Author Topic: What comes after the ACA?  (Read 1468146 times)

pecunia

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Re: What comes after the ACA?
« Reply #6600 on: November 12, 2020, 08:35:00 AM »
Would it be possible to "shame" the Republicans into incremental healthcare law improvements?  Biden will have the bully pulpit.  Healthcare affects everyone.

I remember a few years back when Republicans were trying to repeal the ACA and replace it with the ACHA, there were videos of Town Halls that would practically bring you to tears.  Constituents would tell their representatives in all seriousness that the law change would kill their wives and ask them if they really wanted to do this.  People in those Town hall meetings were very very angry.  Could the force of the public be channeled into positive changes

Maybe, Mitch has no shame.

wenchsenior

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Re: What comes after the ACA?
« Reply #6601 on: November 12, 2020, 09:01:58 AM »
Would it be possible to "shame" the Republicans into incremental healthcare law improvements?  Biden will have the bully pulpit.  Healthcare affects everyone.



HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAAHAAA!!!!

:wipes tears:

OtherJen

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Re: What comes after the ACA?
« Reply #6602 on: November 12, 2020, 09:05:34 AM »
Would it be possible to "shame" the Republicans into incremental healthcare law improvements?  Biden will have the bully pulpit.  Healthcare affects everyone.



HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAAHAAA!!!!

:wipes tears:

I needed a good laugh.

Seriously, though, I don't think we can begin to have a serious national conversation about healthcare until the Tea Party/MAGA Republicans are voted out of office. More moderate Republicans would likely be willing to collaborate and compromise if the national party (and thus their ability to hold office) wasn't controlled by the extremist fringe.

Luck12

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Re: What comes after the ACA?
« Reply #6603 on: November 12, 2020, 09:45:41 AM »

Recently, I was talking with a neighbor who told me he was really concerned about a Biden/Harris administration ruining the US. When I asked him what he was most worried Joe and Kamala might do, he replied, "socialized healthcare." I said, "So...you're concerned they might help more people to be able to go to a doctor if they get sick?" He said, "There's no way we could ever possibly afford to give healthcare to everyone in the US. The country would go broke."

You should tell him a sovereign currency issuer like the US Gov't can afford anything it wants to afford, it cannot go broke unless it chooses to do so.  Buy him a copy of The Deficit Myth by Stephanie Kelton.   I'm sick of this "we're gonna go broke" and "how will you pay for it" bullshit.  We have to educate people on this most important topic.  Every year there are millions/billions spent by right wing billionaires to brainwash people into believing this nonsense.   The important issue(s) are not about how we are going to pay for it, but rather how will we ensure that we have enough doctors and hospitals to serve patients and what we're going to do about the lost jobs (albeit most are bullshit jobs) as a result of the private health insurance industry shrinking. 

If we could get people understand federal fiscal reality more of them would never settle for the crumbs we're getting.  Then of course there are those monstrous socipathic people who would understand fiscal reality but still wouldn't give a shit about people  dying or going bankrupt due to a lack of affordable health care.
« Last Edit: November 12, 2020, 09:49:37 AM by Luck12 »

rab-bit

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Re: What comes after the ACA?
« Reply #6604 on: November 12, 2020, 10:10:27 AM »

Recently, I was talking with a neighbor who told me he was really concerned about a Biden/Harris administration ruining the US. When I asked him what he was most worried Joe and Kamala might do, he replied, "socialized healthcare." I said, "So...you're concerned they might help more people to be able to go to a doctor if they get sick?" He said, "There's no way we could ever possibly afford to give healthcare to everyone in the US. The country would go broke."

You should tell him a sovereign currency issuer like the US Gov't can afford anything it wants to afford, it cannot go broke unless it chooses to do so.  Buy him a copy of The Deficit Myth by Stephanie Kelton.   I'm sick of this "we're gonna go broke" and "how will you pay for it" bullshit.  We have to educate people on this most important topic.  Every year there are millions/billions spent by right wing billionaires to brainwash people into believing this nonsense.   The important issue(s) are not about how we are going to pay for it, but rather how will we ensure that we have enough doctors and hospitals to serve patients and what we're going to do about the lost jobs (albeit most are bullshit jobs) as a result of the private health insurance industry shrinking. 

If we could get people understand federal fiscal reality more of them would never settle for the crumbs we're getting.  Then of course there are those monstrous socipathic people who would understand fiscal reality but still wouldn't give a shit about people  dying or going bankrupt due to a lack of affordable health care.

Paying for universal healthcare is also a question of priorities. Shaving a little off the defense budget would go a long way toward covering any additional expense.

jim555

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Re: What comes after the ACA?
« Reply #6605 on: November 12, 2020, 10:27:26 AM »
Nothing will get done with Mitch controlling the Senate, period.

Luck12

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Re: What comes after the ACA?
« Reply #6606 on: November 12, 2020, 10:34:47 AM »

Recently, I was talking with a neighbor who told me he was really concerned about a Biden/Harris administration ruining the US. When I asked him what he was most worried Joe and Kamala might do, he replied, "socialized healthcare."

Also people don't understand the difference between "socialized healthcare" and "socialized health care financing".   You can have one without the other, both, or none.    People are fucking dumb but that's nothing new. 

John Galt incarnate!

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Re: What comes after the ACA?
« Reply #6607 on: November 12, 2020, 12:14:50 PM »
I am curious about the next steps after a ruling on severability.

Suppose it comes down to severability and the SC rules that the individual mandate is severable from the rest of the law. What happens next? Do Congress and the President have to do anything, like pass an amended law?

Neither Congress nor the president have to to do anything. 

Congress has exclusive power  to pass  bills  if it so chooses and the president has exclusive power to  sign them into law or veto  them  if he so chooses.

However, for bills to be signed into law the separation of power between the legislative and executive branches cannot be hermetic.  Signing a bill into law involves a coordinate exercise of legislative and executive power.

If Congress' acts are to be signed into law they must be crafted so that  the president approves of them which means  there has to be sufficient compromise between the branches so that "each side gets some of what it wants."


 If yes, is it possible the the GOP-controlled Senate refuses to cooperate and what would happen in that case?

Yes, it is certainly possible in which case the ACA's status quo ante stands.

« Last Edit: January 06, 2021, 10:50:46 AM by John Galt incarnate! »

Shane

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Re: What comes after the ACA?
« Reply #6608 on: November 12, 2020, 02:10:19 PM »

Recently, I was talking with a neighbor who told me he was really concerned about a Biden/Harris administration ruining the US. When I asked him what he was most worried Joe and Kamala might do, he replied, "socialized healthcare." I said, "So...you're concerned they might help more people to be able to go to a doctor if they get sick?" He said, "There's no way we could ever possibly afford to give healthcare to everyone in the US. The country would go broke."

You should tell him a sovereign currency issuer like the US Gov't can afford anything it wants to afford, it cannot go broke unless it chooses to do so.  Buy him a copy of The Deficit Myth by Stephanie Kelton.   I'm sick of this "we're gonna go broke" and "how will you pay for it" bullshit.  We have to educate people on this most important topic.  Every year there are millions/billions spent by right wing billionaires to brainwash people into believing this nonsense.   The important issue(s) are not about how we are going to pay for it, but rather how will we ensure that we have enough doctors and hospitals to serve patients and what we're going to do about the lost jobs (albeit most are bullshit jobs) as a result of the private health insurance industry shrinking. 

If we could get people understand federal fiscal reality more of them would never settle for the crumbs we're getting.  Then of course there are those monstrous socipathic people who would understand fiscal reality but still wouldn't give a shit about people  dying or going bankrupt due to a lack of affordable health care.
  Have heard of Stephanie Kelton and MMT, but haven't yet read her book. Just put a hold on it through the library. Thanks for the recommendation!

Shane

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Re: What comes after the ACA?
« Reply #6609 on: November 12, 2020, 02:14:46 PM »

Recently, I was talking with a neighbor who told me he was really concerned about a Biden/Harris administration ruining the US. When I asked him what he was most worried Joe and Kamala might do, he replied, "socialized healthcare." I said, "So...you're concerned they might help more people to be able to go to a doctor if they get sick?" He said, "There's no way we could ever possibly afford to give healthcare to everyone in the US. The country would go broke."

You should tell him a sovereign currency issuer like the US Gov't can afford anything it wants to afford, it cannot go broke unless it chooses to do so.  Buy him a copy of The Deficit Myth by Stephanie Kelton.   I'm sick of this "we're gonna go broke" and "how will you pay for it" bullshit.  We have to educate people on this most important topic.  Every year there are millions/billions spent by right wing billionaires to brainwash people into believing this nonsense.   The important issue(s) are not about how we are going to pay for it, but rather how will we ensure that we have enough doctors and hospitals to serve patients and what we're going to do about the lost jobs (albeit most are bullshit jobs) as a result of the private health insurance industry shrinking. 

If we could get people understand federal fiscal reality more of them would never settle for the crumbs we're getting.  Then of course there are those monstrous socipathic people who would understand fiscal reality but still wouldn't give a shit about people  dying or going bankrupt due to a lack of affordable health care.

Paying for universal healthcare is also a question of priorities. Shaving a little off the defense budget would go a long way toward covering any additional expense.
It seems like we should be able to provide everyone in the US with universal healthcare for far less money than we are spending right now. Every other OECD country does it. Many of them are far smaller than the US. Due to economies of scale, we should be able to provide quality healthcare to our people for even less than a country like Canada that only has a little more than 10% of our population.

reeshau

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Re: What comes after the ACA?
« Reply #6610 on: November 12, 2020, 03:00:42 PM »

Recently, I was talking with a neighbor who told me he was really concerned about a Biden/Harris administration ruining the US. When I asked him what he was most worried Joe and Kamala might do, he replied, "socialized healthcare." I said, "So...you're concerned they might help more people to be able to go to a doctor if they get sick?" He said, "There's no way we could ever possibly afford to give healthcare to everyone in the US. The country would go broke."

You should tell him a sovereign currency issuer like the US Gov't can afford anything it wants to afford, it cannot go broke unless it chooses to do so.  Buy him a copy of The Deficit Myth by Stephanie Kelton.   I'm sick of this "we're gonna go broke" and "how will you pay for it" bullshit.  We have to educate people on this most important topic.  Every year there are millions/billions spent by right wing billionaires to brainwash people into believing this nonsense.   The important issue(s) are not about how we are going to pay for it, but rather how will we ensure that we have enough doctors and hospitals to serve patients and what we're going to do about the lost jobs (albeit most are bullshit jobs) as a result of the private health insurance industry shrinking. 

If we could get people understand federal fiscal reality more of them would never settle for the crumbs we're getting.  Then of course there are those monstrous socipathic people who would understand fiscal reality but still wouldn't give a shit about people  dying or going bankrupt due to a lack of affordable health care.

Paying for universal healthcare is also a question of priorities. Shaving a little off the defense budget would go a long way toward covering any additional expense.
It seems like we should be able to provide everyone in the US with universal healthcare for far less money than we are spending right now. Every other OECD country does it. Many of them are far smaller than the US. Due to economies of scale, we should be able to provide quality healthcare to our people for even less than a country like Canada that only has a little more than 10% of our population.

Adjusting US healthcare will be a dislocation for more than the companies and voters.  A GP in Ireland, even in high-cost Dublin, even with experience (i.e. not a resident) will make under $100k.  That isn't as bad as it seems, because they won't have a six-figure student loan to pay back.  But to emulate other single-payer systems, there is as much threat to skilled salaries as there is to provider profits.  (Too low?  How do you set It?  And what about that expensive education?)

There is also a potential impact that the high US drug prices, which fund a lot of research, effectively subsidize countries that institute price controls.  Once a drug exists, then yes look at the incremental manufacturing costs and sell into that country.  But if you can't amortized your R&D somewhere, then innovation grinds to a halt, or also needs a new way to think through it.

GuitarStv

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Re: What comes after the ACA?
« Reply #6611 on: November 12, 2020, 06:10:27 PM »

Recently, I was talking with a neighbor who told me he was really concerned about a Biden/Harris administration ruining the US. When I asked him what he was most worried Joe and Kamala might do, he replied, "socialized healthcare." I said, "So...you're concerned they might help more people to be able to go to a doctor if they get sick?" He said, "There's no way we could ever possibly afford to give healthcare to everyone in the US. The country would go broke."

You should tell him a sovereign currency issuer like the US Gov't can afford anything it wants to afford, it cannot go broke unless it chooses to do so.  Buy him a copy of The Deficit Myth by Stephanie Kelton.   I'm sick of this "we're gonna go broke" and "how will you pay for it" bullshit.  We have to educate people on this most important topic.  Every year there are millions/billions spent by right wing billionaires to brainwash people into believing this nonsense.   The important issue(s) are not about how we are going to pay for it, but rather how will we ensure that we have enough doctors and hospitals to serve patients and what we're going to do about the lost jobs (albeit most are bullshit jobs) as a result of the private health insurance industry shrinking. 

If we could get people understand federal fiscal reality more of them would never settle for the crumbs we're getting.  Then of course there are those monstrous socipathic people who would understand fiscal reality but still wouldn't give a shit about people  dying or going bankrupt due to a lack of affordable health care.

Paying for universal healthcare is also a question of priorities. Shaving a little off the defense budget would go a long way toward covering any additional expense.
It seems like we should be able to provide everyone in the US with universal healthcare for far less money than we are spending right now. Every other OECD country does it. Many of them are far smaller than the US. Due to economies of scale, we should be able to provide quality healthcare to our people for even less than a country like Canada that only has a little more than 10% of our population.

Adjusting US healthcare will be a dislocation for more than the companies and voters.  A GP in Ireland, even in high-cost Dublin, even with experience (i.e. not a resident) will make under $100k.  That isn't as bad as it seems, because they won't have a six-figure student loan to pay back.  But to emulate other single-payer systems, there is as much threat to skilled salaries as there is to provider profits.  (Too low?  How do you set It?  And what about that expensive education?)

There is also a potential impact that the high US drug prices, which fund a lot of research, effectively subsidize countries that institute price controls.  Once a drug exists, then yes look at the incremental manufacturing costs and sell into that country.  But if you can't amortized your R&D somewhere, then innovation grinds to a halt, or also needs a new way to think through it.

Extremely low salaries as those in Ireland are certainly not a rule.

The average salary for a Canadian doctor is about 280k for a family doctor, and goes up quite a lot if the doctor is a specialist.  Opthamologists make 770k a year, surgeons around 480k, etc.  My understanding is that that's in the same ballpark as what US doctors make.

reeshau

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Re: What comes after the ACA?
« Reply #6612 on: November 13, 2020, 04:12:50 AM »

Recently, I was talking with a neighbor who told me he was really concerned about a Biden/Harris administration ruining the US. When I asked him what he was most worried Joe and Kamala might do, he replied, "socialized healthcare." I said, "So...you're concerned they might help more people to be able to go to a doctor if they get sick?" He said, "There's no way we could ever possibly afford to give healthcare to everyone in the US. The country would go broke."

You should tell him a sovereign currency issuer like the US Gov't can afford anything it wants to afford, it cannot go broke unless it chooses to do so.  Buy him a copy of The Deficit Myth by Stephanie Kelton.   I'm sick of this "we're gonna go broke" and "how will you pay for it" bullshit.  We have to educate people on this most important topic.  Every year there are millions/billions spent by right wing billionaires to brainwash people into believing this nonsense.   The important issue(s) are not about how we are going to pay for it, but rather how will we ensure that we have enough doctors and hospitals to serve patients and what we're going to do about the lost jobs (albeit most are bullshit jobs) as a result of the private health insurance industry shrinking. 

If we could get people understand federal fiscal reality more of them would never settle for the crumbs we're getting.  Then of course there are those monstrous socipathic people who would understand fiscal reality but still wouldn't give a shit about people  dying or going bankrupt due to a lack of affordable health care.

Paying for universal healthcare is also a question of priorities. Shaving a little off the defense budget would go a long way toward covering any additional expense.
It seems like we should be able to provide everyone in the US with universal healthcare for far less money than we are spending right now. Every other OECD country does it. Many of them are far smaller than the US. Due to economies of scale, we should be able to provide quality healthcare to our people for even less than a country like Canada that only has a little more than 10% of our population.

Adjusting US healthcare will be a dislocation for more than the companies and voters.  A GP in Ireland, even in high-cost Dublin, even with experience (i.e. not a resident) will make under $100k.  That isn't as bad as it seems, because they won't have a six-figure student loan to pay back.  But to emulate other single-payer systems, there is as much threat to skilled salaries as there is to provider profits.  (Too low?  How do you set It?  And what about that expensive education?)

There is also a potential impact that the high US drug prices, which fund a lot of research, effectively subsidize countries that institute price controls.  Once a drug exists, then yes look at the incremental manufacturing costs and sell into that country.  But if you can't amortized your R&D somewhere, then innovation grinds to a halt, or also needs a new way to think through it.

Extremely low salaries as those in Ireland are certainly not a rule.

The average salary for a Canadian doctor is about 280k for a family doctor, and goes up quite a lot if the doctor is a specialist.  Opthamologists make 770k a year, surgeons around 480k, etc.  My understanding is that that's in the same ballpark as what US doctors make.

That's a lot more than for a US GP actually, but the others are comparable, yes.  I haven't been able to find any global comparisons to tell which situation would be more typical.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #6613 on: November 13, 2020, 04:40:15 AM »

Recently, I was talking with a neighbor who told me he was really concerned about a Biden/Harris administration ruining the US. When I asked him what he was most worried Joe and Kamala might do, he replied, "socialized healthcare." I said, "So...you're concerned they might help more people to be able to go to a doctor if they get sick?" He said, "There's no way we could ever possibly afford to give healthcare to everyone in the US. The country would go broke."

You should tell him a sovereign currency issuer like the US Gov't can afford anything it wants to afford, it cannot go broke unless it chooses to do so.  Buy him a copy of The Deficit Myth by Stephanie Kelton.   I'm sick of this "we're gonna go broke" and "how will you pay for it" bullshit.  We have to educate people on this most important topic.  Every year there are millions/billions spent by right wing billionaires to brainwash people into believing this nonsense.   The important issue(s) are not about how we are going to pay for it, but rather how will we ensure that we have enough doctors and hospitals to serve patients and what we're going to do about the lost jobs (albeit most are bullshit jobs) as a result of the private health insurance industry shrinking. 

If we could get people understand federal fiscal reality more of them would never settle for the crumbs we're getting.  Then of course there are those monstrous socipathic people who would understand fiscal reality but still wouldn't give a shit about people  dying or going bankrupt due to a lack of affordable health care.

Paying for universal healthcare is also a question of priorities. Shaving a little off the defense budget would go a long way toward covering any additional expense.
It seems like we should be able to provide everyone in the US with universal healthcare for far less money than we are spending right now. Every other OECD country does it. Many of them are far smaller than the US. Due to economies of scale, we should be able to provide quality healthcare to our people for even less than a country like Canada that only has a little more than 10% of our population.

Adjusting US healthcare will be a dislocation for more than the companies and voters.  A GP in Ireland, even in high-cost Dublin, even with experience (i.e. not a resident) will make under $100k.  That isn't as bad as it seems, because they won't have a six-figure student loan to pay back.  But to emulate other single-payer systems, there is as much threat to skilled salaries as there is to provider profits.  (Too low?  How do you set It?  And what about that expensive education?)

There is also a potential impact that the high US drug prices, which fund a lot of research, effectively subsidize countries that institute price controls.  Once a drug exists, then yes look at the incremental manufacturing costs and sell into that country.  But if you can't amortized your R&D somewhere, then innovation grinds to a halt, or also needs a new way to think through it.

Extremely low salaries as those in Ireland are certainly not a rule.

The average salary for a Canadian doctor is about 280k for a family doctor, and goes up quite a lot if the doctor is a specialist.  Opthamologists make 770k a year, surgeons around 480k, etc.  My understanding is that that's in the same ballpark as what US doctors make.

If provider compensation isn't the issue, how are the cost savings achieved in the Canadian model?

former player

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Re: What comes after the ACA?
« Reply #6614 on: November 13, 2020, 05:26:14 AM »

If provider compensation isn't the issue, how are the cost savings achieved in the Canadian model?
Some of it is drug costs as mentioned above, some of it is admin costs -

https://time.com/5759972/health-care-administrative-costs/

That's a lot of nicely paid but ultimately economically unproductive jobs, of course.  And some big political donors in those companies.

GuitarStv

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Re: What comes after the ACA?
« Reply #6615 on: November 13, 2020, 07:28:52 AM »

If provider compensation isn't the issue, how are the cost savings achieved in the Canadian model?
Some of it is drug costs as mentioned above, some of it is admin costs -

https://time.com/5759972/health-care-administrative-costs/

That's a lot of nicely paid but ultimately economically unproductive jobs, of course.  And some big political donors in those companies.

Yep.  The US has created a gigantic layer of bureaucracy that needs to be paid between a person and medical providers . . . insurance salesmen, insurance adjusters, experts to co-ordinate between insurance and doctors, hospital administration to deal with various forms of insurance, plus all the claims people involved in chasing down unpaid bills.  I'm probably forgetting some.  That's entirely unnecessary overhead, and is very expensive.

In Canada you pay mostly for health care.  In the US you pay to keep a fantastically huge layer of bureaucracy going, and then for some health care on top.

pecunia

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Re: What comes after the ACA?
« Reply #6616 on: November 13, 2020, 08:30:29 AM »

- SNIP -

Yep.  The US has created a gigantic layer of bureaucracy that needs to be paid between a person and medical providers . . . insurance salesmen, insurance adjusters, experts to co-ordinate between insurance and doctors, hospital administration to deal with various forms of insurance, plus all the claims people involved in chasing down unpaid bills.  I'm probably forgetting some.  That's entirely unnecessary overhead, and is very expensive.

In Canada you pay mostly for health care.  In the US you pay to keep a fantastically huge layer of bureaucracy going, and then for some health care on top.

"fantastially huge layer of bureaucracy"

I never hear the Canadians complain about their health care.  If someone does do they just point South and they immediately shut up?

GuitarStv

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Re: What comes after the ACA?
« Reply #6617 on: November 13, 2020, 08:49:44 AM »

- SNIP -

Yep.  The US has created a gigantic layer of bureaucracy that needs to be paid between a person and medical providers . . . insurance salesmen, insurance adjusters, experts to co-ordinate between insurance and doctors, hospital administration to deal with various forms of insurance, plus all the claims people involved in chasing down unpaid bills.  I'm probably forgetting some.  That's entirely unnecessary overhead, and is very expensive.

In Canada you pay mostly for health care.  In the US you pay to keep a fantastically huge layer of bureaucracy going, and then for some health care on top.

"fantastially huge layer of bureaucracy"

I never hear the Canadians complain about their health care.  If someone does do they just point South and they immediately shut up?

No, we complain all the time.

In our system you can't buy your way to the top.  People are triaged and treated based upon need (not wealth).  So if you have an annoying but not life threatening medical issue, it will probably take longer to get a doctor to see it.  Especially if it's a problem that needs a specialist, you might have to wait a few months to have your appointment - that sort of thing.  This is a very common complaint.

Because we don't separate our health care quality into classes based on money, the US system definitely works better than the Canadian system if you're rich.  There are a few extremely rich people in Canada who are constantly complaining about how we should make our health care more like the US.  Overall, the health care system is pretty well liked by the majority of us . . . and yes, the US is typically used as a cautionary tale of the dangers of trying to force a human right into a capitalist profit-making mold.

Shane

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Re: What comes after the ACA?
« Reply #6618 on: November 13, 2020, 11:19:40 AM »

If provider compensation isn't the issue, how are the cost savings achieved in the Canadian model?
Some of it is drug costs as mentioned above, some of it is admin costs -

https://time.com/5759972/health-care-administrative-costs/

That's a lot of nicely paid but ultimately economically unproductive jobs, of course.  And some big political donors in those companies.

Yep.  The US has created a gigantic layer of bureaucracy that needs to be paid between a person and medical providers . . . insurance salesmen, insurance adjusters, experts to co-ordinate between insurance and doctors, hospital administration to deal with various forms of insurance, plus all the claims people involved in chasing down unpaid bills.  I'm probably forgetting some.  That's entirely unnecessary overhead, and is very expensive.

In Canada you pay mostly for health care.  In the US you pay to keep a fantastically huge layer of bureaucracy going, and then for some health care on top.

On top of the expenses Steve mentioned that go to the middle-men insurance companies, another layer of expense is that all 50 states have their own licensing requirements for insurance companies. If an insurance company could just have one set of policies that would cover all 330MM Americans, in all 50 states, even private insurance would be much cheaper than it is now. That's not how it is, though. It literally makes no sense how we do it in the US.

DaMa

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Re: What comes after the ACA?
« Reply #6619 on: November 13, 2020, 01:51:30 PM »
Every state also has a bureaucracy to manage Medicaid. 

The drug argument against national health care is full of holes.  Drug companies spend far more on marketing than they do on R&D.  Most basic research is done with government and philanthropic funding.   Drug companies spend a lot of their research dollars on me-too drugs.

Shane

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Re: What comes after the ACA?
« Reply #6620 on: November 13, 2020, 05:13:57 PM »
Dr. David Belk's website: truecostofhealthcare.org, offers some explanation of why healthcare costs so much more in the US than anywhere else in the world. Dr. Belk's book, which just came out earlier this year: The Great American Healthcare Scam: How Kickbacks, Collusion and Propaganda Have Exploded Healthcare Costs in the United States, looks good, as well. Hoping my library will buy it for me...

Quote
From Dr. Belk's website:

"Pfizer’s 2011 financial review.

On page 17 you’ll find the above table which is an analysis of the consolidated statements of income for Pfizer. You can see from the first line that Pfizer reported just over $67 billion in revenue in 2011. A few lines down you can see that they spent just over $9 billion on research and development that same year. OK, $9 billion is a lot of money. It was nearly 14% of their total revenue.

But what’s really interesting is that you can see that Pfizer spent more than twice as much on Marketing (selling, informational and administrative expenses) as they spent on research; over $19 billion! And look at their profit for that year. They made just over $10 billion in net income (after taxes) which, by the way, is more than they spent on their research for that year.

So the cost of research wasn’t exactly eating all of Pfizer’s income pie in 2011. But that’s one pharmaceutical company’s financial statement for one year. How about the rest of them?

As I said before, I went over seven years of financial reports for 13 major pharmaceutical companies and here is some of what I found:

-The combined total revenue for all 13 companies over 8 years was about $3.78 Trillion.

-The Combined total profits for these companies was about $744 Billion.

-All 13 pharmaceutical companies spent a total of $643 Billion on research.

-The total amount they spent on marketing was about 60% more than what they spent on research: $1.04 Trillion."


John Galt incarnate!

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Re: What comes after the ACA?
« Reply #6621 on: November 13, 2020, 07:00:30 PM »


yes, the US is typically used as a cautionary tale of the dangers of trying to force a human right into a capitalist profit-making mold.

I understand that the Canadian Constitution is called the CANADIAN CHARTER OF RIGHTS AND FREEDOMS.

Is "healthcare is a human right" or synonymous language enshrined in  the CANADIAN CHARTER OF RIGHTS AND FREEDOMS?

I'm curious.

Bloop Bloop Reloaded

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Re: What comes after the ACA?
« Reply #6622 on: November 14, 2020, 04:16:26 AM »

Recently, I was talking with a neighbor who told me he was really concerned about a Biden/Harris administration ruining the US. When I asked him what he was most worried Joe and Kamala might do, he replied, "socialized healthcare." I said, "So...you're concerned they might help more people to be able to go to a doctor if they get sick?" He said, "There's no way we could ever possibly afford to give healthcare to everyone in the US. The country would go broke."

You should tell him a sovereign currency issuer like the US Gov't can afford anything it wants to afford, it cannot go broke unless it chooses to do so.  Buy him a copy of The Deficit Myth by Stephanie Kelton.   I'm sick of this "we're gonna go broke" and "how will you pay for it" bullshit.  We have to educate people on this most important topic.  Every year there are millions/billions spent by right wing billionaires to brainwash people into believing this nonsense.   The important issue(s) are not about how we are going to pay for it, but rather how will we ensure that we have enough doctors and hospitals to serve patients and what we're going to do about the lost jobs (albeit most are bullshit jobs) as a result of the private health insurance industry shrinking. 

If we could get people understand federal fiscal reality more of them would never settle for the crumbs we're getting.  Then of course there are those monstrous socipathic people who would understand fiscal reality but still wouldn't give a shit about people  dying or going bankrupt due to a lack of affordable health care.

Obviously the government can print as much money as it wants to and can pay off any debt it wants to. But that money doesn't just operate at a vacuum. If you print too much money inflation goes up and/or the relative buying power of people in society changes. There's no way, in other words, to solve a discrete problem (like healthcare) without changing the balance of other needs/wants among different groups of people. You might be all for that, but you have to deal with people who aren't or who are worried.

Bloop Bloop Reloaded

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Re: What comes after the ACA?
« Reply #6623 on: November 14, 2020, 04:52:55 AM »

- SNIP -

Yep.  The US has created a gigantic layer of bureaucracy that needs to be paid between a person and medical providers . . . insurance salesmen, insurance adjusters, experts to co-ordinate between insurance and doctors, hospital administration to deal with various forms of insurance, plus all the claims people involved in chasing down unpaid bills.  I'm probably forgetting some.  That's entirely unnecessary overhead, and is very expensive.

In Canada you pay mostly for health care.  In the US you pay to keep a fantastically huge layer of bureaucracy going, and then for some health care on top.

"fantastially huge layer of bureaucracy"

I never hear the Canadians complain about their health care.  If someone does do they just point South and they immediately shut up?

No, we complain all the time.

In our system you can't buy your way to the top.  People are triaged and treated based upon need (not wealth).  So if you have an annoying but not life threatening medical issue, it will probably take longer to get a doctor to see it.  Especially if it's a problem that needs a specialist, you might have to wait a few months to have your appointment - that sort of thing.  This is a very common complaint.

Because we don't separate our health care quality into classes based on money, the US system definitely works better than the Canadian system if you're rich.  There are a few extremely rich people in Canada who are constantly complaining about how we should make our health care more like the US.  Overall, the health care system is pretty well liked by the majority of us . . . and yes, the US is typically used as a cautionary tale of the dangers of trying to force a human right into a capitalist profit-making mold.

I don't understand why you'd have to wait a few months to have a specialist appointment. Are there not private specialists who operate outside the public system and require payment upfront (either cash or via private insurance)? Here in Australia, where we also have universal healthcare, how it works is that you go to your GP (for free - bulk billed), the GP writes out a specialist referral, and you take it to any specialist you want. Some specialists operate in the public system and the waiting list is months or years. Some operate a private clinic and you can get an appointment within a few weeks or even sooner than that if you ask nicely (but of course you have to cover the majority of the costs yourself).

ixtap

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Re: What comes after the ACA?
« Reply #6624 on: November 14, 2020, 06:04:40 AM »
Here in the US, it can also take months to see a specialist, so I never understood this argument. If I want to schedule an annual physical with my PCP, it can take 2-3 months.

American GenX

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Re: What comes after the ACA?
« Reply #6625 on: November 14, 2020, 06:54:29 AM »
Here in the US, it can also take months to see a specialist, so I never understood this argument. If I want to schedule an annual physical with my PCP, it can take 2-3 months.

I'm in the U.S. also.  I only call about a week in advance of making a yearly appointment.  I was referred to a specialist only once, and that was only about a week or so also.

GuitarStv

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Re: What comes after the ACA?
« Reply #6626 on: November 14, 2020, 07:00:22 AM »

- SNIP -

Yep.  The US has created a gigantic layer of bureaucracy that needs to be paid between a person and medical providers . . . insurance salesmen, insurance adjusters, experts to co-ordinate between insurance and doctors, hospital administration to deal with various forms of insurance, plus all the claims people involved in chasing down unpaid bills.  I'm probably forgetting some.  That's entirely unnecessary overhead, and is very expensive.

In Canada you pay mostly for health care.  In the US you pay to keep a fantastically huge layer of bureaucracy going, and then for some health care on top.

"fantastially huge layer of bureaucracy"

I never hear the Canadians complain about their health care.  If someone does do they just point South and they immediately shut up?

No, we complain all the time.

In our system you can't buy your way to the top.  People are triaged and treated based upon need (not wealth).  So if you have an annoying but not life threatening medical issue, it will probably take longer to get a doctor to see it.  Especially if it's a problem that needs a specialist, you might have to wait a few months to have your appointment - that sort of thing.  This is a very common complaint.

Because we don't separate our health care quality into classes based on money, the US system definitely works better than the Canadian system if you're rich.  There are a few extremely rich people in Canada who are constantly complaining about how we should make our health care more like the US.  Overall, the health care system is pretty well liked by the majority of us . . . and yes, the US is typically used as a cautionary tale of the dangers of trying to force a human right into a capitalist profit-making mold.

I don't understand why you'd have to wait a few months to have a specialist appointment. Are there not private specialists who operate outside the public system and require payment upfront (either cash or via private insurance)? Here in Australia, where we also have universal healthcare, how it works is that you go to your GP (for free - bulk billed), the GP writes out a specialist referral, and you take it to any specialist you want. Some specialists operate in the public system and the waiting list is months or years. Some operate a private clinic and you can get an appointment within a few weeks or even sooner than that if you ask nicely (but of course you have to cover the majority of the costs yourself).

Nope.

We operate one health care system.  There isn't a separate one for rich people - if there was then the rich would receive a different standard of care than the poor.  There would also be the problem of private health care siphoning off talent from the public system.

Bloop Bloop Reloaded

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Re: What comes after the ACA?
« Reply #6627 on: November 14, 2020, 07:04:58 AM »
That's interesting. Does this mean that no one pays for healthcare in Canada (or that everyone pays about the same for each service)?

Here in Australia, there's a private system which is partly compelled by the government (forcing high income earners to take out private health insurance) and partly compelled by market forces. All doctors do their training in public hospitals. Some then continue working as employees of public hospitals while others start up or work in private clinics, which operate on a free-market basis, except that in most fields (plastics being a notable exception) even specialists working in private will feel some compulsion to not increase fees beyond what a normal middle class person could afford.

I'm consistently surprised by how cheap healthcare is in Australia, even on a private basis. My surgeon charges something like $200 AUD for a 30 minute consult which is less than what you'd pay an accountant.

GuitarStv

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Re: What comes after the ACA?
« Reply #6628 on: November 14, 2020, 07:14:31 AM »
That's interesting. Does this mean that no one pays for healthcare in Canada (or that everyone pays about the same for each service)?

Here in Australia, there's a private system which is partly compelled by the government (forcing high income earners to take out private health insurance) and partly compelled by market forces. All doctors do their training in public hospitals. Some then continue working as employees of public hospitals while others start up or work in private clinics, which operate on a free-market basis, except that in most fields (plastics being a notable exception) even specialists working in private will feel some compulsion to not increase fees beyond what a normal middle class person could afford.

I'm consistently surprised by how cheap healthcare is in Australia, even on a private basis. My surgeon charges something like $200 AUD for a 30 minute consult which is less than what you'd pay an accountant.

Canadian health care varies from province to province, but in general drugs, optometry, and dental work are not covered.  Most Canadians keep private insurance for these(otherwise you're paying out of pocket).  For other health care you pretty much just pay taxes.

stoaX

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Re: What comes after the ACA?
« Reply #6629 on: November 14, 2020, 07:24:46 AM »
Here in the US, it can also take months to see a specialist, so I never understood this argument. If I want to schedule an annual physical with my PCP, it can take 2-3 months.

I'm in the U.S. also.  I only call about a week in advance of making a yearly appointment.  I was referred to a specialist only once, and that was only about a week or so also.

My recent experiences for Mrs. stoaX and I, in both Orange County California and the suburbs south of Charlotte have been more of the "few days to a week" variety as well.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #6630 on: November 14, 2020, 08:39:37 AM »
I have yet to figure out how to solve the drug price issue, which is one reason I have cut down investing in drug companies quite a bit.   They really don't generate the profits that tech does.  Tech has problems of course with anti trust, but the big companies seem to be able to pay off/ shrug off this.

wenchsenior

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Re: What comes after the ACA?
« Reply #6631 on: November 14, 2020, 09:01:28 AM »
Here in the US, it can also take months to see a specialist, so I never understood this argument. If I want to schedule an annual physical with my PCP, it can take 2-3 months.

I'm in the U.S. also.  I only call about a week in advance of making a yearly appointment.  I was referred to a specialist only once, and that was only about a week or so also. (And I have a fairly large N, b/c I have to see a lot of specialists, unfortunately).


My recent experiences for Mrs. stoaX and I, in both Orange County California and the suburbs south of Charlotte have been more of the "few days to a week" variety as well.

I'm in a city of more than 100,000 with two major medical centers, and it regularly takes 4-8 weeks to see most specialists here, unless you go to a private clinic on your own.  PCP takes 1-2 weeks, more if if you want to see a particular person (usually more like 4 weeks).

My N of specialists is actually quite high, so I know whereof I speak.
« Last Edit: November 14, 2020, 09:04:17 AM by wenchsenior »

OtherJen

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Re: What comes after the ACA?
« Reply #6632 on: November 14, 2020, 09:32:44 AM »
Here in the US, it can also take months to see a specialist, so I never understood this argument. If I want to schedule an annual physical with my PCP, it can take 2-3 months.

I'm in the U.S. also.  I only call about a week in advance of making a yearly appointment.  I was referred to a specialist only once, and that was only about a week or so also. (And I have a fairly large N, b/c I have to see a lot of specialists, unfortunately).


My recent experiences for Mrs. stoaX and I, in both Orange County California and the suburbs south of Charlotte have been more of the "few days to a week" variety as well.

I'm in a city of more than 100,000 with two major medical centers, and it regularly takes 4-8 weeks to see most specialists here, unless you go to a private clinic on your own.  PCP takes 1-2 weeks, more if if you want to see a particular person (usually more like 4 weeks).

My N of specialists is actually quite high, so I know whereof I speak.

Wait times are similar here, and we have several health systems in the region.

GuitarStv

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Re: What comes after the ACA?
« Reply #6633 on: November 14, 2020, 12:19:06 PM »
Not sure if I made my point about wait times clearly.

We triage everyone in the Canadian system based on need.  So wait time for something important is typically quite short.  Several years back I was sparring and recieved a kick to the head that broke my jaw and detached the retina of my right eye.  I saw specialists to fix both that same day.  Conversely, as a teenager I had cystic acne and regularly needed to see a dermatologist for different antibiotics and skin creams.  Usually appointments required a month or two of wait time.

I feel like there's a fixation on maximum wait time for less important problems while ignoring that wait times for things that are very important are typically extremely short.

Exflyboy

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Re: What comes after the ACA?
« Reply #6634 on: November 14, 2020, 03:32:43 PM »
Same in the UK.. Have a heart attack and you will get the highest level of care as fast as is humanly possible.

Something not urgent sure you are likely to wait.

Out of pocket cost... $zero (apart from smallish prescription copays).

geekette

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Re: What comes after the ACA?
« Reply #6635 on: November 14, 2020, 03:52:12 PM »
Honestly, in my experience it's the same in the US.  If you're bleeding or can't breathe, you're in.  Just basic triage. 

New patient for a specialist, a few months.  GP, a day or two for urgent needs, weeks to months for a yearly physical.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #6636 on: November 14, 2020, 06:22:02 PM »
Honestly, in my experience it's the same in the US.  If you're bleeding or can't breathe, you're in.  Just basic triage. 

New patient for a specialist, a few months.  GP, a day or two for urgent needs, weeks to months for a yearly physical.

That's generally been my experience as well, except there is no way I'm getting in to see my GP on a day or two notice, regardless of urgency.  But I can usually get in to see someone else in the same practice.

reeshau

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Re: What comes after the ACA?
« Reply #6637 on: November 14, 2020, 06:51:03 PM »
That's interesting. Does this mean that no one pays for healthcare in Canada (or that everyone pays about the same for each service)?

Here in Australia, there's a private system which is partly compelled by the government (forcing high income earners to take out private health insurance) and partly compelled by market forces. All doctors do their training in public hospitals. Some then continue working as employees of public hospitals while others start up or work in private clinics, which operate on a free-market basis, except that in most fields (plastics being a notable exception) even specialists working in private will feel some compulsion to not increase fees beyond what a normal middle class person could afford.

I'm consistently surprised by how cheap healthcare is in Australia, even on a private basis. My surgeon charges something like $200 AUD for a 30 minute consult which is less than what you'd pay an accountant.

That's similar to how Ireland operates: public healthcare and facilities available to all, but full-service private available, and common to have insurance.  There are also "high tech" hospital's which cost you more out of pocket, but are better equipped.

pecunia

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Re: What comes after the ACA?
« Reply #6638 on: November 14, 2020, 09:24:12 PM »
In the United States you pay for the fast emergency service.  You can pay a lot.

American GenX

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Re: What comes after the ACA?
« Reply #6639 on: November 15, 2020, 10:34:42 AM »
Here in the US, it can also take months to see a specialist, so I never understood this argument. If I want to schedule an annual physical with my PCP, it can take 2-3 months.

I'm in the U.S. also.  I only call about a week in advance of making a yearly appointment.  I was referred to a specialist only once, and that was only about a week or so also. (And I have a fairly large N, b/c I have to see a lot of specialists, unfortunately).


My recent experiences for Mrs. stoaX and I, in both Orange County California and the suburbs south of Charlotte have been more of the "few days to a week" variety as well.

I'm in a city of more than 100,000 with two major medical centers, and it regularly takes 4-8 weeks to see most specialists here, unless you go to a private clinic on your own.  PCP takes 1-2 weeks, more if if you want to see a particular person (usually more like 4 weeks).

My N of specialists is actually quite high, so I know whereof I speak.

I was misquoted above (bold - strike-through by me).  I had only seen one specialist - a couple years back, who I was able to get in and see quickly.

wenchsenior

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Re: What comes after the ACA?
« Reply #6640 on: November 15, 2020, 12:19:45 PM »
Here in the US, it can also take months to see a specialist, so I never understood this argument. If I want to schedule an annual physical with my PCP, it can take 2-3 months.

I'm in the U.S. also.  I only call about a week in advance of making a yearly appointment.  I was referred to a specialist only once, and that was only about a week or so also. (And I have a fairly large N, b/c I have to see a lot of specialists, unfortunately).


My recent experiences for Mrs. stoaX and I, in both Orange County California and the suburbs south of Charlotte have been more of the "few days to a week" variety as well.

I'm in a city of more than 100,000 with two major medical centers, and it regularly takes 4-8 weeks to see most specialists here, unless you go to a private clinic on your own.  PCP takes 1-2 weeks, more if if you want to see a particular person (usually more like 4 weeks).

My N of specialists is actually quite high, so I know whereof I speak.

I was misquoted above (bold - strike-through by me).  I had only seen one specialist - a couple years back, who I was able to get in and see quickly.

Glad you caught that.  That was my quote that I missed deleting when I was trying to reply to a string of quotes.

I'm the one who sees a lot of specialists every year. And it always takes weeks and week to get in to see them. They also frequently cancel my appointments...recently, my gastro cancelled 2 appointments in a row, each about 3 months apart. So while I am supposed to see them every 6 months, it had been almost a year and half since I was actually able to get in and see them.  This is not atypical, in my experience.  My GP appointments have never been cancelled that I can recall in the past 20 years, but I've had MANY specialists cancel appointments on me, even after a 6 week wait. E.g., in July/August, I waited 6 weeks to see a sports medicine specialist and they cancelled 2 days beforehand with no openings for another month.

simmias

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Re: What comes after the ACA?
« Reply #6641 on: November 16, 2020, 06:18:02 PM »
My recent experiences for Mrs. stoaX and I, in both Orange County California and the suburbs south of Charlotte have been more of the "few days to a week" variety as well.

Where were you going in Charlotte where you only waited a week to see a specialist? Certainly not Atrium.

stoaX

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Re: What comes after the ACA?
« Reply #6642 on: November 18, 2020, 04:43:11 AM »
My recent experiences for Mrs. stoaX and I, in both Orange County California and the suburbs south of Charlotte have been more of the "few days to a week" variety as well.

Where were you going in Charlotte where you only waited a week to see a specialist? Certainly not Atrium.

It was in Rock Hill.... the PCP is an Atrium provider, the specialist is in network but not employed by Atrium.

In Orange County California the specialists were all thru Kaiser Permanente. 

Of course we're just 2 relatively healthy people so we're just a few data points in the grand scheme of things. 

American GenX

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Re: What comes after the ACA?
« Reply #6643 on: December 22, 2020, 11:24:45 AM »
There was some discussion about surprise billing for out of network services earlier in this thread.

Here's some new news on that front:

"Congress set to ban surprise medical billing in year-end spending package" 

https://www.foxbusiness.com/economy/congress-set-to-ban-surprise-medical-billing-in-year-end-spending-package

On the other hand, it looks like it got watered down.

"How powerful health providers tamed a ‘surprise' billing threat"

https://www.politico.com/news/2020/12/21/surprise-billing-health-providers-congress-449759

DaMa

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Re: What comes after the ACA?
« Reply #6644 on: December 22, 2020, 06:10:35 PM »
That's easy.  If the insurance companies and/or for-profit hospital systems are happy with it, it is not good for the patients.

bacchi

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Re: What comes after the ACA?
« Reply #6645 on: January 05, 2021, 10:19:12 PM »
Things are looking good for the ACA. If Warnock and Ossoff pull it off, the ACA could be amended by the slimmest of margins.

Exflyboy

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Re: What comes after the ACA?
« Reply #6646 on: January 06, 2021, 12:57:00 AM »
Things are looking good for the ACA. If Warnock and Ossoff pull it off, the ACA could be amended by the slimmest of margins.

Yup Warnock won and Ossoff is currently 10k votes ahead.. I really have to go to bed!

jim555

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Re: What comes after the ACA?
« Reply #6647 on: January 06, 2021, 02:14:33 AM »
With a unified government that Supreme Court ACA lawsuit can be mooted with a one paragraph bill on day one.

American GenX

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Re: What comes after the ACA?
« Reply #6648 on: January 06, 2021, 06:37:30 AM »
If you follow the comments from the SCOTUS justices up thread from the oral arguments in November, it looks like the ACA is going to stand, regardless of any further changes.  Of course, that's not a guarantee how they will finally rule, so I'm for anything that solidifies that possibility.

Edit.  Found this comment from Ossoff:  “If the Supreme Court strikes down the Affordable Care Act, it will be up to Congress to decide how to legislate such that preexisting conditions remain covered.”

That's no good.  Protections for those with "pre-existing conditions" falls far short of upholding the ACA and letting the court potentially strike it down before taking any action, as Ossoff stated.
« Last Edit: January 06, 2021, 08:02:42 AM by American GenX »

WhiteTrashCash

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Re: What comes after the ACA?
« Reply #6649 on: January 06, 2021, 10:13:37 AM »
With the Democrats taking control of the Senate, I think we can expect the individual mandate penalty to be reinstated very shortly which will make the Supreme Court decision moot anyway.