Author Topic: What comes after the ACA?  (Read 778711 times)

Mr. Green

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Re: What comes after the ACA?
« Reply #4400 on: June 21, 2018, 08:11:35 AM »
Speaking of Medicare and those darn cost-effective government programs:
https://www.washingtonpost.com/news/business/wp/2018/06/19/house-gop-plan-would-cut-medicare-social-security-to-balance-budget/

The republicans have been trying to gut Medicare for years, often talking about converting it to a voucher based program, as if seniors aren't already stuck with high enough medical bills that Medicare doesn't cover (as was detailed to some degree several posts back).  Their plans would only make things worse.

The great irony - give tax cuts to the rich who don't need it which increases the deficit, and then try to cut Medicare for deserving seniors to decrease the deficit.  There's something wrong with this picture.

Thatís not irony. That was the plan from the very beginning. The permanent corporate tax cut was simply a vehicle to create a massive deficit that has to be plugged by gutting social welfare programs. This has been on the conservative agenda since the very inception of these programs.

What I don't get is why.  What goal is served by making life worse for millions of people?  Is it just pure greed and cronyism, or do they have some notion that "the market" will magically fix everything?  If so, what would that look like?
Because there really is a whole raft of people out there who think people should fuck off and die if they can't figure out how to afford to pay for healthcare with the greed markup that's been built into it.

Jrr85

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Re: What comes after the ACA?
« Reply #4401 on: June 21, 2018, 08:46:08 AM »
Speaking of Medicare and those darn cost-effective government programs:
https://www.washingtonpost.com/news/business/wp/2018/06/19/house-gop-plan-would-cut-medicare-social-security-to-balance-budget/

The republicans have been trying to gut Medicare for years, often talking about converting it to a voucher based program, as if seniors aren't already stuck with high enough medical bills that Medicare doesn't cover (as was detailed to some degree several posts back).  Their plans would only make things worse.

The great irony - give tax cuts to the rich who don't need it which increases the deficit, and then try to cut Medicare for deserving seniors to decrease the deficit.  There's something wrong with this picture.

Thatís not irony. That was the plan from the very beginning. The permanent corporate tax cut was simply a vehicle to create a massive deficit that has to be plugged by gutting social welfare programs. This has been on the conservative agenda since the very inception of these programs.

What I don't get is why.  What goal is served by making life worse for millions of people?  Is it just pure greed and cronyism, or do they have some notion that "the market" will magically fix everything?  If so, what would that look like?

It couldn't be that medicare is astronomically expensive and generally involves poorer people paying to subsidize the care of richer people? 

Nahhh...has to be just greed. 

Paul der Krake

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Re: What comes after the ACA?
« Reply #4402 on: June 21, 2018, 10:36:00 AM »
It couldn't be that medicare is astronomically expensive and generally involves poorer people paying to subsidize the care of richer people? 

Nahhh...has to be just greed.
Medicare is a flat payroll tax, not subject to the SS cap, and there's even a surcharge for high income. How is that a subsidy from the poor to the rich?

Besides, don't Republicans love flat taxes? They spend hours touting how that's the fair way to do things during primaries.

Jrr85

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Re: What comes after the ACA?
« Reply #4403 on: June 21, 2018, 11:45:26 AM »
It couldn't be that medicare is astronomically expensive and generally involves poorer people paying to subsidize the care of richer people? 

Nahhh...has to be just greed.
Medicare is a flat payroll tax, not subject to the SS cap, and there's even a surcharge for high income. How is that a subsidy from the poor to the rich?
 
On average, it may or may not work out to be a subsidy from the poor to the rich.  But at every percentile of networth once you get above the 10th percentile, retirees are richer than other age brackets (and that's excluding the value of any pensions or annuities or SS/Medicare).  Now obviously, a 50 year old with a net worth of $122k and a good income is arguably more well off than a retiree with a net worth of $210K and no ability to work if you ignore SS, so net worth isn't the only important thing to look at, but certainly there are a lot of poor workers paying for SS and Medicare of rich retirees.   That's perverse. 

https://dqydj.com/the-net-worth-of-american-retirees-america-2013/
https://dqydj.com/the-net-worth-of-different-age-groups-in-america/


Besides, don't Republicans love flat taxes? They spend hours touting how that's the fair way to do things during primaries.
 

I'm a fan of Flat taxes.  Generally, i think paying a proportional amount of your income in taxes is fair.   But if you're taxing workers to give money to retirees, even if the retirees are rich, funding it with a flat tax doesn't fix what an awful policy that is.
« Last Edit: June 21, 2018, 11:48:44 AM by Jrr85 »

Monkey Uncle

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Re: What comes after the ACA?
« Reply #4404 on: June 21, 2018, 12:32:39 PM »
But if you're taxing workers to give money to retirees, even if the retirees are rich, funding it with a flat tax doesn't fix what an awful policy that is.

All workers will be eligible for Medicare when they reach the age at which people of ordinary means (and their employers) can no longer afford to pay for their health care.  Taxes of today's workers pay for the care of today's old people.  When today's workers are old, taxes from tomorrow's workers will pay for their health care.  That's how the social contract works.  Yes, there are serious demographic problems on the horizon due to the increasing proportion of the population that is old vs. the proportion that is working.  But that doesn't mean we just tell tomorrow's (or today's) old people that they can just suck it.  A serious republic would find a way to finance a humane level of care that doesn't bankrupt people after they've worked their entire lives.

Luck12

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Re: What comes after the ACA?
« Reply #4405 on: June 21, 2018, 12:46:38 PM »
It couldn't be that medicare is astronomically expensive and generally involves poorer people paying to subsidize the care of richer people? 

Nahhh...has to be just greed.

It is.  Being a Republican is about social domination and looking down on anyone who's not rich.   They used to at least hide it but not anymore (e.g. Romney and 47%, Paul Ryan talking about how he's been dreaming of cutting Medicaid since he was in college). 

Paul der Krake

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Re: What comes after the ACA?
« Reply #4406 on: June 21, 2018, 12:57:30 PM »
It couldn't be that medicare is astronomically expensive and generally involves poorer people paying to subsidize the care of richer people? 

Nahhh...has to be just greed.
Medicare is a flat payroll tax, not subject to the SS cap, and there's even a surcharge for high income. How is that a subsidy from the poor to the rich?
 
On average, it may or may not work out to be a subsidy from the poor to the rich.  But at every percentile of networth once you get above the 10th percentile, retirees are richer than other age brackets (and that's excluding the value of any pensions or annuities or SS/Medicare).  Now obviously, a 50 year old with a net worth of $122k and a good income is arguably more well off than a retiree with a net worth of $210K and no ability to work if you ignore SS, so net worth isn't the only important thing to look at, but certainly there are a lot of poor workers paying for SS and Medicare of rich retirees.   That's perverse. 

https://dqydj.com/the-net-worth-of-american-retirees-america-2013/
https://dqydj.com/the-net-worth-of-different-age-groups-in-america/


Besides, don't Republicans love flat taxes? They spend hours touting how that's the fair way to do things during primaries.
 

I'm a fan of Flat taxes.  Generally, i think paying a proportional amount of your income in taxes is fair.   But if you're taxing workers to give money to retirees, even if the retirees are rich, funding it with a flat tax doesn't fix what an awful policy that is.
It sounds like you're advocating for more redistribution, in the sense that rich retirees shouldn't receive as many benefits?

But I kinda resent the idea that funding Medicare is giving money to retirees. It's mostly just giving money to the health industry, because there's no way retirees would pay out of pocket if that money went away. They'd just die.

Roadrunner53

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Re: What comes after the ACA?
« Reply #4407 on: June 21, 2018, 01:36:34 PM »
But if you're taxing workers to give money to retirees, even if the retirees are rich, funding it with a flat tax doesn't fix what an awful policy that is.

All workers will be eligible for Medicare when they reach the age at which people of ordinary means (and their employers) can no longer afford to pay for their health care.  Taxes of today's workers pay for the care of today's old people.  When today's workers are old, taxes from tomorrow's workers will pay for their health care.  That's how the social contract works.  Yes, there are serious demographic problems on the horizon due to the increasing proportion of the population that is old vs. the proportion that is working.  But that doesn't mean we just tell tomorrow's (or today's) old people that they can just suck it.  A serious republic would find a way to finance a humane level of care that doesn't bankrupt people after they've worked their entire lives.

As far as I know, you HAVE to go on Medicare when you are 65 unless you are still working and covered by an employer. I am on ACA and go on Medicare in August. Even if I wanted to stay on ACA I can't.

katsiki

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Re: What comes after the ACA?
« Reply #4408 on: June 21, 2018, 01:38:07 PM »
This thread is very informative.  Let's not spoil it with group A vs group B nonsense.  You can't paint every R, D or I with the same brush...

OK, I'm off my soapbox.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #4409 on: June 21, 2018, 02:03:40 PM »
This thread is very informative.  Let's not spoil it with group A vs group B nonsense.  You can't paint every R, D or I with the same brush...

OK, I'm off my soapbox.

Dude, have you even read this thread?  That's what the whole thing is about. ;)

Roadrunner53

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Re: What comes after the ACA?
« Reply #4410 on: June 21, 2018, 02:14:06 PM »
This thread is very informative.  Let's not spoil it with group A vs group B nonsense.  You can't paint every R, D or I with the same brush...

OK, I'm off my soapbox.

Dude, have you even read this thread?  That's what the whole thing is about. ;)

I don't even get what he is talking about!

toganet

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Re: What comes after the ACA?
« Reply #4411 on: June 21, 2018, 02:36:33 PM »
This thread is very informative.  Let's not spoil it with group A vs group B nonsense.  You can't paint every R, D or I with the same brush...

OK, I'm off my soapbox.

Dude, have you even read this thread?  That's what the whole thing is about. ;)

I don't even get what he is talking about!

Snark alert

Something like, "All generalizations are bad."  Or maybe, "All Independent voters are exactly alike!"

Let me expand a bit on my question above, as I'm not interested in tribalism or generalization here either, but trying to understand the actual rationale.  I know it may be naive to try to understand the POV and argument that leads someone to a different opinion than my own, it's just a bad habit of mine I can't seem to kick.

So without Medicare, ACA, Medicaid, CHIP, etc., some taxes would go away, leaving more money in people's pockets.  That's the argument, right? 

Those tax dollars that used to go to pay doctors and nurses and pharmaceutical companies and medical suppliers, now goes where?  I supposed "job creation" is the answer here.  Will those jobs be in health care?  Probably not, as demand from the most reliably sick part of our population (the elderly) just dried up, so the market will just wave goodbye with its invisible hand.  Those folks aren't likely to be abled-bodied enough to get jobs that might provide healthcare -- and they're probably a bit peeved that the system they paid into for their entire working lives just abandoned them.  But they'll be dead sooner now, since they don't get healthcare, so we can ignore them.

Now the healthcare industry as a whole has shrunk, and there are a bunch of out-of-work doctors who can't pay their student loans anymore, and can't afford to buy health insurance either -- but at least they can health themselves.

Poor and disabled folks (and their kids) are supposed to grabbing at bootstraps at this point, right?  Folks who were not able to find work prior to this change will somehow be able to do so now that they don't have access to healthcare? 

So at the end of the day, we would abolish a working (but imperfect) system in order to make lots of people worse off, so that other people would have a marginal benefit?  Why?  Am I misunderstanding how it would be expected to play out?

This is where I always end up between the horns of the dilemma:  Either the proponents of these types of policies are dumb or dishonest.  Though I guess it could be both.

iris lily

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Re: What comes after the ACA?
« Reply #4412 on: June 21, 2018, 02:37:20 PM »
It couldn't be that medicare is astronomically expensive and generally involves poorer people paying to subsidize the care of richer people? 

Nahhh...has to be just greed.

It is.  Being a Republican is about social domination and looking down on anyone who's not rich.   
Ack! You are onto us!

Jrr85

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Re: What comes after the ACA?
« Reply #4413 on: June 21, 2018, 03:02:39 PM »
It couldn't be that medicare is astronomically expensive and generally involves poorer people paying to subsidize the care of richer people? 

Nahhh...has to be just greed.
Medicare is a flat payroll tax, not subject to the SS cap, and there's even a surcharge for high income. How is that a subsidy from the poor to the rich?
 
On average, it may or may not work out to be a subsidy from the poor to the rich.  But at every percentile of networth once you get above the 10th percentile, retirees are richer than other age brackets (and that's excluding the value of any pensions or annuities or SS/Medicare).  Now obviously, a 50 year old with a net worth of $122k and a good income is arguably more well off than a retiree with a net worth of $210K and no ability to work if you ignore SS, so net worth isn't the only important thing to look at, but certainly there are a lot of poor workers paying for SS and Medicare of rich retirees.   That's perverse. 

https://dqydj.com/the-net-worth-of-american-retirees-america-2013/
https://dqydj.com/the-net-worth-of-different-age-groups-in-america/


Besides, don't Republicans love flat taxes? They spend hours touting how that's the fair way to do things during primaries.
 

I'm a fan of Flat taxes.  Generally, i think paying a proportional amount of your income in taxes is fair.   But if you're taxing workers to give money to retirees, even if the retirees are rich, funding it with a flat tax doesn't fix what an awful policy that is.
It sounds like you're advocating for more redistribution, in the sense that rich retirees shouldn't receive as many benefits?
  I'm advocating for less redistribution.  I am just arguing in particular against the redistribution that goes to relatively rich people. 

But I kinda resent the idea that funding Medicare is giving money to retirees. It's mostly just giving money to the health industry, because there's no way retirees would pay out of pocket if that money went away. They'd just die.
  Well, it's giving in-kind services to retirees.  I'm not sure how much of the cost of Medicare goes to rents the healthcare industry would not be able to get otherwise.  Probably a good amount for pharmaceuticals.  Maybe not as much for doctors, since they do have to take lower rates for medicare. 

Jrr85

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Re: What comes after the ACA?
« Reply #4414 on: June 21, 2018, 03:05:15 PM »
But if you're taxing workers to give money to retirees, even if the retirees are rich, funding it with a flat tax doesn't fix what an awful policy that is.

All workers will be eligible for Medicare when they reach the age at which people of ordinary means (and their employers) can no longer afford to pay for their health care.  Taxes of today's workers pay for the care of today's old people.  When today's workers are old, taxes from tomorrow's workers will pay for their health care.  That's how the social contract works.  Yes, there are serious demographic problems on the horizon due to the increasing proportion of the population that is old vs. the proportion that is working.  But that doesn't mean we just tell tomorrow's (or today's) old people that they can just suck it.  A serious republic would find a way to finance a humane level of care that doesn't bankrupt people after they've worked their entire lives.
  It's a shame the only option is to keep Medicare as is or have zero welfare for elderly related to healthcare.  If only it were possible to consider other options.  If only...

DreamFIRE

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Re: What comes after the ACA?
« Reply #4415 on: June 21, 2018, 05:20:35 PM »
Speaking of Medicare and those darn cost-effective government programs:
https://www.washingtonpost.com/news/business/wp/2018/06/19/house-gop-plan-would-cut-medicare-social-security-to-balance-budget/

The republicans have been trying to gut Medicare for years, often talking about converting it to a voucher based program, as if seniors aren't already stuck with high enough medical bills that Medicare doesn't cover (as was detailed to some degree several posts back).  Their plans would only make things worse.

The great irony - give tax cuts to the rich who don't need it which increases the deficit, and then try to cut Medicare for deserving seniors to decrease the deficit.  There's something wrong with this picture.

Thatís not irony. That was the plan from the very beginning.

No, it's ironic.  Being a plan makes it no less so.

Quote
The permanent corporate tax cut was simply a vehicle to create a massive deficit that has to be plugged by gutting social welfare programs.

I'm also referring to the personal tax cuts that gave the largest cuts to the wealthy.

They already had an agenda and spoke openly about "needing" to cut Medicare and SS even before the tax cut, going back years, because of the deficit, so the tax cut wasn't even necessary to increase the deficit with tax cuts for the rich, but it does add more irony to the situation.

As others have said, it looks like it's all about greed for these people.  They care about padding their own bank accounts versus providing for seniors who paid into the system over their entire careers and who are already paying huge amounts out of pocket during their senior years despite the help they get from Medicare.

I wouldn't call myself rich by any stretch, and I'm already paying much higher taxes as a single person to subsidize young families with children who have the same household income, but I wouldn't have a problem with paying a much higher payroll tax to shore up SS & Medicare to make them better, not the destruction that the republicans want to bring onto them while the rich get tax cuts.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #4416 on: June 21, 2018, 06:31:35 PM »
But if you're taxing workers to give money to retirees, even if the retirees are rich, funding it with a flat tax doesn't fix what an awful policy that is.

All workers will be eligible for Medicare when they reach the age at which people of ordinary means (and their employers) can no longer afford to pay for their health care.  Taxes of today's workers pay for the care of today's old people.  When today's workers are old, taxes from tomorrow's workers will pay for their health care.  That's how the social contract works.  Yes, there are serious demographic problems on the horizon due to the increasing proportion of the population that is old vs. the proportion that is working.  But that doesn't mean we just tell tomorrow's (or today's) old people that they can just suck it.  A serious republic would find a way to finance a humane level of care that doesn't bankrupt people after they've worked their entire lives.
  It's a shame the only option is to keep Medicare as is or have zero welfare for elderly related to healthcare.  If only it were possible to consider other options.  If only...

Who said anything about zero Medicare?  Republicans are proposing to cut large sums of money from the Medicare budget with no concrete plans for controlling health care costs.  I wonder who is going to get stuck with the difference?  And I wonder how many of them will be bankrupted because of it?

EnjoyIt

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Re: What comes after the ACA?
« Reply #4417 on: June 22, 2018, 08:06:03 AM »
Speaking of Medicare and those darn cost-effective government programs:
https://www.washingtonpost.com/news/business/wp/2018/06/19/house-gop-plan-would-cut-medicare-social-security-to-balance-budget/

The republicans have been trying to gut Medicare for years, often talking about converting it to a voucher based program, as if seniors aren't already stuck with high enough medical bills that Medicare doesn't cover (as was detailed to some degree several posts back).  Their plans would only make things worse.

The great irony - give tax cuts to the rich who don't need it which increases the deficit, and then try to cut Medicare for deserving seniors to decrease the deficit.  There's something wrong with this picture.

Thatís not irony. That was the plan from the very beginning. The permanent corporate tax cut was simply a vehicle to create a massive deficit that has to be plugged by gutting social welfare programs. This has been on the conservative agenda since the very inception of these programs.

What I don't get is why.  What goal is served by making life worse for millions of people?  Is it just pure greed and cronyism, or do they have some notion that "the market" will magically fix everything?  If so, what would that look like?

Yep, that's all there is to it.  They think, "I got mine, why couldn't you get yours?  You've just been lazy, or you have some other character deficiency or made some other bad choice that caused you to not be able to afford astronomically expensive health care.  Therefore, I'm not going to reward your bad behavior by paying taxes to support you."

Except for the corruption that is found on both sides of the isle, I truly believe that the Republican thinking is:  If corporations do well, they will spend the extra cash on R+D, expansion/growth, and that creates jobs, spending and increased taxes.  As more people have better jobs, they spend more in the economy which fuels further income and more taxes.  It is the classic trickle down economics but from the corporate side which may or may not work. Most fiscal conservatives believe that it works. Fact is that the economy is better today than it was just a few years ago.  Is it because of policy or because of the basic economic cycle? This is just one more question that is hard to answer. 

As avid saver and investors, we mustachians should welcome increased corporate profits as it allows us to FIRE sooner. Though, we may need more money to help pay the costs of social services that were cut or reduced.

accolay

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Re: What comes after the ACA?
« Reply #4418 on: June 24, 2018, 12:02:21 PM »
I've been avoiding this thread for a while. Did you guys figure out a solution yet?

SwordGuy

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Re: What comes after the ACA?
« Reply #4419 on: June 24, 2018, 12:06:49 PM »
It couldn't be that medicare is astronomically expensive and generally involves poorer people paying to subsidize the care of richer people? 

Nahhh...has to be just greed.
Medicare is a flat payroll tax, not subject to the SS cap, and there's even a surcharge for high income. How is that a subsidy from the poor to the rich?

Besides, don't Republicans love flat taxes? They spend hours touting how that's the fair way to do things during primaries.


If the flat tax was favorable to the rich, we would have been paying a flat tax 45 years ago (at least).  That's when I heard it brought up.

pecunia

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Re: What comes after the ACA?
« Reply #4420 on: June 24, 2018, 07:59:35 PM »
Dreamfire:
Quote
As others have said, it looks like it's all about greed for these people.

Actions seem to be speaking louder than words these days.  There's this medical thing, the dreamers, separating children from their parents, unnecessary wars and of course the RUSSIANS.

I haven't read the many posts before this, but other countries have other health systems that cost less and in some cases work better.  I haven't heard of any of these other countries wanting a system like we have in the USA.  Seems like if you have something that works better and is cheaper, it's a no-brainer.  Yet, I would say making this change is only discussed in the equivalent of political whispers.

Paul der Krake

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Re: What comes after the ACA?
« Reply #4421 on: June 27, 2018, 11:18:04 PM »
Preliminary numbers for 2019 premiums, gathered and analyzed by the Kaiser Family Foundation:
https://www.kff.org/private-insurance/issue-brief/tracking-2019-premium-changes-on-aca-exchanges/

Apparently Minnesota implemented a reinsurance program and it appears to be paying off: declines across all categories.

Bad news for unsubsidized folks in WA and MD picking bronze plans: 32% and 41% increases!

Exflyboy

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Re: What comes after the ACA?
« Reply #4422 on: June 27, 2018, 11:23:16 PM »
I seriously wonder how long the ACA has to live now another Trump nominated crony will be appointed to the Supreme Court.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4423 on: June 28, 2018, 04:06:08 AM »
I seriously wonder how long the ACA has to live now another Trump nominated crony will be appointed to the Supreme Court.


Sometimes it feels like we're overrun by lunatics.

Maenad

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Re: What comes after the ACA?
« Reply #4424 on: June 28, 2018, 04:59:29 AM »
For added fun, it looks like one of the premises of HSAs, that they would decrease overspending by patients who didn't see the costs, has gone too far. Turns out, people with HSAs just aren't getting care, even when they need it: https://ournextlife.com/2018/06/25/hsa/.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4425 on: June 28, 2018, 05:22:24 AM »
I think that article underscores the importance of the free health benefits that the ACA requires insurers to fully pay for such as screenings, free health check ups, and immunizations, as well as other services. It's surprising that someone with a high deductible wouldn't take advantage of these free health care provisions. I got a free colonoscopy and immunizations and a wellness check up too.

chasesfish

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Re: What comes after the ACA?
« Reply #4426 on: June 28, 2018, 05:22:45 AM »
I've been avoiding this thread for a while. Did you guys figure out a solution yet?

I got a laugh out of this, it looks like page 89 is going to be non-helpful.   I really enjoyed the thread back when it was real-time updates on proposed policies that had a chance of passing.

Now the arguments are down tot his:

"R's propose cutting X " - You can basically take this news story from any point in the last forty years and it doesn't happen.  Since when does a politician make tough decisions?

Then the counter argument - "If you provide tax cuts for the rich, you can pay for XYZ (even if that XYZ is penis enlarging benefits for all, because you know, we want people's mental health to improve)"

Mr. Green

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Re: What comes after the ACA?
« Reply #4427 on: June 28, 2018, 08:06:22 AM »
I seriously wonder how long the ACA has to live now another Trump nominated crony will be appointed to the Supreme Court.
I can only hope that by the time a case makes it to the Supreme Court, the public pressure will be so great that something will be done about healthcare. I'm very wary, though. My wife leaves her job in a couple days and we will be truly reliant on the ACA for the first time. While our budget will handle increased premiums should the ACA go away, I won't tolerate a return to the pre-ACA days where one could suddenly be dropped by an insurer or refused a policy renewal at any time. We will likely move out of the country if it gets to that point. Working only because it's the only way to ensure one has health insurance is a system I refuse to participate in.
« Last Edit: June 28, 2018, 08:08:05 AM by Mr. Green »

Paul der Krake

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Re: What comes after the ACA?
« Reply #4428 on: June 28, 2018, 02:09:26 PM »
I think that article underscores the importance of the free health benefits that the ACA requires insurers to fully pay for such as screenings, free health check ups, and immunizations, as well as other services. It's surprising that someone with a high deductible wouldn't take advantage of these free health care provisions. I got a free colonoscopy and immunizations and a wellness check up too.
I'm not surprised one bit by this. Health plans are complex and the ACA by and large covers unsophisticated consumers.

High deductible plans are also scary Ė I'm guilty of putting off appointments even though my HDHP deductible is almost entirely covered by employer contributions + tax benefits, and I have a boatload of savings. For someone who is barely scraping by, deciding whether to go to a doctor's office or not must be excruciating.

shenlong55

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Re: What comes after the ACA?
« Reply #4429 on: June 28, 2018, 03:03:17 PM »
I think that article underscores the importance of the free health benefits that the ACA requires insurers to fully pay for such as screenings, free health check ups, and immunizations, as well as other services. It's surprising that someone with a high deductible wouldn't take advantage of these free health care provisions. I got a free colonoscopy and immunizations and a wellness check up too.
I'm not surprised one bit by this. Health plans are complex and the ACA by and large covers unsophisticated consumers.

High deductible plans are also scary – I'm guilty of putting off appointments even though my HDHP deductible is almost entirely covered by employer contributions + tax benefits, and I have a boatload of savings. For someone who is barely scraping by, deciding whether to go to a doctor's office or not must be excruciating.
It is.  I've been there.  I hate telling my wife and/or daughters that we should wait to go to the doctor because it might get better on its own/might not be serious.  I constantly worry  about making the wrong call and catching a serious issue too late.  I do the best I can to research the problem and determine if it's worth a visit, but I'm not a medical professional, I don't have training in triage, I shouldn't have to do this.

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Mr. Green

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Re: What comes after the ACA?
« Reply #4430 on: June 28, 2018, 03:57:57 PM »
I think that article underscores the importance of the free health benefits that the ACA requires insurers to fully pay for such as screenings, free health check ups, and immunizations, as well as other services. It's surprising that someone with a high deductible wouldn't take advantage of these free health care provisions. I got a free colonoscopy and immunizations and a wellness check up too.
I'm not surprised one bit by this. Health plans are complex and the ACA by and large covers unsophisticated consumers.

High deductible plans are also scary Ė I'm guilty of putting off appointments even though my HDHP deductible is almost entirely covered by employer contributions + tax benefits, and I have a boatload of savings. For someone who is barely scraping by, deciding whether to go to a doctor's office or not must be excruciating.
It is.  I've been there.  I hate telling my wife and/or daughters that we should wait to go to the doctor because it might get better on its own/might not be serious.  I constantly worry  about making the wrong call and catching a serious issue too late.  I do the best I can to research the problem and determine if it's worth a visit, but I'm not a medical professional, I don't have training in triage, I shouldn't have to do this.

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Not only that but then you're looking up your ailment on the internet and it seems like your symptoms match brain, lung and testicular cancer (sarcasm illustrating how "serious" the internet can make something feel) and you're now paranoid that you might really be dying. I've been there.

Paul der Krake

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Re: What comes after the ACA?
« Reply #4431 on: June 28, 2018, 04:12:23 PM »
Something else mentioned in that article is the BS surrounding the idea of shopping around for best prices.

Great, that may encourage me to shop for a good deal on glasses or a first-aid kit (woohoo, $20 savings), but anytime I actually need to see a health professional all bets are off. Even for things as routine as physical therapy with hundreds of providers within a 20 mile radius, there is no way even for a motivated bargain seeker to rate shop.

Classical_Liberal

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Re: What comes after the ACA?
« Reply #4432 on: June 28, 2018, 06:20:23 PM »
I think that article underscores the importance of the free health benefits that the ACA requires insurers to fully pay for such as screenings, free health check ups, and immunizations, as well as other services. It's surprising that someone with a high deductible wouldn't take advantage of these free health care provisions. I got a free colonoscopy and immunizations and a wellness check up too.
I'm not surprised one bit by this. Health plans are complex and the ACA by and large covers unsophisticated consumers.
This is the crux of the problem.  Medical billing is a total cluster fuck.  No free market alternatives will make any bit of difference until consumers can actually understand what they are paying for and the benefits they receive for said payments.  It also wouldn't hurt if people understood what level of care is needed for their medical issues (ie overuse of ER's).

Given my proclivities towards free market, it may seem hypocritical that I'm an outspoken proponent for some type of national health care (or at least a national reinsurance program). BUT,  in order to fix the current system with pure free market, there would be too much time involved unwinding the above mentioned billing cluster that has evolved.  People would die in the years it would take for the market to fix what we have done.  That's not acceptable, so choices are limited.

Step One, national reinsurance program to limit liability of private insurers(low income folks can qualify for more reinsurance driving down their premiums). This will keep premiums relatively stable for consumers while driving up government costs.  Step two, transparency in billing and costs become a requirement for insurers to remain eligible for reinsurance. Consumers can begin to understand what services are actually costing. Step three, market solutions begin to form as a result of insurers and consumers now being able to make intelligent choices regarding allocation of capital. Step four, health care costs begin to drop, government and private burdens are reduced... One persons opinion of
I've been avoiding this thread for a while. Did you guys figure out a solution yet?
« Last Edit: June 28, 2018, 06:22:21 PM by Classical_Liberal »

former player

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Re: What comes after the ACA?
« Reply #4433 on: June 29, 2018, 06:11:09 AM »
I think that article underscores the importance of the free health benefits that the ACA requires insurers to fully pay for such as screenings, free health check ups, and immunizations, as well as other services. It's surprising that someone with a high deductible wouldn't take advantage of these free health care provisions. I got a free colonoscopy and immunizations and a wellness check up too.
I'm not surprised one bit by this. Health plans are complex and the ACA by and large covers unsophisticated consumers.
This is the crux of the problem.  Medical billing is a total cluster fuck.  No free market alternatives will make any bit of difference until consumers can actually understand what they are paying for and the benefits they receive for said payments.  It also wouldn't hurt if people understood what level of care is needed for their medical issues (ie overuse of ER's).

Given my proclivities towards free market, it may seem hypocritical that I'm an outspoken proponent for some type of national health care (or at least a national reinsurance program). BUT,  in order to fix the current system with pure free market, there would be too much time involved unwinding the above mentioned billing cluster that has evolved.  People would die in the years it would take for the market to fix what we have done.  That's not acceptable, so choices are limited.

Yes.  The problem with all the people saying "free markets are the answer" is that in this complicated, technological, interconnected and interdependent world  where we are all subject to the rule of law there are no truly free markets.   Nor is the answer even "more government vs less government" or "more regulation vs less regulation".   The only questions left to us are "good government vs bad government" and "good regulation vs bad regulation".  "Good", in this context may mean more of something or less of something.  But the only way to get to the best possible result is to quantify good/bad and let more/less be the result not the aim.

chasesfish

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Re: What comes after the ACA?
« Reply #4434 on: June 29, 2018, 06:54:23 AM »
Another year passes...my comment ends up being the same

The US really only has two 1st world systems to model that can work.  Switzerland (and to a lesser extend Germany) which requires everyone purchase basic health insurance.  Its not optional, its not a soft penalty, everyone has it.

OR

Costa Rica, which has government and private hospitals.  We can accomplish this by opening up and expanding the VA system to the uninsured, taking their cost burden out of the private system.

Instead, we continue to do neither.  The ACA was close, but way too many exemptions under the last administration and just doing away with the fake mandate all together by the current administration doesn't help.

There really isn't an effective free market solution when healthcare is limited in supply.  People are generally idiots and have to be protected from themselves, including the people in their 20s that are perfectly able to buy health insurance that instead spend money on dumb shit. 

Roadrunner53

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Re: What comes after the ACA?
« Reply #4435 on: June 29, 2018, 06:59:55 AM »
What happened? Donny Boy said when he was elected he would create a better health care system and it would cheaper. All he has done was chop it up so no way it could exist. HE DOES NOT CARE!

pecunia

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Re: What comes after the ACA?
« Reply #4436 on: June 29, 2018, 07:43:58 AM »
Roadrunner 52:
Quote
What happened? Donny Boy said when he was elected he would create a better health care system and it would cheaper. All he has done was chop it up so no way it could exist. HE DOES NOT CARE!

HE DOES NOT CARE.  Sure he does.  He cares about the extra revenue he is getting for his properties since he was elected.  As far as healthcare, why should he care?  Are today's sick people going to help him?  Remember what he told Hillary in one of the debates about him not paying taxes, "I'm smart."  I'd be very surprised if he ran again.  He gets good support from his party by not caring, Why should he buck the system?  His health care is paid.

In case you haven't noticed, ever since the days of Ronald Reagan, there has been a war against the non-rich.  This war can be won if you have a bunch of poor people running around.  They will be happy to perform any task asked for by the rich and will be happy for the trickle down that will occur.  This trickle down will amount to crumbs.  Look around the world at the countries that have a few rich people and a few rich.  They don't complain about health care in those countries.  Their priorities are on more important thing like food.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4437 on: June 29, 2018, 09:35:48 AM »
Another year passes...my comment ends up being the same

The US really only has two 1st world systems to model that can work.  Switzerland (and to a lesser extend Germany) which requires everyone purchase basic health insurance.  Its not optional, its not a soft penalty, everyone has it.

OR

Costa Rica, which has government and private hospitals.  We can accomplish this by opening up and expanding the VA system to the uninsured, taking their cost burden out of the private system.

Instead, we continue to do neither.  The ACA was close, but way too many exemptions under the last administration and just doing away with the fake mandate all together by the current administration doesn't help.

There really isn't an effective free market solution when healthcare is limited in supply.  People are generally idiots and have to be protected from themselves, including the people in their 20s that are perfectly able to buy health insurance that instead spend money on dumb shit.

The more I watch this debacle the more I like the idea of a real hybrid system where the government offers very cheap or subsidized health insurance for basic no frills care for everyone who wants to opt into it.  Everyone else can buy health care in the open market if they so choose.  No frills means low cost generic drugs where the price was negotiated with the manufacturer. Waiting lists for non emergency procedures, double and quadruple boarding in the hospital.  I am looking for good and appropriate medical care.  Then, if anyone wants to spend more on speed or private rooms they should be able to.

toganet

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Re: What comes after the ACA?
« Reply #4438 on: June 29, 2018, 09:45:00 AM »
Another year passes...my comment ends up being the same

The US really only has two 1st world systems to model that can work.  Switzerland (and to a lesser extend Germany) which requires everyone purchase basic health insurance.  Its not optional, its not a soft penalty, everyone has it.

OR

Costa Rica, which has government and private hospitals.  We can accomplish this by opening up and expanding the VA system to the uninsured, taking their cost burden out of the private system.

Instead, we continue to do neither.  The ACA was close, but way too many exemptions under the last administration and just doing away with the fake mandate all together by the current administration doesn't help.

There really isn't an effective free market solution when healthcare is limited in supply.  People are generally idiots and have to be protected from themselves, including the people in their 20s that are perfectly able to buy health insurance that instead spend money on dumb shit.

The more I watch this debacle the more I like the idea of a real hybrid system where the government offers very cheap or subsidized health insurance for basic no frills care for everyone who wants to opt into it.  Everyone else can buy health care in the open market if they so choose.  No frills means low cost generic drugs where the price was negotiated with the manufacturer. Waiting lists for non emergency procedures, double and quadruple boarding in the hospital.  I am looking for good and appropriate medical care.  Then, if anyone wants to spend more on speed or private rooms they should be able to.

This sounds like the sort of plan I think would work here.  Feds provide basic coverage for everyone, no opt in needed; no way to opt out.  It would create a "floor" for healthcare, but would be supplemented by employer-sponsored or privately-purchased plans from the existing insurance companies.  This plan would have to include preventative care to some degree, as well.

pecunia

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Re: What comes after the ACA?
« Reply #4439 on: June 29, 2018, 09:46:30 AM »
Enjoyit:
Quote
The more I watch this debacle the more I like the idea of a real hybrid system where the government offers very cheap or subsidized health insurance for basic no frills care for everyone who wants to opt into it.  Everyone else can buy health care in the open market if they so choose.  No frills means low cost generic drugs where the price was negotiated with the manufacturer. Waiting lists for non emergency procedures, double and quadruple boarding in the hospital.  I am looking for good and appropriate medical care.  Then, if anyone wants to spend more on speed or private rooms they should be able to.

Sounds like an excellent compromise.  It also may be closer to being politically palatable and affordable.

SugarMountain

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Re: What comes after the ACA?
« Reply #4440 on: June 29, 2018, 02:11:35 PM »
Enjoyit:
Quote
The more I watch this debacle the more I like the idea of a real hybrid system where the government offers very cheap or subsidized health insurance for basic no frills care for everyone who wants to opt into it.  Everyone else can buy health care in the open market if they so choose.  No frills means low cost generic drugs where the price was negotiated with the manufacturer. Waiting lists for non emergency procedures, double and quadruple boarding in the hospital.  I am looking for good and appropriate medical care.  Then, if anyone wants to spend more on speed or private rooms they should be able to.

A certain segment of the population would decry this as Socialism and the insurance lobby would pitch a fit about potentially losing customers to the government.

Sounds like an excellent compromise.  It also may be closer to being politically palatable and affordable.

pecunia

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Re: What comes after the ACA?
« Reply #4441 on: June 29, 2018, 02:52:27 PM »
Sugar:
Quote
A certain segment of the population would decry this as Socialism and the insurance lobby would pitch a fit about potentially losing customers to the government.

A few news stories about mothers with kids who can't afford simple medical treatment could quickly take center stage and drown out those people.  Public schools, roads, parks, fire and police protection and other things are socialist and seem to function OK.  That same segment you mentioned would not even allow me a public library if they had their druthers.

jim555

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Re: What comes after the ACA?
« Reply #4442 on: June 29, 2018, 03:32:17 PM »
Kentucky's Medicaid work requirements via 1115 waiver have been stuck down by a federal judge.

https://www.cnn.com/2018/06/29/politics/kentucky-medicaid-work-requirements-lawsuit/index.html

protostache

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Re: What comes after the ACA?
« Reply #4443 on: June 29, 2018, 04:24:58 PM »
A certain segment of the population would decry this as Socialism and the insurance lobby would pitch a fit about potentially losing customers to the government.

Screw them. Bring on the socialism.

Exflyboy

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Re: What comes after the ACA?
« Reply #4444 on: June 29, 2018, 04:58:39 PM »
Kentucky's Medicaid work requirements via 1115 waiver have been stuck down by a federal judge.

https://www.cnn.com/2018/06/29/politics/kentucky-medicaid-work-requirements-lawsuit/index.html

I sure ope they don't do this for ACA subsidies! Do actual work or pay $14k/year in premiums.. hmm.

tyort1

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Re: What comes after the ACA?
« Reply #4445 on: June 29, 2018, 05:48:27 PM »
Sugar:
Quote
A certain segment of the population would decry this as Socialism and the insurance lobby would pitch a fit about potentially losing customers to the government.

A few news stories about mothers with kids who can't afford simple medical treatment could quickly take center stage and drown out those people.  Public schools, roads, parks, fire and police protection and other things are socialist and seem to function OK.  That same segment you mentioned would not even allow me a public library if they had their druthers.

Probably because they've never actually, you know, been IN a public library before. 

chasesfish

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Re: What comes after the ACA?
« Reply #4446 on: June 29, 2018, 07:29:41 PM »
Another year passes...my comment ends up being the same

The US really only has two 1st world systems to model that can work.  Switzerland (and to a lesser extend Germany) which requires everyone purchase basic health insurance.  Its not optional, its not a soft penalty, everyone has it.

OR

Costa Rica, which has government and private hospitals.  We can accomplish this by opening up and expanding the VA system to the uninsured, taking their cost burden out of the private system.

Instead, we continue to do neither.  The ACA was close, but way too many exemptions under the last administration and just doing away with the fake mandate all together by the current administration doesn't help.

There really isn't an effective free market solution when healthcare is limited in supply.  People are generally idiots and have to be protected from themselves, including the people in their 20s that are perfectly able to buy health insurance that instead spend money on dumb shit.

The more I watch this debacle the more I like the idea of a real hybrid system where the government offers very cheap or subsidized health insurance for basic no frills care for everyone who wants to opt into it.  Everyone else can buy health care in the open market if they so choose.  No frills means low cost generic drugs where the price was negotiated with the manufacturer. Waiting lists for non emergency procedures, double and quadruple boarding in the hospital.  I am looking for good and appropriate medical care.  Then, if anyone wants to spend more on speed or private rooms they should be able to.

This sounds like the sort of plan I think would work here.  Feds provide basic coverage for everyone, no opt in needed; no way to opt out.  It would create a "floor" for healthcare, but would be supplemented by employer-sponsored or privately-purchased plans from the existing insurance companies.  This plan would have to include preventative care to some degree, as well.

That really is the route we're going, it probably involves passing this "Medicare for all" tag line we see with some forced premiums, then tons of docs/hospitals not accepting new Medicare patients creating longer wait times but effectively rationing the government provided care.

pecunia

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Re: What comes after the ACA?
« Reply #4447 on: June 29, 2018, 07:39:22 PM »
Maybe the Canadians will invade raise taxes, force Molson upon us but provide health care for all.

doggyfizzle

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Re: What comes after the ACA?
« Reply #4448 on: June 29, 2018, 07:57:45 PM »
Maybe the Canadians will invade raise taxes, force Molson upon us but provide health care for all.

One could only hope for a sensible national healthcare outcome like that for the US.  Iím more of a Labatt drinker myself though.

jim555

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Re: What comes after the ACA?
« Reply #4449 on: June 29, 2018, 08:14:17 PM »
Individual mandate gone, not so fast...
Massachusetts, Vermont, New Jersey, and DC are imposing the individual mandate on their residents.