ACA?
« Reply #4750 on: September 03, 2018, 03:02:04 PM »
No one thinks about long term solution in this country.  it is about short term.  Realistically single payer would accomplish very little without curtailing delivery and regulatory costs.  Sure it will go down a little but I think it would be a small dent to the overlying problem.  Getting everyone on a single payer system is also very problematic of a transition costing hundreds of thousands of jobs which is also political suicide.  Opening up current standards to everyone is very expensive.  instead we need have cheap/affordable options easily available and then universally provide them for everybody.  No private rooms in hospitals, no expensive cutting edge medication, no expensive robotic surgeries and no costly prolonged end of life care for those who are practically dead to begin with.  Then add a capitalist system on top of it to allow for all those extra amenities to be covered out of pocket or through a high deductible catastrophic insurance plan. This should fit the democrat stance of providing healthcare to everyone with the conservative pro capitalist twist to allow for a for profit motive.

Before we even consider enacting this we need to make the healthcare system transparent today.  Step one is mandate all pricing available and easily accessible to everyone.  We will never have lower costs when health care delivery is double blind.  The provider and the receiver of healthcare have no clue what the cost is.  Next, we need to allow the government to negotiate on rates for purchasing pharmaceuticals as well as equipment.  Those two measures alone would cost cost dramatically and open up a way to provide cheap affordable healthcare to the population.

pecunia

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Re: What comes after the ACA?
« Reply #4751 on: September 03, 2018, 03:46:46 PM »
Enjoy It, That was a good post and probably worth repeating.

-SNIP-

Before we even consider enacting this we need to make the healthcare system transparent today.  Step one is mandate all pricing available and easily accessible to everyone.  We will never have lower costs when health care delivery is double blind.  The provider and the receiver of healthcare have no clue what the cost is.  Next, we need to allow the government to negotiate on rates for purchasing pharmaceuticals as well as equipment.  Those two measures alone would cost cost dramatically and open up a way to provide cheap affordable healthcare to the population.

That seems like a great first step.  As I've probably stated before, I've been to the doctor and asked what the cost will be and have been met with this odd look and reaction as though, "Why are you even asking this?"  I think it would even help the insurance companies.  I guess I've never considered their perspective before, but the job of determining payments may be quite difficult.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4752 on: September 03, 2018, 04:01:15 PM »
Enjoy It, That was a good post and probably worth repeating.

-SNIP-

Before we even consider enacting this we need to make the healthcare system transparent today.  Step one is mandate all pricing available and easily accessible to everyone.  We will never have lower costs when health care delivery is double blind.  The provider and the receiver of healthcare have no clue what the cost is.  Next, we need to allow the government to negotiate on rates for purchasing pharmaceuticals as well as equipment.  Those two measures alone would cost cost dramatically and open up a way to provide cheap affordable healthcare to the population.

That seems like a great first step.  As I've probably stated before, I've been to the doctor and asked what the cost will be and have been met with this odd look and reaction as though, "Why are you even asking this?"  I think it would even help the insurance companies.  I guess I've never considered their perspective before, but the job of determining payments may be quite difficult.

It is not just difficult but frankly impossible because every insurance company has different nuances for each and every plan it sells.  Plus, sometimes they agree to pay, sometimes they pay a portion and sometimes they just don't like how you billed and refuse to pay all together.  One would think that single payer would fix this, but the same thing happens with medicare and medicaid. If the cost for a service was fixed irrespective of insurance then the cost of billing would drop as well as all the back door negotiations that occur making the system so complex. 

Remember, most of our healthcare is not set in the emergency department and the consumer has some ability to shop around. According to the American College of Emergency medicine, the ER encompasses only 2% of healthcare dollars spent.  I'm sure those figures are a bit biased but even if they are 2 or 3 times as large, the numbers point that emergency care is not where all the healthcare dollars are going. This also means consumers do have the option to shop around. http://newsroom.acep.org/2009-01-04-costs-of-emergency-care-fact-sheet

pecunia

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Re: What comes after the ACA?
« Reply #4753 on: September 03, 2018, 06:48:20 PM »
EnjoyIt:

"Remember, most of our healthcare is not set in the emergency department and the consumer has some ability to shop around. According to the American College of Emergency medicine, the ER encompasses only 2% of healthcare dollars spent.  I'm sure those figures are a bit biased but even if they are 2 or 3 times as large, the numbers point that emergency care is not where all the healthcare dollars are going. This also means consumers do have the option to shop around. http://newsroom.acep.org/2009-01-04-costs-of-emergency-care-fact-sheet"

I don't get sick very much but when I do I certainly don't want to spend time "shopping around."  Hey doc - How much for a broken leg.  It's a compound fracture.  Do you guys happen to be running a special this week?  I've been saving coupons.  Do you take them?

I don't like doctors so it doesn't make much difference to me which one does the poking and prodding, but many people want to deal with their primary physician.  I'll bet they don't want to shop either.

I guess if you shop around the old adage, "Let the Buyer Beware" could have some serious consequences.

I just don't think this capitalism thing works very well for medicine.

sol

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Re: What comes after the ACA?
« Reply #4754 on: September 03, 2018, 06:51:18 PM »
Remember, most of our healthcare is not set in the emergency department and the consumer has some ability to shop around.

Just because care is provided outside of an ER does not mean you can shop around.

On a percentage basis, most healthcare costs are related to end-of-life care, and those elderly patients can't shop around.  When Grandma falls and breaks a hip she'll spend 12 hours in the ER, three weeks in the ICU, and then three to six months receiving palliative care in some kind of supervised facility.  Then hospice.  She can't shop shop for the ER visit, and the ER is going to send her directly to the ICU where she can't shop either.  She could maybe compare rates for a rehab home or hospice program, but when people are literally staring death in the face they are seldom in a mood to comparison shop rates vs service plans.  The ER visit is a tiny fraction of her total costs, but she still can't shop around.

Another (totally unrelated) example; when I went in for physical therapy recently I was offered three different PT places.  While I was totally free to comparison shop, the prices they offered were basically identical.  The ability to shop around doesn't help you lower costs at all, if the costs are uniformly high everywhere because every place expects to bill your insurance company.

"Comparison shopping" sounds like a good thing, but in reality doesn't seem to help very much.  Too much of medical care is necessarily urgent, or immediate referrals and transfers, or fixed price anyway.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4755 on: September 03, 2018, 10:53:53 PM »
@sol @pecunia

You are both right that in an emergency situation you can't shop around nor should you.  But most of healthcare is not emergency care as you allude to.  A broken hip or a open fracture is indeed an emergency and that is what I am not referring to.  I am talking about having a primary care doctor and getting regular checkups.  I am talking about getting out patient imaging.  I am talking about physical therapy because if it was transparent the prices would indeed go down sol.  I am talking about looking for your chemo and radiation.  I can go on and on. That complexity in our current system is one of the reasons for high cost.  Remember complexity is a feature that benefits the insurance industry.  They don't want you knowing the cost, want you to think it is astronomical (which it is) and get you into their network. 

Believe me you two.  I am not advocating that price transparency is the end all be all for fixing healthcare, but it is a necessity to begin bringing some semblance of cost into discussion.  It must happen.

And yes end of life care is the highest line item on healthcare spending that also needs to be curtailed. We as a society need to accept the fact that providing healthcare to the practically brain dead is cruel, inhumane and needs to stop being the standard of care.

I am not against some form of single payer coverage as I described a couple of posts up.  I just don't think it is the panacea many here hope it will be.  I am offering real solutions that we can implement today that help start addressing costs in our current model.  With lower costs it would be even easier to provide universal coverage.  Isn't that what we all want, affordable healthcare for everyone? Can't we even discuss an option without throwing extreme examples of self nursing an open fracture in your kitchen while googling prices?

Monkey Uncle

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Re: What comes after the ACA?
« Reply #4756 on: September 04, 2018, 04:38:45 AM »
I think that depends on the public outcry. If it gets loud enough they'll do something. You can only ignore a tidal wave so long before it drowns you. But that assumes it becomes that important to the citizenry.
The citizenry was already consulted, and by and large they DGAF. But Corporate America is getting tired of spending 10k per worker with nothing to show for it, and they have influence with lawmakers. Sadly, I think it's our best hope for some sort of cost control. Fix the cost and all the other problems will hopefully disappear.
They may not seem to care now, but the concern is growing. It doesn't take much to push something to the forefront of everyone's attention. Just look at healthcare in general. Before Trump was elected it wasn't a hot topic but now it's all I hear about from people. Maybe it won't reach a critical mass, but as more people start to realize that it's actually costs driving the cost of their health insurance I think the focus will shift.

Maybe an early indicator that people are starting to care?

https://www.washingtonpost.com/opinions/health-care-rules-the-labor-market/2018/09/02/05d13672-ad2f-11e8-b1da-ff7faa680710_story.html?utm_term=.a0e17d084988

Quote
All these explanations may matter, but a major contributor — perhaps the major contributor — may lie elsewhere: health costs. Money once reserved for wage increases is now diverted to pay for employer-provided health insurance. A new study provides stunning estimates: For the bottom 60 percent of U.S. workers, wage gains have been completely wiped out by contributions for employer-provided health insurance.

This was a big factor in the West Virginia teacher's strike earlier this year.  The initial tiny proposed raise would have been more than eaten up by increases in the employee contribution to health insurance.  Unfortunately, the solutions that the teacher's unions have focused on so far all involve various ways to raise taxes to cover the increase, rather than finding ways to reduce the costs.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4757 on: September 04, 2018, 11:04:12 AM »
@sol @pecunia
But most of healthcare is not emergency care as you allude to.  A broken hip or a open fracture is indeed an emergency and that is what I am not referring to.  I am talking about having a primary care doctor and getting regular checkups.  I am talking about getting out patient imaging.  I am talking about physical therapy because if it was transparent the prices would indeed go down sol.  I am talking about looking for your chemo and radiation.  I can go on and on. That complexity in our current system is one of the reasons for high cost.  Remember complexity is a feature that benefits the insurance industry.

Here's a post from the FinanceBuff blog that speaks to the comparison shopping for those with a high deductible.

https://thefinancebuff.com/shop-healthcare-cost-high-deductible-insurance.html

"The treatment cost estimator listed the average total cost by each specific provider in the network, in the same fashion as when you look for airfare on Expedia or Kayak. I printed out the list. My wife took it to the doctor. When the doctor said she needed an MRI, she asked the doctor to order it at one of the lower-cost facilities as long as the doctor’s assistant was able to confirm that the facility could do what the doctor wanted. It turned out the $174 place couldn’t but the $539 place could. So the order was sent to the $539 place."

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4758 on: September 04, 2018, 11:07:49 AM »
Paul Krugman weighs in on Republican ACA repeal efforts that are obfuscated by the Republican's claim that they won't get rid of pre-existing conditions protection- just a ploy to win the mid-term election.

Get Sick, Go Bankrupt and Die
https://nyti.ms/2MLCo3h

"So if you’re an American who suffers from a pre-existing medical condition, or fear that you might develop such a condition in the future, you need to be clear about the reality: Republicans are coming for your health care. If they hold the line in November, health insurance at an affordable price — maybe at any price — will be gone in a matter of months."


Threshkin

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Re: What comes after the ACA?
« Reply #4759 on: September 04, 2018, 02:02:58 PM »
There are new rules requiring healthcare pricing transparency coming in 2019.

https://www.commentarymagazine.com/american-society/hospital-prices-transparency/

This is just one of several articles on the new rules.  Google is your friend*.

*Actually Google is not your friend but it is useful.

fuzzy math

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Re: What comes after the ACA?
« Reply #4760 on: September 04, 2018, 03:02:29 PM »
Hospitals employ people called Chargemasters.

I had one contact me about a disposable product that's used in my field. She wanted to know what the length of use would be for a typical patient ( > or < 30 days).  The product probably cost under $100 (cheap as far as specialty supplies go). It was frightening how little she knew of my field, and it made me really pause and wonder what sort of decision making goes into pricing items. What on earth does the length of use have to do with what the patient will ultimately be charged for it??
« Last Edit: September 04, 2018, 03:04:53 PM by fuzzy math »

EnjoyIt

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Re: What comes after the ACA?
« Reply #4761 on: September 04, 2018, 07:52:41 PM »
There are new rules requiring healthcare pricing transparency coming in 2019.

https://www.commentarymagazine.com/american-society/hospital-prices-transparency/

This is just one of several articles on the new rules.  Google is your friend*.

*Actually Google is not your friend but it is useful.

This is freakin awesome if this going to happen.  +1 for Trump on this one.
Thanks for sharing.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4762 on: September 04, 2018, 08:04:21 PM »
@sol @pecunia
But most of healthcare is not emergency care as you allude to.  A broken hip or a open fracture is indeed an emergency and that is what I am not referring to.  I am talking about having a primary care doctor and getting regular checkups.  I am talking about getting out patient imaging.  I am talking about physical therapy because if it was transparent the prices would indeed go down sol.  I am talking about looking for your chemo and radiation.  I can go on and on. That complexity in our current system is one of the reasons for high cost.  Remember complexity is a feature that benefits the insurance industry.

Here's a post from the FinanceBuff blog that speaks to the comparison shopping for those with a high deductible.

https://thefinancebuff.com/shop-healthcare-cost-high-deductible-insurance.html

"The treatment cost estimator listed the average total cost by each specific provider in the network, in the same fashion as when you look for airfare on Expedia or Kayak. I printed out the list. My wife took it to the doctor. When the doctor said she needed an MRI, she asked the doctor to order it at one of the lower-cost facilities as long as the doctor’s assistant was able to confirm that the facility could do what the doctor wanted. It turned out the $174 place couldn’t but the $539 place could. So the order was sent to the $539 place."

One can always find anecdotal evidence that goes for or against an argument.  I needed basic blood work done and found a lab that will do it for ~30% less than the cost of a nearby Quest lab.  Does that mean that price transparency will cut costs by 70 percent?  Of course not and neither is the financial buff's example indicative of all healthcare.

BTW, do you have anything against price transparency? Do you prefer the current blindfolded system we have now? I mentioned before that price transparency is not the end all be all to our healthcare problem.  But I strongly believe that we will never be able to curtail costs until we have a clear picture of what exactly we are paying.

As the saying goes "that which is measured will improve."

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4763 on: September 04, 2018, 08:06:22 PM »
I thought I provided an example where The Finance Buff shows that price transparency will work.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4764 on: September 04, 2018, 08:09:43 PM »
I thought I provided an example where The Finance Buff shows that price transparency will work.

Well then I am an idiot and and should read more carefully.  oops.

I thought it was an example of it not working because he ended up going to the more expensive place anyways.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4765 on: September 04, 2018, 08:10:52 PM »
Don't feel bad, I couldn't figure out what flavor of crackers is best on the GoCurryCracker blog when I tried to register.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4766 on: September 04, 2018, 08:15:32 PM »
Trump analyzing price transparency for the pharmaceutical industry as well

https://www.commonwealthfund.org/publications/newsletter-article/2018/aug/trumps-plan-drug-pricing-transparency-takes-step-forward

This is a yuuuge step and another +1 for Trump. 

Damn! Unemployment is low, markets are up, and if he decreases the cost of healthcare he is guaranteed for a second term.
« Last Edit: September 04, 2018, 08:32:13 PM by EnjoyIt »

Paul der Krake

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Re: What comes after the ACA?
« Reply #4767 on: September 04, 2018, 08:29:12 PM »
Trump analyzing price transparency for the pharmaceutical industry as well

https://www.commonwealthfund.org/publications/newsletter-article/2018/aug/trumps-plan-drug-pricing-transparency-takes-step-forward

This is a yuuuge step another +1 for Trump. 

Damn! Unemployment is low, markets are up, and if he decreases the cost of healthcare he is guaranteed for a second term.
I think nobody here will mind crediting whomever meaningfully decreases costs. I'll write them Christmas cards if that means I don't need to talk about what should be a non-problem on the internet any more.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #4768 on: September 05, 2018, 06:05:03 AM »
There are new rules requiring healthcare pricing transparency coming in 2019.

https://www.commentarymagazine.com/american-society/hospital-prices-transparency/

This is just one of several articles on the new rules.  Google is your friend*.

*Actually Google is not your friend but it is useful.

This is freakin awesome if this going to happen.  +1 for Trump on this one.
Thanks for sharing.

This is certainly a step in the right direction, and I am happy to give Trump and Verma credit for it.  However, from reading various news pieces, it appears that it only applies to sticker prices, which very few people actually pay (mostly the uninsured and the handful of people who are still on true fee-for-service insurance plans).  It would be far more helpful if they required hospitals to post all the prices that they've negotiated with all the PPOs and HMOs, through which the lion's share of health care is funneled these days.  And it would be even more helpful if it applied to more than just hospitals, as so much care is provided outside of the hospital setting.

Also, it's worth noting that hospitals have been required to provide this information upon request for years.  Posting it on line definitely makes things easier, but it's not like the information was previously unavailable.

pecunia

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Re: What comes after the ACA?
« Reply #4769 on: September 05, 2018, 06:12:10 AM »
Trump analyzing price transparency for the pharmaceutical industry as well

https://www.commonwealthfund.org/publications/newsletter-article/2018/aug/trumps-plan-drug-pricing-transparency-takes-step-forward

This is a yuuuge step and another +1 for Trump. 

Damn! Unemployment is low, markets are up, and if he decreases the cost of healthcare he is guaranteed for a second term.

Most news stories about Trump and health care seem to be quite negative.  Of course these could be fake news.

https://www.washingtonpost.com/opinions/americans-are-starting-to-suffer-from-trumps-health-care-sabotage/2018/05/06/c60fb6fa-4fb2-11e8-b725-92c89fe3ca4c_story.html?utm_term=.5bdecc1055c6

https://www.washingtonpost.com/opinions/americans-are-starting-to-suffer-from-trumps-health-care-sabotage/2018/05/06/c60fb6fa-4fb2-11e8-b725-92c89fe3ca4c_story.html?utm_term=.5bdecc1055c6

Health care companies are smart.  There will be some sort of loophole to displaying prices.

If he isn't impeached, they will probably run him again as he is an incumbent with an inflexible base.


DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4770 on: September 05, 2018, 07:53:22 PM »
Remember, most of our healthcare is not set in the emergency department and the consumer has some ability to shop around. According to the American College of Emergency medicine, the ER encompasses only 2% of healthcare dollars spent.  I'm sure those figures are a bit biased but even if they are 2 or 3 times as large, the numbers point that emergency care is not where all the healthcare dollars are going. This also means consumers do have the option to shop around. http://newsroom.acep.org/2009-01-04-costs-of-emergency-care-fact-sheet

CONTRADICTED !

Blame Emergency Rooms for the Out-of-Control Cost of Health Care
https://nyti.ms/2CnQsvj

By Glenn Melnick
Dr. Melnick writes frequently on health care and the economy.
Sept. 5, 2018

In most states, health care plans are required to tell their members to go to the nearest hospital in an emergency, even if that hospital is out of network.

There are many reasons Americans pay more for health care than citizens of any other country. But one of the most powerful forces driving cost increases is buried in a little-known set of regulations concerning emergency room care.
These regulations have granted hospitals what is essentially a monopoly over emergency room patients, allowing them to charge basically whatever they want.
Readily available emergency treatment is among the most fundamental services of our health care system. To ensure it, most states require health care plans to tell their members to go to the nearest hospital in an emergency and that insurance will cover the visit — even if their plan does not have a contract with that hospital and the emergency care they receive will be out of network. This provision is meant to assure timely access to needed care and, although some patients have to wait hours to be seen by a doctor, and some still get hit with additional charges, it generally works pretty well.
The problem is that the rules give hospitals tremendous pricing power when they’re negotiating with health insurance companies. Increasingly, hospitals have learned that if they demand higher prices from health plans and do not get them, the hospitals can just cancel their contract. They will still get paid for treating emergency patients under those plans — and in fact will be paid more, because those patients will be out of network. (While this applies only to emergency room patients, about half of all hospital admissions come through emergency rooms.)

When there is no contract, the hospital issues a highly inflated “billed charge.” What was a $500 E.R. visit under a contract can become a $5,000 billed charge. This greatly reduces the health plans’ ability to negotiate lower prices.
Data from California illustrate how hospitals have exploited this situation. From 2002 to 2016, total billed charges by hospitals rose by a staggering $263 billion, to $386 billion, even though the number of patients admitted did not increase. Billed charges to health plans grew from $6,900 per day to over $19,500 per day. This astronomical run-up in billed charges gave California hospitals leverage to demand and receive much higher prices for in-network patients, too. The average price paid by health plans to hospitals for all care grew almost 200 percent — to $7,200 per day from $2,500.
In effect, they could threaten: Pay us $7,200 per day to sign a contract or $19,500 per day for emergency admissions without a contract.
Many patients might not know or care about this fight between hospitals and insurers. But they should.

Whenever insurance companies have to pay more, patients do too, in premium increases. In some cases, patients have to pay inflated out-of-network E.R. charges directly to hospitals in the form of “balance billing.” Hospitals are also expanding at a rapid pace, acquiring medical groups and other outpatient services, and they are using their E.R. power to gain higher rates for these other services, too.
States urgently need to change their regulations to limit hospital prices for out-of-network emergency care.
Capping billed charges at 125 percent of contracted prices would keep hospitals from exploiting their E.R. advantage. Maryland has instituted a policy along these lines. This change alone would result in immediate price reductions and savings to consumers exceeding many billions of dollars. And it would begin to restore some competition that would help keep prices down in the long run.
An American family of four with an employer-sponsored P.P.O. health plan now pays on average more than $28,000 a year for health care. If nothing changes, health care prices and insurance premiums will continue to grow. This will mean lower take-home pay for millions of working Americans and increases in the ranks of the uninsured. Public policy and hospitals are supposed to help us in emergencies, not create them.


Glenn Melnick is a professor of public policy at the University of Southern California and a researcher at its Schaeffer Center for Health Policy and Economics.
Follow The New York Times Opinion section on Facebook and Twitter (@NYTopinion), and sign up for the Opinion Today newsletter.

pecunia

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Re: What comes after the ACA?
« Reply #4771 on: September 05, 2018, 08:31:22 PM »
David Ann Arbor:

"States urgently need to change their regulations to limit hospital prices for out-of-network emergency care.
Capping billed charges at 125 percent of contracted prices would keep hospitals from exploiting their E.R. advantage. Maryland has instituted a policy along these lines. This change alone would result in immediate price reductions and savings to consumers exceeding many billions of dollars. And it would begin to restore some competition that would help keep prices down in the long run."

Wow!  It's hard to argue with that government regulation.  Very good post.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4772 on: September 05, 2018, 10:24:52 PM »
There are new rules requiring healthcare pricing transparency coming in 2019.

https://www.commentarymagazine.com/american-society/hospital-prices-transparency/

This is just one of several articles on the new rules.  Google is your friend*.

*Actually Google is not your friend but it is useful.

This is freakin awesome if this going to happen.  +1 for Trump on this one.
Thanks for sharing.

This is certainly a step in the right direction, and I am happy to give Trump and Verma credit for it.  However, from reading various news pieces, it appears that it only applies to sticker prices, which very few people actually pay (mostly the uninsured and the handful of people who are still on true fee-for-service insurance plans).  It would be far more helpful if they required hospitals to post all the prices that they've negotiated with all the PPOs and HMOs, through which the lion's share of health care is funneled these days.  And it would be even more helpful if it applied to more than just hospitals, as so much care is provided outside of the hospital setting.

Also, it's worth noting that hospitals have been required to provide this information upon request for years.  Posting it on line definitely makes things easier, but it's not like the information was previously unavailable.

I fully agree and think this is a small part of a good start.

Trump analyzing price transparency for the pharmaceutical industry as well

https://www.commonwealthfund.org/publications/newsletter-article/2018/aug/trumps-plan-drug-pricing-transparency-takes-step-forward

This is a yuuuge step and another +1 for Trump. 

Damn! Unemployment is low, markets are up, and if he decreases the cost of healthcare he is guaranteed for a second term.

Most news stories about Trump and health care seem to be quite negative.  Of course these could be fake news.

https://www.washingtonpost.com/opinions/americans-are-starting-to-suffer-from-trumps-health-care-sabotage/2018/05/06/c60fb6fa-4fb2-11e8-b725-92c89fe3ca4c_story.html?utm_term=.5bdecc1055c6

https://www.washingtonpost.com/opinions/americans-are-starting-to-suffer-from-trumps-health-care-sabotage/2018/05/06/c60fb6fa-4fb2-11e8-b725-92c89fe3ca4c_story.html?utm_term=.5bdecc1055c6

Health care companies are smart.  There will be some sort of loophole to displaying prices.

If he isn't impeached, they will probably run him again as he is an incumbent with an inflexible base.

Hmm liberal media writing negative pieces on a republican president. Seams about right.


@DavidAnnArbor
Not that I disagree with capping out of network billing but the article has two points that need clearing up.

The article says total billed charges for hospitals are $386 billion.  We all know that billed charges are not what actually gets paid and often times a tiny fraction of the cost.  Lets just assume half for this argument though I know it is much less. This means about $193 Billion is spent in the ER. CMS states that our healthcare expenditure in the US was 3.2 trillion in 2015 which makes Emergency care expenditure 6% and still a tiny fraction of all healthcare costs.

Actually there has been a war waged by insurance companies to cap out of network billing.  This war is against hospitals and doctors.  and both have lobbyist from each side paying huge fortunes to write pro and con articles just like this. 

The argument on the pro side is that insurance companies often time negotiate below average rates for certain items and 125% of that would be unreasonable for the care delivered.  I do agree though that stories of doctors or hospitals charging 1000+% above CMS rates are obscene and the practice needs to stop.

rantk81

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Re: What comes after the ACA?
« Reply #4773 on: September 06, 2018, 03:42:18 AM »
If out of network charges for all medical services were capped at 125% of what they negotiate with insurance companies, I would feel that self insurance would again become a viable option for many...

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4774 on: September 06, 2018, 08:56:38 AM »
How do we lower medical care costs?

One way is simply to reduce the amount of medical care needed. In so doing while the price for medical procedures might not drop, the price of health insurance, which pools all the money we pay in, might drop.

How was it done?  ACA provided for Health Coaches.  Yeah Democrats !  Solving problems !  Using Science !


http://www.sandiegouniontribune.com/news/health/sd-no-heart-study-20180904-story.html##nws=mcnewsletter

Why is San Diego's heart attack rate 20 percent lower than the rest of the state?

"San Diego County saw 3,826 fewer heart attack hospitalizations than expected from 2011 to 2016, saving nearly $86 million in avoided medical costs."

“We organized our community in a way that we were goal-oriented to reduce heart attacks and strokes,” DeMaria said. “That orientation allowed us to share the data with each other that’s necessary to identify the patients who are most at risk and make sure they are aggressively treated.”

Once patients with high blood pressure or out-of-range cholesterol or blood sugar are identified, participating groups became more aggressive with prescribing a “bundle” of medications shown to protect heart health, including aspirin, statins and anti-hypertension drugs.

A federal grant also helped pay for medical groups to hire health coaches to work one-on-one with a group of 4,000 residents countywide who were judged to be at the highest risk of heart attack or stroke. These workers were available to help participants change eating and exercise habits and make sure that they were taking their medications as prescribed.
Grant money also paid to hire a small professional staff in 2013 to coordinate the program countywide.

“That’s the thing about coronary artery disease,” Bhatt said. “A lot of it’s not about sexy interventions. It’s just a matter of taking care of the usual risk factors day in and day out year after year. There is no magic bullet. Everyone has to do the work.”

Sharp HealthCare was a big part of the effort, enrolling more people in the 4,000-patient grant-funded project than any other local health system.
Dr. Parag Agnihotri, medical director of population health at Sharp Rees-Stealy Medical Group, cited collaboration among doctors as another key to Be There San Diego’s success. Defining the goal properly, he said, made doctors from competing providers willing to work with each other and share their methods.

pecunia

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Re: What comes after the ACA?
« Reply #4775 on: September 06, 2018, 09:15:21 AM »
David AnnArbor:

"One way is simply to reduce the amount of medical care needed. In so doing while the price for medical procedures might not drop, the price of health insurance, which pools all the money we pay in, might drop."

“That’s the thing about coronary artery disease,” Bhatt said. “A lot of it’s not about sexy interventions. It’s just a matter of taking care of the usual risk factors day in and day out year after year. There is no magic bullet. Everyone has to do the work.”

Another great post.  An ounce of prevention is worth a lb of cure.  Changing US health care to single payer or other tax funded plans may put a greater emphasis on preventive medicine.  There will be a common incentive for us all to maintain good health as tax dollars will be saved.





DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4776 on: September 06, 2018, 09:57:13 AM »
Yes I agree Pecunia, preventive medicine and research onto lowering health care costs and improving health outcomes are probably the best drivers to lowering cost.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4777 on: September 07, 2018, 12:43:40 PM »
David AnnArbor:

"One way is simply to reduce the amount of medical care needed. In so doing while the price for medical procedures might not drop, the price of health insurance, which pools all the money we pay in, might drop."

“That’s the thing about coronary artery disease,” Bhatt said. “A lot of it’s not about sexy interventions. It’s just a matter of taking care of the usual risk factors day in and day out year after year. There is no magic bullet. Everyone has to do the work.”

Another great post.  An ounce of prevention is worth a lb of cure.  Changing US health care to single payer or other tax funded plans may put a greater emphasis on preventive medicine.  There will be a common incentive for us all to maintain good health as tax dollars will be saved.

You don't need single payer to accomplish this.  One very large payer can create this incentive and already has via the new MACRA payment structure.  Physicians are incentivized via increased reimbursement to manage quality.  Some of the quality initiatives are idiotic while others are spot on and improving the outcomes of a population.  Things like lowering Heamoglobin A1c (a marker of diabetes control) for a majority of their diabetic patients is an example that will decrease morbidity. Although it affects CMS reimbursement, providers follow these measures on everyone.  Every speciality has its own quality measures.

It would be nice to have "health coaches" teach people to better take care of themselves though.  I am positive counselors and coaches are a hell of a lot cheaper than stroke rehab or cardiac bypass surgery. 

One of the best ways to cut the cost of healthcare is to stop performing unnecessary surgery and heroic measures on the practically deceased.  I know it is cold and heartless but we as a population are torturing our elderly who have no brain power to say stop.  This is one of the most expensive expenditures of our healthcare dollar that is flat out cruel.

I also don't think single payer is the end all be all for healthcare as a hybrid model seams to do very well in places like Germany. 
I think single payer for all for inexpensive no frills appropriate healthcare is the way to go with private enterprise doing more of a concierge healthcare for those who want to pay for it.  Pay for faster service, private rooms, new cutting edge technology, etc.

Paul der Krake

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Re: What comes after the ACA?
« Reply #4778 on: September 20, 2018, 08:11:22 PM »
Paging @Exflyboy

Bi-partisan draft senate bill to ban balance billing at the federal level: https://khn.org/news/senators-unveil-legislation-to-protect-patients-against-surprise-medical-bills/

BTDretire

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Re: What comes after the ACA?
« Reply #4779 on: September 21, 2018, 08:48:43 AM »
Republicans are truly fucking evil.   Mobilize your friends, family, anybody you know that gives a shit about people to vote these assholes out this year and in 2020.     
You think it's evil for people to think it's wrong to do this huge disruption to the healthcare insurance system
to cover 3.3%* of the population.
 My private BCBS policy has increased 350% since the ACA regulations started.
 From where I stand, snowflakes liberals are,  give me, give me, give me.
Although, I usually just leave it to, we all have opinions and that's fine, but when you are so brainwashed that
you call Republicans evil, you are way past just having an opinion on healthcare.
 I've bought my Families private health insurance for at least the last 24 years, these ACA years have seen the greatest premium increases in all that time.
 It was a poorly designed plan from the moment Obama lied and said "this will save families $2,500" and "you can keep your doctor".
premium increases.

*How many people are enrolled in the Affordable Care Act?
So, an average of 11.4 million people are expected to be in Obamacare policies during 2017. Some 10.4 million people were enrolled as of June, the most recent figures available. The Obama administration is encouraging people to sign up to show Trump and Congressional Republicans how important Obamacare is to Americans.Dec 21, 2016
Obamacare 2017 enrollment hits record, despite Trump's threat to repeal
https://money.cnn.com/2016/12/21/news/economy/obamacare-enrollment.../index.html

chasesfish

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Re: What comes after the ACA?
« Reply #4780 on: September 21, 2018, 09:07:58 AM »
I'm going to be the broken record...

ACA would have worked if the Obama administration actually enforced the mandates.  Not some penalty that could be waived for every exemption under the sun, but don't issue drivers licenses, passports, or tax refunds until someone proves they have insurance.  We still have 40mil people without insurance that are freeloading on the system.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4781 on: September 21, 2018, 09:11:17 AM »
Republicans are truly fucking evil.   Mobilize your friends, family, anybody you know that gives a shit about people to vote these assholes out this year and in 2020.     
You think it's evil for people to think it's wrong to do this huge disruption to the healthcare insurance system
to cover 3.3%* of the population.
 
*How many people are enrolled in the Affordable Care Act?
So, an average of 11.4 million people are expected to be in Obamacare policies during 2017. Some 10.4 million people were enrolled as of June, the most recent figures available.

ACA also includes the Medicaid expansion, so that's another 10 million people, which would be even higher if more states expanded Medicaid under the ACA, then you had other provisions in the law such as younger adults maintaining coverage on their parents' insurance rather than losing coverage, guaranteed issue, etc.

bacchi

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Re: What comes after the ACA?
« Reply #4782 on: September 21, 2018, 09:23:23 AM »
It was a poorly designed plan from the moment Obama lied and said "this will save families $2,500" and "you can keep your doctor".
premium increases.

Oh, yeah, it was poorly designed.

But the previous system was untenable. It worked for the healthy and those that remained healthy. Rescinsion was a real thing. (And premiums also jumped each year, pre-ACA.)

I just wish the party that voted 40+ times to repeal the ACA also took some time to meet with think tanks and other countries and constituents to figure out the best possible plan to get lower-cost health care for everyone. They didn't. We have no plan. This is especially egregious considering every other westernized country has some form of health-care-for-all, for less cost.

It's almost as if large corporations are making sure that it doesn't get fixed.

fuzzy math

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Re: What comes after the ACA?
« Reply #4783 on: September 21, 2018, 09:34:47 AM »

One of the best ways to cut the cost of healthcare is to stop performing unnecessary surgery and heroic measures on the practically deceased.  I know it is cold and heartless but we as a population are torturing our elderly who have no brain power to say stop.  This is one of the most expensive expenditures of our healthcare dollar that is flat out cruel.


+1

chasesfish

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Re: What comes after the ACA?
« Reply #4784 on: September 21, 2018, 09:38:30 AM »
I failed to mention that in my criticism of the Obama administration, its not like Republicans have done anything to enforce the mandate either, which was originally a republican idea.

The quicker we get to a German or Swiss style, the better.  We're not setup to go the Canada/England route because of the private/not for profit ownership structure of hospitals.  Compulsory insurance is the only logical solution.

Oh, and stop torturing senior citizens in their last months with unnecessary medical procedures.

Exflyboy

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Re: What comes after the ACA?
« Reply #4785 on: September 21, 2018, 09:39:55 AM »
Paging @Exflyboy

Bi-partisan draft senate bill to ban balance billing at the federal level: https://khn.org/news/senators-unveil-legislation-to-protect-patients-against-surprise-medical-bills/



Somehow I think this legislation has a snowball's chance in Hell of passing but hope springs eternal.

And here we are safely in the UK where me and my American Wife can have a heart attack and be billed precisely $zero!.. Even as visitors!


swampwiz

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Re: What comes after the ACA?
« Reply #4786 on: September 21, 2018, 04:43:27 PM »
I'm going to be the broken record...

ACA would have worked if the Obama administration actually enforced the mandates.  Not some penalty that could be waived for every exemption under the sun, but don't issue drivers licenses, passports, or tax refunds until someone proves they have insurance.  We still have 40mil people without insurance that are freeloading on the system.

I see, so Obama not enforcing the mandates (LIE) is worse than Trump OBLITERATING the mandates?  Go back to watching Hannity.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4787 on: September 21, 2018, 05:54:38 PM »
I'm going to be the broken record...

ACA would have worked if the Obama administration actually enforced the mandates.  Not some penalty that could be waived for every exemption under the sun, but don't issue drivers licenses, passports, or tax refunds until someone proves they have insurance.  We still have 40mil people without insurance that are freeloading on the system.

I see, so Obama not enforcing the mandates (LIE) is worse than Trump OBLITERATING the mandates?  Go back to watching Hannity.

No, there's still a mandate, and there's still a penalty for now.  Only the penalty goes away beginning in 2019.

Of course there's a 20 state lawsuit to overturn Obamacare as being unconstitutional due to the removal of the penalty.

pecunia

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Re: What comes after the ACA?
« Reply #4788 on: September 21, 2018, 06:42:01 PM »


Republicans are truly fucking evil.   Mobilize your friends, family, anybody you know that gives a shit about people to vote these assholes out this year and in 2020.     

He He He  Who's face popped into my head when I read that?  Mitch Mcconnell with horns on his head.

He's right though.  One group cares about people, one cares about their money.  The great thing about changing our health care system is that you help people AND SAVE MONEY!

Exflyboy

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Re: What comes after the ACA?
« Reply #4789 on: September 21, 2018, 09:15:00 PM »


Republicans are truly fucking evil.   Mobilize your friends, family, anybody you know that gives a shit about people to vote these assholes out this year and in 2020.     

He He He  Who's face popped into my head when I read that?  Mitch Mcconnell with horns on his head.

He's right though.  One group cares about people, one cares about their money.  The great thing about changing our health care system is that you help people AND SAVE MONEY!

Yes but then the HC sector makes LESS money which means less dividends and less stock growth.. The more money you have in the stock market the more you "lose".

Thus the more expensive healthcare costs = more money for billionaires.. Of course they want HC to be as expensive as possible.

The Fat Baby G. Malenkov

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Re: What comes after the ACA?
« Reply #4790 on: September 21, 2018, 10:09:42 PM »
Look. If I break my leg just shoot me in the head like the horse from True Grit.

Please sir. this is a Taco Bell. There are other customers

former player

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Re: What comes after the ACA?
« Reply #4791 on: September 22, 2018, 01:22:53 AM »
I'm going to be the broken record...

ACA would have worked if the Obama administration actually enforced the mandates.  Not some penalty that could be waived for every exemption under the sun, but don't issue drivers licenses, passports, or tax refunds until someone proves they have insurance.  We still have 40mil people without insurance that are freeloading on the system.

I see, so Obama not enforcing the mandates (LIE) is worse than Trump OBLITERATING the mandates?  Go back to watching Hannity.

The Obama administration ran out of time for enforcing the mandates while setting up the system.  The Trump administration deliberately obstructed the will of Congress as expressed in the law.  There's a difference.

pecunia

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Re: What comes after the ACA?
« Reply #4792 on: September 22, 2018, 09:29:47 AM »

Yes but then the HC sector makes LESS money which means less dividends and less stock growth.. The more money you have in the stock market the more you "lose".

Thus the more expensive healthcare costs = more money for billionaires.. Of course they want HC to be as expensive as possible.

OK - The health care sector is a money making organization.  Why do they make money?  People have to spend money on health care that they would rather spend somewhere else.  So, if the US socialized it's health care, maybe these industries wouldn't do so well.  So what happens to all that money which people have been paying into our less efficient health care system?  It is spent somewhere else.  Some other industries do better because they now have that money that was spent on health care. 

If you are into the index fund thing, I think you'll find that as the medical stocks decline, others will rise due to the consumer's money being freed up and said consumers can buy goods and services that they otherwise could not.  They also will have more money to bid up the prices of your precious stocks.

You know, in the past we used horses.  Using animal power was less efficient than electrical and fossil fuel machinery.  It simply took more resources.  We are better off in most ways that the use of horses has been supplanted by other means.  In a similar manner if we replaced our health care system with one that is a more efficient user of resources, i.e. socialized medicine, we would be better off.  Our existing medical system can be thought of as the use of horses.  Replacing it with a more efficient socialized system can be thought of as the automobile.  In which system would you like to travel a long distance?

sol

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Re: What comes after the ACA?
« Reply #4793 on: September 22, 2018, 10:15:37 AM »
Our existing medical system can be thought of as the use of horses.  Replacing it with a more efficient socialized system can be thought of as the automobile.  In which system would you like to travel a long distance?

That depends, am I a wealthy horse breeder?  Do I make 20% of my income for horse-related transport or stable support services?  Is there a chance that my current position of wealth and privilege will be threatened if every dumb schmuck with a dollar can travel long distances without paying me?  Will I still get invited to fancy parties if no one needs my horses anymore, or if horses are suddenly so cheap that I lose my status and favored position in society?

Because if any of that is true, I'm likely to use all of my vast horse-related fortune to lobby Congress to oppose the transition to the automobile.

In reality, the historical transition from horses to cars was largely driven by the profit-seeking automobile, which used ruthlessly capitalistic policies like buying competitors and shutting them down, or subsidizing paved roads over public transportation.  New people got rich by bankrupting the old rich people.  The transition to a more efficient health care system seems unlikely to find a champion unless there are some new people looking to get rich.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4794 on: September 22, 2018, 12:17:55 PM »
The ACA did nothing to improve healthcare delivery in the country and even less in controlling cost of that delivery.  The law mainly dictates who will pay. In the process there were some provisions that are a huge benefit to our society such as the pre-existing condition clause.  Other than that, the law was a means of extracting money from the rich and the middle class and divert it to the insurance companies.

Since the ACA the insurance industry has seen historic profits and stock gains.  Just google any insurance stock price and prove me wrong.  Sure early retirees love the ACA since they can get free insurance but is it actually good for society as a whole? 

The law can be fixed by implementing cost cutting measures but outside of Trump looking to create some transparency I see little done in that direction. 

smoghat

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Re: What comes after the ACA?
« Reply #4795 on: September 22, 2018, 03:03:12 PM »
Do away with employer healthcare.
Individual mandate
No subsidies for people who choose not to work. No welfare for you if you don’t want to work. You want the subsidy? You have to enroll in a program to get you a job. FIRE’d too low? No subsidy.
Free marketplace for insurance across state lines. Some basic preconditions but mainly it’s up to the consumer.
Pre-existing conditions have to be covered so long as you were enrolled in insurance for five or ten years.
You go to the ER and have the ability to pay but aren’t insured? You pay, even if it’s over five years.
One national billing system.
Doc->national billing system->insurer
This will save colossal amounts.

And it’s Mitch McConnell back into the pits of hell while you are at it. Ever seen the guy? Looks like some kind of demented turtle. About as much of a brain too. I am sure even his mom thinks he is an idiot.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4796 on: September 23, 2018, 09:55:08 AM »

No subsidies for people who choose not to work. No welfare for you if you don’t want to work. You want the subsidy? You have to enroll in a program to get you a job. FIRE’d too low? No subsidy.
Free marketplace for insurance across state lines. Some basic preconditions but mainly it’s up to the consumer.


But, but, but. All these early retirees on this forum, they can't retire. This isn't going to work for them.
I would agree if the delivery of healthcare was much less expensive and there existed a good,low cost catastrophic insurance option.

As for a national biking billing agency, very interesting though. Would it add more or less BS to the billing process? Having one biller should make everything a bit simpler. I think I like the idea but need to mull it over for a few days to think of more pros vs cons.

EDIT: Corrected biking to billing
« Last Edit: September 23, 2018, 10:58:25 PM by EnjoyIt »

maizeman

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Re: What comes after the ACA?
« Reply #4797 on: September 23, 2018, 10:35:18 AM »
As for a national biking agency, very interesting though.

I realize this is a typo, yet enjoy that it would also be a quite effective way of reducing healthcare spending.

pecunia

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Re: What comes after the ACA?
« Reply #4798 on: September 23, 2018, 11:19:10 AM »
"As for a national biking agency,"

Are bicycles a representative of the socialistic way of life?  They have a lot of bikes in Denmark where they also have socialized medicine.  Maybe there is sort of a domino effect.  If public healthcare came about and made us all do preventive medicine, maybe the bike paths would follow.  We'd all have to much energy for the couch potato thing.

I guess I could go for that.  Use them for cross country skiing in Winter.

rantk81

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Re: What comes after the ACA?
« Reply #4799 on: September 23, 2018, 05:46:41 PM »
As for a national biking agency, very interesting though.

Lol, my first pass over that "typo" I read it as "bilking" ... But that's what we have now
« Last Edit: September 23, 2018, 06:07:08 PM by rantk81 »