Author Topic: What comes after the ACA?  (Read 1675871 times)

Paul der Krake

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Re: What comes after the ACA?
« Reply #6050 on: July 16, 2020, 11:10:02 PM »
Politics is driven in large part by gut, not rational thought. And deep down, we are all hardwired to distrust people who are too different from us.

If you're a poor American, you might as well be a different species. The American upper middle class has more in common with their international counterparts that live thousands of miles away than with the residents of the low-income neighborhood across the railroad tracks. Sure we come up with explanations like "incentive to work" and "fiscal sustainability", but it's much more primal than this.

pecunia

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Re: What comes after the ACA?
« Reply #6051 on: July 17, 2020, 06:05:21 AM »
I can see no reason as to why you are not correct.  I'd guess most of them will take their dogs to the vet when they are ill.

"Let me tell you about the very rich. They are different from you and me. They possess and enjoy early, and it does something to them, makes them soft, where we are hard, cynical where we are trustful, in a way that, unless you were born rich, it is very difficult to understand." - F. Scott Fitzgerald

talltexan

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Re: What comes after the ACA?
« Reply #6052 on: July 17, 2020, 07:21:14 AM »
I just don't get why they are so opposed to poor folks being able to go to the doctor.  Won't it help the rich people in this country to have a healthy work force to help make money for them?  Seems like a worthwhile investment and rich people have hired a lot of smart people to do their thinking for them.  How come the rich haven't told the GOP to back off a bit?  I mean, Trump is one of their own, a little crazy, but still one of their own.  He was born with a silver spoon in his mouth.

I can sort of understand the race thing.  They don't want healthy minorities, but doesn't the increase of riches even supersede this interest?  There is more money to be made from having people be healthy rather than sick.  Look how much money was made in the cotton fields 150 years ago.  History repeats itself, man.

Maybe, I should write a letter to the Koch brothers and their buds.  They are getting bad advice.

Part of it is that ACA was basically a heritage foundation plan, with many details worked out by MIT economics professors (who used to be pretty dang conservative Pre-Trump); these were the same MIT professors who'd helped Gov. Romney with the Massachusetts plan. Part of the indignity was that Obama essentially stole the clothes of conservatives to get it done because no more liberal plan could have passed Congress even with 59 Democrats in the Senate. So he left almost no way for a productive backlash to happen. The surest sign of this was in the structure of the American Health Care Act passed in 2017, which basically accepted the logic of Obamacare in having almost the same structure.

sherr

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Re: What comes after the ACA?
« Reply #6053 on: July 17, 2020, 07:31:57 AM »
Part of it is that ACA was basically a heritage foundation plan, with many details worked out by MIT economics professors (who used to be pretty dang conservative Pre-Trump); these were the same MIT professors who'd helped Gov. Romney with the Massachusetts plan. Part of the indignity was that Obama essentially stole the clothes of conservatives to get it done because no more liberal plan could have passed Congress even with 59 Democrats in the Senate. So he left almost no way for a productive backlash to happen. The surest sign of this was in the structure of the American Health Care Act passed in 2017, which basically accepted the logic of Obamacare in having almost the same structure.

Democrats passing a largely conservative healthcare reform = "the unreasonability of the backlash is Obama's fault because he left no path for reasonable backlash".

This is not even close to the first time you've used similar logic to blame Democrats for Republican's failings. I know you're no fan of Trump, but this seems to be a pretty obvious bias. Aren't Republicans supposed to be the party of personal responsibility? Why does that not extend to them taking responsibility for their own actions?

talltexan

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Re: What comes after the ACA?
« Reply #6054 on: July 17, 2020, 08:35:32 AM »
@sherr, thanks for responding: I've seen enough of your posts to know that you are thoughtful, so I will attempt to be sincere here, when I often fall short of that standard. Maybe "blaming" isn't the impression I want to give. Rather that there isn't a productive policy direction conservatives can go, so they just angrily grabbed the steering wheel of the country away from Democrats.

I think the ACA was reasonable, as it was a way to make some progress at all, when many Democrats still had a bitter taste from the failure of reform in 1993-1994 (and even though that reform failed, they lost the House for twelve years). Obama pragmatically opted for that over a symbolic push for M4All, which Liebermann made clear he would block. He should not be held responsible for Boehner witholding republican votes at the last minute.

sherr

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Re: What comes after the ACA?
« Reply #6055 on: July 17, 2020, 09:29:13 AM »
@sherr, thanks for responding: I've seen enough of your posts to know that you are thoughtful, so I will attempt to be sincere here, when I often fall short of that standard. Maybe "blaming" isn't the impression I want to give. Rather that there isn't a productive policy direction conservatives can go, so they just angrily grabbed the steering wheel of the country away from Democrats.

I think the ACA was reasonable, as it was a way to make some progress at all, when many Democrats still had a bitter taste from the failure of reform in 1993-1994 (and even though that reform failed, they lost the House for twelve years). Obama pragmatically opted for that over a symbolic push for M4All, which Liebermann made clear he would block. He should not be held responsible for Boehner witholding republican votes at the last minute.

Yes there is. They could have been happy that they got what they wanted out of health care reform, and moved on to other issues and/or worked to improve the ACA as problems arose. You know, like you yourself sound like you want.

I agree with you on everything else, that the ACA was reasonable, that nothing closer to M4All could have passed at the time, etc. And I also think that you are a pretty thoughtful poster.

My point though is that the right assumes that Republicans always have to "yank the steering wheel to the right" on every issue. Which is not true. And when they do, and we find ourselves in crazyland as a result, a right-leaning tendency is to assign blame to both sides - to the Republicans for getting us here, but also to the Democrats for not giving them "space" to "correct" things to without ending up in crazyland. That it's really the Democrat's fault because they're too reasonable and too centrist that they've allowed the knee-jerk-to-the-right Republican party to shift the Overton window too much.

It's the Republican party's fault that the Overton Window is this far right, no one else's. It's the Republican party's fault that they "had" to make the ACA a partisan issue and obstruct-everything for 8 years and steal a Supreme Court appointee from Obama. And that's been an effective strategy, I'm not denying that. But the blame for the Republican's unreasonable reaction to the ACA lies solely on the Republican party, not on the Democrats for being "too centrist". If the Democrats propose a reasonable compromise (like the ACA) then the Republicans should join them and work with them, and if they don't they have no one but themselves to blame.

talltexan

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Re: What comes after the ACA?
« Reply #6056 on: July 17, 2020, 09:35:51 AM »
Indeed the Republicans don't work with the Democrats because they see their mission as preventing change. No progress is what they're trying to maintain. As long as reform is thwarted, they feel like they've served their voters.

And as long as they maintain power, there's not even that much danger of progress. So Republicans have successfully created a culture where they can properly weaponize fear of that progress to maintain their own power.

rmorris50

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Re: What comes after the ACA?
« Reply #6057 on: July 17, 2020, 05:01:42 PM »
How many people work just for the health benefits, and how many people would stop working/retire if there was universal healthcare. I have no idea, but I wonder if that's the dirty little secret that never gets talked about. Republicans feel people have all the more incentive to work if families' healthcare depends on it, and thus keep the economic engine going.


sherr

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Re: What comes after the ACA?
« Reply #6058 on: July 17, 2020, 07:30:22 PM »
How many people work just for the health benefits, and how many people would stop working/retire if there was universal healthcare. I have no idea, but I wonder if that's the dirty little secret that never gets talked about. Republicans feel people have all the more incentive to work if families' healthcare depends on it, and thus keep the economic engine going.

I don't know if anyone has statistics, but I think there's a ton of boomers who are in that situation right now actually. And probably me as well.

pecunia

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Re: What comes after the ACA?
« Reply #6059 on: July 17, 2020, 10:06:53 PM »
How many people work just for the health benefits, and how many people would stop working/retire if there was universal healthcare. I have no idea, but I wonder if that's the dirty little secret that never gets talked about. Republicans feel people have all the more incentive to work if families' healthcare depends on it, and thus keep the economic engine going.

I don't know if anyone has statistics, but I think there's a ton of boomers who are in that situation right now actually. And probably me as well.

I was doing it until quite recently and have known other for whom this situation was their reality.

How many businesses are not being started because people are hampered by this health care thing?  How many good ideas are stifled?  If someone could put cash aside and freely take six months or a year off to pursue some sort of new gadget, well, we'd have that new gadget.  Man, we could have the flux capacitor!

How many existing businesses are not doing as well as they could be doing because you've got people whose heart and soul are not in their vocation, but only plod along day after day to maintain their healthcare?

The GOP has always claimed to be the party of business.  They should get behind some sort of universal healthcare thing to stay aligned with their core values.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #6060 on: July 18, 2020, 06:14:28 AM »
How many people work just for the health benefits, and how many people would stop working/retire if there was universal healthcare. I have no idea, but I wonder if that's the dirty little secret that never gets talked about. Republicans feel people have all the more incentive to work if families' healthcare depends on it, and thus keep the economic engine going.
I don't think it's logical to think of healthcare as unique here.  Or, put another way, "How many people just work so they can put food on the table," or "How many people work just so they can have a place to live?...Republicans feel people have all the more incentive to work if their housing depends on it...."  Healthcare costs money.  Of course more people will retire if you make it cheaper by making workers pay for it!

Having health insurance tied to employment is certainly an obstacle to be overcome, though.  Employers don't typically pay for their employees' mortgages (or a portion thereof), or pay for their groceries.

American GenX

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Re: What comes after the ACA?
« Reply #6061 on: July 18, 2020, 07:25:37 AM »
I was going to FIRE in the spring of 2019.  I put that off a year at first and now until at least the spring of 2021 due to the ruling by the federal judge in Texas back in Dec 2018 and continued uncertainty as the case plays out and is to be heard by SCOTUS.

But I would never state that I'm working just for health care benefits.  If I wasn't getting paid as well, I would quit.

pecunia

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Re: What comes after the ACA?
« Reply #6062 on: July 18, 2020, 07:57:20 AM »
How many people work just for the health benefits, and how many people would stop working/retire if there was universal healthcare. I have no idea, but I wonder if that's the dirty little secret that never gets talked about. Republicans feel people have all the more incentive to work if families' healthcare depends on it, and thus keep the economic engine going.
I don't think it's logical to think of healthcare as unique here.  Or, put another way, "How many people just work so they can put food on the table," or "How many people work just so they can have a place to live?...Republicans feel people have all the more incentive to work if their housing depends on it...."  Healthcare costs money.  Of course more people will retire if you make it cheaper by making workers pay for it!

Having health insurance tied to employment is certainly an obstacle to be overcome, though.  Employers don't typically pay for their employees' mortgages (or a portion thereof), or pay for their groceries.

Mr nonunion hardhat I just don't think it is the same.  You can save to cover the food.  You can save to cover the housing.  However, healthcare costs can destroy your life.  It is true ruination both physically and financially.  I am sure you already know this.  Bucky, it just ain't the same.

It is a unique thing.  I guess if it wasn't people wouldn't be all stirred up about it.  I don't see people getting stirred up about free food or housing. 

Paul der Krake

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Re: What comes after the ACA?
« Reply #6063 on: July 18, 2020, 09:08:16 AM »
Meh, if that were true, you'd see a much higher labor participation rate than in the rest of developed countries that do have universal coverage. But that's not the case.

rmorris50

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Re: What comes after the ACA?
« Reply #6064 on: July 18, 2020, 09:46:28 AM »
How many people work just for the health benefits, and how many people would stop working/retire if there was universal healthcare. I have no idea, but I wonder if that's the dirty little secret that never gets talked about. Republicans feel people have all the more incentive to work if families' healthcare depends on it, and thus keep the economic engine going.
I don't think it's logical to think of healthcare as unique here.  Or, put another way, "How many people just work so they can put food on the table," or "How many people work just so they can have a place to live?...Republicans feel people have all the more incentive to work if their housing depends on it...."  Healthcare costs money.  Of course more people will retire if you make it cheaper by making workers pay for it!

Having health insurance tied to employment is certainly an obstacle to be overcome, though.  Employers don't typically pay for their employees' mortgages (or a portion thereof), or pay for their groceries.

Mr nonunion hardhat I just don't think it is the same.  You can save to cover the food.  You can save to cover the housing.  However, healthcare costs can destroy your life.  It is true ruination both physically and financially.  I am sure you already know this.  Bucky, it just ain't the same.

It is a unique thing.  I guess if it wasn't people wouldn't be all stirred up about it.  I don't see people getting stirred up about free food or housing.

Agreed. Another difference is the cost of health insurance can be substantially cheaper from an employer vs the individual market. Food and housing costs the same whether you're employed or not.

John Galt incarnate!

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Re: What comes after the ACA?
« Reply #6065 on: July 18, 2020, 10:22:15 AM »


It is a unique thing.  I guess if it wasn't people wouldn't be all stirred up about it. 

That's the reason this  thread has 1,343,156 views.

People fear the unknown of the upper limit of the range of future healthcare costs.

« Last Edit: July 18, 2020, 10:41:09 AM by John Galt incarnate! »

zolotiyeruki

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Re: What comes after the ACA?
« Reply #6066 on: July 18, 2020, 11:11:03 AM »
How many people work just for the health benefits, and how many people would stop working/retire if there was universal healthcare. I have no idea, but I wonder if that's the dirty little secret that never gets talked about. Republicans feel people have all the more incentive to work if families' healthcare depends on it, and thus keep the economic engine going.
I don't think it's logical to think of healthcare as unique here.  Or, put another way, "How many people just work so they can put food on the table," or "How many people work just so they can have a place to live?...Republicans feel people have all the more incentive to work if their housing depends on it...."  Healthcare costs money.  Of course more people will retire if you make it cheaper by making workers pay for it!

Having health insurance tied to employment is certainly an obstacle to be overcome, though.  Employers don't typically pay for their employees' mortgages (or a portion thereof), or pay for their groceries.

Mr nonunion hardhat I just don't think it is the same.  You can save to cover the food.  You can save to cover the housing.  However, healthcare costs can destroy your life.  It is true ruination both physically and financially.  I am sure you already know this.  Bucky, it just ain't the same.

It is a unique thing.  I guess if it wasn't people wouldn't be all stirred up about it.  I don't see people getting stirred up about free food or housing.
There's a distinction here that I didn't explicitly point out, that you're missing.  I'm talking about health insurance, not healthcare.  Employers sponsor health insurance, which costs a usually-predictable amount each month, similar to housing and food costs.

Agreed. Another difference is the cost of health insurance can be substantially cheaper from an employer vs the individual market. Food and housing costs the same whether you're employed or not.
That's true, in large part because in the individual market, you're evaluated on your individual risk profile.  And part of the issue with insurance is that some risk factors are things you can control (smoking, weight, etc), and others you can't (family history, accidents, etc).

seattlecyclone

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Re: What comes after the ACA?
« Reply #6067 on: July 18, 2020, 11:32:40 AM »
I think if people learned more about the ACA and trusted that it, or something better, would exist until they become eligible for Medicare, they wouldn't be so afraid of leaving their employer health insurance behind.

That said, health insurance isn't quite the same as food or other necessities that people buy with their paychecks. Employers buy the insurance for their employees, usually at a very significant discount, and often a better quality than is available through the ACA exchanges.

I know the employer-based coverage I left last year had a lower deductible than all but a few of the gold plans on my local exchange, a lower out-of-pocket maximum than any of them, and there were no premiums for employee-only coverage. If those were the only material differences, all you need to do is save up some cash and the ACA will work fine for you. Health insurance is expensive and people who are used to heavily subsidized coverage from their employers often don't realize how expensive it is, but saving up for it on your own is possible even if you have a spendypants retirement with no premium subsidies.

There is one more wrinkle though. The coverage I had through my former employer would pay for routine care across the US. None of the ACA plans available in my area will do that. They all have networks narrowly confined to within the state of Washington and some have little to no coverage outside the Seattle metro area. They'll all pay for "emergency" care anywhere because the ACA makes them, but you can expect them to try and argue against anything borderline being an "emergency" at all. Of the six companies offering coverage in my area, only one (Kaiser Permanente) will even cover urgent care out of network. None of the companies covers non-urgent visits. That's not a big deal for me and my healthy family, but could be a major source of concern if you have a condition that requires occasional routine services and you want to do any sort of extended travel ever.

Bringing it back to the food analogy, it's not just that your employer is giving you a discount on fancy meals, it's that the meals they're giving you aren't available at any price if you go it alone. Whether the less-fancy stuff will provide adequate nourishment depends a lot on the individual.

jim555

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Re: What comes after the ACA?
« Reply #6068 on: August 03, 2020, 08:27:29 AM »
Missouri will vote on Medicaid expansion through a ballot measure tomorrow.

pecunia

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Re: What comes after the ACA?
« Reply #6069 on: August 03, 2020, 09:41:10 AM »

jim555

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Re: What comes after the ACA?
« Reply #6070 on: August 05, 2020, 06:54:58 AM »

Exflyboy

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Re: What comes after the ACA?
« Reply #6071 on: August 05, 2020, 08:02:41 AM »
It seems the desire for a healthcare system that works for more than just the one percenters is gaining traction in the USA.

I remain hopeful.

Shane

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Re: What comes after the ACA?
« Reply #6072 on: August 05, 2020, 08:43:47 PM »

rantk81

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Re: What comes after the ACA?
« Reply #6073 on: August 08, 2020, 07:17:35 AM »
I think if people learned more about the ACA and trusted that it, or something better, would exist until they become eligible for Medicare, they wouldn't be so afraid of leaving their employer health insurance behind.

That said, health insurance isn't quite the same as food or other necessities that people buy with their paychecks. Employers buy the insurance for their employees, usually at a very significant discount, and often a better quality than is available through the ACA exchanges.

I know the employer-based coverage I left last year had a lower deductible than all but a few of the gold plans on my local exchange, a lower out-of-pocket maximum than any of them, and there were no premiums for employee-only coverage. If those were the only material differences, all you need to do is save up some cash and the ACA will work fine for you. Health insurance is expensive and people who are used to heavily subsidized coverage from their employers often don't realize how expensive it is, but saving up for it on your own is possible even if you have a spendypants retirement with no premium subsidies.

There is one more wrinkle though. The coverage I had through my former employer would pay for routine care across the US. None of the ACA plans available in my area will do that. They all have networks narrowly confined to within the state of Washington and some have little to no coverage outside the Seattle metro area. They'll all pay for "emergency" care anywhere because the ACA makes them, but you can expect them to try and argue against anything borderline being an "emergency" at all. Of the six companies offering coverage in my area, only one (Kaiser Permanente) will even cover urgent care out of network. None of the companies covers non-urgent visits. That's not a big deal for me and my healthy family, but could be a major source of concern if you have a condition that requires occasional routine services and you want to do any sort of extended travel ever.

Bringing it back to the food analogy, it's not just that your employer is giving you a discount on fancy meals, it's that the meals they're giving you aren't available at any price if you go it alone. Whether the less-fancy stuff will provide adequate nourishment depends a lot on the individual.

This is 100% Truth in my experience.

In my "health care market/locale", the plans on the ACA exchange pretty much only include services by the same doctors and facilities that are also associated with the "County" health care system.  That "County" system basically provides care to anyone, regardless of their ability to pay anyway.  They send bills for services, but for uninsured self-payers, they essentially don't aggressively pursue nor expect to receive payment.  Seems like it might be a sucker's game to actually pay for one of those ACA insurance plans.

And yes, of course, none of the plans on the ACA exchange my zip code include access to any providers outside of the hyper-local geographic area.

In terms of employer plans, I've had a wide range of doctor networks, spanning from Open Access plans that seem to include every single doctor that I've ever bothered to look up.  Or other employer plans with a very restrictive local network of doctors within 1 or 2 "Medical Group Systems" in the area.  But in each case, the plans have always included at least one "option" for a medical group that is associated with one of the major medical research universities in the area.  Those choices are just not available at all on any plan that are on the ACA Exchange.

Even though my family is generally healthy, I know that may not always be the case.  It's a big part of the reason why I still continue to work for an employer with a group medical plan.
« Last Edit: August 08, 2020, 07:21:13 AM by rantk81 »

Roadrunner53

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Re: What comes after the ACA?
« Reply #6074 on: August 08, 2020, 12:08:04 PM »
What happened to Trumps claim he was going to create a better plan and cost less? Lies, lies, lies...


Exflyboy

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Re: What comes after the ACA?
« Reply #6075 on: August 08, 2020, 01:13:11 PM »
What happened to Trumps claim he was going to create a better plan and cost less? Lies, lies, lies...

Apparently goldfish have 3 second memories.. About the same as the average voter in my estimation.

So you're WAY above average and I'm sure will vote accordingly..:)

Roadrunner53

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Re: What comes after the ACA?
« Reply #6076 on: August 08, 2020, 02:52:41 PM »
Yes, Exflyboy, I will vote accordingly and I am sure you can imagine who that might be.

So many lies during this Presidency. He can't even come up with enough good lies now to tell us what he fake proposes for the next 4 years. He can't say the economy is good, the stock market goes up and down every day, massive unemployment, Covid-19 that he did nothing about and all the deaths. He is beating up Biden as hating God now! I don't want to hear that crap! I want to know what you are going to do for the American people. He surely did nothing good the first 4 years.

I was on ACA and moved onto Medicare but I was concerned while on it if it was going to get ripped away. The system is in place and it is a no brainer to fix it, improve it, work on it, mold it. I am not saying there aren't problems with it but people need it and it sure wasn't that affordable in my opinion. However, the Medicare choices I chose are MORE expensive than ACA. So get ready for that ride when you get on it. Medicare is one of those things that you get what you pay for. The more you pay the more you get, the less you pay the less you get.

jim555

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Re: What comes after the ACA?
« Reply #6077 on: August 08, 2020, 03:06:06 PM »
His big executive order is to declare insurance companies can't consider pre-existing conditions.  The ACA ALREADY does this.  He is pressing the Supreme Court to have the ACA overturned at the same time he is trying to look like he will do good things for healthcare.  Typical.

Then he is suspending the payroll tax to destroy Social Security funding by Executive Order.  Totally illegal, this will be stopped in the courts.
« Last Edit: August 08, 2020, 03:15:05 PM by jim555 »

Monkey Uncle

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Re: What comes after the ACA?
« Reply #6078 on: August 08, 2020, 05:59:08 PM »
I think if people learned more about the ACA and trusted that it, or something better, would exist until they become eligible for Medicare, they wouldn't be so afraid of leaving their employer health insurance behind.

That said, health insurance isn't quite the same as food or other necessities that people buy with their paychecks. Employers buy the insurance for their employees, usually at a very significant discount, and often a better quality than is available through the ACA exchanges.

I know the employer-based coverage I left last year had a lower deductible than all but a few of the gold plans on my local exchange, a lower out-of-pocket maximum than any of them, and there were no premiums for employee-only coverage. If those were the only material differences, all you need to do is save up some cash and the ACA will work fine for you. Health insurance is expensive and people who are used to heavily subsidized coverage from their employers often don't realize how expensive it is, but saving up for it on your own is possible even if you have a spendypants retirement with no premium subsidies.

There is one more wrinkle though. The coverage I had through my former employer would pay for routine care across the US. None of the ACA plans available in my area will do that. They all have networks narrowly confined to within the state of Washington and some have little to no coverage outside the Seattle metro area. They'll all pay for "emergency" care anywhere because the ACA makes them, but you can expect them to try and argue against anything borderline being an "emergency" at all. Of the six companies offering coverage in my area, only one (Kaiser Permanente) will even cover urgent care out of network. None of the companies covers non-urgent visits. That's not a big deal for me and my healthy family, but could be a major source of concern if you have a condition that requires occasional routine services and you want to do any sort of extended travel ever.

Bringing it back to the food analogy, it's not just that your employer is giving you a discount on fancy meals, it's that the meals they're giving you aren't available at any price if you go it alone. Whether the less-fancy stuff will provide adequate nourishment depends a lot on the individual.

This is 100% Truth in my experience.

In my "health care market/locale", the plans on the ACA exchange pretty much only include services by the same doctors and facilities that are also associated with the "County" health care system.  That "County" system basically provides care to anyone, regardless of their ability to pay anyway.  They send bills for services, but for uninsured self-payers, they essentially don't aggressively pursue nor expect to receive payment.  Seems like it might be a sucker's game to actually pay for one of those ACA insurance plans.

And yes, of course, none of the plans on the ACA exchange my zip code include access to any providers outside of the hyper-local geographic area.

In terms of employer plans, I've had a wide range of doctor networks, spanning from Open Access plans that seem to include every single doctor that I've ever bothered to look up.  Or other employer plans with a very restrictive local network of doctors within 1 or 2 "Medical Group Systems" in the area.  But in each case, the plans have always included at least one "option" for a medical group that is associated with one of the major medical research universities in the area.  Those choices are just not available at all on any plan that are on the ACA Exchange.

Even though my family is generally healthy, I know that may not always be the case.  It's a big part of the reason why I still continue to work for an employer with a group medical plan.

After hearing a number of stories like this, I can't believe how lucky I got with the ACA.  I'm on a BCBS silver plan that is as good or better than the employer-provided insurance that I had when I worked for Uncle Sam (in terms of out of pocket amounts).  It includes essentially all providers in the state, and most providers in nearby areas of neighboring states.  It covers me nationwide when I travel, as long as the provider accepts their local BCBS plan.  And I live in the middle of bumfuck nowhere.  If everyone had access to ACA plans like this, employer-provided insurance would be a thing of the past.

pecunia

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Re: What comes after the ACA?
« Reply #6079 on: August 08, 2020, 09:46:02 PM »
Everyone needs electricity.  Everyone needs water.  Everyone needs sanitation.  These are either regulated to keep costs fair of municipally provided which also keeps costs down.

Everyone needs healthcare.  Maybe it's time to throw sensible regulations on this industry in the interests of keeping costs down and basic quality for the consumer.   Alternatively, it could be government provided.  Some of you will tell me that they are doing that now.  However, I've learned that I cannot believe everything I read on the internet.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #6080 on: August 09, 2020, 05:22:01 AM »
Everyone needs electricity.  Everyone needs water.  Everyone needs sanitation.  These are either regulated to keep costs fair of municipally provided which also keeps costs down.

Everyone needs healthcare.  Maybe it's time to throw sensible regulations on this industry in the interests of keeping costs down and basic quality for the consumer.   Alternatively, it could be government provided.  Some of you will tell me that they are doing that now.  However, I've learned that I cannot believe everything I read on the internet.

I've often had the same thought. 

The government is providing paying for health care to a large number of people already through medicare, tricare, public employees, and the ACA exchanges.  The missing part is regulation of prices.

American GenX

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Re: What comes after the ACA?
« Reply #6081 on: August 09, 2020, 10:22:56 AM »
After hearing a number of stories like this, I can't believe how lucky I got with the ACA.  I'm on a BCBS silver plan that is as good or better than the employer-provided insurance that I had when I worked for Uncle Sam (in terms of out of pocket amounts).  It includes essentially all providers in the state, and most providers in nearby areas of neighboring states.  It covers me nationwide when I travel, as long as the provider accepts their local BCBS plan.  And I live in the middle of bumfuck nowhere.  If everyone had access to ACA plans like this, employer-provided insurance would be a thing of the past.

This sounds like the BCBS plan I have through my employer.  But my employer subsidizes it, so it's another perk and attraction for me to work there.   So, I don't see how having direct access to ACA plans being like that would eliminate employers wanting to provide better benefits to their employees including covering more of their health insurance costs.  After a big premium increase this year, I'm still paying only about $60 per paycheck on premiums now with a low deductible in-network.  It would be FAR more if I was paying for the whole premium out of pocket.

American GenX

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Re: What comes after the ACA?
« Reply #6082 on: August 09, 2020, 10:29:32 AM »
Everyone needs electricity.  Everyone needs water.  Everyone needs sanitation.  These are either regulated to keep costs fair of municipally provided which also keeps costs down.
They seems to keep going up a lot for me.  With my electrical bill, I have to pay $50 before I even use my first Kwh.

Quote
Everyone needs healthcare.  Maybe it's time to throw sensible regulations on this industry in the interests of keeping costs down and basic quality for the consumer.

Hundreds of health facilities have gone out of business in recent years and many more are teetering on collapse.   Medicare and Medicaid already underpay them, and many people don't pay their bills.  Forcing them to cut costs further while increasing regulation will only drive hundreds more out of business.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #6083 on: August 09, 2020, 12:26:52 PM »
After hearing a number of stories like this, I can't believe how lucky I got with the ACA.  I'm on a BCBS silver plan that is as good or better than the employer-provided insurance that I had when I worked for Uncle Sam (in terms of out of pocket amounts).  It includes essentially all providers in the state, and most providers in nearby areas of neighboring states.  It covers me nationwide when I travel, as long as the provider accepts their local BCBS plan.  And I live in the middle of bumfuck nowhere.  If everyone had access to ACA plans like this, employer-provided insurance would be a thing of the past.

This sounds like the BCBS plan I have through my employer.  But my employer subsidizes it, so it's another perk and attraction for me to work there.   So, I don't see how having direct access to ACA plans being like that would eliminate employers wanting to provide better benefits to their employees including covering more of their health insurance costs.  After a big premium increase this year, I'm still paying only about $60 per paycheck on premiums now with a low deductible in-network.  It would be FAR more if I was paying for the whole premium out of pocket.

As it stands now, it's true that anyone making a middle class income or higher isn't eligible for a premium tax credit and would have to pay through the nose for ACA insurance.  Also, anyone who has access to employer-provided insurance can't get the ACA premium tax credit, regardless of how low their income is.  But if that were to change, people would have an incentive to comparison shop ACA vs. employer-provided insurance.  Joe Biden has proposed expanding PTC eligibility and allowing people with employer-sponsored insurance to shop the "public option" plan.  I guess we'll see if (1) he gets elected, and (2) if he can get such a plan passed by Congress. 

Also, it may or may not be the case that your employer "wants" to provide health insurance.  Right now the ACA requires companies that employ 50 or more full-time employees to provide health insurance.  That's one of the parts of the ACA that I think is counterproductive and should be changed.  Let employers off the hook, which should greatly expand the pool of people using ACA insurance, and in turn lead to a wider variety of offerings at better prices.  Also, if your employer wasn't paying through the nose for your health insurance, they could probably afford to pay you more, which might take some of the sting out of an increased premium.

pecunia

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Re: What comes after the ACA?
« Reply #6084 on: August 09, 2020, 08:59:31 PM »
Everyone needs electricity.  Everyone needs water.  Everyone needs sanitation.  These are either regulated to keep costs fair of municipally provided which also keeps costs down.
They seems to keep going up a lot for me.  With my electrical bill, I have to pay $50 before I even use my first Kwh.

Quote
Everyone needs healthcare.  Maybe it's time to throw sensible regulations on this industry in the interests of keeping costs down and basic quality for the consumer.

Hundreds of health facilities have gone out of business in recent years and many more are teetering on collapse.   Medicare and Medicaid already underpay them, and many people don't pay their bills.  Forcing them to cut costs further while increasing regulation will only drive hundreds more out of business.

Sounds like you have a raw deal on electricity.  I only have bills in excess of $50 in the Winter when the furnace fan runs.

With what they charge for medicine for even basic stuff these days, they ought to be able to make a go at it.  I guess if they go out of business that is OK.  It is a necessary service and there is certainly a demand.  Maybe market forces will work in some strange way and the ones that go out of business will be replaced by more efficient or less greedy folks.  That's the way right wingers say it ought to work.  The benefits of them going out of business and further consolidation of what's left will increase marketplace efficiencies and the net result will be a trickling down in costs that benefits consumers.

Right.

I wonder if it would be legal for the nurses unions to take over the facilities that are failing.  That sort of thing could be a win win for the workers and the customers.  Karl Marx would have liked it.

Just glad I'm not sick.

American GenX

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Re: What comes after the ACA?
« Reply #6085 on: August 10, 2020, 11:26:59 AM »
But if that were to change, people would have an incentive to comparison shop ACA vs. employer-provided insurance.  Joe Biden has proposed expanding PTC eligibility and allowing people with employer-sponsored insurance to shop the "public option" plan.  I guess we'll see if (1) he gets elected, and (2) if he can get such a plan passed by Congress. 

Yes, if we start adding "other changes" to the mix, that changes the equation vs. just having access without a PCT.  I certainly wouldn't qualify for PCT with my income with today's rate.

Quote
Also, it may or may not be the case that your employer "wants" to provide health insurance.  Right now the ACA requires companies that employ 50 or more full-time employees to provide health insurance.

My various employers had health care insurance benefits many years before the ACA.

Quote
Also, if your employer wasn't paying through the nose for your health insurance, they could probably afford to pay you more, which might take some of the sting out of an increased premium.

Yes, they could afford to pay more, but I suspect that for most people, the additional cost would be passed on to the employee while the employer pockets most or all of the savings in the short term, with perhaps a gradual shift up in wages over time in order to attract talent.

American GenX

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Re: What comes after the ACA?
« Reply #6086 on: August 10, 2020, 11:43:33 AM »
Everyone needs electricity.  Everyone needs water.  Everyone needs sanitation.  These are either regulated to keep costs fair of municipally provided which also keeps costs down.
They seems to keep going up a lot for me.  With my electrical bill, I have to pay $50 before I even use my first Kwh.

Quote
Everyone needs healthcare.  Maybe it's time to throw sensible regulations on this industry in the interests of keeping costs down and basic quality for the consumer.

Hundreds of health facilities have gone out of business in recent years and many more are teetering on collapse.   Medicare and Medicaid already underpay them, and many people don't pay their bills.  Forcing them to cut costs further while increasing regulation will only drive hundreds more out of business.

Sounds like you have a raw deal on electricity.  I only have bills in excess of $50 in the Winter when the furnace fan runs.

With what they charge for medicine for even basic stuff these days, they ought to be able to make a go at it.  I guess if they go out of business that is OK.  It is a necessary service and there is certainly a demand.  Maybe market forces will work in some strange way and the ones that go out of business will be replaced by more efficient or less greedy folks.  That's the way right wingers say it ought to work.  The benefits of them going out of business and further consolidation of what's left will increase marketplace efficiencies and the net result will be a trickling down in costs that benefits consumers.

I'm not seeing much if anything fill the void.  Read up on "medical deserts".

seattlecyclone

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Re: What comes after the ACA?
« Reply #6087 on: August 10, 2020, 09:12:41 PM »
Quote
Also, it may or may not be the case that your employer "wants" to provide health insurance.  Right now the ACA requires companies that employ 50 or more full-time employees to provide health insurance.

My various employers had health care insurance benefits many years before the ACA.

Yes, the tax code gave them every incentive to do that. If they give you $5,000 cash you would be taxed on it and have less than $5,000 left to spend on things you want or need. If they give you $5,000 worth of health insurance it's a tax-free fringe benefit and you get the full value of that $5,000. Any employer looking to compensate their employees above the minimum wage would do well to include health insurance as part of the compensation. It's simply more tax-efficient that way.

The ACA doubled down on this system by not only maintaining the non-taxability of employer health insurance (so long as it wasn't expensive enough to be a "Cadillac plan"), but it created a new tax penalty for many employers that did not provide health insurance to their employees.

If it were up to me we'd go the other way. There's no good reason why a person whose employer buys health insurance for them should pay less tax than someone who gets the same compensation in cash form and buys their own insurance. There's no good reason why an employer that doesn't buy their employees health insurance should have a tax penalty for that, any more than employers should have tax penalties for not feeding their employees in a corporate dining hall or housing their employees in a corporate barracks.

pecunia

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Re: What comes after the ACA?
« Reply #6088 on: August 10, 2020, 10:01:01 PM »
Everyone needs electricity.  Everyone needs water.  Everyone needs sanitation.  These are either regulated to keep costs fair of municipally provided which also keeps costs down.
They seems to keep going up a lot for me.  With my electrical bill, I have to pay $50 before I even use my first Kwh.

Quote
Everyone needs healthcare.  Maybe it's time to throw sensible regulations on this industry in the interests of keeping costs down and basic quality for the consumer.

Hundreds of health facilities have gone out of business in recent years and many more are teetering on collapse.   Medicare and Medicaid already underpay them, and many people don't pay their bills.  Forcing them to cut costs further while increasing regulation will only drive hundreds more out of business.

Sounds like you have a raw deal on electricity.  I only have bills in excess of $50 in the Winter when the furnace fan runs.

With what they charge for medicine for even basic stuff these days, they ought to be able to make a go at it.  I guess if they go out of business that is OK.  It is a necessary service and there is certainly a demand.  Maybe market forces will work in some strange way and the ones that go out of business will be replaced by more efficient or less greedy folks.  That's the way right wingers say it ought to work.  The benefits of them going out of business and further consolidation of what's left will increase marketplace efficiencies and the net result will be a trickling down in costs that benefits consumers.

I'm not seeing much if anything fill the void.  Read up on "medical deserts".

Thanks - Read up on it.

Guess the free market hasn't kicked in yet to solve this problem.  I did note that one of the big problems noted was they had to treat people without insurance. 

I wouldn't expect all places to have all things medical.  However, places should have basic clinics.  I think this is particularly true in areas that are relatively populated.  Another example of the system just being wrong.

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

I hope I don't get sick traveling through one of these medical deserts.

I wonder if people started protesting this in the streets like "Black Lives matter," would it finally light the fire for change?

American GenX

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Re: What comes after the ACA?
« Reply #6089 on: August 11, 2020, 06:52:38 AM »
Quote
Also, it may or may not be the case that your employer "wants" to provide health insurance.  Right now the ACA requires companies that employ 50 or more full-time employees to provide health insurance.

My various employers had health care insurance benefits many years before the ACA.

Yes, the tax code gave them every incentive to do that. If they give you $5,000 cash you would be taxed on it and have less than $5,000 left to spend on things you want or need. for them should pay less tax than someone who gets the same compensation in cash form and buys their own insurance.

Getting a tax incentive does not mean free.  I specifically stated "years before the ACA", and the employer was already providing insurance.  Which was my point - they were providing subsidized coverage before the ACA, it wasn't because the ACA was forcing them to - that was in response to a previous poster saying that my employer may not want to if not for the ACA.   And despite any tax breaks, providing health insurance was (and is) a great cost to the organization that I work for.  They started fitness incentive programs for employees to try to bring those costs down.  There was no secret about that and the cost to the organization to provide that benefit.

Under the ACA, I would pay much more out of pocket for premiums and deductibles under the current PCT/CSR structure than I currently pay under my employer.  And I really doubt any proposed changes will bring those subsidies up to my income level.  So, I would prefer the system still work the way it does for employers to offer these benefits to their employees but to also make health care insurance more affordable for people who have to purchase insurance outside of employement.

American GenX

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Re: What comes after the ACA?
« Reply #6090 on: August 11, 2020, 07:00:15 AM »
Guess the free market hasn't kicked in yet to solve this problem.  I did note that one of the big problems noted was they had to treat people without insurance. 
And also, Medicare and Medicaid don't pay sufficiently - and paying an even a lower percentage of the cost than they used to, while costs have gone up.  And many of those people without insurance that you mentioned don't pay their bills.

billy

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Re: What comes after the ACA?
« Reply #6091 on: August 11, 2020, 08:11:27 AM »
I'm finally paying attention to ACA more as I'm getting close to firing.....I read over Biden's campaign site, ACA revamp plan, he's saying he wants to: remove the income limit eligibility, lower monthly premium coverage from 9.86% of income to 8.5% of income, add medicaid expansion for all states. It goes on to say he's going to remove lot's of inefficiency and abuse in the healthcare industries.....a few I could see it done by executive order, but the rest seems like a lot of lip service, like every democrat candidate.

Is it reasonable to think Biden would have the political support to do everything in his plan? And It seems it will end up throuthing more tax dollars a the problem, increasing the federal deficit.

jim555

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Re: What comes after the ACA?
« Reply #6092 on: August 11, 2020, 09:01:04 AM »
Is it reasonable to think Biden would have the political support to do everything in his plan? And It seems it will end up throuthing more tax dollars a the problem, increasing the federal deficit.
Depends if the Senate flips.  Even if the Senate doesn't flip, Biden will stop the constant attacks on the ACA from the Republicans.

ctuser1

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Re: What comes after the ACA?
« Reply #6093 on: August 11, 2020, 09:20:33 AM »
I'm finally paying attention to ACA more as I'm getting close to firing.....I read over Biden's campaign site, ACA revamp plan, he's saying he wants to: remove the income limit eligibility, lower monthly premium coverage from 9.86% of income to 8.5% of income, add medicaid expansion for all states. It goes on to say he's going to remove lot's of inefficiency and abuse in the healthcare industries.....a few I could see it done by executive order, but the rest seems like a lot of lip service, like every democrat candidate.

Is it reasonable to think Biden would have the political support to do everything in his plan? And It seems it will end up throuthing more tax dollars a the problem, increasing the federal deficit.

Any cite on the bolded part?

Obamacare reduced deficit, primarily due to secondary benefits from reducing the number of uninsured and other efficiency gains added to a non-functional system. It is possible that any further decrease in the # of uninsured will cost more and offer less benefits per $ spent, hence my ask for a cite.

In general, I would phrase the bolded part as "It will end up investing more taxpayer money in the American Healthcare System, which may or may not increase the federal deficit depending on the investment returns, which needs to be further studied".

pecunia

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Re: What comes after the ACA?
« Reply #6094 on: August 11, 2020, 09:31:45 AM »
I'm finally paying attention to ACA more as I'm getting close to firing.....I read over Biden's campaign site, ACA revamp plan, he's saying he wants to: remove the income limit eligibility, lower monthly premium coverage from 9.86% of income to 8.5% of income, add medicaid expansion for all states. It goes on to say he's going to remove lot's of inefficiency and abuse in the healthcare industries.....a few I could see it done by executive order, but the rest seems like a lot of lip service, like every democrat candidate.

Is it reasonable to think Biden would have the political support to do everything in his plan? And It seems it will end up throuthing more tax dollars a the problem, increasing the federal deficit.

Is it reasonable to think Biden would have the political support to do everything in his plan?

Biden should not be expected to get political support.

Look at it from a little different viewpoint.  Not too different.  Take the analogy of the Military Industrial complex.  The US doesn't need to spend all the money it does on unproductive military activity.  (Sure - it needs some)  However, there are military manufacturers located all over the US and these are important to keep the folks working and the money flowing into the politician's home territory.  So they support the politician and he supports them .  The country gets the Military Industrial complex.

Lots of cities haven't done so well as the manufacturing has moved overseas.  What good paying jobs are left?  What good paying jobs have developed?   Well - There's lots of big buildings with insurance companies.  There's lots of hospital complexes.  These people who work in these places have good lives.  The guys in charge are raking in the big bucks.  Politicians do not want to disrupt the lives of these important constituents.  They support the politician with votes and payments.  These medical facilities are like the military industrial complex.  They are all over.  they will support the politician and the politician will support them.

It's like Cancer that has thoroughly infested the body.  In other countries they have something similar called corruption.

That was a long 'NO."

bacchi

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Re: What comes after the ACA?
« Reply #6095 on: August 11, 2020, 10:10:54 AM »
Look, the money's being spent. The US pays anywhere from 25-50% more per capita than other industrialized countries, often with poorer results.

So rural hospitals may be faltering but someone, somewhere, is making bank. It could be United Health Care (1), it might be doctor salaries (2), it could be other community hospitals (3) or hospital networks, it's probably Big Pharma (4) and crazy-ass regulations and top heavy administration (5), but there's a leak.

If only the US could use what other countries have learned. (6)

Quote from: (6)
In fact, the United States spends about $940 per person on administrative costs — four times more than the average of other wealthy countries and significantly more than we spend on preventive or long-term healthcare.
[...]
Despite significantly higher healthcare spending, America’s health outcomes are not any better than those in other developed countries. The United States actually performs worse in some common health metrics like life expectancy, infant mortality, and unmanaged diabetes.



(1) https://www.healthcaredive.com/news/unitedhealth-reports-nearly-14b-in-2019-profit/570474/
(2) https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557/
(3) https://www.modernhealthcare.com/article/20180104/NEWS/180109966/hospital-profits-continued-their-rise-in-2016
(4) https://www.newsweek.com/big-pharma-companies-profits-industries-study-1490407
(5) https://www.pgpf.org/blog/2020/07/how-does-the-us-healthcare-system-compare-to-other-countries
(6)  https://data.oecd.org/healthres/health-spending.htm

SugarMountain

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Re: What comes after the ACA?
« Reply #6096 on: August 11, 2020, 11:20:43 AM »
Look, the money's being spent. The US pays anywhere from 25-50% more per capita than other industrialized countries, often with poorer results.

So rural hospitals may be faltering but someone, somewhere, is making bank. It could be United Health Care (1), it might be doctor salaries (2), it could be other community hospitals (3) or hospital networks, it's probably Big Pharma (4) and crazy-ass regulations and top heavy administration (5), but there's a leak.

If only the US could use what other countries have learned. (6)

Quote from: (6)
In fact, the United States spends about $940 per person on administrative costs — four times more than the average of other wealthy countries and significantly more than we spend on preventive or long-term healthcare.
[...]
Despite significantly higher healthcare spending, America’s health outcomes are not any better than those in other developed countries. The United States actually performs worse in some common health metrics like life expectancy, infant mortality, and unmanaged diabetes.



(1) https://www.healthcaredive.com/news/unitedhealth-reports-nearly-14b-in-2019-profit/570474/
(2) https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557/
(3) https://www.modernhealthcare.com/article/20180104/NEWS/180109966/hospital-profits-continued-their-rise-in-2016
(4) https://www.newsweek.com/big-pharma-companies-profits-industries-study-1490407
(5) https://www.pgpf.org/blog/2020/07/how-does-the-us-healthcare-system-compare-to-other-countries
(6)  https://data.oecd.org/healthres/health-spending.htm

It may not even be high cost administrators, it's not like the claims adjusters at UNH are getting paid big bucks or the people who manage it at your doctor's office.  I really think our whole insurance model is a big problem because of the overhead and paperwork involved.  There is also a flaw with the ACA wherein insurers have their profits capped at a percent of claims paid (something like 20%).  So to increase profitability they need to increase the amount the pay for claims, so they are happy to allow doctors and hospitals to charge more and do unnecessary tests as long as they can ultimately pass it along in the form of higher premiums the next year and thus increase their profitability.  This cycle is part of why $UNH has done so well since the ACA became law.

bacchi

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Re: What comes after the ACA?
« Reply #6097 on: August 11, 2020, 11:32:07 AM »
It may not even be high cost administrators, it's not like the claims adjusters at UNH are getting paid big bucks or the people who manage it at your doctor's office.  I really think our whole insurance model is a big problem because of the overhead and paperwork involved.

Agreed. It doesn't have to be well paid admin (though C-level administrators at hospitals are often very well paid); it can be too much admin.


Quote
There is also a flaw with the ACA wherein insurers have their profits capped at a percent of claims paid (something like 20%).  So to increase profitability they need to increase the amount the pay for claims, so they are happy to allow doctors and hospitals to charge more and do unnecessary tests as long as they can ultimately pass it along in the form of higher premiums the next year and thus increase their profitability.  This cycle is part of why $UNH has done so well since the ACA became law.

It's a perverse incentive for sure.

talltexan

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Re: What comes after the ACA?
« Reply #6098 on: August 19, 2020, 08:56:25 AM »
Yes, Exflyboy, I will vote accordingly and I am sure you can imagine who that might be.

So many lies during this Presidency. He can't even come up with enough good lies now to tell us what he fake proposes for the next 4 years. He can't say the economy is good, the stock market goes up and down every day, massive unemployment, Covid-19 that he did nothing about and all the deaths. He is beating up Biden as hating God now! I don't want to hear that crap! I want to know what you are going to do for the American people. He surely did nothing good the first 4 years.

I was on ACA and moved onto Medicare but I was concerned while on it if it was going to get ripped away. The system is in place and it is a no brainer to fix it, improve it, work on it, mold it. I am not saying there aren't problems with it but people need it and it sure wasn't that affordable in my opinion. However, the Medicare choices I chose are MORE expensive than ACA. So get ready for that ride when you get on it. Medicare is one of those things that you get what you pay for. The more you pay the more you get, the less you pay the less you get.

After he lost the 2012 (Vice-) Presidential election, Paul Ryan could have hired an aid--one policy aid--and assigned him full-time to work on a replacement for ACA to be ready when Republicans won the WH in 2016. He didn't, and--when they had the chance--the best he could come up with was the American Health Care Act, which basically accepted the underlying logic of ACA, but without the mandate. Trump has many flaws, but he cannot be blamed for this failure, it's on the GOP establishment, who invested no resources whatsoever to develop a credible alternative.

former player

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Re: What comes after the ACA?
« Reply #6099 on: August 19, 2020, 09:37:36 AM »
The GOP didn't bother to develop a right-wing alternative to ACA because there isn't room for one - anything further right than the ACA is necessarily either about removing coverage or limiting costs.  It would like to do the first but it is politically unacceptable, the second is politically acceptable but it doesn't want to do it.