Author Topic: What comes after the ACA?  (Read 1431335 times)

former player

  • Walrus Stache
  • *******
  • Posts: 5916
  • Location: Avalon
Re: What comes after the ACA?
« Reply #6450 on: October 29, 2020, 06:52:18 AM »
- The premiums are too high and I don't get a subsidy! (That just means your income is high enough to be able to afford the premiums.  Yes, you'll have to make choices about perhaps paying your insurance premium instead of always buying the newest shiny gadget right away...)
...
In my mind, it's really disturbing how ill-informed people are on basic facts.

In 2020 for our family of 5, if we have an AGI of $120,680 we get a PTC of $9,228. If we make $120,685 we get a PTC of $0.

That's the subsidy cliff. Biden's ACA 2.0 is supposed to fix it. But it is a legitimate complaint. Then there's the deductibles and copays.

We've been skirting with the cliff since the ACA became law. In 2018 I bought $2k worth of laptop that I didn't really need so I could save >$8k on health insurance. That's a nutty system.

(This is for a 2020 Bronze Plan - Family of 5 - Premium $1434/month, $17,213/year before subsidy. Deductible $7,700 individual/$15,400 family.)

How did buying a laptop save you $8K in health insurance? Just curious!
Self-employe tax write-off moving someone into a different subsidy category would be my guess.  Not something available to the employed.

former player

  • Walrus Stache
  • *******
  • Posts: 5916
  • Location: Avalon
Re: What comes after the ACA?
« Reply #6451 on: October 29, 2020, 06:59:37 AM »
I think "excessive consumption" will take place no matter who foots the bill.  This is why it must be monitored and evaluated in any form offered.  ie company plans that self-insure or cover a large portion of the costs for employees evaluate this and routinely add controls or adjust premiums.  I am no insurance expert but it seems like this is just part of the recipe and must be figured out regardless of provider.

Katsiki, as a retired health insurance underwriter, your text above is pretty spot on. 
.
And yes, if there are no copays or other ways that the patient shares in the cost, even if just a little, there will be excess consumption.

I'm curious about how other countries handle this. I believe I've heard that there are some sort of copays in many government-run healthcare situations like Brittain and the UK. Does anyone know if this is correct?

From a quick google search, there is no copay for the NHS. @Exflyboy ?

Is this similar to when they drug tested welfare recipients in Florida and it cost way more than they saved? Sure, a few people overuse the services but it's so few that why bother with a copay at all?

https://www.kingsfund.org.uk/reports/thenhsif/what-if-people-were-to-pay-10-to-see-a-gp/

Quote
Other research – not least the famous RAND health insurance experiment carried out in the 1980s – has shown that charges that are not based on ability to pay have a detrimental impact on demand from the very people who need care most – older people and the poor.

There is a copay for prescription drugs under the NHS. Currently thats around $12/per prescription. There are a number of groups that are exempt from paying this though.. Pensioners, students, low income folks etc.

Everything else is free at the point of use. Last tie I looked the UK spent $3500/person for HC.. The US is nearer $10,000.

The NHS covers medical and dental plus vision for kids and people with glaucoma.

There is also a thriving private market in the UK for elective procedures that can be bought through private hospitals.

Just curious, how elective is elective? Are we talking plastic surgery and lasik or, I dunno, hip replacements and other stuff that won't kill you but really help?
The NHS does do hip and knee replacements for emergencies and for quality of life, although you might have to wait and possibly lose weight (outcomes for joint replacements are much better for the less obese, so better value for money).  It does plastic surgery but at the severe need level rather than the purely cosmetic.  Lasik is almost certainly going to be private, with both eyes costing about £3k for someone who does not have private insurance.

The NHS mostly runs its own hospitals and clinics but does buy in some provision from the private sector, so your NHS hip replacement might be done in a private hospital by a private doctor - although the private doctor probably works part time in the NHS hospital next door.

More information here: https://www.england.nhs.uk/

jrhampt

  • Handlebar Stache
  • *****
  • Posts: 1199
  • Age: 43
  • Location: Connecticut
Re: What comes after the ACA?
« Reply #6452 on: October 29, 2020, 07:03:29 AM »
On the topic of excess consumption...who are these people who want to spend all their time at various doctors?

pecunia

  • Handlebar Stache
  • *****
  • Posts: 1711
Re: What comes after the ACA?
« Reply #6453 on: October 29, 2020, 07:13:35 AM »
So - if we had government medicine, there would be a form of rationing due to the entire medical system being engaged.  There may not be enough resources for some procedures that do not cause the patient undue hardship.  Right now we have a system that is rationed to enable some to get unnecessary medical procedures done while others die.

Which system would stimulate more innovation?

The present system has cash rolling in.  There is no real competition other than maybe having medical procedures done overseas.  I guess the incentive to innovate is that medical companies can sell more drugs and medical gadgets and make money.

Would the incentive to innovate change if the system "wanted" to treat the people that are now estranged from the system?  Would this government run system provide incentives to innovate?  Would the nature of the innovations change to maybe treating more people with less resources?  Would the nature of the innovations change to maybe more drugs and gadgets to prevent people from becoming sick in the first place and so saving medical resources?

GuitarStv

  • Senior Mustachian
  • ********
  • Posts: 16906
  • Age: 39
  • Location: Toronto, Ontario, Canada
Re: What comes after the ACA?
« Reply #6454 on: October 29, 2020, 08:06:15 AM »
On the topic of excess consumption...who are these people who want to spend all their time at various doctors?

Haven't you ever woken up in the morning, had a nice breakfast and thought . . . I need more flourescent lighting, pastel paint, and weird medical smells.  Time to head to the ER for 6 - 7 hours!

the_fixer

  • Pencil Stache
  • ****
  • Posts: 967
  • Location: Colorado
  • mind on my money money on my mind
What comes after the ACA?
« Reply #6455 on: October 29, 2020, 08:26:21 AM »
I would think that in the end more people going to the doctor more often would be a good thing and we would have a healthier population and spend less in the long run.

Earlier diagnosis of diseases like cancer and diabetes

Heart and blood pressure issues could be managed before they cause additional damage

Someone getting PT before something becomes a chronic issue that requires surgery

Lack of people spreading communicable diseases

Kind of like a house or car, neglecting it now might save you time and money today but it will cost you more time and money in the future and possibly result in a catastrophic failure.


Sent from my iPhone using Tapatalk
« Last Edit: October 29, 2020, 08:42:47 AM by the_fixer »

stoaX

  • Pencil Stache
  • ****
  • Posts: 606
  • Location: South Carolina
  • 'tis nothing good nor bad but thinking makes it so
Re: What comes after the ACA?
« Reply #6456 on: October 29, 2020, 08:35:36 AM »
On the topic of excess consumption...who are these people who want to spend all their time at various doctors?

Speaking as a retired health insurance underwriter, it is amazing how much the number of office visits per person per month will decline if an office visit goes from a $0 copay to $10. I personally can't imagine wanting to go to the doctor unless I really needed to even if it's free, but apparently enough people think differently.

stoaX

  • Pencil Stache
  • ****
  • Posts: 606
  • Location: South Carolina
  • 'tis nothing good nor bad but thinking makes it so
Re: What comes after the ACA?
« Reply #6457 on: October 29, 2020, 08:59:07 AM »
I would think that in the end more people going to the doctor more often would be a good thing and we would have a healthier population and spend less in the long run.

Earlier diagnosis of diseases like cancer and diabetes

Heart and blood pressure issues could be managed before they cause additional damage

Someone getting PT before something becomes a chronic issue that requires surgery

Lack of people spreading communicable diseases

Kind of like a house or car, neglecting it now might save you time and money today but it will cost you more time and money in the future and possibly result in a catastrophic failure.


Sent from my iPhone using Tapatalk

Yes, that's why, since 2014, the ACA has required $0 cost share for preventive care visits. So to the extent that has caused the things to happen that you mention in your post above, it's already been part of the healthcare landscape in the USA.

dresden

  • Stubble
  • **
  • Posts: 113
Re: What comes after the ACA?
« Reply #6458 on: October 29, 2020, 09:17:00 AM »
- The premiums are too high and I don't get a subsidy! (That just means your income is high enough to be able to afford the premiums.  Yes, you'll have to make choices about perhaps paying your insurance premium instead of always buying the newest shiny gadget right away...)
...
In my mind, it's really disturbing how ill-informed people are on basic facts.

In 2020 for our family of 5, if we have an AGI of $120,680 we get a PTC of $9,228. If we make $120,685 we get a PTC of $0.

That's the subsidy cliff. Biden's ACA 2.0 is supposed to fix it. But it is a legitimate complaint. Then there's the deductibles and copays.

We've been skirting with the cliff since the ACA became law. In 2018 I bought $2k worth of laptop that I didn't really need so I could save >$8k on health insurance. That's a nutty system.

(This is for a 2020 Bronze Plan - Family of 5 - Premium $1434/month, $17,213/year before subsidy. Deductible $7,700 individual/$15,400 family.)

How did buying a laptop save you $8K in health insurance? Just curious!
Self-employe tax write-off moving someone into a different subsidy category would be my guess.  Not something available to the employed.
pre tax 401k contributions will work the same you just need to make sure you don't underestimate any income that might come in.  401k limit was 19.5k in 2020 and another 6,000 if you 50+.  There are also HSAs which you can contribute up to 7,100 for families and another 1,000 for 55+.  So there are plenty of ways for an employed person near the cliff to lower taxable income.   If your company doesn't have a 401k there is always an IRA.  At least some of the bronze plans are eligible for HSA.

GuitarStv

  • Senior Mustachian
  • ********
  • Posts: 16906
  • Age: 39
  • Location: Toronto, Ontario, Canada
Re: What comes after the ACA?
« Reply #6459 on: October 29, 2020, 09:24:28 AM »
On the topic of excess consumption...who are these people who want to spend all their time at various doctors?

Speaking as a retired health insurance underwriter, it is amazing how much the number of office visits per person per month will decline if an office visit goes from a $0 copay to $10. I personally can't imagine wanting to go to the doctor unless I really needed to even if it's free, but apparently enough people think differently.

It would be interesting to graph the long term health care costs over time of the two types of health care.

Going regularly to the doctor might mean finding a lump that indicates cancer faster - and stage 1 or 2 cancer is likely going to be a lot less expensive to treat than ignoring the problem until it's at stage 4.

AdrianC

  • Handlebar Stache
  • *****
  • Posts: 1134
  • Location: Cincinnati
Re: What comes after the ACA?
« Reply #6460 on: October 29, 2020, 10:19:02 AM »
- The premiums are too high and I don't get a subsidy! (That just means your income is high enough to be able to afford the premiums.  Yes, you'll have to make choices about perhaps paying your insurance premium instead of always buying the newest shiny gadget right away...)
...
In my mind, it's really disturbing how ill-informed people are on basic facts.

In 2020 for our family of 5, if we have an AGI of $120,680 we get a PTC of $9,228. If we make $120,685 we get a PTC of $0.

That's the subsidy cliff. Biden's ACA 2.0 is supposed to fix it. But it is a legitimate complaint. Then there's the deductibles and copays.

We've been skirting with the cliff since the ACA became law. In 2018 I bought $2k worth of laptop that I didn't really need so I could save >$8k on health insurance. That's a nutty system.

(This is for a 2020 Bronze Plan - Family of 5 - Premium $1434/month, $17,213/year before subsidy. Deductible $7,700 individual/$15,400 family.)

How did buying a laptop save you $8K in health insurance? Just curious!
Self-employe tax write-off moving someone into a different subsidy category would be my guess.  Not something available to the employed.
pre tax 401k contributions will work the same you just need to make sure you don't underestimate any income that might come in.  401k limit was 19.5k in 2020 and another 6,000 if you 50+.  There are also HSAs which you can contribute up to 7,100 for families and another 1,000 for 55+.  So there are plenty of ways for an employed person near the cliff to lower taxable income.   If your company doesn't have a 401k there is always an IRA.  At least some of the bronze plans are eligible for HSA.

Yes, self-employed. Buying the computer dropped our MAGI enough to qualify for subsidies.

We max out the 401k and traditional IRAs when we can. This year, according to my spreadsheet, we have $152k in net business income plus dividends/interest (I'm trying to FIRE, here), and a MAGI of $69k. Very much under the subsidy cap. Last year we were very much over the cap and paid full freight ($18,554.16 for a Bronze plan).

John Galt incarnate!

  • Handlebar Stache
  • *****
  • Posts: 1733
  • Location: On Cloud Nine
Re: What comes after the ACA?
« Reply #6461 on: October 29, 2020, 10:37:44 AM »
On the topic of excess consumption...who are these people who want to spend all their time at various doctors?

Speaking as a retired health insurance underwriter, it is amazing how much the number of office visits per person per month will decline if an office visit goes from a $0 copay to $10. I personally can't imagine wanting to go to the doctor unless I really needed to even if it's free, but apparently enough people think differently.


 
I heard a person somewhat sheepishly admit that they go to a doctor (or  was it another provider who wasn't a M.D.?) to have their toenails trimmed because their heath insurance pays for it.

I was told that French healthcare includes a nominal charge specifically for the reason that policymakers wanted the public to understand that healtcare is not free.

 
« Last Edit: October 29, 2020, 12:12:38 PM by John Galt incarnate! »

DaMa

  • Bristles
  • ***
  • Posts: 460
Re: What comes after the ACA?
« Reply #6462 on: October 29, 2020, 12:56:52 PM »
On the topic of excess consumption...who are these people who want to spend all their time at various doctors?

Speaking as a retired health insurance underwriter, it is amazing how much the number of office visits per person per month will decline if an office visit goes from a $0 copay to $10. I personally can't imagine wanting to go to the doctor unless I really needed to even if it's free, but apparently enough people think differently.

It would be interesting to graph the long term health care costs over time of the two types of health care.

Going regularly to the doctor might mean finding a lump that indicates cancer faster - and stage 1 or 2 cancer is likely going to be a lot less expensive to treat than ignoring the problem until it's at stage 4.

Speaking as another retired health insurance professional (actuarial)...

One of the issues in the US system is that preventive care will reduce long term expense (stage 1 cancer treatment rather than stage 4), but people move between insurance plans so much that the one who pays for the cheaper treatment doesn't usually get the long term savings. 

(My knowledge is pre-ACA when we added a no-cost annual physical to our plans.  Maybe now that it is universal perhaps it has a greater impact.)



maizefolk

  • Magnum Stache
  • ******
  • Posts: 4998
Re: What comes after the ACA?
« Reply #6463 on: October 29, 2020, 02:32:12 PM »
On the topic of excess consumption...who are these people who want to spend all their time at various doctors?

Speaking as a retired health insurance underwriter, it is amazing how much the number of office visits per person per month will decline if an office visit goes from a $0 copay to $10. I personally can't imagine wanting to go to the doctor unless I really needed to even if it's free, but apparently enough people think differently.

As someone who was once a child, I'd speculate a good chunk of the people who "over consume" healthcare in the absence of any incentive not to are some (but not all) parents of children who are understandably over reactive about making sure their kids get and stay healthy.

As a single adult I'm averaging one visit to a doctor about every five years, plus a stop at the local CVS/Walgreens for an annual flu shot. (Yes I know once you hit a certain age annual checkups are recommended, I'll get to it at some point).

Similarly people are often more likely to push their significant others to go to the doctor than a single person is to push themselves. Of course the flip side of over consumption of healthcare is under consumption of healthcare, which explains at least part of why single people tend to die earlier than married folks.

jrhampt

  • Handlebar Stache
  • *****
  • Posts: 1199
  • Age: 43
  • Location: Connecticut
Re: What comes after the ACA?
« Reply #6464 on: October 30, 2020, 10:10:14 AM »
I already spend far more time at the doctor than I would like to, and that's just with the recommended preventative care:

1 pcp visit for yearly physical + bloodwork for cholesterol check (usually the bloodwork necessitates a separate lab visit)
1 gynecologist visit for PAP
1 radiologist visit for mammogram (they tried to get me to come twice for this with an additional ultrasound this year)
1 full body mole check with dermatologist (sometimes additional visit if they find anything they want to biopsy)
1 visit for flu shot (either pcp or costco etc.)

Add in two routine dental visits for cleanings (IF everything looks good and there are no cavities), and that's already 6-8 visits minimum per year.  And that's with nothing in particular wrong with me. 

Who has time for more?  Who has time to cart their kids to the doctor constantly, too?

WhiteTrashCash

  • Handlebar Stache
  • *****
  • Posts: 1330
Re: What comes after the ACA?
« Reply #6465 on: October 30, 2020, 11:02:24 AM »
We're about to find out what comes after the ACA. One week after the election, the ACA will be struck down by the Supreme Court because the individual mandate was removed. It is inevitable now after Trump packed the Court. Then, it really depends on who is elected as President. If Trump is reelected, then nothing will replace the ACA because the Democratic House will not work with him. If Biden is elected, then the ACA Act will again be made law with the restoration of the individual mandate. At least, that's what I figure at this point.

sherr

  • Handlebar Stache
  • *****
  • Posts: 1430
  • Age: 35
  • Location: North Carolina, USA
Re: What comes after the ACA?
« Reply #6466 on: October 30, 2020, 11:49:02 AM »
We're about to find out what comes after the ACA. One week after the election, the ACA will be struck down by the Supreme Court because the individual mandate was removed. It is inevitable now after Trump packed the Court. Then, it really depends on who is elected as President. If Trump is reelected, then nothing will replace the ACA because the Democratic House will not work with him. If Biden is elected, then the ACA Act will again be made law with the restoration of the individual mandate. At least, that's what I figure at this point.

The SC won't rule on the case until summer 2021. And if it's still a problem then I expect them to at worst strike down only the individual mandate, not the entire law.

> If Trump is reelected, then nothing will replace the ACA because the Democratic House will not work with him.

I think you misspelled "because the Republicans will be unable to come up with a replacement plan, just like they were in 2018, and really every day in the last decade". The House has passed 400 bills that the Senate hasn't even bothered scheduling a vote on (much less passed their own version of, and gone to reconciliation over), and that number is 8 months old. Including, more recently, their version of a 2nd round of COVID relief. The House is not the side that's refusing to work with the other.
« Last Edit: October 30, 2020, 12:12:44 PM by sherr »

American GenX

  • Bristles
  • ***
  • Posts: 498
Re: What comes after the ACA?
« Reply #6467 on: October 30, 2020, 12:13:47 PM »
We're about to find out what comes after the ACA. One week after the election, the ACA will be struck down by the Supreme Court because the individual mandate was removed. It is inevitable now after Trump packed the Court. Then, it really depends on who is elected as President. If Trump is reelected, then nothing will replace the ACA because the Democratic House will not work with him. If Biden is elected, then the ACA Act will again be made law with the restoration of the individual mandate. At least, that's what I figure at this point.

The SC won't rule on the case until summer 2021. And if it's still a problem then I expect them to at worst strike down only the individual mandate, not the entire law.

I wouldn't call that "worst".   At worst, they will overturn all of the ACA, and that is a very real possibility.  Just think about how it held on by a thread in past rulings with a less conservative court and also the Texas court/judge who ruled the whole law was unconstitutional now before appeal.   If only the mandate is repealed, that will be a good thing, as there effectively isn't a mandate now anyway with the penalty being set to $0, which is the basis for this lawsuit in the first place.

rmorris50

  • Stubble
  • **
  • Posts: 177
Re: What comes after the ACA?
« Reply #6468 on: October 30, 2020, 07:24:56 PM »
I started a new job earlier this year, and come to find out my employer participates in an ACA-like market place to provide health insurance. The look, feel and online marketplace feels very similar to healthcare.gov. You basically shop bronze, silver and gold plans from different insurance companies. The big difference is the employers that participate pay a significant portion of the cost, and the coverage is better. Has anyone else experienced this? I found it interesting there is employer sponsored health insurance mimicking the marketplace approach.

I do hope the ACA survives and gets improved upon, it's a good step in the right direction to making insurance available to almost everyone. The fact Republicans fight it to me is just because it's associated with Obama. I also think a lot of people are afraid coverage won't be as good if everyone has to participate in the ACA (the whole how is health care rationed thing).


maizefolk

  • Magnum Stache
  • ******
  • Posts: 4998
Re: What comes after the ACA?
« Reply #6469 on: October 30, 2020, 08:10:23 PM »
Is your employer a small business? If so that may not be an ACA-like marketplace but a second marketplace that was also created specifically as part of the ACA called SHOP (Small Business Health Options Program).

American GenX

  • Bristles
  • ***
  • Posts: 498
Re: What comes after the ACA?
« Reply #6470 on: November 04, 2020, 03:41:53 AM »

With the election results at this point early morning Wednesday, it's not looking promising for the ACA and health care in general.  Trump looks to be on his way to victory, and the Democrats aren't taking the Senate.   Indeed, a very surprising and sad day(s) for so many people.

Omy

  • Pencil Stache
  • ****
  • Posts: 634
Re: What comes after the ACA?
« Reply #6471 on: November 04, 2020, 05:19:14 AM »
I guess it will actually take losing healthcare before some people will vote for their own best interests.

Monkey Uncle

  • Handlebar Stache
  • *****
  • Posts: 1655
  • Location: West-by-god-Virginia
Re: What comes after the ACA?
« Reply #6472 on: November 04, 2020, 06:29:46 AM »

With the election results at this point early morning Wednesday, it's not looking promising for the ACA and health care in general.  Trump looks to be on his way to victory, and the Democrats aren't taking the Senate.   Indeed, a very surprising and sad day(s) for so many people.

Hold on there; results are not in yet for many of the battleground states.

GuitarStv

  • Senior Mustachian
  • ********
  • Posts: 16906
  • Age: 39
  • Location: Toronto, Ontario, Canada
Re: What comes after the ACA?
« Reply #6473 on: November 04, 2020, 07:01:04 AM »

With the election results at this point early morning Wednesday, it's not looking promising for the ACA and health care in general.  Trump looks to be on his way to victory, and the Democrats aren't taking the Senate.   Indeed, a very surprising and sad day(s) for so many people.

Hold on there; results are not in yet for many of the battleground states.

Even assuming they take the presidency and the house, without the senate the Republicans will continue to block every attempt by the Democrats to do anything.  McConnel certainly followed that approach with Obama to great 'success'.  The heavily partisan Supreme Court will continue to erode existing law into an extreme right (including repealing the provisions of Roe V Wade and the ACA), and there will be nothing at all that Democrats can do about it.

pecunia

  • Handlebar Stache
  • *****
  • Posts: 1711
Re: What comes after the ACA?
« Reply #6474 on: November 04, 2020, 08:10:06 AM »
I just don't get it.  Trump's inappropriate actions killed tens of thousands of people.  This election should have been a condemnation of his actions.  The resounding vote should have been to elect Biden and improve health care.


toocold

  • 5 O'Clock Shadow
  • *
  • Posts: 49
Re: What comes after the ACA?
« Reply #6475 on: November 04, 2020, 08:20:39 AM »
I just don't get it.  Trump's inappropriate actions killed tens of thousands of people.  This election should have been a condemnation of his actions.  The resounding vote should have been to elect Biden and improve health care.

Jury is still out.  Why do people think Trump won?  He did much better than what the pollsters projected though.

JGS1980

  • Bristles
  • ***
  • Posts: 452
Re: What comes after the ACA?
« Reply #6476 on: November 04, 2020, 08:43:55 AM »
I just don't get it.  Trump's inappropriate actions killed tens of thousands of people.  This election should have been a condemnation of his actions.  The resounding vote should have been to elect Biden and improve health care.

Jury is still out.  Why do people think Trump won?  He did much better than what the pollsters projected though.

Trump simply has beat all expectations. It's a "relative" win.

We will see how Michigan, Nevada, Wisconsin, and finally, PA end up.  If he wins the other 3, Biden does not need PA to win the election (with exactly 270 electoral votes).

What's a guy got to do around here to get fired? Nuclear Armageddon? Raping and Pillaging on live TV?


Mr. Green

  • Magnum Stache
  • ******
  • Posts: 2546
  • Age: 37
  • Location: Wilmington, NC
Re: What comes after the ACA?
« Reply #6477 on: November 04, 2020, 08:44:53 AM »
It's amazing how many states are so close. It certainly looks better for Biden now than it did at midnight. If vote counting ceased right now Biden would win. I'm surprised it wasn't closer in FL and TX. If anything, this ought to tell folks to not trust polls anymore. Two elections running now where they were junk.

sherr

  • Handlebar Stache
  • *****
  • Posts: 1430
  • Age: 35
  • Location: North Carolina, USA
Re: What comes after the ACA?
« Reply #6478 on: November 04, 2020, 08:54:29 AM »
It's amazing how many states are so close. It certainly looks better for Biden now than it did at midnight. If vote counting ceased right now Biden would win. I'm surprised it wasn't closer in FL and TX. If anything, this ought to tell folks to not trust polls anymore. Two elections running now where they were junk.

They were pretty good in 2018. It might just be Trump in particular that throws off the polls.

ysette9

  • Walrus Stache
  • *******
  • Posts: 7112
  • Location: Bay Area, CA
    • The Best Is Yet To Come
Re: What comes after the ACA?
« Reply #6479 on: November 04, 2020, 12:23:50 PM »
Maybe it's a fear of creeping Socialism.  All they have to do is to look North of the border and see possible impact on the bottom line.  They may not be able to stop health care reform, but if they can delay it another generation that's all they need.  You'll note a similar tact seems to be the reaction to global warming.

Despite negative caricatures of conservatives against government involvement in healthcare, the fact is that most of the common voters who are against it believe that the government will mess it up. It's as simple as that. Note this is not talking about politicians against it, just average people.
This part perplexes me. If we had something good now and there was fear of breaking it, that would be one thing. But the current system is so utterly broken it is hard to argue that just about anything with actual intentions to help would be worse.

I say intentions to improve to weed out he republican non-plans that just want to dismantle ACA with no viable replacement.

seattlecyclone

  • Walrus Stache
  • *******
  • Posts: 5523
  • Age: 36
  • Location: Seattle, WA
    • My blog
Re: What comes after the ACA?
« Reply #6480 on: November 04, 2020, 12:58:46 PM »
It's amazing how many states are so close. It certainly looks better for Biden now than it did at midnight. If vote counting ceased right now Biden would win. I'm surprised it wasn't closer in FL and TX. If anything, this ought to tell folks to not trust polls anymore. Two elections running now where they were junk.

They were pretty good in 2018. It might just be Trump in particular that throws off the polls.

This seems very likely to me. We are seeing absolutely huge voter turnout numbers. I think a lot of the polls and pundits assumed that would lead to a Democratic landslide because Republicans have historically been more consistent about voting, so higher turnout has historically correlated with more success for the blue team. However what we're seeing in yesterday's results are that turnout seems to have been way up on both sides. In Florida, Biden got at least 750k more votes than Clinton did in 2016, but Trump increased his vote count by more than a million. In Texas, Biden got 1.3 million more votes than Clinton did, while Trump increased by almost 1.2 million since 2016. Each party increased its vote count by over 200k in Wisconsin. In Washington, Trump has basically equaled his 2016 total despite a big chunk of ballots remaining to be counted. The same thing has played out in every other state I've checked: vote counts quite a bit higher on both sides.

Exflyboy

  • Walrus Stache
  • *******
  • Posts: 7120
  • Age: 59
  • Location: Corvallis, Oregon
  • Expat Brit living in the New World..:)
Re: What comes after the ACA?
« Reply #6481 on: November 04, 2020, 01:10:24 PM »
Maybe it's a fear of creeping Socialism.  All they have to do is to look North of the border and see possible impact on the bottom line.  They may not be able to stop health care reform, but if they can delay it another generation that's all they need.  You'll note a similar tact seems to be the reaction to global warming.

Despite negative caricatures of conservatives against government involvement in healthcare, the fact is that most of the common voters who are against it believe that the government will mess it up. It's as simple as that. Note this is not talking about politicians against it, just average people.
This part perplexes me. If we had something good now and there was fear of breaking it, that would be one thing. But the current system is so utterly broken it is hard to argue that just about anything with actual intentions to help would be worse.

I say intentions to improve to weed out he republican non-plans that just want to dismantle ACA with no viable replacement.

Well people are sheep. Just look at our elections where 50% of the country can elect such a clown to be President! Not only that he spreads dangerous ideas. and most of his followers agree with them.

People are so married to the "religious dogma" of "Socialism is baaaad", that logic simply flys out the window.

Whats more the American HC system works very well indeed.. if you're rich!

 HC Is a profit making machine so uber rich folks (like politicians) have precisely no incentive to fix the system for the average person in the street.

Case in point.. I broke my wrist last year. My insurance was billed $28k for the surgery. Now I made more than $28k in 2019 from the HC portion of my stock index funds. If I had more millions I'd make even more money, so in theory its awesome!

Why would I want "free" HC where the companies in that sector would pay a fraction of the dividends they do today?

ysette9

  • Walrus Stache
  • *******
  • Posts: 7112
  • Location: Bay Area, CA
    • The Best Is Yet To Come
Re: What comes after the ACA?
« Reply #6482 on: November 04, 2020, 01:57:49 PM »
Maybe it's a fear of creeping Socialism.  All they have to do is to look North of the border and see possible impact on the bottom line.  They may not be able to stop health care reform, but if they can delay it another generation that's all they need.  You'll note a similar tact seems to be the reaction to global warming.

Despite negative caricatures of conservatives against government involvement in healthcare, the fact is that most of the common voters who are against it believe that the government will mess it up. It's as simple as that. Note this is not talking about politicians against it, just average people.
This part perplexes me. If we had something good now and there was fear of breaking it, that would be one thing. But the current system is so utterly broken it is hard to argue that just about anything with actual intentions to help would be worse.

I say intentions to improve to weed out he republican non-plans that just want to dismantle ACA with no viable replacement.

Well people are sheep. Just look at our elections where 50% of the country can elect such a clown to be President! Not only that he spreads dangerous ideas. and most of his followers agree with them.

People are so married to the "religious dogma" of "Socialism is baaaad", that logic simply flys out the window.

Whats more the American HC system works very well indeed.. if you're rich!

 HC Is a profit making machine so uber rich folks (like politicians) have precisely no incentive to fix the system for the average person in the street.

Case in point.. I broke my wrist last year. My insurance was billed $28k for the surgery. Now I made more than $28k in 2019 from the HC portion of my stock index funds. If I had more millions I'd make even more money, so in theory its awesome!

Why would I want "free" HC where the companies in that sector would pay a fraction of the dividends they do today?
Is it even working for the rich though?

I’ve spent most of my life with Kaiser and got used to things just being integrated and working. These past six months we have been on not-Kaiser through my husband’s work due to a move. While we have very generous insurance and even a concierge service to help fight bills and explain benefits, it has been a dumpster fire. The inefficiencies are breathtaking and the difficulty of getting care has been a real stressor for me. Thankfully we are going back to Kaiser in January and so I just have a To Do list now of minor health concerns to deal with then once I am back in a smoothly-run system. In my short experience in the outside world I would say the American healthcare system is fundamentally  broken for everyone.

pecunia

  • Handlebar Stache
  • *****
  • Posts: 1711
Re: What comes after the ACA?
« Reply #6483 on: November 04, 2020, 04:43:11 PM »
Through your stock ownership, you are speaking as businessman.  Let's say you build widgets.  Some company in Korea also builds widgets.  They are cleaning your clock because you have to pay for expensive healthcare for your employees.  This makes you less competitive.  It doesn't help the stock price.

Sure the medical sector does well.  However, it's doing well by dragging every other industry down.  Those extra medical premiums could be paid out as dividends if the employer didn't have the added cost.

I'm not a bean-counter.  (I don't like bean-counters.)  So, I expect you guys will poke at my thinking.

It looks like it is down to the vote of a few cowboys in Nevada.  They are deciding your health care.

Exflyboy

  • Walrus Stache
  • *******
  • Posts: 7120
  • Age: 59
  • Location: Corvallis, Oregon
  • Expat Brit living in the New World..:)
Re: What comes after the ACA?
« Reply #6484 on: November 04, 2020, 04:46:07 PM »
Not really. Nevada looks like it might had the Presidency to Biden but that won't flip the Senate.

So then its down to SCOTUS.. Yipes!

Even Michigan puts the republican Senator ahead right now.*

*update.. Dem is barely ahead currently
« Last Edit: November 04, 2020, 04:48:01 PM by Exflyboy »

pecunia

  • Handlebar Stache
  • *****
  • Posts: 1711
Re: What comes after the ACA?
« Reply #6485 on: November 04, 2020, 06:08:12 PM »
Looks like the Michigan Senate Democrat, Gary Peters, might edge out John James after the mail in ballots are fully counted.

ACA - You are right.  The do nothing Senate may do nothing to help people's health care and a lot of other things.  The Democrats also lost some seats in the House.


EscapeVelocity2020

  • Magnum Stache
  • ******
  • Posts: 3288
  • Age: 47
  • Location: Houston
    • EscapeVelocity2020
Re: What comes after the ACA?
« Reply #6486 on: November 04, 2020, 11:36:00 PM »
...people looked upon the ACA in 2010 as the beginning of the end, and fortunately, before the end of 2020, the grand experiment had died!  Thank you Republicans.  Healthcare in the USA finally reverted to what it should have been all along in a capitalist society - for the fortunate.  For others, it is a thing to strive for and covet...

At least that is the impression I get from the results of this election.  I would have thought folks generally would have wanted to protect the ACA, but they did not.

Exflyboy

  • Walrus Stache
  • *******
  • Posts: 7120
  • Age: 59
  • Location: Corvallis, Oregon
  • Expat Brit living in the New World..:)
Re: What comes after the ACA?
« Reply #6487 on: November 04, 2020, 11:58:23 PM »
...people looked upon the ACA in 2010 as the beginning of the end, and fortunately, before the end of 2020, the grand experiment had died!  Thank you Republicans.  Healthcare in the USA finally reverted to what it should have been all along in a capitalist society - for the fortunate.  For others, it is a thing to strive for and covet...

At least that is the impression I get from the results of this election.  I would have thought folks generally would have wanted to protect the ACA, but they did not.

I think when half of the electorate will hang on every word that comes out of Trump's mouth, its hardly surprising they will believe almost anything.

ACA is a evil Socialist deep State plot.. Yup, Q-anon.. lovely people, If Trump loses the election then there MUST be fraud.. Where's my gun?

I note a bunch of armed trump intimidators are protesting outside Maricopa county in Arizona as we speak.

We seemed to have lost any ability for critical thinking in the great unwashed masses.

stoaX

  • Pencil Stache
  • ****
  • Posts: 606
  • Location: South Carolina
  • 'tis nothing good nor bad but thinking makes it so
Re: What comes after the ACA?
« Reply #6488 on: November 05, 2020, 04:47:27 AM »
Maybe it's a fear of creeping Socialism.  All they have to do is to look North of the border and see possible impact on the bottom line.  They may not be able to stop health care reform, but if they can delay it another generation that's all they need.  You'll note a similar tact seems to be the reaction to global warming.

Despite negative caricatures of conservatives against government involvement in healthcare, the fact is that most of the common voters who are against it believe that the government will mess it up. It's as simple as that. Note this is not talking about politicians against it, just average people.
This part perplexes me. If we had something good now and there was fear of breaking it, that would be one thing. But the current system is so utterly broken it is hard to argue that just about anything with actual intentions to help would be worse.

I say intentions to improve to weed out he republican non-plans that just want to dismantle ACA with no viable replacement.

Well people are sheep. Just look at our elections where 50% of the country can elect such a clown to be President! Not only that he spreads dangerous ideas. and most of his followers agree with them.

People are so married to the "religious dogma" of "Socialism is baaaad", that logic simply flys out the window.

Whats more the American HC system works very well indeed.. if you're rich!

 HC Is a profit making machine so uber rich folks (like politicians) have precisely no incentive to fix the system for the average person in the street.

Case in point.. I broke my wrist last year. My insurance was billed $28k for the surgery. Now I made more than $28k in 2019 from the HC portion of my stock index funds. If I had more millions I'd make even more money, so in theory its awesome!

Why would I want "free" HC where the companies in that sector would pay a fraction of the dividends they do today?
Is it even working for the rich though?

I’ve spent most of my life with Kaiser and got used to things just being integrated and working. These past six months we have been on not-Kaiser through my husband’s work due to a move. While we have very generous insurance and even a concierge service to help fight bills and explain benefits, it has been a dumpster fire. The inefficiencies are breathtaking and the difficulty of getting care has been a real stressor for me. Thankfully we are going back to Kaiser in January and so I just have a To Do list now of minor health concerns to deal with then once I am back in a smoothly-run system. In my short experience in the outside world I would say the American healthcare system is fundamentally  broken for everyone.

I too recently left Kaiser due to a move. While my experience in the more traditional, non-Kaiser world hasn't been a "dumpster fire", you are right about Kaiser being more efficient. And I think the integrated system usually results in better care.

toocold

  • 5 O'Clock Shadow
  • *
  • Posts: 49
Re: What comes after the ACA?
« Reply #6489 on: November 05, 2020, 06:38:08 AM »
...people looked upon the ACA in 2010 as the beginning of the end, and fortunately, before the end of 2020, the grand experiment had died!  Thank you Republicans.  Healthcare in the USA finally reverted to what it should have been all along in a capitalist society - for the fortunate.  For others, it is a thing to strive for and covet...

At least that is the impression I get from the results of this election.  I would have thought folks generally would have wanted to protect the ACA, but they did not.

I think Healthcare was probably the third or fourth priority issue, so I don't read it this way. 

My personal opinion is, if Biden does win and is able to work with the Republicans on a longer term solution for healthcare, it will stabilize.  I recall that since Obama had both the house and senate, they were able to push through the ACA with very few Republican support, and it has been a contentious policy ever since then.

GuitarStv

  • Senior Mustachian
  • ********
  • Posts: 16906
  • Age: 39
  • Location: Toronto, Ontario, Canada
Re: What comes after the ACA?
« Reply #6490 on: November 05, 2020, 07:16:44 AM »
I recall that since Obama had both the house and senate, they were able to push through the ACA with very few Republican support, and it has been a contentious policy ever since then.

Do you recall that 'Obamacare' was a Republican idea that had widespread support from that party - until Obama suggested it?

pecunia

  • Handlebar Stache
  • *****
  • Posts: 1711
Re: What comes after the ACA?
« Reply #6491 on: November 05, 2020, 07:17:45 AM »
...people looked upon the ACA in 2010 as the beginning of the end, and fortunately, before the end of 2020, the grand experiment had died!  Thank you Republicans.  Healthcare in the USA finally reverted to what it should have been all along in a capitalist society - for the fortunate.  For others, it is a thing to strive for and covet...

At least that is the impression I get from the results of this election.  I would have thought folks generally would have wanted to protect the ACA, but they did not.

I think Healthcare was probably the third or fourth priority issue, so I don't read it this way. 

My personal opinion is, if Biden does win and is able to work with the Republicans on a longer term solution for healthcare, it will stabilize.  I recall that since Obama had both the house and senate, they were able to push through the ACA with very few Republican support, and it has been a contentious policy ever since then.

As has been stated previously, ole Mitch will still be standing in the way - Kentucky strikes me as a stereotype state for Trump type supporters.

katsiki

  • Handlebar Stache
  • *****
  • Posts: 1650
  • Age: 40
  • Location: La.
Re: What comes after the ACA?
« Reply #6492 on: November 05, 2020, 07:21:38 AM »
I think when half of the electorate will hang on every word that comes out of Trump's mouth, its hardly surprising they will believe almost anything.

Not to defend Trump or blind Trump devotees, I don't think 50% are hanging on his every word.  I understand your point - that is how they are voting.  However, I think many folks (probably on both sides) held their nose and voted for the best available option.  In the case of Trump voters I know, many dislike him and much of what he has done; however, they are voting for him in support of some of what he has done that they support.  ie supreme court justices, abortion policy, etc.

Hope everyone can stay calm while we wait this out... I worry about riots and crazy behavior!!

toocold

  • 5 O'Clock Shadow
  • *
  • Posts: 49
Re: What comes after the ACA?
« Reply #6493 on: November 05, 2020, 07:30:21 AM »
I recall that since Obama had both the house and senate, they were able to push through the ACA with very few Republican support, and it has been a contentious policy ever since then.

Do you recall that 'Obamacare' was a Republican idea that had widespread support from that party - until Obama suggested it?

Yes, the heritage foundation contributed to coming up with it and had a number of republicans support it, and it was first adopted by MA under Romney.

Do you recall when ACA was initially passed, the republican threatened with a "nuclear option" if the democrats passed it without any republican support?

I'm not taking sides, I'm just saying that most long lasting policies (e.g. SS, Medicare) happen when both sides agree to a concept, not just one side ramming it through the other side through a reconciliation process. 
« Last Edit: November 05, 2020, 07:32:36 AM by toocold »

GuitarStv

  • Senior Mustachian
  • ********
  • Posts: 16906
  • Age: 39
  • Location: Toronto, Ontario, Canada
Re: What comes after the ACA?
« Reply #6494 on: November 05, 2020, 07:35:24 AM »
I recall that since Obama had both the house and senate, they were able to push through the ACA with very few Republican support, and it has been a contentious policy ever since then.

Do you recall that 'Obamacare' was a Republican idea that had widespread support from that party - until Obama suggested it?

Yes, the heritage foundation contributed to coming up with it and had a number of republicans support it, and it was first adopted by MA under Romney.

Do you recall when ACA was initially passed, the republican threatened with a "nuclear option" if the democrats passed it without any republican support?

I'm not taking sides, I'm just saying that most long lasting policies (e.g. SS, Medicare) happen when both sides agree to a concept, not just one side ramming it through the other side through a reconciliation process.

I recall that Republicans had taken the position that anything proposed by Obama would be opposed out of hand . . . so am wondering how you expect any legislation would have been passed with Republican support.

Both sides agreeing to a concept is a good way to pass things - absolutely.  But how is it possible when one side says that their only goal in office it to prevent the other side from doing their job?

toocold

  • 5 O'Clock Shadow
  • *
  • Posts: 49
Re: What comes after the ACA?
« Reply #6495 on: November 05, 2020, 07:45:25 AM »
I recall that since Obama had both the house and senate, they were able to push through the ACA with very few Republican support, and it has been a contentious policy ever since then.

Do you recall that 'Obamacare' was a Republican idea that had widespread support from that party - until Obama suggested it?

Yes, the heritage foundation contributed to coming up with it and had a number of republicans support it, and it was first adopted by MA under Romney.

Do you recall when ACA was initially passed, the republican threatened with a "nuclear option" if the democrats passed it without any republican support?

I'm not taking sides, I'm just saying that most long lasting policies (e.g. SS, Medicare) happen when both sides agree to a concept, not just one side ramming it through the other side through a reconciliation process.

I recall that Republicans had taken the position that anything proposed by Obama would be opposed out of hand . . . so am wondering how you expect any legislation would have been passed with Republican support.

Both sides agreeing to a concept is a good way to pass things - absolutely.  But how is it possible when one side says that their only goal in office it to prevent the other side from doing their job?

When Clinton lost big during his first midterm election, he reached across the aisle and worked with the republicans on a number of good policies -- I would say more than his first term.  Obama should have done the same but I think he was looking for a big policy win quickly.

For now, we are where we are, and we can only hope for the future, and I'm hoping that if Biden wins, he can bring some civility back and they are able to make some progress.




sherr

  • Handlebar Stache
  • *****
  • Posts: 1430
  • Age: 35
  • Location: North Carolina, USA
Re: What comes after the ACA?
« Reply #6496 on: November 05, 2020, 07:47:59 AM »
I recall that Republicans had taken the position that anything proposed by Obama would be opposed out of hand . . . so am wondering how you expect any legislation would have been passed with Republican support.

Both sides agreeing to a concept is a good way to pass things - absolutely.  But how is it possible when one side says that their only goal in office it to prevent the other side from doing their job?

When Clinton lost big during his first midterm election, he reached across the aisle and worked with the republicans on a number of good policies -- I would say more than his first term.  Obama should have done the same but I think he was looking for a big policy win quickly.

For now, we are where we are, and we can only hope for the future, and I'm hoping that if Biden wins, he can bring some civility back and they are able to make some progress.

Senate Minority Leader Mitch McConnell: "The single most important thing we want to achieve is for President Obama to be a one-term president."

House Minority Leader John Boehner: "This is not a time for compromise, and I can tell you that we will not compromise on our principles. We're going to do everything — and I mean everything we can do — to kill it (Obama's agenda / policies), stop it, slow it down, whatever we can."

In order for compromise to be a possible option, both sides have to be willing to compromise. Republicans don't want to compromise, they want to obstruct. Complete obstruction plays into their "Government is bad and we should have less of it" narrative, as well as their "Democratic presidents can't get anything done" narrative. Why would they want to compromise? That may serve the American people, but it doesn't serve Republican interests.

toocold

  • 5 O'Clock Shadow
  • *
  • Posts: 49
Re: What comes after the ACA?
« Reply #6497 on: November 05, 2020, 07:51:46 AM »
I recall that Republicans had taken the position that anything proposed by Obama would be opposed out of hand . . . so am wondering how you expect any legislation would have been passed with Republican support.

Both sides agreeing to a concept is a good way to pass things - absolutely.  But how is it possible when one side says that their only goal in office it to prevent the other side from doing their job?

When Clinton lost big during his first midterm election, he reached across the aisle and worked with the republicans on a number of good policies -- I would say more than his first term.  Obama should have done the same but I think he was looking for a big policy win quickly.

For now, we are where we are, and we can only hope for the future, and I'm hoping that if Biden wins, he can bring some civility back and they are able to make some progress.

Senate Minority Leader Mitch McConnell: "The single most important thing we want to achieve is for President Obama to be a one-term president."

House Minority Leader John Boehner: "This is not a time for compromise, and I can tell you that we will not compromise on our principles. We're going to do everything — and I mean everything we can do — to kill it (Obama's agenda / policies), stop it, slow it down, whatever we can."

In order for compromise to be a possible option, both sides have to be willing to compromise. Republicans don't want to compromise, they want to obstruct. Complete obstruction plays into their "Government is bad and we should have less of it" narrative, as well as their "Democratic presidents can't get anything done" narrative. Why would they want to compromise? That may serve the American people, but it doesn't serve Republican interests.

Nice job of taking quotes 3 weeks before Obama's midterm election, 6 months after Obama pushed through the ACA without any Republican support.  And you are shocked at their attitude?
« Last Edit: November 05, 2020, 07:54:04 AM by toocold »

sherr

  • Handlebar Stache
  • *****
  • Posts: 1430
  • Age: 35
  • Location: North Carolina, USA
Re: What comes after the ACA?
« Reply #6498 on: November 05, 2020, 08:01:18 AM »
I recall that Republicans had taken the position that anything proposed by Obama would be opposed out of hand . . . so am wondering how you expect any legislation would have been passed with Republican support.

Both sides agreeing to a concept is a good way to pass things - absolutely.  But how is it possible when one side says that their only goal in office it to prevent the other side from doing their job?

When Clinton lost big during his first midterm election, he reached across the aisle and worked with the republicans on a number of good policies -- I would say more than his first term.  Obama should have done the same but I think he was looking for a big policy win quickly.

For now, we are where we are, and we can only hope for the future, and I'm hoping that if Biden wins, he can bring some civility back and they are able to make some progress.

Senate Minority Leader Mitch McConnell: "The single most important thing we want to achieve is for President Obama to be a one-term president."

House Minority Leader John Boehner: "This is not a time for compromise, and I can tell you that we will not compromise on our principles. We're going to do everything — and I mean everything we can do — to kill it (Obama's agenda / policies), stop it, slow it down, whatever we can."

In order for compromise to be a possible option, both sides have to be willing to compromise. Republicans don't want to compromise, they want to obstruct. Complete obstruction plays into their "Government is bad and we should have less of it" narrative, as well as their "Democratic presidents can't get anything done" narrative. Why would they want to compromise? That may serve the American people, but it doesn't serve Republican interests.

Nice job of taking quotes 3 weeks before Obama's midterm election, 6 months after Obama pushed through the ACA without any Republican support.  And you are shocked at their attitude?

The history of Obama (and Democrats in general) begging the Republicans to participate in the ACA is well documented. The fact that exactly zero Republicans ended up voting for it in spite of all the previous negotiation is evidence for my thesis of Republican Total Obstruction, not your thesis of Democrats Not Being Willing To Compromise.

sherr

  • Handlebar Stache
  • *****
  • Posts: 1430
  • Age: 35
  • Location: North Carolina, USA
Re: What comes after the ACA?
« Reply #6499 on: November 05, 2020, 08:12:21 AM »
I recommend everyone in the country to take half an hour or so and read this excellent interview with Former Speaker Newt Gingrich. If you're wondering how we wound up here politically, he'll proudly tell you why: because this is how he made it and wants it to be. And it apparently works, so Republicans have kept doing it since.