Author Topic: What comes after the ACA?  (Read 773070 times)

sol

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Re: What comes after the ACA?
« Reply #550 on: January 19, 2017, 08:14:02 AM »
Generally speaking, I wonder how long the system could go on before collapse. As said before, my HDHP health insurance is $24k a year. I mean, that is what some people make in a year.

Do you not understand how the ACA works, or was this an intentionally facetious argument?  ACA subsidies were designed to make insurance affordable to everyone by capping your costs to no more than 10% of your income if you make less than 400% the FPL.  If you are paying $24k in premiums them you must have a great income. 

It wasn't a perfect system, but it did ensure that nobody who made 25k per year was paying 24k per year for insurance, which is what you seemed to be suggesting could happen.

nereo

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Re: What comes after the ACA?
« Reply #551 on: January 19, 2017, 08:55:22 AM »
So much mis-information out there right now as the GOP rushes to hack apart the ACA before DJT even takes office.
The ACA was the first real attempt at controlling and reducing increasing health care costs across multiple levels (out of pocket expenses, % of income, profit limitations on insurers, etc)

I'm still waiting to see how costs will be lowered (as promised by DJT) once these controls are gone.  I'm not holding my breath.

Helvegen

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Re: What comes after the ACA?
« Reply #552 on: January 19, 2017, 08:59:15 AM »
Generally speaking, I wonder how long the system could go on before collapse. As said before, my HDHP health insurance is $24k a year. I mean, that is what some people make in a year.

Do you not understand how the ACA works, or was this an intentionally facetious argument?  ACA subsidies were designed to make insurance affordable to everyone by capping your costs to no more than 10% of your income if you make less than 400% the FPL.  If you are paying $24k in premiums them you must have a great income. 

It wasn't a perfect system, but it did ensure that nobody who made 25k per year was paying 24k per year for insurance, which is what you seemed to be suggesting could happen.

Heh? Please read more carefully. I was making no argument of the sort you are talking about AT ALL. I am saying if the ACA goes away and that is the cost then what? I can't afford that without subsidy.

That is what my company pays along with my portion. See:
Quote from: Helvegen
How long can companies themselves afford to pay these prices, even the kinds of megacorps that I work for?

I also was referencing a post I made earlier in the thread that spelled that out.

« Last Edit: January 19, 2017, 09:01:44 AM by Helvegen »

BFGirl

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Re: What comes after the ACA?
« Reply #553 on: January 19, 2017, 09:34:42 AM »
I am less concerned about age thing (but I am glad that it looks like it will stay for the time being).  I am more concerned about the fact that he has a pre-existing condition.  To be honest, I am not sure he will be able to hold a job that provides benefits,  so he may have a hell of a time getting affordable insurance. 

You would have to think that all this uncertainty would also be driving up insurance costs as well.



If the ACA blows up with nothing good to replace it, I don't think I'll ever truely be able to FIRE in the US because the only way I can reasonably afford health insurance is through my employer.

+1
« Last Edit: January 19, 2017, 09:37:39 AM by BFGirl »

Paul der Krake

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Re: What comes after the ACA?
« Reply #554 on: January 19, 2017, 10:06:19 AM »
I am less concerned about age thing (but I am glad that it looks like it will stay for the time being).  I am more concerned about the fact that he has a pre-existing condition.  To be honest, I am not sure he will be able to hold a job that provides benefits,  so he may have a hell of a time getting affordable insurance. 

You would have to think that all this uncertainty would also be driving up insurance costs as well.



If the ACA blows up with nothing good to replace it, I don't think I'll ever truely be able to FIRE in the US because the only way I can reasonably afford health insurance is through my employer.

+1
I sense a business opportunity here...

How much would you guys pay me to hold your hand through the process of moving to a European country of your choice?

sol

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Re: What comes after the ACA?
« Reply #555 on: January 19, 2017, 10:20:10 AM »
Heh? Please read more carefully. I was making no argument of the sort you are talking about AT ALL.


Sorry, h.  I shouldn't post to the forum early in the morning before my brain is working.

infogoon

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Re: What comes after the ACA?
« Reply #556 on: January 19, 2017, 11:15:19 AM »
How much would you guys pay me to hold your hand through the process of moving to a European country of your choice?

I would pay a significant sum for guidance through the process of claiming citizenship in the countries my grandparents emigrated from.

BFGirl

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Re: What comes after the ACA?
« Reply #557 on: January 19, 2017, 01:09:35 PM »
I am less concerned about age thing (but I am glad that it looks like it will stay for the time being).  I am more concerned about the fact that he has a pre-existing condition.  To be honest, I am not sure he will be able to hold a job that provides benefits,  so he may have a hell of a time getting affordable insurance. 

You would have to think that all this uncertainty would also be driving up insurance costs as well.



If the ACA blows up with nothing good to replace it, I don't think I'll ever truely be able to FIRE in the US because the only way I can reasonably afford health insurance is through my employer.

+1
I sense a business opportunity here...

How much would you guys pay me to hold your hand through the process of moving to a European country of your choice?

If I'm that determined to move, I'll research it and figure it out myself for free ;)

CDP45

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Re: What comes after the ACA?
« Reply #558 on: January 19, 2017, 02:31:19 PM »
Since there are so many people with pre-existing conditions, why don't they get together into their own insurance pool?

Is there anything preventing a state from providing Obamacare to its own residents? Or single-payer to its own residents?

Why is the only answer total federal control of the entire health system?

Paul der Krake

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Re: What comes after the ACA?
« Reply #559 on: January 19, 2017, 02:42:44 PM »
Since there are so many people with pre-existing conditions, why don't they get together into their own insurance pool?

Is there anything preventing a state from providing Obamacare to its own residents? Or single-payer to its own residents?

Why is the only answer total federal control of the entire health system?
There is no restriction of movement within the United States. People shop around for the best deal all the time, whether it's Washingtonians doing their Christmas shopping in Oregon or businesses flocking to states with low corporate taxes.

If Kansas start offering a great deal for people with expensive conditions, it's reasonable that they will draw people who benefit the most from the new arrangement. How many people will move to Kansas is anyone's guess, but it doesn't take too long for a system to be overwhelmed if the proportion of unhealthy people is more than expected. Taxpayers' sense of fairness will be tested.

So your realistic choices to make this work are either:
1) Restrict movement/impose a waiting period
2) Make gradual changes, and hoping neighboring states follow suit

Gin1984

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Re: What comes after the ACA?
« Reply #560 on: January 19, 2017, 02:52:21 PM »
Since there are so many people with pre-existing conditions, why don't they get together into their own insurance pool?

Is there anything preventing a state from providing Obamacare to its own residents? Or single-payer to its own residents?

Why is the only answer total federal control of the entire health system?
You do realize that the ACA was modeled after the Massachusetts' Romneycare formally called "An Act Providing Access to Affordable, Quality, Accountable Health Care.", right?  Yes, California, New York etc could just make their own.  That will limit movement to those other states (which means less funds) but more than that, many people actually care about the poorer people in the red states.

CDP45

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Re: What comes after the ACA?
« Reply #561 on: January 19, 2017, 03:10:10 PM »
Healthcare is now 17% of GDP, so to keep the same level of care/spending, but do away with all the insurance and games, everyone could just pay $9,402 per person. Per worldbank: http://data.worldbank.org/indicator/SH.XPD.PCAP?locations=US.

Now this level of spending doesn't please everyone, and there are still millions of uninsured, so to expand that the per-person cost would just be greater as well. Basically if you're paying less than $9,402, you're not paying your "fair-share."

There are thousands of insurance products sold in the country, yet there is only 1 market in constant crisis, the Health insurance market. Can you point to a market where competition is limited but prices don't skyrocket or quality decreases? There's no magic folks, dollars spent can only come from dollars paid.

Clamoring for more free shit isn't going to fix this. [But here's a hint- when the government pays unlimited dollars for those over 65: For survivors to age 85, more than one-third of their lifetime expenditures will accrue in their remaining years.]

You're competing for healthcare against (obese) geriatrics backed by unlimited government dollars, think you can win under the current system?

Metric Mouse

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Re: What comes after the ACA?
« Reply #562 on: January 20, 2017, 01:20:23 AM »
Re: Universal Access

I found this analogy useful for those confused by the (intentially) similar terms universal access and universal coverage.

Universal Coverage is covering (or attempting to cover) absolutely everyone.  It isn't really universal coverage if more than a tiny fraction of people lack coverage for whatever reason.

Universal Access is ensuring that everyone can purchase insurance if they can afford it.  It's accessible in the same way that a BMW SUV is accessible to everyone; you can have one as long as you can find the money to have one.

And the ACA was an attempt at the latter, under the guise of the former.

nereo

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Re: What comes after the ACA?
« Reply #563 on: January 20, 2017, 06:53:45 AM »
Re: Universal Access

I found this analogy useful for those confused by the (intentially) similar terms universal access and universal coverage.

Universal Coverage is covering (or attempting to cover) absolutely everyone.  It isn't really universal coverage if more than a tiny fraction of people lack coverage for whatever reason.

Universal Access is ensuring that everyone can purchase insurance if they can afford it.  It's accessible in the same way that a BMW SUV is accessible to everyone; you can have one as long as you can find the money to have one.

And the ACA was an attempt at the latter, under the guise of the former.

I'd say the opposite;  it was an attempt at Universal Coverage but ultimately it had to be scaled back to universal access, with extensive subsidies and price controls (e.g 10% of income).

Schaefer Light

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Re: What comes after the ACA?
« Reply #564 on: January 20, 2017, 07:49:16 AM »
If the ACA blows up with nothing good to replace it, I don't think I'll ever truely be able to FIRE in the US because the only way I can reasonably afford health insurance is through my employer.

I'm of the opinion that insurance should be completely separated from employment.

elysianfields

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Re: What comes after the ACA?
« Reply #565 on: January 20, 2017, 08:08:48 AM »

Did Republicans ever care about balanced budgets or was it another issue talking point to get the grumpy old men of America riled up?

Of course not, it's their excuse to cut or destroy social programs.

Why do they keep proposing privatizing Social Security, Medicare, education?  "We can't afford it."  "It'll explode the deficit." and other bullshit excuses.

elysianfields

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Re: What comes after the ACA?
« Reply #566 on: January 20, 2017, 08:43:51 AM »
And that is exactly what we deserve.  America, you built this.

Quote from: H. L. Mencken
Democracy is the theory that the common people know what they want, and deserve to get it good and hard.

Iplawyer

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Re: What comes after the ACA?
« Reply #567 on: January 20, 2017, 09:07:16 AM »
Healthcare is now 17% of GDP, so to keep the same level of care/spending, but do away with all the insurance and games, everyone could just pay $9,402 per person. Per worldbank: http://data.worldbank.org/indicator/SH.XPD.PCAP?locations=US.

Now this level of spending doesn't please everyone, and there are still millions of uninsured, so to expand that the per-person cost would just be greater as well. Basically if you're paying less than $9,402, you're not paying your "fair-share."

There are thousands of insurance products sold in the country, yet there is only 1 market in constant crisis, the Health insurance market. Can you point to a market where competition is limited but prices don't skyrocket or quality decreases? There's no magic folks, dollars spent can only come from dollars paid.

Clamoring for more free shit isn't going to fix this. [But here's a hint- when the government pays unlimited dollars for those over 65: For survivors to age 85, more than one-third of their lifetime expenditures will accrue in their remaining years.]

You're competing for healthcare against (obese) geriatrics backed by unlimited government dollars, think you can win under the current system?

CDP45 - you are going to be geriatric someday  - or the alternative is not too good.  Most seniors are not obese.  And boomers are really taking care of themselves.  Nonetheless - a body ages and has problems.  What is your plan when you get there?

GuitarStv

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Re: What comes after the ACA?
« Reply #568 on: January 20, 2017, 09:12:24 AM »
Ironically, it has already been pointed out in this thread that obese seniors tend to cost health care less since they don't live as long as fit seniors.

Metric Mouse

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Re: What comes after the ACA?
« Reply #569 on: January 20, 2017, 09:53:16 AM »
Re: Universal Access

I found this analogy useful for those confused by the (intentially) similar terms universal access and universal coverage.

Universal Coverage is covering (or attempting to cover) absolutely everyone.  It isn't really universal coverage if more than a tiny fraction of people lack coverage for whatever reason.

Universal Access is ensuring that everyone can purchase insurance if they can afford it.  It's accessible in the same way that a BMW SUV is accessible to everyone; you can have one as long as you can find the money to have one.

And the ACA was an attempt at the latter, under the guise of the former.

I'd say the opposite;  it was an attempt at Universal Coverage but ultimately it had to be scaled back to universal access, with extensive subsidies and price controls (e.g 10% of income).
I guess this is a matter of optics- i feel it was sold as universal coverage that "had to be scaled back" when it was really not.  Either way, the effect is the same, sadly.

Schaefer Light

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Re: What comes after the ACA?
« Reply #570 on: January 20, 2017, 10:34:24 AM »
I think that the people advocating no system or a "free market" system are immoral.

I've been called worse ;).

Schaefer Light

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Re: What comes after the ACA?
« Reply #571 on: January 20, 2017, 10:37:23 AM »
That is the one big problem I have with republicans, even though I do sometimes vote republican (didn't vote trump, did vote for GJ but in WA state which really was always going for Jillary).

They are all about pro-life, abortion is murder, get out in the street and hold up signs.

then Baby is born

Fuck paying for that!  Die in the street kid if you can't support yourself.

They are a funny bunch.

I guess I'm a different kind of Republican.  I'm all for abortions for the people who can't afford kids.  In fact, if you're already on welfare with kids to support and you get pregnant again I'd force you to have an abortion.

nereo

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Re: What comes after the ACA?
« Reply #572 on: January 20, 2017, 10:38:53 AM »
That is the one big problem I have with republicans, even though I do sometimes vote republican (didn't vote trump, did vote for GJ but in WA state which really was always going for Jillary).

They are all about pro-life, abortion is murder, get out in the street and hold up signs.

then Baby is born

Fuck paying for that!  Die in the street kid if you can't support yourself.

They are a funny bunch.

I guess I'm a different kind of Republican.  I'm all for abortions for the people who can't afford kids.  In fact, if you're already on welfare with kids to support and you get pregnant again I'd force you to have an abortion.

Seriously?  you're going to force abortions on people?

NoStacheOhio

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Re: What comes after the ACA?
« Reply #573 on: January 20, 2017, 10:41:03 AM »
That is the one big problem I have with republicans, even though I do sometimes vote republican (didn't vote trump, did vote for GJ but in WA state which really was always going for Jillary).

They are all about pro-life, abortion is murder, get out in the street and hold up signs.

then Baby is born

Fuck paying for that!  Die in the street kid if you can't support yourself.

They are a funny bunch.

I guess I'm a different kind of Republican.  I'm all for abortions for the people who can't afford kids.  In fact, if you're already on welfare with kids to support and you get pregnant again I'd force you to have an abortion.

Seriously?  you're going to force abortions on people?

#smallgovernment

GuitarStv

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Re: What comes after the ACA?
« Reply #574 on: January 20, 2017, 10:53:36 AM »
That is the one big problem I have with republicans, even though I do sometimes vote republican (didn't vote trump, did vote for GJ but in WA state which really was always going for Jillary).

They are all about pro-life, abortion is murder, get out in the street and hold up signs.

then Baby is born

Fuck paying for that!  Die in the street kid if you can't support yourself.

They are a funny bunch.

I guess I'm a different kind of Republican.  I'm all for abortions for the people who can't afford kids.  In fact, if you're already on welfare with kids to support and you get pregnant again I'd force you to have an abortion.

Seriously?  you're going to force abortions on people?

#smallgovernment

It's OK guys, he's only in favour of forcing abortions on the poors.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #575 on: January 20, 2017, 11:01:08 AM »
That is the one big problem I have with republicans, even though I do sometimes vote republican (didn't vote trump, did vote for GJ but in WA state which really was always going for Jillary).

They are all about pro-life, abortion is murder, get out in the street and hold up signs.

then Baby is born

Fuck paying for that!  Die in the street kid if you can't support yourself.

They are a funny bunch.

I guess I'm a different kind of Republican.  I'm all for abortions for the people who can't afford kids.  In fact, if you're already on welfare with kids to support and you get pregnant again I'd force you to have an abortion.

Seriously?  you're going to force abortions on people?

#smallgovernment

It's OK guys, he's only in favour of forcing abortions on the poors.

Well yeah, anything else would be big government overreach.

RosieTR

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Re: What comes after the ACA?
« Reply #576 on: January 20, 2017, 12:09:07 PM »
I guess I'm a different kind of Republican.  I'm all for abortions for the people who can't afford kids.  In fact, if you're already on welfare with kids to support and you get pregnant again I'd force you to have an abortion.

Go big or go home. If you're going to do this, why not just pre-sterilize everyone reversibly (vasectomies can be reversed, or better yet, just have every young man jizz in a cup and freeze it when he signs up for Selective Service. Ladies get an IUD or progesterone implant which can be removed; no depending on remembering a pill or some such)?
You want a baby? You have to prove a certain level of income and savings, pass the basic US Citizenship test and hey maybe a little logic/math test too. Plus that high school exercise of a week of having the doll that screams and needs its key turned to shut up. Pass all that and hey, good to go.

This would fix both poverty and the education system, as well as dropping abortions nearly to zero (there will always be a few cases of horrible fetal defects or in utero death of the fetus or high risk of death to the mother).

Schaefer Light

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Re: What comes after the ACA?
« Reply #577 on: January 20, 2017, 12:30:20 PM »
That is the one big problem I have with republicans, even though I do sometimes vote republican (didn't vote trump, did vote for GJ but in WA state which really was always going for Jillary).

They are all about pro-life, abortion is murder, get out in the street and hold up signs.

then Baby is born

Fuck paying for that!  Die in the street kid if you can't support yourself.

They are a funny bunch.

I guess I'm a different kind of Republican.  I'm all for abortions for the people who can't afford kids.  In fact, if you're already on welfare with kids to support and you get pregnant again I'd force you to have an abortion.

Seriously?  you're going to force abortions on people?

#smallgovernment

It's OK guys, he's only in favour of forcing abortions on the poors.

If you've already proven that you can't provide for your family, you shouldn't be making it any bigger.  And you certainly shouldn't expect others to pay for it.

Schaefer Light

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Re: What comes after the ACA?
« Reply #578 on: January 20, 2017, 12:33:16 PM »
That is the one big problem I have with republicans, even though I do sometimes vote republican (didn't vote trump, did vote for GJ but in WA state which really was always going for Jillary).

They are all about pro-life, abortion is murder, get out in the street and hold up signs.

then Baby is born

Fuck paying for that!  Die in the street kid if you can't support yourself.

They are a funny bunch.

I guess I'm a different kind of Republican.  I'm all for abortions for the people who can't afford kids.  In fact, if you're already on welfare with kids to support and you get pregnant again I'd force you to have an abortion.

Seriously?  you're going to force abortions on people?

I'd prefer to provide IUDs.

Schaefer Light

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Re: What comes after the ACA?
« Reply #579 on: January 20, 2017, 12:35:56 PM »
That is the one big problem I have with republicans, even though I do sometimes vote republican (didn't vote trump, did vote for GJ but in WA state which really was always going for Jillary).

They are all about pro-life, abortion is murder, get out in the street and hold up signs.

then Baby is born

Fuck paying for that!  Die in the street kid if you can't support yourself.

They are a funny bunch.

I guess I'm a different kind of Republican.  I'm all for abortions for the people who can't afford kids.  In fact, if you're already on welfare with kids to support and you get pregnant again I'd force you to have an abortion.

Seriously?  you're going to force abortions on people?

#smallgovernment

Which costs less - an abortion or raising a child?  I want the government to be frugal with its resources.

accolay

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Re: What comes after the ACA?
« Reply #580 on: January 20, 2017, 12:39:36 PM »
That is the one big problem I have with republicans, even though I do sometimes vote republican (didn't vote trump, did vote for GJ but in WA state which really was always going for Jillary).

They are all about pro-life, abortion is murder, get out in the street and hold up signs.

then Baby is born

Fuck paying for that!  Die in the street kid if you can't support yourself.

They are a funny bunch.

I guess I'm a different kind of Republican.  I'm all for abortions for the people who can't afford kids.  In fact, if you're already on welfare with kids to support and you get pregnant again I'd force you to have an abortion.

Seriously?  you're going to force abortions on people?

#smallgovernment

It's OK guys, he's only in favour of forcing abortions on the poors.

If you've already proven that you can't provide for your family, you shouldn't be making it any bigger.  And you certainly shouldn't expect others to pay for it.

Poor form for this trolling attempt to rile up the left. Par for the course from the right though.

But whatever, I'll go with it. So then, why is the right always against  common sense sexual education? Why against Planned Parenthood: it's in the name. Abstinence only education doesn't work.

Schaefer Light

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Re: What comes after the ACA?
« Reply #581 on: January 20, 2017, 12:41:35 PM »
That is the one big problem I have with republicans, even though I do sometimes vote republican (didn't vote trump, did vote for GJ but in WA state which really was always going for Jillary).

They are all about pro-life, abortion is murder, get out in the street and hold up signs.

then Baby is born

Fuck paying for that!  Die in the street kid if you can't support yourself.

They are a funny bunch.

I guess I'm a different kind of Republican.  I'm all for abortions for the people who can't afford kids.  In fact, if you're already on welfare with kids to support and you get pregnant again I'd force you to have an abortion.

Seriously?  you're going to force abortions on people?

#smallgovernment

It's OK guys, he's only in favour of forcing abortions on the poors.

If you've already proven that you can't provide for your family, you shouldn't be making it any bigger.  And you certainly shouldn't expect others to pay for it.

Poor form for this trolling attempt to rile up the left. Par for the course from the right though.

But whatever, I'll go with it. So then, why is the right always against  common sense sexual education? Why against Planned Parenthood: it's in the name. Abstinence only education doesn't work.

I don't care about Planned Parenthood.  I want whatever is going to cost the government less money.

Schaefer Light

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Re: What comes after the ACA?
« Reply #582 on: January 20, 2017, 12:42:12 PM »
That is the one big problem I have with republicans, even though I do sometimes vote republican (didn't vote trump, did vote for GJ but in WA state which really was always going for Jillary).

They are all about pro-life, abortion is murder, get out in the street and hold up signs.

then Baby is born

Fuck paying for that!  Die in the street kid if you can't support yourself.

They are a funny bunch.

I guess I'm a different kind of Republican.  I'm all for abortions for the people who can't afford kids.  In fact, if you're already on welfare with kids to support and you get pregnant again I'd force you to have an abortion.

Seriously?  you're going to force abortions on people?

I'd prefer to provide IUDs.

So it's the woman's responsibility?  What are you going to do to keep deadbeat dads from procreating?  And IUDs aren't without risk or discomfort, believe me I know.

I'm good with that, too.

Metric Mouse

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Re: What comes after the ACA?
« Reply #583 on: January 20, 2017, 12:48:06 PM »
I guess I'm a different kind of Republican.  I'm all for abortions for the people who can't afford kids.  In fact, if you're already on welfare with kids to support and you get pregnant again I'd force you to have an abortion.

Go big or go home. If you're going to do this, why not just pre-sterilize everyone reversibly (vasectomies can be reversed, or better yet, just have every young man jizz in a cup and freeze it when he signs up for Selective Service. Ladies get an IUD or progesterone implant which can be removed; no depending on remembering a pill or some such)?
You want a baby? You have to prove a certain level of income and savings, pass the basic US Citizenship test and hey maybe a little logic/math test too. Plus that high school exercise of a week of having the doll that screams and needs its key turned to shut up. Pass all that and hey, good to go.

This would fix both poverty and the education system, as well as dropping abortions nearly to zero (there will always be a few cases of horrible fetal defects or in utero death of the fetus or high risk of death to the mother).

Many people seem to find it preferable to make a baby and then kill it than it is to prevent a baby being made i  the first place. Control over one's reproductive rights is important, even if it's not optimal from many standpoints. Since the cost of universal sterilization is likely higher than the cost of abortion, which is cheaper than taking care of unwanted children  (which neither side seem to want to particularly do) then abortion, and women's choice of them, is clearly the most efficent, and least burdensome option overall.

accolay

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Re: What comes after the ACA?
« Reply #584 on: January 20, 2017, 12:49:18 PM »
I don't care about Planned Parenthood.  I want whatever is going to cost the government less money.

Obviously. Then why need abortions? Let the poor eat their children, a la Jonathan Swift.

CDP45

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Re: What comes after the ACA?
« Reply #585 on: January 20, 2017, 12:58:44 PM »

CDP45 - you are going to be geriatric someday  - or the alternative is not too good.  Most seniors are not obese.  And boomers are really taking care of themselves.  Nonetheless - a body ages and has problems.  What is your plan when you get there?

Ohh and diabetics (obese) spend on average $10,000 more each per year: https://www.ncbi.nlm.nih.gov/pubmed/18308683 [2007]

2012 update! https://www.ncbi.nlm.nih.gov/pubmed/23468086

Quote: "People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes."

But we're evil for suggesting that people should pay for their lifestyle choices which should be 230%*$9,402= $21,624/yr/person for diabetics.

Boomers are absolutely not taking care of themselves, and someone mentioned that deficits and balanced budgets were made up? The bill is coming due faster than we think folks, and Obamacare merely accelerated it.

"Federal spending on major health care programs will jump by $104 billion, or 11.1 percent, this year, according to Congressional Budget Office estimates published on Monday Jan 25th 2016."  Not sustainable, and the bill is going to come due, it's just a matter of who is going to pay for it, and right now it's the workers and young that are paying for it, not the people incurring the costs.

GuitarStv

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Re: What comes after the ACA?
« Reply #586 on: January 20, 2017, 01:01:09 PM »
Which costs less - an abortion or raising a child?  I want the government to be frugal with its resources.

You're looking at this in a small picture, short term sort of way.  You're right that an abortion doesn't cost much, and raising a child is expensive.  You're quite misguided if you think that this captures the costs involved in what you're proposing.  You'll also need:
- extra law enforcement hired to find pregnant women and bring them for forcible abortion (likely psychological help for these people will be necessary)
- great legal teams who will be able to handle the thousands of lawsuits brought against your government
- even better legal teams to defend your actions to the rest of the world (the US justified invasion of Iraq for less cause than what you're proposing)
- extra security to protect the government from the inevitable generations of terrorists that you'll be brewing in your own country by following through
- doctors willing to perform this procedure (probably not actually doctors because they have to follow the hippocratic oath)
- a plan for the children who are hidden and manage not to be aborted . . . (Do you just kill them on sight?  Will you have special executioners on payroll?)
- etc.

If you want something that will cost the government less money, you should probably tally up total costs.

GuitarStv

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Re: What comes after the ACA?
« Reply #587 on: January 20, 2017, 01:06:59 PM »

CDP45 - you are going to be geriatric someday  - or the alternative is not too good.  Most seniors are not obese.  And boomers are really taking care of themselves.  Nonetheless - a body ages and has problems.  What is your plan when you get there?

Ohh and diabetics (obese) spend on average $10,000 more each per year: https://www.ncbi.nlm.nih.gov/pubmed/18308683 [2007]

2012 update! https://www.ncbi.nlm.nih.gov/pubmed/23468086

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050029
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225433/

Over their lifetime, the obese cost less to public health care than those who are normal weight.  (Third time mentioned.)

Metric Mouse

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Re: What comes after the ACA?
« Reply #588 on: January 20, 2017, 01:15:58 PM »
Which costs less - an abortion or raising a child?  I want the government to be frugal with its resources.

You're looking at this in a small picture, short term sort of way.  You're right that an abortion doesn't cost much, and raising a child is expensive.  You're quite misguided if you think that this captures the costs involved in what you're proposing.  You'll also need:
- extra law enforcement hired to find pregnant women and bring them for forcible abortion (likely psychological help for these people will be necessary)
- great legal teams who will be able to handle the thousands of lawsuits brought against your government
- even better legal teams to defend your actions to the rest of the world (the US justified invasion of Iraq for less cause than what you're proposing)
- extra security to protect the government from the inevitable generations of terrorists that you'll be brewing in your own country by following through
- doctors willing to perform this procedure (probably not actually doctors because they have to follow the hippocratic oath)
- a plan for the children who are hidden and manage not to be aborted . . . (Do you just kill them on sight?  Will you have special executioners on payroll?)
- etc.

If you want something that will cost the government less money, you should probably tally up total costs.

Exactly.  Abortions may cost less than raising a child; but the cost of mandatory abortions or sterilization far outweigh the cost of raising the number of unwanted children who are currently born.

CDP45

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Re: What comes after the ACA?
« Reply #589 on: January 20, 2017, 01:30:50 PM »

CDP45 - you are going to be geriatric someday  - or the alternative is not too good.  Most seniors are not obese.  And boomers are really taking care of themselves.  Nonetheless - a body ages and has problems.  What is your plan when you get there?

Ohh and diabetics (obese) spend on average $10,000 more each per year: https://www.ncbi.nlm.nih.gov/pubmed/18308683 [2007]

2012 update! https://www.ncbi.nlm.nih.gov/pubmed/23468086

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050029
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225433/

Over their lifetime, the obese cost less to public health care than those who are normal weight.  (Third time mentioned.)

Sorry if I missed the earlier mention, but the 17MM (homogenous) people of the Netherlands isn't a great comparison to the 350mm+ Americans, and the 2 multi-year studies I posted above reviewing Americans. But good job looking for evidence honestly, most just believe what they read on forums ;)


EnjoyIt

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Re: What comes after the ACA?
« Reply #590 on: January 20, 2017, 11:25:22 PM »
No one really gets turned down for life-saving medical care in the US.  Sure, you might get a bill and have to apply for assistance through the hospital (to write off your bill), but they're not going to withhold treatment.

Well, what a hospital defines as "life-saving medical care" and what is actually life-saving medical care can differ significantly. The example I always come back to is a friend of mine who was diagnosed with Type I diabetes in his late teens. He was into music, so started a band, worked at some shitty CD stores earning minimum wage with no benefits, etc. No insurance, no possibility of insurance with a pre-existing condition like that one. He became an entrepreneur at one point, with a successful small business. He kinda managed his diabetes but you know, he had to buy insulin, syringes, and blood testing supplies. I have no idea how much it was back then, but this month I had to buy insulin for a cat (there is no special cat insulin, this is normally sold for humans) to the tune of $275-$300 for 10ml. The cat, at 11.5 lbs, gets 0.04ml/day but I would imagine a human uses much more. If it's a linear extrapolation, a 115 lb human would use 0.4ml/day, so about 25 days worth. I can't remember what the syringes cost and the blood testing kits are purchased by the vet and incorporated into the vet visits. I will guess that if the cat's diabetes costs $300 or more a month, a human would be at least that. So on minimum wage, that's a pretty significant portion of one's take-home pay. Gross pay would be $290/week for a 40 hr week-all of this in today's dollars. So, one week out of each month is going to basic "don't die" maintenance.
Suffice to say, I'll hazard a guess that this friend tried to stretch things a little. Test the blood less often than recommended. Fiddle with the insulin to make it last the whole month (25 days isn't even all of February). Etc. Maybe he had a particularly difficult manifestation of the disease, I don't know. I didn't talk to him about the details of his medical care because I barely do that with my blood relatives. What I do know is, eventually his kidneys were basically non-functional because of this. He lost most of his eyesight. He had some strokes. His nerves to his legs failed and he became paralyzed. His digestive system become problematic. Along the way, he could no longer maintain his work and at some point in this process, yes, Medicaid picked up the tab because in their definition it became "life-saving care". The United States health care system, touted by conservatives at the time as "the best in the world", would not pay for his insulin or testing or regular visits to an internal med MD, but happily gave him dialysis several times a week and MRIs for some strokes and then after his wife couldn't care for him at home, housing and care in a long term care facility until even that wasn't enough and he passed away in 2016.

He was 40 years old. Forty. Now, I have zero idea how much Medicare paid out for his care over the last few years of his short life. I surmise it was a FUCKTON MORE THAN INSULIN FOR FUCK'S SAKE. Insulin! Which, by the way, was discovered well over 100 years ago, so who the fuck knows why there are still patents all over the place and it costs as much as many people here pay in rent. All this due to the "best health care system in the world". Saying it's the best does not make it the best. If this person had been born in and lived in any other industrialized nation, he would still be not only alive, but quite possibly thriving. When a normal person dies at half his age expectancy from a fully treatable disease that lacked for nothing more than support to pay for it, it is in no way the best health care system or even anywhere close to all that great. If the ACA had been passed when conservatives were shitting a brick over Hillary's first attempt at a better system, he would have gotten the support he needed and would probably be alive today. And paying taxes.

So yeah, if the ACA is repealed and there is no reasonably decent alternative, people like this WILL die. Not just obese people or smokers...regular people who just happen to have bad luck or who are poor. This includes children and babies, and women giving birth, for those of you who think you are "pro-life" but also that everyone "should take care of themselves". You either have to accept that lack of a health care system will mean preventable deaths of Americans, or you have to support a comprehensive health care system, or you have to be OK with huge deficit spending (if you mandate health care but don't tax the population appropriately to pay for it). Or I suppose you would have to compel doctors and nurses to work for much less/free, and somehow seize pharmaceuticals from the companies that charge high prices for them. It's math plus morality. I think that the people advocating no system or a "free market" system are immoral.

Insulin 10ml from walmart $25
https://www.goodrx.com/novolin-70-30

accolay

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Re: What comes after the ACA?
« Reply #591 on: January 21, 2017, 09:38:07 AM »
Insulin 10ml from walmart $25
https://www.goodrx.com/novolin-70-30

What's the catch? Sounds a little too good to be true since all the other prices are around $150.

bacchi

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Re: What comes after the ACA?
« Reply #592 on: January 21, 2017, 09:45:42 AM »
Sorry if I missed the earlier mention, but the 17MM (homogenous) people of the Netherlands isn't a great comparison to the 350mm+ Americans, and the 2 multi-year studies I posted above reviewing Americans. But good job looking for evidence honestly, most just believe what they read on forums ;)

Wtf is up with this? It's always trotted out like it means something. Do non-white people need widely different health care?

Do African-American doctors go to specialists because their needs are so much different than white folk? Do Chinese-Americans go to different doctors when their legs get broken?

I've never encountered this in my community but maybe they do it elsewhere.


(If it quacks like a duck...)

CDP45

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Re: What comes after the ACA?
« Reply #593 on: January 21, 2017, 10:00:52 AM »
Sorry if I missed the earlier mention, but the 17MM (homogenous) people of the Netherlands isn't a great comparison to the 350mm+ Americans, and the 2 multi-year studies I posted above reviewing Americans. But good job looking for evidence honestly, most just believe what they read on forums ;)

Wtf is up with this? It's always trotted out like it means something. Do non-white people need widely different health care?

Do African-American doctors go to specialists because their needs are so much different than white folk? Do Chinese-Americans go to different doctors when their legs get broken?

I've never encountered this in my community but maybe they do it elsewhere.


(If it quacks like a duck...)

Tell me how the US health care system is free of racism and discrimination against the poor and uneducated?  What community do you live in that has this solved?

The Dutch are much more uniformly wealthy as well.

packlawyer04

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Re: What comes after the ACA?
« Reply #594 on: January 21, 2017, 10:07:25 AM »
Since there are so many people with pre-existing conditions, why don't they get together into their own insurance pool?

Is there anything preventing a state from providing Obamacare to its own residents? Or single-payer to its own residents?

Why is the only answer total federal control of the entire health system?

The ban against insurers not insuring pre-existing conditions is going to stay.  Any new plan is going to include that provision.  That was the only good thing that came out of the ACA. Republicans know that is going to be included in future plans.

Other than that, I'm glad to see the ACA go.  It is about time.  People who actually pay for their own insurance will be paying a bit less once it goes.  I just don't see anything coming out yet to truly address the problem but we shall see.

bacchi

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Re: What comes after the ACA?
« Reply #595 on: January 21, 2017, 10:19:30 AM »
Sorry if I missed the earlier mention, but the 17MM (homogenous) people of the Netherlands isn't a great comparison to the 350mm+ Americans, and the 2 multi-year studies I posted above reviewing Americans. But good job looking for evidence honestly, most just believe what they read on forums ;)

Wtf is up with this? It's always trotted out like it means something. Do non-white people need widely different health care?

Do African-American doctors go to specialists because their needs are so much different than white folk? Do Chinese-Americans go to different doctors when their legs get broken?

I've never encountered this in my community but maybe they do it elsewhere.


(If it quacks like a duck...)

Tell me how the US health care system is free of racism and discrimination against the poor and uneducated?  What community do you live in that has this solved?

The Dutch are much more uniformly wealthy as well.

Ah, ok, that makes sense. So the US would need more services for poor areas and more focus on certain ailments, like diabetes, in certain areas.

It requires some planning but it's not impossible. I mean, this is America! We went to the motherfuckin' moon! Surely we can create a system that, ya know, provides more treatment for those who need it.


nereo

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Re: What comes after the ACA?
« Reply #596 on: January 21, 2017, 10:24:07 AM »
Since there are so many people with pre-existing conditions, why don't they get together into their own insurance pool?

Is there anything preventing a state from providing Obamacare to its own residents? Or single-payer to its own residents?

Why is the only answer total federal control of the entire health system?

The ban against insurers not insuring pre-existing conditions is going to stay.  Any new plan is going to include that provision.  That was the only good thing that came out of the ACA. Republicans know that is going to be included in future plans.

Other than that, I'm glad to see the ACA go.  It is about time.  People who actually pay for their own insurance will be paying a bit less once it goes.  I just don't see anything coming out yet to truly address the problem but we shall see.
A few responses on your post:
1) I agree that the ban against insurers denying coverage for pre-existing conditions will stay, however I (sadly) anticipate that many will find insurance premiums to be so high that they will be out of reach.  This is the tragedy of "universal access" - sure it's available, but if it's unaffordable what difference does that make?

2) I strongly disagree that people who actually pay for their own insurance will be paying a bit less.  THe ACA had numerous cost-controlling measures that are the first to go - how will insurance rates go DOWN under this new scenario?

3) Other provisions I think the ACA got right:  allowing children to stay on their parents plan until age 26 (incredibly important for those that go to graduate school), limiting the profits of insurance companies, limiting premiums to 10% of income.

sol

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Re: What comes after the ACA?
« Reply #597 on: January 21, 2017, 10:27:00 AM »
Ah, ok, that makes sense. So the US would need more services for poor areas and more focus on certain ailments, like diabetes, in certain areas.

I think you're misunderstanding.

When conservatives say "universal health care can't work in America because America is too big and diverse" they aren't saying that we need to address the issue of unequal access to care, they are saying that we have too many poor and black people who need care and they don't want rich and white people to pay for that.

It's not a call to action, which is how you seem to have interpreted it.  It's not a plan to make things better.  It's just another reason to say "diversity is bad, we should be a more homogenous country" and "black people are bad, we can't have nice things anymore because we've given up on white superiority".  It's only thinly veiled racism.  You can stop giving them the benefit of the doubt on this one.

packlawyer04

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Re: What comes after the ACA?
« Reply #598 on: January 21, 2017, 10:31:03 AM »
Since there are so many people with pre-existing conditions, why don't they get together into their own insurance pool?

Is there anything preventing a state from providing Obamacare to its own residents? Or single-payer to its own residents?

Why is the only answer total federal control of the entire health system?

The ban against insurers not insuring pre-existing conditions is going to stay.  Any new plan is going to include that provision.  That was the only good thing that came out of the ACA. Republicans know that is going to be included in future plans.

Other than that, I'm glad to see the ACA go.  It is about time.  People who actually pay for their own insurance will be paying a bit less once it goes.  I just don't see anything coming out yet to truly address the problem but we shall see.
A few responses on your post:
1) I agree that the ban against insurers denying coverage for pre-existing conditions will stay, however I (sadly) anticipate that many will find insurance premiums to be so high that they will be out of reach.  This is the tragedy of "universal access" - sure it's available, but if it's unaffordable what difference does that make?

2) I strongly disagree that people who actually pay for their own insurance will be paying a bit less.  THe ACA had numerous cost-controlling measures that are the first to go - how will insurance rates go DOWN under this new scenario?

3) Other provisions I think the ACA got right:  allowing children to stay on their parents plan until age 26 (incredibly important for those that go to graduate school), limiting the profits of insurance companies, limiting premiums to 10% of income.

Serious question.  have you read the law?  Like, actually went to the statute and read it. I had to for work to advise companies. Just curious because I know about 3 people who have actually read it but everybody seems to know how it works and what it does.

Bucksandreds

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Re: What comes after the ACA?
« Reply #599 on: January 21, 2017, 11:17:09 AM »
Ah, ok, that makes sense. So the US would need more services for poor areas and more focus on certain ailments, like diabetes, in certain areas.

I think you're misunderstanding.

When conservatives say "universal health care can't work in America because America is too big and diverse" they aren't saying that we need to address the issue of unequal access to care, they are saying that we have too many poor and black people who need care and they don't want rich and white people to pay for that.

It's not a call to action, which is how you seem to have interpreted it.  It's not a plan to make things better.  It's just another reason to say "diversity is bad, we should be a more homogenous country" and "black people are bad, we can't have nice things anymore because we've given up on white superiority".  It's only thinly veiled racism.  You can stop giving them the benefit of the doubt on this one.

I agree. As crazy as this sounds given who's in power I think that by 2020 we will never see as conservative of a government again. Democrats got more votes for president, senate and house but do not control any due to our system. Demogrsphics are making it harder and harder for conservatives to win and independents tend to vote against whoever is currently in charge.  2018 will be interesting to see how close the dems get in the house and 2020 would be shocking if the republicans control the presidency, senate and house. If Repubs screw over millions repealing the ACA and hand out massive tax breaks to the rich it's 50/50 we'll see a dem supermajority by 2020 again. If that happens again because the repubs screwed 10s of millions out of health insurance then hello single payer.  The repubs would come right back again, I'm sure of that, but sooner or later conservatism will have to shift to the center due to demographics.  The tea party and ridiculousness going on in the GOP is a symptom of it's current iteration being in its death throes.  I'm no liberal (in center left) but looking at what the demographics shows, the current GOP platform stands a 0.00% chance to win elections by 2020.