Author Topic: What comes after the ACA?  (Read 304591 times)

waltworks

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Re: What comes after the ACA?
« Reply #1400 on: March 08, 2017, 02:28:49 PM »
If you want to address costs, probably the fact that US doctors make a ton of money is the place to start. The AMA is not going to be happy about any sort of reform that cuts their pay, though.

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Psychstache

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Re: What comes after the ACA?
« Reply #1401 on: March 08, 2017, 02:32:11 PM »
With everyone mentioning universal healthcare, the question is whether providers would be onboard.  If nothing else were to change, and everyone went on medicare, I doubt they would.  Doctors are already stingy with how many medicare/medicaid patients they take, the amount of resources these patients can use exceeds the financial gain.  Government and insurance involvement in dictating healthcare is already too much for many providers and having more government involvement, in its current form, is not going to help.

If 90+% of the population chooses not to buy private insurance and only uses the public option, what choice would most providers have except to play ball?

sol

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Re: What comes after the ACA?
« Reply #1402 on: March 08, 2017, 02:35:52 PM »
The healthcare is not affordable.  Although they get subsidies their deductible is $6000 and then they cover 20%  There is nothing affordable about that.  It is not a good thing.

Maybe it depends on where you live?  Because around here, ACA plans for a family making the median income are about $400/mo with s $1k deductible and $2.5k OOP max, and that's with only getting $160/mo in ACA subsidy.  And if you earn less than $38k/yr you get free coverage under expanded Medicaid.  What's not affordable about free?

Maybe you meant "affordable" for people too rich for the ACA subsidies?  If your family of five makes more than $114k/year you don't currently get subsidies on the individual market, just like you didn't before the ACA was passed.  But you also make more than double the median household income, so I don't feel too bad for you.
« Last Edit: March 08, 2017, 02:49:11 PM by sol »

jodelino

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Re: What comes after the ACA?
« Reply #1403 on: March 08, 2017, 02:41:54 PM »
With everyone mentioning universal healthcare, the question is whether providers would be onboard.  If nothing else were to change, and everyone went on medicare, I doubt they would.  Doctors are already stingy with how many medicare/medicaid patients they take, the amount of resources these patients can use exceeds the financial gain.  Government and insurance involvement in dictating healthcare is already too much for many providers and having more government involvement, in its current form, is not going to help.

You underestimate many health care providers. Check out Physicians for a National Healthcare Program:

http://www.pnhp.org

Many, many doctors would welcome a single payer plan, for many reasons: the morality of it; the simplicity of not having to wrangle with an array of health care companies and plans; the higher quality for patients and more reliable payment for themselves (doctors I know say that Medicare is a much better and more reliable payer than most insurance companies, both to them and to the labs etc. whose services they order).
« Last Edit: March 08, 2017, 10:20:05 PM by jodelino »

sol

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Re: What comes after the ACA?
« Reply #1404 on: March 08, 2017, 02:44:16 PM »
Doctors are already stingy with how many medicare/medicaid patients they take, the amount of resources these patients can use exceeds the financial gain. 

We can make more doctors.  They are only stingy because they can be, bc private insurance is so much more profitable for them.

I agree that doctors will make less money.  This is a good thing, and is the way that other countries manage to provide healthcare so much more cost effectively than the US does.  They use a lot more nurse practitioners instead of MDs to look at runny noses and prescribe antibiotics.

Step two, then, will be to figure out how to lower the cost of training new medical staff so that doctors who only make $150k instead of $300k per year don't start out their practices with $400k of debt.
« Last Edit: March 08, 2017, 02:57:42 PM by sol »

Paul der Krake

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Re: What comes after the ACA?
« Reply #1405 on: March 08, 2017, 02:44:41 PM »
If you want to address costs, probably the fact that US doctors make a ton of money is the place to start. The AMA is not going to be happy about any sort of reform that cuts their pay, though.

-W
I don't give two shits what doctors think. We can import some that are just as qualified who don't have 300k in student loans and won't bitch about not having 3 vacations homes.

Same goes for the billing department of any hospital, and 90% of the medical-industrial complex. There is no reason to have thousands of administrative staff who don't provide direct medical support. This shit costs everyone thousands of dollars because every single fucking claim needs to go through a bazillion people and endless phone trees. If there's ever been a middle-man tax, this is it.

Burn this shit to the ground.

waltworks

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Re: What comes after the ACA?
« Reply #1406 on: March 08, 2017, 02:54:58 PM »
Agreed, I was just pointing out that the AMA is (yet another) significant barrier to any real cost reduction efforts.

The whole concept of the doctor as the highest educated/paid professional in society is a little ridiculous IMO. 95% of stuff doctors do can be done by nurse practitioners with just a few years of school, because it's dead easy.

But everyone wants their doctor to basically have a PhD for some reason, c'est la vie.

-W

sol

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Re: What comes after the ACA?
« Reply #1407 on: March 08, 2017, 03:13:49 PM »
If you want to address costs, probably the fact that US doctors make a ton of money is the place to start.

The ACA has already addressed some other potential cost saving measures.  It penalizes providers for fraudulent claims, it encourages market competition by established insurance exchanges where plans can be comparison shopped, it incentives new cost saving therapies, expanded reinsurance programs, covered free preventative care, promoted ACOs, and (this is the big one) moved more people into the Medicaid pay structure.  All of these things lower the actual cost of care.  I just wish the republicans hadn't gutted the provision to allow negotiation of drug prices.

Republicans have wisely decided to keep every one of these cost control provisions.  They didn't do anything new to make care more affordable on the provider side, but at least they didn't make it worse either.

Again, allowing drug prices to be negotiated would be a huge one, and would spread the pain from doctors to big pharma.  But republicans hate that idea, because it benefits American citizens instead of the biggest American corporations.  It's easy to see who their real constituents are.

EnjoyIt

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Re: What comes after the ACA?
« Reply #1408 on: March 08, 2017, 05:03:46 PM »
Many believe doctors make a ton of money, and I agree being a doctor I do get paid well, but I promise you that I would never have chosen to give up 12 years of my life if I also did not get reimbursed well for my effort.  Many of you talk about retiring in their 30s while many physicians start $300k in debt get their first legitimate paycheck in their 30s.  Also, because of our progressive tax system a doctor making $200k a year does not really make 4x as much as a person making $50k.  Keep in mind doctors pay much much more in taxes, do not get any of the tax deductions, and need to pay a a significant amount of money to keep and renew their license.  Not to mention most physicians work well over 40 hours a week as well as take call working overnights.  In all honesty the physician deserves to be paid a reasonable amount for the work they do.  So I say fuck you to anyone who thinks I don't serve my income.  Especially when I save the life of someone you care about.  Fuck you for demanding that I bust my ass for so may years and then you are willing to just screw me over and not allow me to make the living I was promised which BTW is already lower than what was promised.  And if you think we can make more doctors, maybe you are right, but how many bright people will choose other professions?  Instead of getting America's brightest, we will get average providers with an average skill set.  Primary care doctors make a fraction of what they used to 15-20 years ago, and guess what?  We have a shortage of primary care doctors.  The market will always dictate what professions bright young people will go to.  I'm okay with being paid less, but tax me less, reimburse me for my school debt, give me a 9-5 job with no call or no overnights, and don't put me at risk of a lawsuit.   I will be thrilled to make less money then.

I think people just don't understand that we have X dollars, and with these X dollars we can provide healthcare.  We want private rooms, with good meals and cable television.  We want to be seen within 20 minutes of arriving and we want the answer within 3 hours.  We want CTs and MRIs.  We want the most cutting edge robotics to do our surgeries.  We want to keep some of our really sick elderly alive despite the fact they have no idea who they are and haven't gotten out of bed in months or years.  We want the latest and greatest drugs but without any side effects. Well, we can't have it all.  Some of that stuff needs to be rationed or we will continue paying more and more for it.  We can tax those making more money all day long, but our desire for the best and most cutting edge is unlimited while the amount able to be taxed is finite.

The insurance companies are winning.  They have completely distracted us.  Instead of having a real discussion about cost we fight about who will pay for healthcare.  Even when we agree that cost needs to be the main topic we jump to "we need a single payer." Again, that goes back to who will pay and does not talk about cost.  Even if we go to single payer, we will still need to decide how to ration those healthcare dollars to provide the most efficient medicine. 

BTW, I am not against the single payer model.  Though I worry it may be something similar to the VA which has some major rationing of care. Interestingly I find that they spend an exorbitant of money on the latest drugs when lower cost options that are just as good are available. The other extreme is Medicaid which currently pays less than what it costs to take care of a patient. Medicare reimburses better but that is only for 65 and over.

Metric Mouse

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Re: What comes after the ACA?
« Reply #1409 on: March 08, 2017, 05:19:56 PM »
I just think that most Americans will always want some sort of private option or maybe even just a private "buy up" plan.

Private insurance will always be available, even if we someday get single payer universal healthcare.  These things are not mutually exclusive. 

Single payer covers some basic services, but not others (like plastic surgery or laser eyes) so I think there will always be a market for people who want additional coverage.  Maybe you'll want to pay for faster service, or experimental drugs/procedures, or a private doctor who operates outside the single payer system.  Private insurance isn't going away, but it could be made secondary to universal basic coverage for all citizens.

And honestly, it's likely that the only way we'll ever get "universal healthcare" is if the universal coverage is pretty stingy.  Like one physical per year that comes with free advice to quit smoking, ER services, a limited set of prescription services that covers common ailments like diabetes with hefty copays, and then rationed care for catastrophic events.  It would be insufficient by itself for most people, but would still save thousands of lives per year. And it would b cheap to provide and administer.
Source?

Don't see it happening. Republicans won't spend the money and Democrats won't give the shaft to their corporate insurance lobby interests.
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Exflyboy

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Re: What comes after the ACA?
« Reply #1410 on: March 08, 2017, 05:24:37 PM »
There are plenty of unemployed coal miners.. Can't we make them all into Doctors and high tech workers?.. Heck we won't even need H1b visas then..:)

Huffduf41

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Re: What comes after the ACA?
« Reply #1411 on: March 08, 2017, 05:34:17 PM »
To those that think doctors are overpaid:

Please tell me what is more important than your health.

I would personally prefer that the best and brightest attend med school and are able to cure whatever shit I get myself into.  Without superior compensation the majority of those able to get through the process would NEVER consider it.

Exflyboy

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Re: What comes after the ACA?
« Reply #1412 on: March 08, 2017, 05:50:05 PM »
Hmm.. funny all those thousands of dead Europeans that pay less than half what we do... Amazing any of them make it it into old age!

Paul der Krake

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Re: What comes after the ACA?
« Reply #1413 on: March 08, 2017, 05:53:48 PM »
Nobody is suggesting that doctors should be paid less. It's everything else.

I want EnjoyIt to continue making 200k+ or whatever he's making. It's everyone else I have a problem with. I want his malpractice insurance to be in the low 3 digits. I want him to prescribe drugs that are priced like tic-tacs, not printer ink.

But I have no trouble at all putting him on the streets and everyone else who obstructs.





Huffduf41

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Re: What comes after the ACA?
« Reply #1414 on: March 08, 2017, 06:03:08 PM »
I want him to prescribe drugs that are priced like tic-tacs, not printer ink.

Have you ever watched a loved one die due to ALS?  I'd prefer that pharma companies are able to make shitloads of $$$ and hire the best talent and find cures for horrible things.  I would have zero issue paying $250k for some drugs that would save my life...even if it meant I had to work 16-hour days for 10 years straight....IMHO it beats the hell out of being dead.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #1415 on: March 08, 2017, 06:22:58 PM »
To those that think doctors are overpaid:

Please tell me what is more important than your health.

I would personally prefer that the best and brightest attend med school and are able to cure whatever shit I get myself into.  Without superior compensation the majority of those able to get through the process would NEVER consider it.

The same argument can be made for pharma companies but nobody buys it.  I am not talking about companies who buy a 30 year old drug in public domain and jack the price.  I mean companies researching new drugs.   We should encourage the high reward for bringing these drugs to market instead of vilifying them.  Without the superior investment returns many investors would NEVER consider investing in pharma research.

Paul der Krake

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Re: What comes after the ACA?
« Reply #1416 on: March 08, 2017, 06:34:13 PM »
I want him to prescribe drugs that are priced like tic-tacs, not printer ink.

Have you ever watched a loved one die due to ALS?  I'd prefer that pharma companies are able to make shitloads of $$$ and hire the best talent and find cures for horrible things.  I would have zero issue paying $250k for some drugs that would save my life...even if it meant I had to work 16-hour days for 10 years straight....IMHO it beats the hell out of being dead.
Give me a fucking break. Drug companies operate in every country around the world and make massive profits there too. Americans are the only ones dumb enough to oppose any sort of price control on purely ideological grounds. This not even close to being the only two options on the table.

But since we're making ridiculous black or white choices, here is a hypothetical:

You have two levers, and can only pull one.

Lever 1: All healthcare funds are now magically slashed to be on par in terms of share of GDP with any other first world country of your choice. Not a single dollar goes towards US drug or medical research for the next 50 years. This means a number of children with badly understood diseases today have no hope whatsoever of getting better. On the other hand, the remaining 320m+ Americans never have to think about healthcare choices again.

Lever 2: nothing changes.

Which one would you pick?

waltworks

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Re: What comes after the ACA?
« Reply #1417 on: March 08, 2017, 06:37:51 PM »
To those that think doctors are overpaid:

Please tell me what is more important than your health.

I would personally prefer that the best and brightest attend med school and are able to cure whatever shit I get myself into.  Without superior compensation the majority of those able to get through the process would NEVER consider it.

You do not need someone with 10 years of postgraduate education to set a broken bone, treat your influenza symptoms, or prescribe NSAIDs and rest/ice/elevation. That's (I'm simplifying) a huge chunk of what people go to the doctor for.

Doctors are mostly mechanics for your body. If you want brilliant people taking care of you, great. I want the smart people getting biochemistry PhDs so they can figure out, say, how cells do what they do and how to fix things at that level so I never get sick (or get well really fast). I don't need a smart overeducated mechanic for the basic stuff that constitutes 95% of medicine.

-W


jim555

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Re: What comes after the ACA?
« Reply #1418 on: March 08, 2017, 06:41:59 PM »
The US has the highest costs, but what about life expectancy?
Ranked 43 (I removed some for the sake of brevity.)

1    Monaco      89.52   
2   Japan      84.74   
3   Singapore           84.68   
13   Australia           82.15   
14   Italy              82.12   
15   Sweden      81.98   
18   Canada      81.76   
19   France      81.75   
20   Norway      81.70   
21   Spain      81.57   
22   Austria      81.39   
28   New Zealand   81.05   
29   Belgium      80.88   
30   Finland      80.77   
31   Ireland      80.68   
32   Germany      80.57   
33   United Kingdom80.54   
43   United States   79.68   

Exflyboy

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Re: What comes after the ACA?
« Reply #1419 on: March 08, 2017, 06:45:29 PM »
I think what we have fundamantally is the mistaken idea that (as with all things) America is the greatest.

Well guess what.. in some things thats true.. other things such as HC thats a LOOONG way from the truth.

We have a technically good system.. In that you can get good care.. but soon no one will be able to afford it.. So.. whats the point, you can't get HC anyway!

Roland of Gilead

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Re: What comes after the ACA?
« Reply #1420 on: March 08, 2017, 06:51:01 PM »
Give me a fucking break. Drug companies operate in every country around the world and make massive profits there too. Americans are the only ones dumb enough to oppose any sort of price control on purely ideological grounds. This not even close to being the only two options on the table.

Doctors in other countries also are paid massively less than they are in the USA.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #1421 on: March 08, 2017, 06:55:26 PM »
The US has the highest costs, but what about life expectancy?
Ranked 43 (I removed some for the sake of brevity.)

1    Monaco      89.52   
2   Japan      84.74   
3   Singapore           84.68   
13   Australia           82.15   
14   Italy              82.12   
15   Sweden      81.98   
18   Canada      81.76   
19   France      81.75   
20   Norway      81.70   
21   Spain      81.57   
22   Austria      81.39   
28   New Zealand   81.05   
29   Belgium      80.88   
30   Finland      80.77   
31   Ireland      80.68   
32   Germany      80.57   
33   United Kingdom80.54   
43   United States   79.68

Awesome.  We should all move to Monaco.  Let me check the house prices, one sec.

Holy shit, a 3 bd apartment rents for $10,000 a month

radram

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Re: What comes after the ACA?
« Reply #1422 on: March 08, 2017, 07:08:36 PM »
The US has the highest costs, but what about life expectancy?
Ranked 43 (I removed some for the sake of brevity.)

1    Monaco      89.52   
2   Japan      84.74   
3   Singapore           84.68   
13   Australia           82.15   
14   Italy              82.12   
15   Sweden      81.98   
18   Canada      81.76   
19   France      81.75   
20   Norway      81.70   
21   Spain      81.57   
22   Austria      81.39   
28   New Zealand   81.05   
29   Belgium      80.88   
30   Finland      80.77   
31   Ireland      80.68   
32   Germany      80.57   
33   United Kingdom80.54   
43   United States   79.68

Awesome.  We should all move to Monaco.  Let me check the house prices, one sec.

Holy shit, a 3 bd apartment rents for $10,000 a month
That's less than a hospital bed!!!!! Sign me up :)

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #1423 on: March 08, 2017, 07:22:38 PM »
 The best and the brightest medical students in the United States typically prefer to go into high-paying (>$400k) specialties like ear nose throat, radiology, anesthesiology rather than the much more needed primary care Medicine.  Hence we import foreign trained physicians to make up for the primary care shortfall. This is especially critical in rural areas in red states.

 The affordable care act was meant to study best medical practices  in order to get rid of wasteful medical procedures that do not contribute to health -  though they line the pockets of hospitals and physicians group practices.

 The VA hospitals and clinics are vastly under staffed of doctors. Physicians that work there are overwhelmed with the number of cases they have to competently handle.  Republicans in Congress are refusing to adequately fund veterans hospitals and clinics and veterans that depend on these places are underserved.  50% of the doctors at the veterans hospitals are incompetent or simply aren't performing adequately.


frugaldoc

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Re: What comes after the ACA?
« Reply #1424 on: March 08, 2017, 07:24:04 PM »
Depending on how you measure it, physicians "cost" anywhere from 8-20% of the health care dollar. Assuming you could cut physician salaries by 50%, at most you could cut health care costs by 10%.

I can tell you that no one in there right f&*king mind would be a physician for a 50% pay cut. I  would quit tomorrow if you told me I was going to have to do my job for half pay. Too much stress, too much training, too much liability.

Replacing everyone with mid-levels is NOT going to meaningfully reduce costs. Trust me on this. Mid-levels are great because they allow physicians to focus their skills where needed, but cost savings will be negligible.

Physician compensation is not the main driver of health care costs. We are simply not willing as a society to make the tough decisions. Demand for health care is endless, and we will not limit consumption in any meaningful way.

Trumpcare or whatever you want to call it will fail just like Obamacare or whatever you want to call it. There is no meaningful limits on consumption.

I don't know how to fix it. Single payer maybe, but that seems politically unlikely.
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Exflyboy

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Re: What comes after the ACA?
« Reply #1425 on: March 08, 2017, 07:34:35 PM »
Give me a fucking break. Drug companies operate in every country around the world and make massive profits there too. Americans are the only ones dumb enough to oppose any sort of price control on purely ideological grounds. This not even close to being the only two options on the table.

Doctors in other countries also are paid massively less than they are in the USA.

Salaries for ALL professions are less in say the UK than they are in the USA.. My salary doubled when I emigrated to the US.. BUT.. no school loans to pay, retirement benefits are much greater (generally you don't have to save for your own retirement) and nobody sues anybody.

I don't think you can make a generalisation like that without knowing the specifics.
« Last Edit: March 08, 2017, 07:38:57 PM by Exflyboy »

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #1426 on: March 08, 2017, 09:25:49 PM »
I want him to prescribe drugs that are priced like tic-tacs, not printer ink.

Have you ever watched a loved one die due to ALS?  I'd prefer that pharma companies are able to make shitloads of $$$ and hire the best talent and find cures for horrible things.  I would have zero issue paying $250k for some drugs that would save my life...even if it meant I had to work 16-hour days for 10 years straight....IMHO it beats the hell out of being dead.
Give me a fucking break. Drug companies operate in every country around the world and make massive profits there too. Americans are the only ones dumb enough to oppose any sort of price control on purely ideological grounds. This not even close to being the only two options on the table.

But since we're making ridiculous black or white choices, here is a hypothetical:

You have two levers, and can only pull one.

Lever 1: All healthcare funds are now magically slashed to be on par in terms of share of GDP with any other first world country of your choice. Not a single dollar goes towards US drug or medical research for the next 50 years. This means a number of children with badly understood diseases today have no hope whatsoever of getting better. On the other hand, the remaining 320m+ Americans never have to think about healthcare choices again.

Lever 2: nothing changes.

Which one would you pick?

I'd pull the one that provides the highest quality of life for the most people, so I guess that's the first lever?

The more telling part is that other people are defining the levers (setting up a false option scenario) and a select group of others then decide which lever to pull for everyone else.  And after all that hard work, they go back to enjoying their luxury health care that wasn't  an option for the people they 'represent'.
« Last Edit: March 08, 2017, 09:36:49 PM by EscapeVelocity2020 »
Transitioning to FIRE'd albeit somewhat cautiously...

aspiringnomad

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Re: What comes after the ACA?
« Reply #1427 on: March 08, 2017, 10:14:36 PM »
The US has the highest costs, but what about life expectancy?
Ranked 43 (I removed some for the sake of brevity.)

1    Monaco      89.52   
2   Japan      84.74   
3   Singapore           84.68   
13   Australia           82.15   
14   Italy              82.12   
15   Sweden      81.98   
18   Canada      81.76   
19   France      81.75   
20   Norway      81.70   
21   Spain      81.57   
22   Austria      81.39   
28   New Zealand   81.05   
29   Belgium      80.88   
30   Finland      80.77   
31   Ireland      80.68   
32   Germany      80.57   
33   United Kingdom80.54   
43   United States   79.68

Awesome.  We should all move to Monaco.  Let me check the house prices, one sec.

Holy shit, a 3 bd apartment rents for $10,000 a month
That's less than a hospital bed!!!!! Sign me up :)

It's less than 5 days in a hospital bed :)

EnjoyIt

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Re: What comes after the ACA?
« Reply #1428 on: March 09, 2017, 01:26:31 AM »

You do not need someone with 10 years of postgraduate education to set a broken bone, treat your influenza symptoms, or prescribe NSAIDs and rest/ice/elevation. That's (I'm simplifying) a huge chunk of what people go to the doctor for.

Doctors are mostly mechanics for your body. If you want brilliant people taking care of you, great. I want the smart people getting biochemistry PhDs so they can figure out, say, how cells do what they do and how to fix things at that level so I never get sick (or get well really fast). I don't need a smart overeducated mechanic for the basic stuff that constitutes 95% of medicine.

-W

True story: Patient goes to see a nurse practitioner at a clinic for a cough and on multiple occasions gets treated for a viral infection, asthma, or bronchitis.  Until eventually they see a smart overeducated mechanic who diagnosis them with cancer.

True story: Patient sees his midlevel at the doctors office on multiple occasions for a sore throat.  Placed on multiple rounds of antibiotics until finally sees a smart overeducated mechanic who diagnosis them with cancer.

True story: Patient treated by a mid level provider for a minor condition and ready to go home, but after consulting with their overeducated mechanic more studies are ordered and the patient was found to have a disease process that would have killed or maimed them in the near future.  (Specific details held back for patient privacy)

I can go on and on. 

Mid level providers are awesome in helping physicians do their jobs, but they require supervision.  I have worked with amazing mid level providers who function on par of a physician for those 95% of the cases out there.  But often times a physician is required when a patient presents differently or when the prevention does not lead to a cut and dry path for figuring out the disease and treating it.
« Last Edit: March 09, 2017, 06:43:34 AM by EnjoyIt »

boarder42

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Re: What comes after the ACA?
« Reply #1429 on: March 09, 2017, 04:57:04 AM »
The healthcare is not affordable.  Although they get subsidies their deductible is $6000 and then they cover 20%  There is nothing affordable about that.  It is not a good thing.

Maybe it depends on where you live?  Because around here, ACA plans for a family making the median income are about $400/mo with s $1k deductible and $2.5k OOP max, and that's with only getting $160/mo in ACA subsidy.  And if you earn less than $38k/yr you get free coverage under expanded Medicaid.  What's not affordable about free?

Maybe you meant "affordable" for people too rich for the ACA subsidies?  If your family of five makes more than $114k/year you don't currently get subsidies on the individual market, just like you didn't before the ACA was passed.  But you also make more than double the median household income, so I don't feel too bad for you.

I see the same thing around my area over 6k per year in premiums for 10k deductibles.  Why I said it was broken. I could get better more affordable Care before this dumb mess. Thankfully there is health share. I like the GOP plan BC it starts to feed more corporate tax breaks down to individual players by doubling the HSA. Allowing it to be used for premiums would be the next great step. But either way I'll still probably end up on healthshare when fired unless there are dramatic cost changes.  Ifind the penalty stays in place we'll probably carry an ultra high deductible plan as well to maintain coverage without lapse.
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Re: What comes after the ACA?
« Reply #1430 on: March 09, 2017, 05:09:05 AM »
Trump’s Backup Plan: Let Health Care System Explode, Blame Democrats
http://nymag.com/daily/intelligencer/2017/03/trump-blame-democrats-health-care.html

A White House official said Trump made it clear that “this is the chance to repeal and replace,” but Politico and CNN reported that he also brought up his fallback plan: let Obamacare fail on its own, blame the Democrats, and push another Republican health care plan two years from now.

If the ACA is not failing then Trump's back up plan will fail, yes?

No. I expect his back up plan is quite sound.

AdrianC

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Re: What comes after the ACA?
« Reply #1431 on: March 09, 2017, 05:32:26 AM »
Maybe it depends on where you live?  Because around here, ACA plans for a family making the median income are about $400/mo with s $1k deductible and $2.5k OOP max, and that's with only getting $160/mo in ACA subsidy.
So around there an ACA family plan with no subsidy is $560/month, and that's for a plan with a $1K deductible, so that's a Gold or Platinum plan?

Where are you getting your numbers from?

(My ACA family plan (5 people) with no subsidy is $951/month, $6K deductible, Silver plan).

boarder42

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Re: What comes after the ACA?
« Reply #1432 on: March 09, 2017, 06:00:56 AM »
Trump’s Backup Plan: Let Health Care System Explode, Blame Democrats
http://nymag.com/daily/intelligencer/2017/03/trump-blame-democrats-health-care.html

A White House official said Trump made it clear that “this is the chance to repeal and replace,” but Politico and CNN reported that he also brought up his fallback plan: let Obamacare fail on its own, blame the Democrats, and push another Republican health care plan two years from now.

If the ACA is not failing then Trump's back up plan will fail, yes?

No. I expect his back up plan is quite sound.

yeah its very sound.  rates are thru the roof people cant afford them and insurance companies cant make money offering plans and keep pulling out.  how thats not failing i dont know.
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NoStacheOhio

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Re: What comes after the ACA?
« Reply #1433 on: March 09, 2017, 06:51:52 AM »
True story: Patient goes to see a nurse practitioner at a clinic for a cough and on multiple occasions gets treated for a viral infection, asthma, or bronchitis.  Until eventually they see a smart overeducated mechanic who diagnosis them with cancer.

True story: Patient sees his midlevel at the doctors office on multiple occasions for a sore throat.  Placed on multiple rounds of antibiotics until finally sees a smart overeducated mechanic who diagnosis them with cancer.

True story: Patient treated by a mid level provider for a minor condition and ready to go home, but after consulting with their overeducated mechanic more studies are ordered and the patient was found to have a disease process that would have killed or maimed them in the near future.  (Specific details held back for patient privacy)

I can go on and on. 

Mid level providers are awesome in helping physicians do their jobs, but they require supervision.  I have worked with amazing mid level providers who function on par of a physician for those 95% of the cases out there.  But often times a physician is required when a patient presents differently or when the prevention does not lead to a cut and dry path for figuring out the disease and treating it.

You're describing the system working. A practice with say, ten midlevels working with three physicians can take good care of lots of people for a reasonable cost, while still catching the more serious stuff that actually requires a doctor. They just need to be working closely enough to know when to bump someone up the food chain.
The first step is acknowledging you have a problem, right?

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radram

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Re: What comes after the ACA?
« Reply #1434 on: March 09, 2017, 06:53:52 AM »
Trump’s Backup Plan: Let Health Care System Explode, Blame Democrats
http://nymag.com/daily/intelligencer/2017/03/trump-blame-democrats-health-care.html

A White House official said Trump made it clear that “this is the chance to repeal and replace,” but Politico and CNN reported that he also brought up his fallback plan: let Obamacare fail on its own, blame the Democrats, and push another Republican health care plan two years from now.

If the ACA is not failing then Trump's back up plan will fail, yes?

No. I expect his back up plan is quite sound.

yeah its very sound.  rates are thru the roof people cant afford them and insurance companies cant make money offering plans and keep pulling out.  how thats not failing i dont know.

Another theory: last years price increases were not needed, and were merely used as a political pawn to get in power the party they(insurance companies) wanted. This leads to another push for fast reform. Under current financial rules, if an insurance company collects too much, they owe it back or face a penalty. Does the new plan rescind that penalty? Of course it does. Why do you think that is?

Other questions: Are the numbers available as to how many people added or dropped coverage as a result of the recent price increases? If the number of insured people continues to increase, then how in the world can we claim unaffordable. Unsustainable is a whole other matter.

I do see that insurance companies are pulling out. That is a big concern. Did that result in people having 0 choices for coverage for 2017? How many people had 0 choices, and what did they do about it?


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Re: What comes after the ACA?
« Reply #1435 on: March 09, 2017, 11:23:54 AM »
Trump’s Backup Plan: Let Health Care System Explode, Blame Democrats
http://nymag.com/daily/intelligencer/2017/03/trump-blame-democrats-health-care.html

A White House official said Trump made it clear that “this is the chance to repeal and replace,” but Politico and CNN reported that he also brought up his fallback plan: let Obamacare fail on its own, blame the Democrats, and push another Republican health care plan two years from now.

If the ACA is not failing then Trump's back up plan will fail, yes?

No. I expect his back up plan is quite sound.

yeah its very sound.  rates are thru the roof people cant afford them and insurance companies cant make money offering plans and keep pulling out.  how thats not failing i dont know.
[/quote ]
Can someone point out to Steve bannon  that single payer would totally fuck up the deep state Washington elite?

« Last Edit: March 09, 2017, 11:44:08 AM by Mr Mark »
Mr. Mark

rpr

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Re: What comes after the ACA?
« Reply #1436 on: March 09, 2017, 11:34:58 AM »
True story: Patient goes to see a nurse practitioner at a clinic for a cough and on multiple occasions gets treated for a viral infection, asthma, or bronchitis.  Until eventually they see a smart overeducated mechanic who diagnosis them with cancer.

True story: Patient sees his midlevel at the doctors office on multiple occasions for a sore throat.  Placed on multiple rounds of antibiotics until finally sees a smart overeducated mechanic who diagnosis them with cancer.

True story: Patient treated by a mid level provider for a minor condition and ready to go home, but after consulting with their overeducated mechanic more studies are ordered and the patient was found to have a disease process that would have killed or maimed them in the near future.  (Specific details held back for patient privacy)

I can go on and on. 

Mid level providers are awesome in helping physicians do their jobs, but they require supervision.  I have worked with amazing mid level providers who function on par of a physician for those 95% of the cases out there.  But often times a physician is required when a patient presents differently or when the prevention does not lead to a cut and dry path for figuring out the disease and treating it.

You're describing the system working. A practice with say, ten midlevels working with three physicians can take good care of lots of people for a reasonable cost, while still catching the more serious stuff that actually requires a doctor. They just need to be working closely enough to know when to bump someone up the food chain.
EnjoyIt -- Wouldn't you rather deal with challenging cases rather than the mundane colds/coughs/sprains? I agree with NoStacheOhio that the system appears to be working. And as you put it, mid-level providers are good for 95% of the cases and experts such as yourself are needed in the more advanced 5%.

sol

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Re: What comes after the ACA?
« Reply #1437 on: March 09, 2017, 11:41:11 AM »
I do see that insurance companies are pulling out. That is a big concern.

The ACA is not failing.  Insurers have always pulled out of specific markets, usually low population rural ones without enough customers, because it's harder to provide cost effective services there.  The ACA helps with this problem by adding customers to the insurance pool in those areas.  The GOP plan will make this problem worse.

In some other markets, like major cities, insurers are making too much money and the ACA profit caps have forced them to refund money to ratepayers.  Plan choices are abundant and affordable in these places, as designed by the ACA's (republican idea) health exchanges to encourage competition.

Health care has always been a regional problem.  Just like with electricity or postal service, it costs more to provide services to rural areas with fewer customers.  The ACA tried to adress this problem by adding the individual mandate, and a bunch of new insurers jumped into these markets to capitalize.  Now some of them are jumping back out again, and those areas are back where they were before the ACA.  This is not the ACA making things worse, it's the ACA making things temporarily better and then the market putting things back the way they were.  Being a market driven approach, this is how the ACA was supposed to work.

I would personally love to see the republicans deliver on better care at lower cost for all Americans.  I would happily support full repeal and replace of the ACA if they had a way to do that.  But they don't.  Republicans in congress don't actually want more people to have health insurance, and they don't want to lower the cost to consumers.  They only want to reduce federal expenditures on healthcare while protecting corporate profit margins, and the only way to accomplish both of those things is to screw over American citizens.   

And provide tax cuts for the rich and new abortion restrictions while they're at it, of course.

waltworks

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Re: What comes after the ACA?
« Reply #1438 on: March 09, 2017, 11:51:07 AM »
True story: Patient goes to see a nurse practitioner at a clinic for a cough and on multiple occasions gets treated for a viral infection, asthma, or bronchitis.  Until eventually they see a smart overeducated mechanic who diagnosis them with cancer.

True story: Patient sees his midlevel at the doctors office on multiple occasions for a sore throat.  Placed on multiple rounds of antibiotics until finally sees a smart overeducated mechanic who diagnosis them with cancer.

True story: Patient treated by a mid level provider for a minor condition and ready to go home, but after consulting with their overeducated mechanic more studies are ordered and the patient was found to have a disease process that would have killed or maimed them in the near future.  (Specific details held back for patient privacy)

I can go on and on. 

Mid level providers are awesome in helping physicians do their jobs, but they require supervision.  I have worked with amazing mid level providers who function on par of a physician for those 95% of the cases out there.  But often times a physician is required when a patient presents differently or when the prevention does not lead to a cut and dry path for figuring out the disease and treating it.

You're describing the system working. A practice with say, ten midlevels working with three physicians can take good care of lots of people for a reasonable cost, while still catching the more serious stuff that actually requires a doctor. They just need to be working closely enough to know when to bump someone up the food chain.

I concur completely. Physicians misdiagnose/undertreat (as well as overtest/overtreat) patients all the time. You can *always* find examples of someone's life being saved by some magic intuition - but that's not the norm, at all. The norm is that your bronchitis is ... bronchitis.

http://www.medscape.com/viewarticle/810692

Money quote "Outcomes for NPs compared to MDs (or teams without NPs) are comparable or better for all 11 outcomes reviewed."

Unless you are a specialist or doing research, you are probably overeducated (meaning, your extra education isn't helping you do your job better) as a doctor in the US.

-W

Metric Mouse

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Re: What comes after the ACA?
« Reply #1439 on: March 09, 2017, 12:30:17 PM »
I do see that insurance companies are pulling out. That is a big concern.

The ACA is not failing.  Insurers have always pulled out of specific markets, usually low population rural ones without enough customers, because it's harder to provide cost effective services there.  The ACA helps with this problem by adding customers to the insurance pool in those areas.  The GOP plan will make this problem worse.

In some other markets, like major cities, insurers are making too much money and the ACA profit caps have forced them to refund money to ratepayers.  Plan choices are abundant and affordable in these places, as designed by the ACA's (republican idea) health exchanges to encourage competition.

Health care has always been a regional problem.  Just like with electricity or postal service, it costs more to provide services to rural areas with fewer customers.  The ACA tried to adress this problem by adding the individual mandate, and a bunch of new insurers jumped into these markets to capitalize.  Now some of them are jumping back out again, and those areas are back where they were before the ACA.  This is not the ACA making things worse, it's the ACA making things temporarily better and then the market putting things back the way they were.  Being a market driven approach, this is how the ACA was supposed to work.

I would personally love to see the republicans deliver on better care at lower cost for all Americans.  I would happily support full repeal and replace of the ACA if they had a way to do that.  But they don't.  Republicans in congress don't actually want more people to have health insurance, and they don't want to lower the cost to consumers.  They only want to reduce federal expenditures on healthcare while protecting corporate profit margins, and the only way to accomplish both of those things is to screw over American citizens.   

And provide tax cuts for the rich and new abortion restrictions while they're at it, of course.
This is exactly what the ACA failing looks like. If a state decided not to expand medicar due to the added costs that weren't covered by the ACA funding under which most of the newly covered people are now getting insurance, and providers are pulling out of market places and raising premiums at double digit rates, there are large subsets of low income people who are not covered, and the people in their state, and the federal government, are still paying for the outrageous profits for the insurance companies.

Of course the current Republican plan doesn't address most of these concerns, but if the discussion is the fiscal failings of the ACA, these are fair points. The ACA is great as a wealth re-distribution scheme; it hasn't been as successful in keeping costs down overall or increasing healthcare outcomes nationally, as was touted. If it had been sold for what it is, fewer people may have been less disappointed.
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AdrianC

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Re: What comes after the ACA?
« Reply #1440 on: March 09, 2017, 12:41:30 PM »
Maybe it depends on where you live?  Because around here, ACA plans for a family making the median income are about $400/mo with s $1k deductible and $2.5k OOP max, and that's with only getting $160/mo in ACA subsidy.
So around there an ACA family plan with no subsidy is $560/month, and that's for a plan with a $1K deductible, so that's a Gold or Platinum plan?

Where are you getting your numbers from?


Let me know the zip code for "around there" and I'll check it myself.

Around here, a family of four, ages, 40, 40, 10, 8, making $52K:
Gold plan $2K deductible (the lowest available), max $5K oop, $989/month, reduced to $558/month with subsidy.

infogoon

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Re: What comes after the ACA?
« Reply #1441 on: March 09, 2017, 01:14:29 PM »
Physician compensation is not the main driver of health care costs. We are simply not willing as a society to make the tough decisions. Demand for health care is endless, and we will not limit consumption in any meaningful way.

Exactly this. A society that calls discussion of end-of-life options "DEATH PANELS!!!!!" isn't ready to accept that it's stupid to throw gobs of money at keeping everyone alive as long as possible, even if their quality of life is nonexistent.

sol

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Re: What comes after the ACA?
« Reply #1442 on: March 09, 2017, 01:18:49 PM »
Maybe it depends on where you live?  Because around here, ACA plans for a family making the median income are about $400/mo with s $1k deductible and $2.5k OOP max, and that's with only getting $160/mo in ACA subsidy.
So around there an ACA family plan with no subsidy is $560/month, and that's for a plan with a $1K deductible, so that's a Gold or Platinum plan?

Where are you getting your numbers from?


Let me know the zip code for "around there" and I'll check it myself.

Around here, a family of four, ages, 40, 40, 10, 8, making $52K:
Gold plan $2K deductible (the lowest available), max $5K oop, $989/month, reduced to $558/month with subsidy.

It's the silver plans with the cost sharing that offer the best deals.

I was getting my info off of the Washington health plan finder, for a median income family with two 40 year old parents and three kids.  That family gets free care from apple health (expanded Medicaid) if it shows paper income under 40k, and gets subsidized care for income up to 114k/year.

I just double checked by searching again.  Still has a whole bunch of plans under $400/mo.  The second lowest silver (the benchmark) plan is $296.99/mo with a $3500 family deductible and family OOP max, and $1 copays.  For $360.85/mo you can reduce that to $1150 family deductible and $1500 OOP max with $10 copays.

I don't dispute that other parts of the country may be worse off, but in Washington state I have 23 silver plans to choose from and prices seem reasonable to me.  This is why I think the ACA is working.

protostache

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Re: What comes after the ACA?
« Reply #1443 on: March 09, 2017, 01:41:30 PM »
Maybe it depends on where you live?  Because around here, ACA plans for a family making the median income are about $400/mo with s $1k deductible and $2.5k OOP max, and that's with only getting $160/mo in ACA subsidy.
So around there an ACA family plan with no subsidy is $560/month, and that's for a plan with a $1K deductible, so that's a Gold or Platinum plan?

Where are you getting your numbers from?


Let me know the zip code for "around there" and I'll check it myself.

Around here, a family of four, ages, 40, 40, 10, 8, making $52K:
Gold plan $2K deductible (the lowest available), max $5K oop, $989/month, reduced to $558/month with subsidy.

It's the silver plans with the cost sharing that offer the best deals.

I was getting my info off of the Washington health plan finder, for a median income family with two 40 year old parents and three kids.  That family gets free care from apple health (expanded Medicaid) if it shows paper income under 40k, and gets subsidized care for income up to 114k/year.

I just double checked by searching again.  Still has a whole bunch of plans under $400/mo.  The second lowest silver (the benchmark) plan is $296.99/mo with a $3500 family deductible and family OOP max, and $1 copays.  For $360.85/mo you can reduce that to $1150 family deductible and $1500 OOP max with $10 copays.

I don't dispute that other parts of the country may be worse off, but in Washington state I have 23 silver plans to choose from and prices seem reasonable to me.  This is why I think the ACA is working.

More anecdote: in SE Michigan the same scenario (using 2015 median income of $51k) there are 30 silver plans available ranging from $226 for an HMO with $500/$1000 deductible to $683 for a BCBS multi-state PPO with vision, and dental with a $700/$1400 deductible.

thenextguy

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Re: What comes after the ACA?
« Reply #1444 on: March 09, 2017, 02:00:47 PM »
Physician compensation is not the main driver of health care costs. We are simply not willing as a society to make the tough decisions. Demand for health care is endless, and we will not limit consumption in any meaningful way.

Exactly this. A society that calls discussion of end-of-life options "DEATH PANELS!!!!!"

A society? You mean Republicans. Because they're the only ones screaming that bullshit solely as a political tactic. I don't think it's fair to say "society" when the reality is that most people are mature enough to discuss the topic in rational manner.

Cassie

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Re: What comes after the ACA?
« Reply #1445 on: March 09, 2017, 04:04:41 PM »
I read that the most $ is spent in the last 30 days of a person's life. Many people in my family had DNR's and used hospice when facing the end. Doctors try to talk people that are terminal and old into treatment all the time. When my Mom was 87 she was diagnosed with lymphoma that was in her stomach, liver, etc. She was not going to do chemo but the doctor talked her into it. She died 2 1/2 years later and really suffered during that time. I went to visit about a month before she died and her doc had sent her to a radiologist who wanted to do radiation on her 5 days/week. I asked him would it extend her life and he said no but she would be more comfortable. Are you kidding me?

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Re: What comes after the ACA?
« Reply #1446 on: March 09, 2017, 04:28:01 PM »
I don't dispute that other parts of the country may be worse off, but in Washington state I have 23 silver plans to choose from and prices seem reasonable to me.  This is why I think the ACA is working.

Working for you does not mean it is not failing many other people.

Ask people here in Colorado in the mountains or rural areas how they have been impacted along with many other people in other states. Costs have skyrocketed and they have few options to choose from.

It should be judged in it's entirety and how it is working for everyone.

Joeko

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Re: What comes after the ACA?
« Reply #1447 on: March 09, 2017, 04:33:21 PM »
New Rebuplican plan allows insurers to charge older folks 5x the amount of youngsters...wtf!  I maybe in my 50s but I don't eat sugar, refined carbs or drink.  Yet I'll have to pay exorbitant rates to cover the cost of people with no regards to their health...what a joke our healthcare system is

doggyfizzle

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Re: What comes after the ACA?
« Reply #1448 on: March 09, 2017, 05:17:05 PM »
Ask people here in Colorado in the mountains or rural areas how they have been impacted along with many other people in other states. Costs have skyrocketed and they have few options to choose from.

Did they have a bunch of better options to choose from prior to ACA?  Premium growth (which was happening all the while prior to ACA) has dramatically slowed nationally since ACA was enacted.  If anything, now people (in many states) have access to a guaranteed, but possibly expensive health insurance policy, whereas prior to ACA there was no guarantee of coverage at all.

waltworks

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Re: What comes after the ACA?
« Reply #1449 on: March 09, 2017, 05:20:03 PM »
Working for you does not mean it is not failing many other people.

Ask people here in Colorado in the mountains or rural areas how they have been impacted along with many other people in other states. Costs have skyrocketed and they have few options to choose from.

It should be judged in it's entirety and how it is working for everyone.

Dude, rural places are so much more f'd if the new "replacement" passes...check out the impact maps from Kaiser. It's nuts.

-W