Author Topic: What comes after the ACA?  (Read 1144585 times)

freya

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Re: What comes after the ACA?
« Reply #5750 on: October 04, 2019, 02:44:33 PM »
The best thing for American diets might be as simple as: Stop eating (frozen) processed foods. Stop eating fast food. Stop drinking cola.

I think you've captured much of part 1 of Michael Pollen's "Eat food. Mostly plants. Not too much." That simplicity really resonates with me.

Our understanding of dietary science changes. I remember in the 90s it was all "Fats are bad! Eat lots of grain instead!" Now it's gone a bit far in the other direction "Grains are bad! Eat lots of fat and protein instead!"

Just eat a reasonable amount of real food, most any kind, and you'll probably do okay.

That was my sentiment also - I was very much on the no processed food, minimize added sugar, eat whole grains and beans bandwagon.  After I hit menopause the pounds just kept climbing no matter what I did.  I finally crossed the line into "overweight" territory at my last checkup, and worse yet it was all around my middle.  Hello metabolic syndrome.

I tried the keto diet because a friend had started it and was getting great results.  To my astonishment, I have shed about 15 lbs in 2 months, feel SO much better, and a whole litany of nagging health problems that I thought was just part of getting older went away.  Completely!  And, I'm no longer dead exhausted at night, or tired in the morning.

I could care less what Michael Pollan or the US food plate says. I do care about properly interpreting studies, which leads one to completely opposite conclusions from the standard mantra of "low-fat, you should base your diet on grains and vegetable oils and avoid red meat like the plague".  This is it for me. Once I'm at a weight I'm happy with, I will add foods back one at a time to find out what my limits are, and then I plan to stay within those limits forever. 

bigote2032

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Re: What comes after the ACA?
« Reply #5751 on: October 04, 2019, 04:22:26 PM »
Ok, I have been reading this nutritional non sense in the last few days.  Some of you deserve a good amount of friendly punches to try to make you healthy and undo the brainwashing from the mainstream media and the meat and diary industry.

In the following points, I  will debunk a bunch of myths first:

Note that my advise is for regular people that don't have any specific digestion issues with some foods.

- You have a war against grains and carbs.  WAKE UP! This is total BS rumors spread by the meat/diary industry people!  Our bodies run on carbs.  Good quality carbs won't make you fat.  My dad told me he gained 5 points by eating potatoes, but then my mom told me about all the pork and beef he ate during that period.

- Stop prioritizing weight loss and focus more on being healthy.  Don't put your health at risk with these diets. One example is the Get-Cancer-Fast diet, I mean, Keto diet.  This diet was manufactured by the meat industry.  You think it is healthy to load yourself with dead animals? Again, don't take advise of those friends hyping and focusing on weight loss, this will make you sick and it is not sustainable.

- You have experience figuring out the truth, you did it with the FIRE movement, you were able to stop listening the mainstream media and the financial apparatus.  You ignored the lies telling you that the only way to retire is until you reach 65.  You might not make it to 65 if you keep harming yourself.  Adopt the FIRE diet.  You ask what is that? The whole foods plant based diet.  It will make you lose weight if you are overweight, it will make you gain weight if you are under your recommended weight range, in other words it will put your body where it is supposed to be.  It will prevent you from dying by one of the top American killers: cancer, cardio-disease, Alzheimer's, dementia, and the list goes on.

- Why is this the FIRE diet you ask? a) You care about money? Good news, this is the cheapest diet you can get, I live on potatoes, rice, beans and bread.  How much is that steak? b) FIRE is about having freedom to do what you want, living a less stressed life, hence being healthy.   Plant based will give you the longest mileage c) Environment: yeah, people go nuts about cars polluting the environment but nobody talks about the largest contributor to climate change, all those cows you are eating.

- Stop coming up with excuses on why you won't eat healthy.  Number one excuse: I need my protein.  Boom, you deserve a big punch in the face now.  You think meat is the only food that has protein? All foods have some level of protein, this is another lie brought to you by the meat industry.  Excess of protein in the American diet is destroying thousands of kidneys every diet.  Kids getting stones in very early ages.  Another excuse? I am a macho macho man and I need my meat.  Boom, uppercut punch for you.  Meat is bad for your blood pressure which eventually affects that genital instrument down there, it won't go up anymore pretty soon, so not too macho.  I practice body building and follow plant based and have actually experienced increased performance and endurance after I stopped eating dead things.  I don't use any of those expensive protein shakes that none of us need, my protein comes from beans, lentils, quinoa, peas, tofu, heck, so many great options for protein.

- Accept the consequences of your decisions, look in the mirror and say to yourself: "I can't give up my great steak, eggs and cheese.  I love it so much.  I have been eating it for long, this is the only way I know of eating.  I accept my destiny, I accept that I can die at any moment.  An artery will eventually be blocked, stroke, heart attacks are very likely.  If these compilations don't kill me before reaching old age, I will experience a slow and painful death caused by dementia or Alzheimer's.  Just be truthful to yourself and the people that care about your health and stop telling people lame excuses.  What you eat is very personal, people are conditioned to eat what society tells you what to eat, what it's considered to be delicious.

- All independent research studies (does not include all studies sponsored by the meat and diary industry which are the ones you most likely will find in mainstream media) have found how bad meat and diary is for you, period!

- Restaurants are not in the business of taking care of your health - STOP eating out! The reason why we love eating out is because restaurants load their foods with the things we love: salt, sugar, oil and butter.  It is good for the FIRE movement but allow yourself to go out for special occasions.

- For most doctors, your health is not their best interest.  The older generations (say my mom who is 75 years old), trust their doctors unconditionally.  The new generations (some X and millennials), thanks to the Internet know much better how the health system works, it is a factory of money.  Your doctors are better off by recommending blood pressure pills than recommending you a natural way to decrease your BP.  Example: my uncle, a man on his early 60s that seems to be a very healthy individual, had a three artery blockage, he is lucky to be alive.  The doctor told him to decrease eating steak and eat chicken instead! Chicken is as bad as steak (BOOK, debunked another falseness), it is fat.  THIS IS AN EMERGENCY, my uncle should stop eating all kinds of meat and diary and oil NOW.  He was given another chance to live but he loves his tasty/unhealthy food too much.  I tried to convince him, no luck, he is just like most humans, nutrition is too personal, don't mess up with what I eat.  He will probably die from cardiovascular complications.

- Still concerned about your weight? Don't kill yourself at the gym! The main thing is what you eat, you are what you eat.

- Stop eating oil!!! Yes, that goes for ANY kind of oil (canola, olive, coconut, you name it).  Oil has very close effect than eating meat.

- If you are willing to change, start slow. Decrease the amount of bad stuff you are eating, eventually become a flexitarian (a plant based dude that occasionally eats meat and diary, say no more than once a week).  Becoming a flexitarian will have tremendous positive effect on your health and the environment.

- We don't have the digestive tract of a lion, our system if not designed to eat meat (this is a fact people, science) , it starts rotting inside of us before we can get it out.  Think about it for a moment, gross right?

- Plant based diet is delicious.  Another lie: plant based is not good or tasty.  Trust me, there are TONS of amazing recipes out there with no dead things on them.  I am the most picky person and I became plant based, you can do it too.

- Meat and diary replacement processed foods are NOT HEALTHY (loaded with sodium and oil) - however, they do give you options to have less negative impact on the environment.  There is the impossible burger and beyond meat burger, but consider BBQ beans burgers, tons of recipes and they are delicious and super healthy.

- Who are you? I am a guy that comes from a family with long tradition of BBQ and steak and eggs, with many relatives dying young (example, an uncle that died at 33 of enlarged heart due to cardio disease) and with high blood pressure.  It is true that some genes in the family can make you more sensitive to cardio decease when you eat unhealthy foods, but you have all the power to control that by eating healthy.  I decided I wanted to live until I get gray hair.  I was like many of you, I was living in denial, took me a period of 5 years to come to terms and decide to give up the foods that I grew up eating and that I love.  It took multiple conversations with friends of  fans of keto, paleo, extreme vegans and plant-based.  I studied the motivations of why people brought diets to their lives, I found great and bad motivations.  I was concerned about my physical performance at sports.  I had so many doubts.  I wanted to keep eating meat without hurting the planet, I though about many alternatives.  In the end I gave up, I tried plant based and never looked bad, it took a couple of years to find my best recipes to make at home or plant based oil free restaurants.  Once I found the, I finally had my system to support my healthy lifestyle.  My BP went down, I sleep better, I have the highest energy levels, my digestive system is doing so much better, heck, even my dental health improved so much by not having pieces of meat rotting between my teeth.  Do you have bad breath? Give plant based a try and you will be surprised!  I took a lot of reading and a lot of research, but I made it here and I am a better version of myself thanks to all that.  And best of all, plant based id sustainable, it is a life style and will keep you healthy forever.  The human body is amazing! It is resilient, if you feed it right, it is capable to reverse chronic disease! Be good to it!

Sorry for the long post, but if this can save somebody's life, it is all worth it.  Remember there are people that love you out there, maybe do it for them?

If this makes any sense to you, here are some resources:

China Study:
https://www.amazon.com/China-Study-Comprehensive-Nutrition-Implications/dp/1941631568/ref=sr_1_2?keywords=china+study&qid=1570227280&sr=8-2

The Starch Solution:
https://www.amazon.com/Starch-Solution-Regain-Health-Weight/dp/1623360277/ref=sr_1_1?keywords=starch+solution+mcdougall&qid=1570227474&sr=8-1

All the best!

Thanks.

All the best
« Last Edit: October 04, 2019, 04:42:08 PM by bigote2032 »

mm1970

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Re: What comes after the ACA?
« Reply #5752 on: October 04, 2019, 04:46:14 PM »
Quote
Good news, this is the cheapest diet you can get, I live on potatoes, rice, beans and bread.

Ah ha ha ha

Quote
- You have experience figuring out the truth, you did it with the FIRE movement, you were able to stop listening the mainstream media and the financial apparatus.  You ignored the lies telling you that the only way to retire is until you reach 65.  You might not make it to 65 if you keep harming yourself.  Adopt the FIRE diet.  You ask what is that? The whole foods plant based diet.  It will make you lose weight if you are overweight, it will make you gain weight if you are under your recommended weight range, in other words it will put your body where it is supposed to be.  It will prevent you from dying by one of the top American killers: cancer, cardio-disease, Alzheimer's, dementia, and the list goes on.

Been there, done that, I'm a pre-menopausal woman who actually figured out what to eat by...you guessed it...experimenting.  Beans, rice, potatoes = extra pounds, overweight, could NOT drop that baby weight (had a baby at 42), kept weighing in at 168 pounds - could get down to 153, then back up to 168.

Managed to get back down to eh...153, then really cut down the carbs to 2 servings a day and got to 140-ish.  It was great!  No more afternoon sleepies, no more constant hunger.  Lots more fat (avocado, nuts, olive oil, whatever.)  Started having digestive issues and then dropped wheat / gluten - BOOM, 8 pounds dropped off like that.  No more digestive issues.  I do MUCH better with a moderate carb (2-4 servings per day) and higher fat diet.

Might I suggest "What to Eat" by Luise Light?  If you are actually interested in reading all types of books, not just the ones that fit your agenda.  (Yes I read the China Study, it's cherry picked to high heaven).

bigote2032

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Re: What comes after the ACA?
« Reply #5753 on: October 04, 2019, 04:57:42 PM »
mm1970, glad you found something that works for you.

You are laughing about how cheap plant based is? This is not for debate, it is a fact.

My wife is gluten intolerant and has IBS, so most carbs hurt her, and she avoids them, that is an edge case.

China study is cherry picked in the sense that the cherries are facts that most people hate to read about.

I have a vague idea on the struggles women go trough in this society since I am married to one.  But keep in mind that just because you are losing weight does not mean you are healthy, you might look good but you are doing harm to your organs.  Take the case of my uncle with the bypass surgery, he could have mistaken for an athlete but he was very unhealthy inside. 

Is actually impossible to gain weight eating rice and beans period.  This is one of the main arguments people have, "I gained ton of weight by eating rice and beans!", but they fail to tell you what other things they were eating (hint: fats, nuts...)

Nobody is going to put their body measurements in their grave's tombstone, make sure you eat something that makes you look good inside and outside.

It is very irresponsible to support an industry that is destroying the planet just because you want to look good.

Make no mistake, meat and fatty diets will manifest themselves in your body one way or the other, short term or long term.  You might feel good know, but down the road a chronic disease will start showing up.  They will come, as certain as taxes. My father in law eats lots of meat, and his BP is perfect, however, he already had some other serious kidney complication because his diet.

I will break it down to you: I don't have an agenda, I work in the tech industry.  The ones with the agenda are the folks in the meat and diary industry, there is no big money in healthy foods.  A good friend of mine works as quality supervisor at a milk company, he talks about me just like you talk about me.  He does have an agenda.

I will read your recommended book, thanks for recommending it.
« Last Edit: October 04, 2019, 07:01:37 PM by bigote2032 »

mm1970

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Re: What comes after the ACA?
« Reply #5754 on: October 04, 2019, 08:49:40 PM »
The last "meat" I ate was a 3 oz piece of salmon on Sunday, so thanks my organs are fine.

The China Study specifically ignored stronger correlations in favor of a singular agenda. There are plenty of critical reviews out there, by people who reviewed the source data.

You cannot talk about carbs and calories without covering the insulin response, which lots of people ignore.  A calorie is not a calorie.

So let me point out this: when keeping caloric intake constant...because yes, I weighed and measured everything...I lost weight after I reduced carbs in favor of fat.

mm1970

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Re: What comes after the ACA?
« Reply #5755 on: October 04, 2019, 09:12:46 PM »
Another good book that I read was "Refuse to Regain" by Dr. Barbara Berkeley. She is an obesity doctor who has worked with and studied obese patients for years. In her work, she found that the bodies function differently, specifically with respect to how they handle carbs.

People who are "NOW" never overweight can process carbs differently than people who were "FOW" formerly overweight. Basically, if you get to be obese, you have possibly permanently altered how your body functions with respect to carbs, and weight loss does not fix it.

It was fascinating.

desert_phoenix

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Re: What comes after the ACA?
« Reply #5756 on: October 04, 2019, 09:39:44 PM »
I have had a few friends of the family (ranging in age from early 30s to late 50s) have great success following diets from Dr. Dean Ornish.

I see he has authored a book that came out earlier this year with rave reviews entitled Undo It! How Simple Lifestyle Changes Can Reverse Most Chronic Diseases.

I believe, though, that this was the book all my acquaintances used:  https://www.amazon.com/Ornishs-Program-Reversing-Heart-Disease/dp/0804110387/ref

Note: I have not read any of his books myself.

freya

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Re: What comes after the ACA?
« Reply #5757 on: October 05, 2019, 10:36:10 AM »
You can lose weight on Dean Ornish, Pritikin, or any number of low-fat, restricted calorie diets.  The problem is that you always gain the weight back, because you have screwed up your metabolism by going into starvation mode and the effects can last for years.

The question is not "can you lose weight" on these diets, it's "can you lose weight and keep the weight off."  Any study that's only a year or so long is therefore suspect.  Also, these restricted calorie diets are problematic because people just aren't going to tolerate being hungry as a lifelong diet plan.  On the keto diet I'm NEVER hungry.  It's very sustainable.

Incidentally, mr. Bigote (interesting choice of screen name there...) you might want to look up papers on the effects of keto on Alzheimer's and a whole host of inflammatory conditions.  Hint, they are positive effects.  That's just one of a large number of inaccuracies in your posts, which I'm not inclined to address point by point as I have more important things to do today.

One point that is worth speaking to:  yes, a low carb diet is more expensive than a grain-based diet, especially if you opt for grass-fed/pastured, small farm-produced meat.  My food bill has gone up.  On the other hand, I am spending less $$ on medications, and slowly figuring out ways to economize on groceries so I'll probably end up breaking even.   Plus, grain and sugar are cheap due to government subsidies and severe overuse of fertilizers, pesticides, GMO seeds etc.  I'd hardly call that sustainable. 

Isn't it amazing to contemplate how government money is pouring into both illness production and treatment?  Interesting little round-robin there.

bigote2032

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Re: What comes after the ACA?
« Reply #5758 on: October 05, 2019, 10:59:43 AM »
Incidentally, mr. Bigote (interesting choice of screen name there...) you might want to look up papers on the effects of keto on Alzheimer's and a whole host of inflammatory conditions.  Hint, they are positive effects.  That's just one of a large number of inaccuracies in your posts, which I'm not inclined to address point by point as I have more important things to do today.

Freya, bigote is Spanish for mustache, what is freya?

Inaccuracies? Maybe for you that are another victim of the keto movement.  And no, keto is not sustainable, is not normal, you are really hurting yourself, I really wish you will quit this soon for your own good.  keto is all about favoring the meat industry, they don't care about your health.  Keto is the "cool" thing to do now, is all over mainstream media, they have brainwashed so many people.  I know I will get a lot of hate since this forum has lots of keto members, but somebody has to say it how it really is.  We are not meant to get our energy from fat.
« Last Edit: October 05, 2019, 11:02:47 AM by bigote2032 »

pecunia

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Re: What comes after the ACA?
« Reply #5759 on: October 05, 2019, 11:17:45 AM »
Lots of smart comments herein.

That "flexitarian" advice sounds pretty good.  It's hard to totally ignore meat.  I am still working long hours on the road and find it difficult to shift to vegetables and fruit.  I am trying.  However, I also believe there is a lot of truth in the keto thing.  It seems like there are just too many posts out there on the web of diabetics improving their health.  I am not diabetic, but have the sense to realize that everyone's metabolism is not the same.  What works for one will not work for all.

I read this a bit back and it just sounded too sensible to be true.  Fat is stored energy.  When are you going to use it?  You are going to use it when no other energy is available.  I've been skipping meals for a while now, feel more energetic and am shedding lbs.  The body is using the stored energy.   Common sense is winning.  Food does taste better too when you are really hungry.


Joeko

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Re: What comes after the ACA?
« Reply #5760 on: October 05, 2019, 11:31:21 AM »
How did the thread go from ACA to angry Vegan rants?

pecunia

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Re: What comes after the ACA?
« Reply #5761 on: October 05, 2019, 11:41:31 AM »
I might have pushed the button a few comments back as I noted that if we had Socialized medicine, there may be more of an incentive for the government to encourage preventive medicine.  One obvious encouragement is proper eating.  This led to the food triangle which may not be the right form of encouragement.

freya

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Re: What comes after the ACA?
« Reply #5762 on: October 05, 2019, 01:01:02 PM »
How did the thread go from ACA to angry Vegan rants?

Well, there's not much to talk about as regards the ACA at the moment.  The thread has been shifting to contributors to the ever-increasing cost of health care, which is a far more important issue, IMHO. 

Tinkering with insurance while ignoring the epidemic of metabolic disease which is driving most of the cost increases is akin to rearranging the deck chairs on the Titanic.

The angry vegan thing certainly took me by surprise.  This comes of stating facts that run contrary to someone's deeply held belief, when that person knows that the belief is open to scientific question.  It's unfortunate that the USDA dietary guidelines amount to a set of beliefs that are backed up by shoddy science - if anything.  That would be an interesting subject to debate, but perhaps in a different thread.

bigote2032

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Re: What comes after the ACA?
« Reply #5763 on: October 05, 2019, 02:25:37 PM »
You are calling me angry vegan? I am not even vegan dude.  I am whole foods plant based, there is a big difference, vegans are not my favorite kind of people to be honest.

ACA has A LOT to do with nutrition, this is one of the most unhealthy countries in the world because of what we eat and we have crappy insurance.  Reason a little bit on this.

I love the ridiculous answers people give me when I ask them why folks from countries that are predominantly rice eaters are more healthy that folks from western diet countries.  If you want to be offended by my comments be my guest, as I said, nutrition is very personal, people don't want to be told what to eat by others.  I spent five years making fun of vegans and plant-based, I did that until plant based saved my life.  Keep eating your burgers and fries and having your 10 pills a day to support your life style and let's see who makes it farther.  Mic drop.
« Last Edit: October 05, 2019, 02:37:00 PM by bigote2032 »

Paul der Krake

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Re: What comes after the ACA?
« Reply #5764 on: October 05, 2019, 02:34:30 PM »
Changing the subject... looks like premiums are stabilizing for 2020!



Source: http://acasignups.net/rate-changes/2020

Open enrollment is just around the corner, starting November 1 for most states.

maizeman

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Re: What comes after the ACA?
« Reply #5765 on: October 05, 2019, 03:02:32 PM »
Seems like good news. Thanks for posting, Paul der Krake!

I'd really been assuming we'd see a continued death spiral of higher premiums lead to more health people dropping out leading to higher premiums particularly with the zeroing out of the individual mandate for 2019.

rantk81

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Re: What comes after the ACA?
« Reply #5766 on: October 05, 2019, 03:38:04 PM »
It still might be pretty bad.  Just because the premium rates on average might be going down a little -- the overall plans could just be worse.  A lot of the plans in my area already have pretty miserable doctor networks, and out of pocket maximums that peg the federal upper limit.  Maybe the deductibles in my area will all now peg the federal maximum for that too...

seattlecyclone

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Re: What comes after the ACA?
« Reply #5767 on: October 05, 2019, 04:11:42 PM »
It still might be pretty bad.  Just because the premium rates on average might be going down a little -- the overall plans could just be worse.  A lot of the plans in my area already have pretty miserable doctor networks, and out of pocket maximums that peg the federal upper limit.  Maybe the deductibles in my area will all now peg the federal maximum for that too...

The high deductibles are likely a symptom of ever-increasing prices at hospitals. The exchange plans have to maintain a fixed "actuarial value" based on the metal value of the plan. This value is the percentage of their customers' total medical bills that they pay. A silver plan needs to pay 70%, for example. The other 30% must be paid directly by the customer in the form of deductibles and coinsurance. If the overall costs double, the overall out-of-pocket costs must also double in order to keep the plan qualifying as a silver plan.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5768 on: October 06, 2019, 08:38:44 PM »
In my area, Jared Kushner's brother, Joshua, has a health insurance company called Oscar that is bringing these dubious health insurance plans that are cheaper and thus bringing down the price of 2nd lowest silver plan.

joshuagraham_xyz

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Re: What comes after the ACA?
« Reply #5769 on: October 07, 2019, 02:22:52 PM »
But if you're taxing workers to give money to retirees, even if the retirees are rich, funding it with a flat tax doesn't fix what an awful policy that is.

All workers will be eligible for Medicare when they reach the age at which people of ordinary means (and their employers) can no longer afford to pay for their health care.  Taxes of today's workers pay for the care of today's old people.  When today's workers are old, taxes from tomorrow's workers will pay for their health care.  That's how the social contract works.  Yes, there are serious demographic problems on the horizon due to the increasing proportion of the population that is old vs. the proportion that is working.  But that doesn't mean we just tell tomorrow's (or today's) old people that they can just suck it.  A serious republic would find a way to finance a humane level of care that doesn't bankrupt people after they've worked their entire lives.

But what about the fact there will just be fewer workers around, period, due to the onslaught of the robot age?  We'll need to to start taxing wealth & unearned income, not earned income.  (Interestingly, it would seem that most of the earned income would come from those in the health care industry.)

pecunia

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Re: What comes after the ACA?
« Reply #5770 on: October 07, 2019, 03:43:17 PM »
Will the cost of health care go down as costs for other industries have with the onset of robotized medicine? 

Maybe with tomorrow's equivalent of Obamacare, you won't lose your doctor because he is kept in a box.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5771 on: October 07, 2019, 08:14:31 PM »
But if you're taxing workers to give money to retirees, even if the retirees are rich, funding it with a flat tax doesn't fix what an awful policy that is.

All workers will be eligible for Medicare when they reach the age at which people of ordinary means (and their employers) can no longer afford to pay for their health care.  Taxes of today's workers pay for the care of today's old people.  When today's workers are old, taxes from tomorrow's workers will pay for their health care.  That's how the social contract works.  Yes, there are serious demographic problems on the horizon due to the increasing proportion of the population that is old vs. the proportion that is working.  But that doesn't mean we just tell tomorrow's (or today's) old people that they can just suck it.  A serious republic would find a way to finance a humane level of care that doesn't bankrupt people after they've worked their entire lives.

But what about the fact there will just be fewer workers around, period, due to the onslaught of the robot age?  We'll need to to start taxing wealth & unearned income, not earned income.  (Interestingly, it would seem that most of the earned income would come from those in the health care industry.)
That concern has been around since at least the Luddites two hundred years ago.  Thus far, such fears have proven to be unfounded.  And I have little concern about that changing--every time humanity automates a job, consumers find something else to spend their money on, whether it be more clothes (in the time of the Luddites), more cars, more electronics, eating out more, bigger houses, more travel, or whatever.

pecunia

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Re: What comes after the ACA?
« Reply #5772 on: October 09, 2019, 06:54:18 PM »
I guess it can never get too bad.  If it is all automated and nobody is working, they won't have a market.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5773 on: October 23, 2019, 04:27:22 PM »
To Treat Chronic Ailments, Fix Diet First
https://nyti.ms/2pIlmZg

In this article it states that the ACA is helping to do research on how to lower hospital utilization rates through improved eating.

"Last year, California’s version of Medicaid, Medi-Cal, introduced a three-year pilot study that’s already showing what experts in the health care field have seen anecdotally — that tailored nutrition can improve health and lower medical costs for chronically ill patients. "

"Because of high utilization rates associated with congestive heart failure, it was one of the conditions of most interest to the federal Centers for Medicare & Medicaid Services in their Hospital Readmissions Reduction Program, under the Affordable Care Act. That program incrementally reduced hospital payments for frequent readmissions. "

"...medically tailored meals can go a long way toward reversing that downward health spiral. A retrospective cohort study headed by Seth Berkowitz, M.D. at the University of North Carolina Chapel Hill School of Medicine, and published in April concluded: “Participation in a medically tailored meals program appears to be associated with fewer hospital and skilled nursing admissions and less overall medical spending.”"

pecunia

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Re: What comes after the ACA?
« Reply #5774 on: October 24, 2019, 10:38:35 AM »
Other than the sickness, I'll bet those altered diets improve those folks lives in other ways as well.  Food is a drug but we don't realize it.

Paul der Krake

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Re: What comes after the ACA?
« Reply #5775 on: October 25, 2019, 09:25:24 PM »
Plan previews for 2020 are here! Happy shopping.

https://www.healthcare.gov/see-plans/


Exflyboy

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Re: What comes after the ACA?
« Reply #5776 on: October 26, 2019, 04:18:13 PM »
Plan previews for 2020 are here! Happy shopping.

https://www.healthcare.gov/see-plans/

Curious bugs with the system. None of the providers in my area list my local doctors offices as a provider from withing Oregon.gov.. But if you go to the individual plan and look up their provider network  (Providence in my case) then my local doctors and their location is shown as providers.

I'm assuming the plan provider network is correct.

geekette

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Re: What comes after the ACA?
« Reply #5777 on: October 26, 2019, 06:55:38 PM »
I got notification from BCBS weeks ago, and at that time, there was very little in the way of providers loaded on their own web page, but they've been trickling in.  My usual doctors are all listed there, but nothing on Healthcare.gov.  It may just take time to get contracts signed and entered.

Wolfpack Mustachian

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Re: What comes after the ACA?
« Reply #5778 on: October 26, 2019, 07:22:39 PM »
You are calling me angry vegan? I am not even vegan dude.  I am whole foods plant based, there is a big difference, vegans are not my favorite kind of people to be honest.

ACA has A LOT to do with nutrition, this is one of the most unhealthy countries in the world because of what we eat and we have crappy insurance.  Reason a little bit on this.

I love the ridiculous answers people give me when I ask them why folks from countries that are predominantly rice eaters are more healthy that folks from western diet countries.  If you want to be offended by my comments be my guest, as I said, nutrition is very personal, people don't want to be told what to eat by others.  I spent five years making fun of vegans and plant-based, I did that until plant based saved my life.  Keep eating your burgers and fries and having your 10 pills a day to support your life style and let's see who makes it farther.  Mic drop.

Just catching up on the end of this thread, but I'm doubting you really spent 5 years making fun of vegans. If you did, you must have a really short memory, because you should know that comments like yours that straw man people who are not vegan into all being people who keep eating burgers and fries and take 10 pills a day (and then you actually type mic drop for your own comment, lol) are probably not comments if you're trying to help people actually be open to your argument. Just thought it's worth saying for anyone who might be actually trying to convince people to eat more fruits and vegetables (instead of appearing to just like to argue). Eating more vegetables and less meat is a worthy thing to try to convince people of; making poor arguments to try to support it is therefore a bad thing....

freya

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Re: What comes after the ACA?
« Reply #5779 on: October 27, 2019, 10:33:04 AM »
I got notification from BCBS weeks ago, and at that time, there was very little in the way of providers loaded on their own web page, but they've been trickling in.  My usual doctors are all listed there, but nothing on Healthcare.gov.  It may just take time to get contracts signed and entered.

Maybe, but be careful about that...providers may be dropping some of these low-cost plans, because they reimburse poorly.  In my state, all Obamacare plans are Medicaid managed care, i.e. they are designed to cover the state's Medicaid population, and patients are mostly restricted to Medicaid clinics and hospitals.

I also saw there's about an 8% average price jump in premiums this year, e.g. individual silver plans went from $560-600/month to $620-$650 range, with deductible/out of pocket staying the same.  That's >4x rate of inflation...the band rolls on.  Seems to be at odds with the chart someone posted above.

geekette

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Re: What comes after the ACA?
« Reply #5780 on: October 27, 2019, 11:26:55 AM »
I’m not sure what I should be careful about - the insurance company has more up to date info than healthcare.gov.

Our rate went down again this year.

pecunia

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Re: What comes after the ACA?
« Reply #5781 on: October 27, 2019, 07:57:46 PM »
I guess these insurance companies are doing their part to encourage us to vote for alternative medicine.  Every year as they raise their prices, it helps me to make my decision as to who to vote for.

ScreamingHeadGuy

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Re: What comes after the ACA?
« Reply #5782 on: October 28, 2019, 07:10:41 PM »
Plan previews for 2020 are here! Happy shopping.

https://www.healthcare.gov/see-plans/

I like to check so I can run estimates numbers for my FIRE spending (now only 1 ACA enrollment away).  Currently looks like a silver plan could be 50% of the number I’ve plugged into my budget, meaning my FIRE spending - which I base my necessary stache on - is 5% high.  Well, looks like I’m suddenly at 29.4x spending based on a revised health insurance cost.  ☺️

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5783 on: October 31, 2019, 04:17:34 PM »
This article from the Washington Post about the benefits of the ACA is very interesting because it helps to clarify that this law is improving the lives of many people.

https://www.washingtonpost.com/health/i-would-be-dead-or-i-would-be-financially-ruined/2019/09/29/e697149c-c80e-11e9-be05-f76ac4ec618c_story.html?wpisrc=nl_most&wpmm=1

DETROIT — Poor people in Michigan with asthma and diabetes were admitted to hospitals less often after they joined Medicaid under the Affordable Care Act. More than 25,000 Ohio smokers got help through the state’s Medicaid expansion that led them to quit. And around the country, patients with advanced kidney disease who went on dialysis were more likely to be alive a year later if they lived in a Medicaid-expansion state.
Such findings are part of an emerging mosaic of evidence that, nearly a decade after it became one of the most polarizing health-care laws in U.S. history, the ACA is making some Americans healthier — and less likely to die.
The evidence is accumulating just as the ACA’s future is, once again, being cast into doubt. The most immediate threat arises from a federal lawsuit, brought by a group of Republican state attorneys general, that challenges the law’s constitutionality. A trial court judge in Texas ruled late last year that the entire law is invalid, and an opinion on the case is expected at any time from the U.S. Court of Appeals for the 5th Circuit. The case could well put the ACA before the Supreme Court for a third time.

President Trump has dismantled as much of the law as his administration can, by expanding the availability of skimpy, inexpensive health plans that skirt ACA rules, for example, and slashing federal aid to help people sign up for coverage through ACA insurance marketplaces.
And some 2020 Democratic presidential candidates contend the country needs further-reaching health reforms than the ACA’s, calling for a government-financed system they call Medicare-for-all.
The ACA’s supporters have not taken political advantage of the signs that the law is translating into better health — at least, not yet.
When the sprawling 2010 statute was new, a central question was whether it would help more people gain affordable health coverage, as intended.

With about 20 million Americans now covered through private health plans under the ACA’s insurance marketplaces or Medicaid expansions, researchers have been focusing on a question that was not an explicit goal of the law: whether anyone is healthier as a result.

It is difficult to prove conclusively that the law has made a difference in people’s health, but strong evidence has emerged in the past few years. Compared with similar people who have stable coverage through their jobs, previously uninsured people who bought ACA health plans with federal subsidies had a big jump in detection of high blood pressure and in the number of prescriptions they had filled, according to a 2018 study in the journal Health Affairs.
And after the law allowed young adults to stay longer on their parents’ insurance policies, fewer 19- to 25-year-olds with asthma failed to see a doctor because it cost too much, according to an analysis of survey results published earlier this year by researchers at the Centers for Disease Control and Prevention.

Most of the emerging evidence concentrates on the health effects of joining Medicaid under the law’s expansion of the safety-net program. Medicaid is an appealing research focus because a 2012 Supreme Court decision gave each state the option to widen eligibility to people who are somewhat less poor, allowing comparisons between the three dozen states that have expanded and the rest that have not. In addition, low-income people without insurance are most likely to have built-up medical problems that get treated once they get covered.

Michigan has emerged as a hub for understanding the ACA’s effects on health because University of Michigan researchers have been rigorously evaluating the Healthy Michigan Plan, as the state calls its Medicaid expansion covering about 650,000 people.

One 2017 study compared heart surgery patients in Michigan and Virginia, which had not yet expanded Medicaid at the time. It found that those who had cardiac bypasses or valve operations in Michigan had fewer complications afterward than similar people in Virginia, where more were uninsured.
One in three Michigan women said that, after joining Medicaid, they could more easily get birth control. And four in 10 people in Healthy Michigan with a chronic health condition — such as high blood pressure, a mood disorder or chronic lung disease — learned of it only after getting the coverage, according to survey results published last month.

In a few neighborhoods here in Detroit, the consequences for patients and their doctors are clear.
*****
Bonnie Sparks, dripping sweat in a mint-green ­T-shirt, reached the finish line of the CHASS community health center’s 5K run/walk. As she trudged the final steps, the center’s chief medical officer, Richard Bryce, urged workers and some medical students to walk alongside her in the 97-degree heat, chanting her name. Then, Bryce wrapped Sparks in a hug.

Sparks came in last of the event’s 270 runners and walkers in late July in a southwest Detroit neighborhood pocked with vacant lots. She was halfway to Clark Park when the center’s executive director found her at the back of the pack and offered a ride. “No way,” Sparks said, insisting on continuing under her own power.

The miracle was that, at 47, she walked the course at all.

CHASS has been a medical haven in Detroit’s Mexicantown for a half-century, since the city’s riots prompted hospitals to close and physicians to move to the suburbs. Five years ago, when Bryce, a family physician, arrived and took over Sparks’s care, she weighed more than 300 pounds and could not get from the clinic parking lot to the front door without help. She’d had her first heart attack at 34. Her anxiety was so sharp she often could not leave her apartment.
On a rare family road trip — to Daytona Beach — she waded into Florida waters where flesh-eating bacteria infected an open sore on her right leg. Back home, she landed in a hospital for 3½ weeks.

For 13 years, Sparks had worked for a defense contractor, NCI Information Systems, overseeing two computer help desks. But when the company lost a contract, her job ended in late 2010, and her good HMO insurance disappeared.

Living on unemployment, she kept taking pills for her diabetes and high blood pressure because she could get the prescriptions for $4 a month through a Walmart discount. But she did not have the $300 a month to pay for Plavix — a blood thinner she needed because of a stent put in her heart — so she stopped.
“I talked to my doctor at the time. I said, ‘I can’t afford this,’ ” recalls Sparks. “He said, ‘You could have another heart attack.’

“And I did.”
The second heart attack, in early 2012, was serious. Afterward, her doctors told her she should not work. She applied for Medicaid twice and received form letters telling her she was denied because she was not under 21, pregnant, blind or taking care of a child.
The following year, she appealed in writing, then asked for a hearing, but a state administrative law judge concluded that, though Sparks had a solid job history and significant medical problems that made it difficult for her to work, she was not technically disabled, so did not qualify for insurance.

“I felt abandoned,” Sparks recalls. “I nearly died. I kept thinking, ‘I am just sick right now.’ ”

So Sparks was uninsured when her boyfriend rushed her to an emergency room for a second time within days after the Florida trip. This time, she was diagnosed with the flesh-eating necrotizing fasciitis. She was having breathing distress and kidney failure because of the infection and was placed in a medically induced coma for most of her time in the Henry Ford Hospital.
But the day she was admitted, April 3, 2014, was the third day the state had begun accepting applications for the Healthy Michigan Plan. On April 29, Sparks got a letter. She was insured.
Medicaid paid her $132,000 hospital bill.
Since then, social workers and a psychologist have helped ease her out of her smoking habit and her anxiety. She met with a bariatric surgeon to consider a gastric bypass but, by that point, had started to lose so much weight by improving her diet and walking that she decided she did not need the surgery. By August, she was down to 234 pounds.

Sparks has an endocrinologist for her diabetes. A cardiologist approved a catheterization when she had more chest pains — and inserted additional stents. And she has an OB/GYN who treated her worsening fibroids and, when they got too severe, made sure she got a hysterectomy.

Bryce, who arrived at CHASS at about the time of Sparks’s infection, says she was like many sick and uninsured patients who can get primary care through the health center but have trouble finding medical specialists willing to treat them.
If not for the health plan she has through Healthy Michigan and Medicare, which she has had since the state eventually classified her as disabled, Sparks said, “I would be dead, or I would be financially ruined.”
On the east side of Detroit, the part of town where poverty and illness are most common and life expectancy is shortest, Healthy Michigan has transformed the lives of patients at the Mercy Primary Care Center. Like Sparks, David Brown says that, without it, “I probably would not be here. I would have had a heart attack and died.”

Before Medicaid expanded, all of Mercy’s patients were uninsured. Now, at 55, Brown is among the half at the clinic covered by Healthy Michigan.
Right after he got laid off in 2007 from a job with Wayne County, driving trucks and front-end loaders at the airport, he began having spells in which his chest was tight, his head spinning. Finally, a friend took him to an emergency room. He was prescribed rest and ordered to follow up with his primary care doctor. Except he did not have one.
Over the next few years, the spells came more often, and he was going to emergency rooms around town, dizzy and with headaches, two or three times a month. When the bills showed up, he stored them, unpaid, in the brown plastic crates where he keeps files.
He does not remember anyone checking his blood sugar, even though his favorite foods were fried chicken, Burger King, cinnamon doughnuts, chocolate milk and — especially — Snickers bars.
Finally, during an emergency room visit, someone mentioned he might be borderline diabetic.
When he finally heard about Mercy and was diagnosed with diabetes by Pamela Williams, a staff physician, Brown recalls, “she started telling me what could happen — amputation, kidney failure, heart failure. I was like, ‘I could lose my foot, my hand?’ I had never heard of anything like that.”

On a Mediterranean diet, Brown, also a licensed pastor who does online counseling, has gone from 340 pounds to 215. His blood sugar has been under control the past few years.
“But unfortunately, the damage was done when he didn’t have insurance,” Williams says.
With coverage from Healthy Michigan, Brown sees a nephrologist for his chronic kidney disease, a cardiologist for his congestive heart failure, an ophthalmologist for eye damage — all downstream effects of the years he did not know he had out-of-control diabetes.
Brown now has three stents in his heart, including a new one this summer after he had balloon angioplasty to open a clogged artery. He takes medicines that, if he had to pay retail, would cost about $2,400 a month.
“This stuff was not available to me without insurance,” Brown says. “I am grateful for it.”
****
Understanding the ways the ACA has affected Americans’ health is a work in progress. In the law’s first years, results were mixed, but signs of improvements have accelerated lately, as people uninsured before now have more years of coverage, giving researchers better data to study.
It is too soon to know whether the patterns might reverse with new U.S. Census Bureau data showing that the uninsured rate rose significantly last year for the first time since the ACA has existed.
The findings that exist are not perfect. One National Bureau of Economic Research paper in July, looking at deaths from all causes among adults from their mid-50s to mid-60s, found that dying in a given year has been significantly less common in the states that expanded Medicaid. The paper said that perhaps 15,600 deaths could have been avoided if the expansion had been nationwide, but it cautioned that is a rough estimate in part because the study was unable to look specifically at the people who signed up for Medicaid.
Similarly, a study last year found that infant deaths — especially among black babies — were dropping more rapidly in parts of the country that had expanded Medicaid. But the study does not distinguish families that got coverage through the ACA expansions.
The University of Michigan work, including on trends in hospital stays for four main chronic diseases, was able to focus specifically on people who had joined Healthy Michigan. It found that from the first year in the program to the second, hospital stays for asthma plummeted by half and also fell for diabetes complications. But hospital stays for heart failure became more common. The researchers have not yet looked at the patterns for additional years.
Still, John Ayanian, director of the University of Michigan’s Institute for Healthcare Policy and Innovation, said, “the weight of evidence is on the positive side.”


pecunia

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Re: What comes after the ACA?
« Reply #5784 on: October 31, 2019, 04:55:24 PM »
Good article - The thing that impressed me was how much good the example people did for themselves by diet and exercise, not pills.  Is it true that an ounce of prevention is worth a lb of cure?

Paul der Krake

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Re: What comes after the ACA?
« Reply #5785 on: November 01, 2019, 12:41:26 PM »
Anyone else having issues with healthcare.gov on this beautiful open enrollment morning?

bacchi

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Re: What comes after the ACA?
« Reply #5786 on: November 01, 2019, 02:42:57 PM »
Anyone else having issues with healthcare.gov on this beautiful open enrollment morning?

Yeah. Seeing an error page,

"The System is down at the moment."

seattlecyclone

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Re: What comes after the ACA?
« Reply #5787 on: November 01, 2019, 03:40:36 PM »
The Washington state exchange seems to be working pretty well at the moment.

geekette

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Re: What comes after the ACA?
« Reply #5788 on: November 01, 2019, 05:14:22 PM »
Seems to be working at this time (in NC).

Annoying glitch.  Healthcare.gov shows all doctors I search for as out of network, but when click the link to the provider network, they're all there.  It's a new plan that doesn't start until 1/1/20, so they aren't in network until...1/1/20.
« Last Edit: November 01, 2019, 05:19:54 PM by geekette »

Exflyboy

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Re: What comes after the ACA?
« Reply #5789 on: November 01, 2019, 07:18:08 PM »
Seems to be working at this time (in NC).

Annoying glitch.  Healthcare.gov shows all doctors I search for as out of network, but when click the link to the provider network, they're all there.  It's a new plan that doesn't start until 1/1/20, so they aren't in network until...1/1/20.

Yeah same here.. I actually called the insurance company and made sure my doc was going to be part of their plan for 2020, even though they were shown for 2019, HC.gov still did not show them as being covered.
« Last Edit: November 01, 2019, 07:22:28 PM by Exflyboy »

Exflyboy

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Re: What comes after the ACA?
« Reply #5790 on: November 01, 2019, 07:26:48 PM »
I got all the way to the end of my application to select my plan.. Then hit submit and the little waiting icon just kept going and going.

After n hour I hit screen refresh and it all disappeared!

So have I applied or not? I went back in and it listed the plan I selected for 2020 and it said it was "active".

Of course you don't get any receipt sent by email so you're never really sure!

pecunia

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Re: What comes after the ACA?
« Reply #5791 on: November 02, 2019, 01:23:43 PM »
I have plans to quit at the end of this year or early next year.  Will the ACA consider that a "life change?"  Seems to me I had no trouble signing up a few years ago when I was without work a month or two.  However, then I had to pay them back because my income went back up.

Exflyboy

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Re: What comes after the ACA?
« Reply #5792 on: November 02, 2019, 01:32:40 PM »
I have plans to quit at the end of this year or early next year.  Will the ACA consider that a "life change?"  Seems to me I had no trouble signing up a few years ago when I was without work a month or two.  However, then I had to pay them back because my income went back up.

Yes.. that is a life change no matter how you "lose" your job and qualifies for a "special Enrollment".

jim555

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Re: What comes after the ACA?
« Reply #5793 on: November 06, 2019, 05:04:33 AM »
Good news, Kentucky will have a Democratic Governor, he will stop the press for Medicaid work requirements.  The courts have been litigating the issue since the law has no such requirements.

Paul der Krake

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Re: What comes after the ACA?
« Reply #5794 on: November 06, 2019, 08:06:00 AM »
Fascinating Bloomberg story about UHC operating transitional housing for their "worst" Medicaid patients.

https://www.bloomberg.com/news/features/2019-11-05/unitedhealth-s-myconnections-houses-the-homeless-through-medicaid

I wish there was more data available about the clear abuse of ERs by a very tiny minority. Maybe something that can be improved legislatively to prevent frequent fliers from getting $300 sandwiches.