Author Topic: What comes after the ACA?  (Read 1140521 times)

pecunia

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Re: What comes after the ACA?
« Reply #5700 on: August 20, 2019, 06:11:44 PM »
You don't need to flood the country with health professionals from other places.  You don't need to rob those places of their needed health professionals.  There just needs to be a concerted effort to train more here.  Change the rules so it doesn't require an MD to perform a lot of the tasks.  There's plenty of young people who would like a decent job in medicine.

caleb

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Re: What comes after the ACA?
« Reply #5701 on: August 20, 2019, 08:10:19 PM »
You don't need to flood the country with health professionals from other places.  You don't need to rob those places of their needed health professionals.  There just needs to be a concerted effort to train more here.  Change the rules so it doesn't require an MD to perform a lot of the tasks.  There's plenty of young people who would like a decent job in medicine.

I agree with the idea that we should train far more people here, and we should lower every barrier to entry reasonable.  But the AMA and others have managed to perpetuate a protectionist racket that we don't seem able to confront.  There isn't a path within the existing paradigm to the sorts of cost reductions (25-50%) we need to see.

Regardless of whether we do it, western Europe and Australia will continue to mine the world for health professionals to subsidize their health systems.  The choice is just whether or not we participate.
« Last Edit: August 20, 2019, 08:22:02 PM by caleb »

iris lily

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Re: What comes after the ACA?
« Reply #5702 on: August 21, 2019, 08:50:39 AM »
I will briefly  relate our saga of staying on an ACA policy for the last few months until DH can get on the government teat of Medicare.

Briefly, he has zero income. He had  zero income a few months ago when the ACA allowed him to have an ACA policy.

A few months ago I qualified for an ACA policy because I had appropriate income. He was on ďmyĒ ACA account. Then I moved to Medicare. He will soon be eligible for Medicare but
ACA threatened to drop him when I dropped our AC?a policy.

The phone drones at ACA Central asked him how much his income is and he truthfully answered $0. He has the same income he had four  months ago which is a household income. I share it with him. We file taxes jointly,  and come tax time we will file exactly as we did last year. ACA subsidies will be determined on that basis.

But the phone drones couldnít wrap their heads around it and determined he was a Medicaid eligible person except that we donít have expanded Medicaid in my state. And him being on Medicaid is ridiculous anyway, so ridiculous I cannot even contemplate that. That aint gonna happen, We would go private insurance before doing Medicaid.

So after several weeks of back-and-forthing with some paperwork, one of the phone drones suggested we send our last 1040 form. So we did, and that seem to satisfy them. Keep in mind this is all for income estimates anyway. The rubber meets the road when the IRS determines income eligibility and subsidies.

I know this is a first world problem but damn it was annoying.



« Last Edit: August 21, 2019, 08:54:52 AM by iris lily »

Exflyboy

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Re: What comes after the ACA?
« Reply #5703 on: August 21, 2019, 09:58:30 AM »
@iris lily I have often wondered what happens when one of you qualifies for Medicare and the other has to remain on the ACA.

As I suspected, this will be another nightmare to look forward to!

This assumes of course the ACA even survives the attacks of the GOP until I qualify 7 years from now.

seattlecyclone

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Re: What comes after the ACA?
« Reply #5704 on: August 21, 2019, 11:03:23 AM »
@iris lily I have often wondered what happens when one of you qualifies for Medicare and the other has to remain on the ACA.

My understanding of what should happen is that you still use the overall household income to calculate what the net cost of the second-cheapest silver plan should be after subsidies, but since you're only covering one person with that amount rather than two the amount of subsidy you get (if any) will go way down. Meanwhile you're paying Medicare premiums as well so your overall health care costs will probably go up for those years.

I'm not aware of any circumstance where a person's individual income factors into ACA or Medicaid coverage, it's all about the household income. If they asked @iris lily's husband for an individual income specifically, I'd sure like to know why. Otherwise, next time they ask "what's your income," you should probably just respond with the household income to avoid a bunch of confusion.

iris lily

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Re: What comes after the ACA?
« Reply #5705 on: August 22, 2019, 06:45:55 PM »
@iris lily I have often wondered what happens when one of you qualifies for Medicare and the other has to remain on the ACA.

My understanding of what should happen is that you still use the overall household income to calculate what the net cost of the second-cheapest silver plan should be after subsidies, but since you're only covering one person with that amount rather than two the amount of subsidy you get (if any) will go way down. Meanwhile you're paying Medicare premiums as well so your overall health care costs will probably go up for those years.

I'm not aware of any circumstance where a person's individual income factors into ACA or Medicaid coverage, it's all about the household income. If they asked @iris lily's husband for an individual income specifically, I'd sure like to know why. Otherwise, next time they ask "what's your income," you should probably just respond with the household income to avoid a bunch of confusion.
I wasnít listening in to the conversation with the ACA representative and DH. But I assume they asked him how much his income is and he he replied zero and then ensued a long conversation about household income. So itís not as though they did not, in multiple phone calls with multiple people, know he had a household income.

Fortunately there wonít be any more of this in six weeks. It was just a short time where he needed
 ACA coverage after my Medicare coverage kicked in.

I donít know how much it will cost but Iím confident itís cheaper than private insurance and I just want to get everything set up on Medicare and supplemental programs. We have had 4 transitions in the past four years since I retired and every transition is tricky.

Roadrunner53

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Re: What comes after the ACA?
« Reply #5706 on: August 23, 2019, 09:54:47 AM »
@iris lily I have often wondered what happens when one of you qualifies for Medicare and the other has to remain on the ACA.

As I suspected, this will be another nightmare to look forward to!

This assumes of course the ACA even survives the attacks of the GOP until I qualify 7 years from now.

My spouse and I were on ACA until he went on Medicare. It is based on household income. When the two of us were on it with subsidy, it cost us around $510 a month for two people. When spouse dropped off ACA to go onto Medicare I was expecting the price to go down by half and that did not happen. It only dropped around $20. So for one person on ACA with the same household income the price is basically the same for one as it was for two. Made me crazy but could have been worse if we had not gotten the subsidy. Got to be very careful to control household income so you stay under the radar screen. Any unexpected income can throw you off the rails. Like overtime, winning some money in the lotto, dipping into IRA's. We were exceptionally careful to not exceed income limits and it worked for us. Now I am on Medicare too and that is a whole other can of worms and is more expensive than ACA if you buy the supplemental Medicare things you need. People don't realize that basic Medicare pays for hospital and there is a huge deductible if you are admitted. Part B you have to pay for and that is for Doctor visits, tests but there is a deductible for that too per year. Then there is Plan D for prescription drugs. Then you have to realize that Medicare only pays 80% of doctor visits, tests and things. You pay the other 20%. That is where a supplemental plan comes in. There are various programs that pay 50%, 75% and one that pays 100% (of the 20% you will owe). If you think ACA is making your head spin, wait till you get on Medicare!

Exflyboy

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Re: What comes after the ACA?
« Reply #5707 on: August 23, 2019, 11:53:43 AM »
yeah that 80% part B coverage is a 20% unlimited liability.. How is Chemo paid?

That looks like Part B to me and with some chemo's costing north of $1M/year.. Yeah you need a Medigap policy or similar.

seattlecyclone

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Re: What comes after the ACA?
« Reply #5708 on: August 23, 2019, 12:12:17 PM »
yeah that 80% part B coverage is a 20% unlimited liability.. How is Chemo paid?

That looks like Part B to me and with some chemo's costing north of $1M/year.. Yeah you need a Medigap policy or similar.

This is one reason why I'm rather wary of the calls for "Medicare for All." The parts of Medicare that you actually buy directly from the government (A and B) have no out-of-pocket maximum, and if you make less than 400% of the poverty level your premiums for a bronze-level ACA plan (with an out-of-pocket maximum!) could well be lower than just the Medicare Part B premiums.

If you're on Medicare and want to limit your financial downsides, you need to buy a supplemental plan from...you guessed it...a private insurance company! These plans don't seem to have any income-based subsidies available, so the difference in premiums only gets bigger.

As much as there is to dislike about the system of private insurance carriers acting under the ACA, simply lowering the Medicare eligibility age without changing the program in other ways seems like it could be one step forward, two steps back for many of us.

ecchastang

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Re: What comes after the ACA?
« Reply #5709 on: August 23, 2019, 01:26:58 PM »
I am glad this year not to have to pay the penalty for not having insurance.  My first year with ACA was 212 per month, next was 320, and I dropped it when it went to over 400 monthly.  Now it is over 500, but next year I will have a low enough income after maxing out solo401k and IRA to get a decent subsidy. 

Exflyboy

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Re: What comes after the ACA?
« Reply #5710 on: August 23, 2019, 02:24:26 PM »
I am glad this year not to have to pay the penalty for not having insurance.  My first year with ACA was 212 per month, next was 320, and I dropped it when it went to over 400 monthly.  Now it is over 500, but next year I will have a low enough income after maxing out solo401k and IRA to get a decent subsidy.

Note if you are interested in a Bronze plan you can also contribute to an HSA to further reduce income, working or not.

ecchastang

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Re: What comes after the ACA?
« Reply #5711 on: August 23, 2019, 02:28:20 PM »
I am glad this year not to have to pay the penalty for not having insurance.  My first year with ACA was 212 per month, next was 320, and I dropped it when it went to over 400 monthly.  Now it is over 500, but next year I will have a low enough income after maxing out solo401k and IRA to get a decent subsidy.

Note if you are interested in a Bronze plan you can also contribute to an HSA to further reduce income, working or not.
Previously had Bronze, but subsidy requires silver.

SugarMountain

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Re: What comes after the ACA?
« Reply #5712 on: August 23, 2019, 02:35:15 PM »
I am glad this year not to have to pay the penalty for not having insurance.  My first year with ACA was 212 per month, next was 320, and I dropped it when it went to over 400 monthly.  Now it is over 500, but next year I will have a low enough income after maxing out solo401k and IRA to get a decent subsidy.

Note if you are interested in a Bronze plan you can also contribute to an HSA to further reduce income, working or not.
Previously had Bronze, but subsidy requires silver.

Does it? I thought you could buy any valid ACA plan but the subsidy amount was based on the 2nd cheapest Silver.

seattlecyclone

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Re: What comes after the ACA?
« Reply #5713 on: August 23, 2019, 02:37:55 PM »
I am glad this year not to have to pay the penalty for not having insurance.  My first year with ACA was 212 per month, next was 320, and I dropped it when it went to over 400 monthly.  Now it is over 500, but next year I will have a low enough income after maxing out solo401k and IRA to get a decent subsidy.

Note if you are interested in a Bronze plan you can also contribute to an HSA to further reduce income, working or not.
Previously had Bronze, but subsidy requires silver.

The cost sharing subsidies (most valuable for folks under 200% of the poverty line) are only available with silver plans. The premium reduction subsidies (for folks under 400% of the poverty line) are available for all plans sold on the exchange, and the dollar amount of the subsidy will be the same regardless of which plan you choose.

Exflyboy

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Re: What comes after the ACA?
« Reply #5714 on: August 23, 2019, 02:53:35 PM »
Right we currently get a subsidy of about $1300/m and pay just over $8/m for our Bronze plan with a $13,200 deductible. Covered at 100% (in theory!) above that.

As we have been on this plan for 3 years and had no claims, the extra savings compared to the Silver plans have more than paid for themselves.

pecunia

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Re: What comes after the ACA?
« Reply #5715 on: August 23, 2019, 06:10:01 PM »
Right we currently get a subsidy of about $1300/m and pay just over $8/m for our Bronze plan with a $13,200 deductible. Covered at 100% (in theory!) above that.

As we have been on this plan for 3 years and had no claims, the extra savings compared to the Silver plans have more than paid for themselves.

That's basically free and you are a rich man.  How do you shield the income?

seattlecyclone

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Re: What comes after the ACA?
« Reply #5716 on: August 23, 2019, 07:43:36 PM »
Right we currently get a subsidy of about $1300/m and pay just over $8/m for our Bronze plan with a $13,200 deductible. Covered at 100% (in theory!) above that.

As we have been on this plan for 3 years and had no claims, the extra savings compared to the Silver plans have more than paid for themselves.

That's basically free and you are a rich man.  How do you shield the income?

You don't necessarily need to shield that much income!

I just signed into our exchange here in Seattle to price out a plan for a couple of 57-year-olds with a $50k income. A bronze HSA plan can be had for $173/month after the $1,042/month subsidy is applied.

The crazy thing is that a 37-year-old couple with the same income would pay more ($286/month after a $331/month subsidy) for the same bronze plan! The reason why? The ACA sets the subsidies so that the net cost of the second-cheapest silver plan in your area is a set percentage of your income. That percentage is the same regardless of your age, so the 37-year-old and 57-year old will end up paying the same price if they pick that particular silver plan. However the insurance companies charge proportionally more for older people.

As you get older, the difference in premiums between different plans will widen, since the sticker price scales up by a similar factor regardless of which plan you choose. If you choose something more expensive than the second-cheapest silver plan, you can therefore expect to pay more for your premiums as you age, assuming constant income. The flip side is that if you choose something less expensive than the second-cheapest silver plan, you can expect your premiums to go down with time.

Given differences in the market between different areas of the country, I could totally believe that the difference in price between a bronze and silver plan is a bit bigger in Corvallis than Seattle, enabling a nearly-free net premium even with a pretty comfortable income level.

ecchastang

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Re: What comes after the ACA?
« Reply #5717 on: August 23, 2019, 07:55:49 PM »
Right we currently get a subsidy of about $1300/m and pay just over $8/m for our Bronze plan with a $13,200 deductible. Covered at 100% (in theory!) above that.

As we have been on this plan for 3 years and had no claims, the extra savings compared to the Silver plans have more than paid for themselves.
[/quote
Had no idea the subsidy would work for a bronze plan.  Income was too high the last couple years to qualify anyway.  Back to having health insurance in 2020.

Exflyboy

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Re: What comes after the ACA?
« Reply #5718 on: August 23, 2019, 08:04:25 PM »
Right we currently get a subsidy of about $1300/m and pay just over $8/m for our Bronze plan with a $13,200 deductible. Covered at 100% (in theory!) above that.

As we have been on this plan for 3 years and had no claims, the extra savings compared to the Silver plans have more than paid for themselves.

That's basically free and you are a rich man.  How do you shield the income?

Actually thats pretty easy, just live on after tax sale of investments.

Then the only real income is the capital gain. Then you can offset some of that by maxing out the contribution to an HSA.


Even better is we don't get hit with Federal income tax either.

A few details.. we need about $50k in spending money and because its all after tax we end up with a MAGI of $31k or so.
« Last Edit: August 23, 2019, 08:19:18 PM by Exflyboy »

SugarMountain

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Re: What comes after the ACA?
« Reply #5719 on: August 23, 2019, 11:04:16 PM »
Right we currently get a subsidy of about $1300/m and pay just over $8/m for our Bronze plan with a $13,200 deductible. Covered at 100% (in theory!) above that.

As we have been on this plan for 3 years and had no claims, the extra savings compared to the Silver plans have more than paid for themselves.

That's basically free and you are a rich man.  How do you shield the income?

Actually thats pretty easy, just live on after tax sale of investments.

Then the only real income is the capital gain. Then you can offset some of that by maxing out the contribution to an HSA.


Even better is we don't get hit with Federal income tax either.

A few details.. we need about $50k in spending money and because its all after tax we end up with a MAGI of $31k or so.

That's basically my plan as well, at least for several years I should be able to manage our income to be very low, harvesting losses and recently invested money that has very little in capital gains. I'm actually worried about showing enough income to stay off of Medicaid

I wasn't aware that you could invest in an HSA as part of the ACA on the exchange. Good to know.

Exflyboy

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Re: What comes after the ACA?
« Reply #5720 on: August 23, 2019, 11:58:02 PM »
Right we currently get a subsidy of about $1300/m and pay just over $8/m for our Bronze plan with a $13,200 deductible. Covered at 100% (in theory!) above that.

As we have been on this plan for 3 years and had no claims, the extra savings compared to the Silver plans have more than paid for themselves.

That's basically free and you are a rich man.  How do you shield the income?

Actually thats pretty easy, just live on after tax sale of investments.

Then the only real income is the capital gain. Then you can offset some of that by maxing out the contribution to an HSA.


Even better is we don't get hit with Federal income tax either.

A few details.. we need about $50k in spending money and because its all after tax we end up with a MAGI of $31k or so.

That's basically my plan as well, at least for several years I should be able to manage our income to be very low, harvesting losses and recently invested money that has very little in capital gains. I'm actually worried about showing enough income to stay off of Medicaid

I wasn't aware that you could invest in an HSA as part of the ACA on the exchange. Good to know.

Actually its the other way round.. If you want to minimise MAGI you want to sell investments with the highest capital gains.

I.e you want to generate the required spending money but minimise your income.

If your income is too low.. then sell investments with minimal gains (but held for longer than 1 year to avoid short term capital gains).. I.e to generate required spending money but getting your MAGI higher.

Yes the HSA only works with a high deductible (Bronze) plan.

We also get about $15k in rent (after depreciation expenses) and so far we have generated our $50k but with a MAGI of about $31k.

We put our rents up this year though so this maybe the last year we score a premium of $8/month.. Gosh darn.. we earn too much money.

God help us when we start pulling on the pensions..:)

Classical_Liberal

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Re: What comes after the ACA?
« Reply #5721 on: August 24, 2019, 12:16:49 AM »
Capital gains are included in MAGI.

Exflyboy

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Re: What comes after the ACA?
« Reply #5722 on: August 24, 2019, 12:17:18 AM »
Ooh.. Here's another thing. You could draw on the contributions to any ROTH IRAs to generate spending money with zero raise in your MAGI.

Exflyboy

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Re: What comes after the ACA?
« Reply #5723 on: August 24, 2019, 12:21:46 AM »
Capital gains are included in MAGI.

Yes but how much spending money you generate per unit of capital gains is the question.

Say you have invested $10k but the investment grows to $20k.. Then you sell. In this case you get $20k you can spend but only have a MAGI increase due to the sale of only $10k.

seattlecyclone

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Re: What comes after the ACA?
« Reply #5724 on: August 24, 2019, 01:05:11 AM »
Yes the HSA only works with a high deductible (Bronze) plan.

A high deductible plan is required for the HSA, yes, but it's not universally true that only bronze plans qualify. While the only HSA-compatible plans on the Seattle exchange right now happen to be at the bronze level, I've seen silver HSA-compatible plans there in prior years, and I've read there's a company planning to offer one again next year.

ecchastang

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Re: What comes after the ACA?
« Reply #5725 on: August 24, 2019, 07:40:04 AM »
Yes the HSA only works with a high deductible (Bronze) plan.

A high deductible plan is required for the HSA, yes, but it's not universally true that only bronze plans qualify. While the only HSA-compatible plans on the Seattle exchange right now happen to be at the bronze level, I've seen silver HSA-compatible plans there in prior years, and I've read there's a company planning to offer one again next year.
Just looked at the exchange and in my area there is one Silver HSA. 

ecchastang

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Re: What comes after the ACA?
« Reply #5726 on: August 24, 2019, 07:54:57 AM »
Here is a question for those in the know. 

Suppose you plug in your numbers and you can get a $421 credit, and you see on the exchange that there is a Bronze HSA plan for $387.  What happens to that $34 difference? 

Can you still get the full tax credit even though the plan you purchase costs less than that?

seattlecyclone

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Re: What comes after the ACA?
« Reply #5727 on: August 24, 2019, 10:07:47 AM »
Here is a question for those in the know. 

Suppose you plug in your numbers and you can get a $421 credit, and you see on the exchange that there is a Bronze HSA plan for $387.  What happens to that $34 difference? 

Can you still get the full tax credit even though the plan you purchase costs less than that?

Nope. You'd forfeit the $34 in that case. See Line 11 of Form 8962. In part (a) you put down your actual premiums for the plan you chose, in part (d) you calculate your maximum credit based on the price of the second-cheapest silver plan, and in part (e) you get your actual credit by choosing the smaller of parts (a) and (d). The government might pay for your health insurance, but they won't pay you to take it.

ecchastang

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Re: What comes after the ACA?
« Reply #5728 on: August 24, 2019, 11:25:20 AM »
Here is a question for those in the know. 

Suppose you plug in your numbers and you can get a $421 credit, and you see on the exchange that there is a Bronze HSA plan for $387.  What happens to that $34 difference? 

Can you still get the full tax credit even though the plan you purchase costs less than that?

Nope. You'd forfeit the $34 in that case. See Line 11 of Form 8962. In part (a) you put down your actual premiums for the plan you chose, in part (d) you calculate your maximum credit based on the price of the second-cheapest silver plan, and in part (e) you get your actual credit by choosing the smaller of parts (a) and (d). The government might pay for your health insurance, but they won't pay you to take it.
Thanks

geekette

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Re: What comes after the ACA?
« Reply #5729 on: August 24, 2019, 11:59:28 AM »
Yes the HSA only works with a high deductible (Bronze) plan.

A high deductible plan is required for the HSA, yes, but it's not universally true that only bronze plans qualify. While the only HSA-compatible plans on the Seattle exchange right now happen to be at the bronze level, I've seen silver HSA-compatible plans there in prior years, and I've read there's a company planning to offer one again next year.
Just looked at the exchange and in my area there is one Silver HSA.
Note that if your income grants you the cost sharing reduction that brings your deductible down below the minimum (I think it was around $1,350 single, $2,700 family in 2019),  it will no longer be HSA eligible.
« Last Edit: August 24, 2019, 01:10:33 PM by geekette »

pecunia

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Re: What comes after the ACA?
« Reply #5730 on: August 24, 2019, 01:19:44 PM »
Capital gains are included in MAGI.

Yes but how much spending money you generate per unit of capital gains is the question.

Say you have invested $10k but the investment grows to $20k.. Then you sell. In this case you get $20k you can spend but only have a MAGI increase due to the sale of only $10k.

You will actually be paying more in a few years when you are of medicare age.  Maybe, we'll have universal health care by then, but there are extremely powerful forces allied against it.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5731 on: August 28, 2019, 02:19:23 PM »
The level of health care problems people can face through no fault of their own is well illustrated in this excellent Netflix show called "Diagnosis"
It's truly extraordinary.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5732 on: September 18, 2019, 07:10:16 PM »
I'm shocked by these statistics:

"And Americans are sick ó much sicker than many realize. More than 100 million adults ó almost half the entire adult population ó have pre-diabetes or diabetes. Cardiovascular disease afflicts about 122 million people and causes roughly 840,000 deaths each year, or about 2,300 deaths each day. Three in four adults are overweight or obese. More Americans are sick, in other words, than are healthy."

Our Food Is Killing Too Many of Us
https://nyti.ms/2KTROA1

pecunia

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Re: What comes after the ACA?
« Reply #5733 on: September 18, 2019, 07:47:38 PM »
I'm shocked by these statistics:

"And Americans are sick ó much sicker than many realize. More than 100 million adults ó almost half the entire adult population ó have pre-diabetes or diabetes. Cardiovascular disease afflicts about 122 million people and causes roughly 840,000 deaths each year, or about 2,300 deaths each day. Three in four adults are overweight or obese. More Americans are sick, in other words, than are healthy."

Our Food Is Killing Too Many of Us
https://nyti.ms/2KTROA1

NY Times doesn't like me.  It won't let me read the article.  I've read too many free articles in their opinion, but I've read similar stuff I'm sure.  What would cause people to have incentive to change their eating habits?

What if we didn't have free market medicine?  There is little incentive for free market medicine to want us to be healthy?  If we have all the diseases brought on by poor eating, they can charge big bucks to treat us.  If the government paid for the health care, it would be from taxes.  There would be a lot of money paid from taxes.  That money would be paying for all of the diseases we have developed from eating the contemporary American diet.  People don't like paying taxes.  There would be an incentive to look for ways to not pay so many taxes.  If there were less sick people, the taxes would be lower.  If people ate right, there would be less sick people.  There would be an incentive to encourage people to eat right. 

The government has had anti smoking campaigns.  They have had a great deal of success.  You can still smoke if you want, but you know some of the health risks.  There is not much of an anti bad food campaign.  Lots of money to be made shoveling fast fried food and junk food to the public.  If the government paid for health care there would be lots of tax dollars saved in keeping people from being sick.  It would not cost a lot of money to have a healthy eating campaign.

Here's another side issue.  If we didn't have to worry about keeping a job for health care, it would free us to do what we wanted.  Is it possible that there would be people who would take time away from present vocations to pursue more creative work?  Would there be new products developed since people would no longer be confined to the work which their employer wants?  Would we have more great novels written?  Basically, would people be more free?

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What comes after the ACA?
« Reply #5734 on: September 19, 2019, 01:44:55 AM »
I think to really address those problems you have to dig a bit deeper and address the farming and farming subsidies issue. The government spends big time to subsidize the types of foods that make us unhealthy. Refined flour and high fructose corn syrup are in everything due to farm subsidies. Meat is cheap due to subsidies as excess corn and soy are given to fatten animals that donít naturally eat corn and soy. How about we pull subsidies for wheat and soy and corn and put them instead in fruits and vegetables and nuts?

Freakonomics had a good podcast recently on this entitled something like how the supermarket helped us win the Cold War.
« Last Edit: September 19, 2019, 01:46:54 AM by ysette9 »

pecunia

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Re: What comes after the ACA?
« Reply #5735 on: September 21, 2019, 06:42:31 PM »
You are right.  It's almost like a conspiracy to keep us unhealthy.  I wonder if people started to eat more healthy if subsidies would be needed.

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Re: What comes after the ACA?
« Reply #5736 on: October 02, 2019, 06:43:45 AM »
To be more specific, you can make a good case that it is the US government's dietary recommendations that are driving the spread of metabolic syndrome.  The recommendation for a high carbohydrate, grain-based diet is simply not consistent with human biology, and many people can't tolerate it.

The idea was based on a combination of shoddy science and personal preferences among a few politicians in the 1970s, and took on a life of its own because it happened to align very well with the needs of the commodity markets, big farming, and (processed) food industry. There are many sources to read more about this, but check out Dr. Malcolm Kendrick's blog as a starting point - he is a British GP who has made a career out of carefully investigating and debunking studies that supposedly support the diet/cholesterol/heart disease hypothesis.

I'm amazed at the depth of the misinformation that's been uncovered, and the fact that since the 1970s we've all been unwitting participants in a giant dietary clinical trial.  Time to stop it!

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Re: What comes after the ACA?
« Reply #5737 on: October 02, 2019, 07:47:10 AM »
To be more specific, you can make a good case that it is the US government's dietary recommendations that are driving the spread of metabolic syndrome.  The recommendation for a high carbohydrate, grain-based diet is simply not consistent with human biology, and many people can't tolerate it.

The idea was based on a combination of shoddy science and personal preferences among a few politicians in the 1970s, and took on a life of its own because it happened to align very well with the needs of the commodity markets, big farming, and (processed) food industry. There are many sources to read more about this, but check out Dr. Malcolm Kendrick's blog as a starting point - he is a British GP who has made a career out of carefully investigating and debunking studies that supposedly support the diet/cholesterol/heart disease hypothesis.

I'm amazed at the depth of the misinformation that's been uncovered, and the fact that since the 1970s we've all been unwitting participants in a giant dietary clinical trial.  Time to stop it!

+1,000,000

I can't even begin to describe how much my health improved after I eliminated nearly all grains/starches/sugars from my diet.  I scrutinize the labels on any groceries I buy.  I don't worry about eating a lot of healthy fats.  The dietary recommendations, the "heart healthy whole grains", the food pyramid -- It's all a bunch of horse shit.  I wish I would have discovered this so much sooner in my life.

Just Joe

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Re: What comes after the ACA?
« Reply #5738 on: October 03, 2019, 11:09:22 AM »
To be more specific, you can make a good case that it is the US government's dietary recommendations that are driving the spread of metabolic syndrome.  The recommendation for a high carbohydrate, grain-based diet is simply not consistent with human biology, and many people can't tolerate it.

The idea was based on a combination of shoddy science and personal preferences among a few politicians in the 1970s, and took on a life of its own because it happened to align very well with the needs of the commodity markets, big farming, and (processed) food industry. There are many sources to read more about this, but check out Dr. Malcolm Kendrick's blog as a starting point - he is a British GP who has made a career out of carefully investigating and debunking studies that supposedly support the diet/cholesterol/heart disease hypothesis.

I'm amazed at the depth of the misinformation that's been uncovered, and the fact that since the 1970s we've all been unwitting participants in a giant dietary clinical trial.  Time to stop it!

+1,000,000

I can't even begin to describe how much my health improved after I eliminated nearly all grains/starches/sugars from my diet.  I scrutinize the labels on any groceries I buy.  I don't worry about eating a lot of healthy fats.  The dietary recommendations, the "heart healthy whole grains", the food pyramid -- It's all a bunch of horse shit.  I wish I would have discovered this so much sooner in my life.

I'd love to know more about what you eat over a week's time.

rantk81

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Re: What comes after the ACA?
« Reply #5739 on: October 03, 2019, 11:32:29 AM »
I'd love to know more about what you eat over a week's time.

Breakfast: Usually not hungry. I have a couple cups of coffee with heavy whipping cream and a spoon full of coconut oil on work days.  On weekends, I'll have a late breakfast in lieu of lunch, typically a spinach or broccoli omelette, with cheese and sour cream.  Alternatively, hard boiled egg salad with avocado oil mayo and tuna.

Lunch: I pack a lunch that usually consists of the left-over protein item from the prior dinner, plus frozen veggies (usually broccoli, green beans, or brussels sprouts), drizzled with olive oil or avocado oil, and sea salt.

Dinner: Protein items are usually the fattier cuts of beef, pork, & chicken.  Occasionally canned tuna.  Non-starchy veggies (cabbage, broccoli, green beans, brussels sprouts, etc) cooked in avocado oil with fresh garlic or ginger or other spices.  Or baby spinach topped with avocado or olive oil, or sour cream, and sea salt.  Half an avocado. Some cheese.

Snacks: Small handful of macadamia nuts or almonds.

I avoid potatoes, pasta, bread, grains, rice, cereals, oats, anything with added sugar, the sweeter fruits, products with seed/vegetable/canola/soybean oils, low-fat diary.

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Re: What comes after the ACA?
« Reply #5740 on: October 03, 2019, 11:40:30 AM »
To be more specific, you can make a good case that it is the US government's dietary recommendations that are driving the spread of metabolic syndrome.  The recommendation for a high carbohydrate, grain-based diet is simply not consistent with human biology, and many people can't tolerate it.

The idea was based on a combination of shoddy science and personal preferences among a few politicians in the 1970s, and took on a life of its own because it happened to align very well with the needs of the commodity markets, big farming, and (processed) food industry. There are many sources to read more about this, but check out Dr. Malcolm Kendrick's blog as a starting point - he is a British GP who has made a career out of carefully investigating and debunking studies that supposedly support the diet/cholesterol/heart disease hypothesis.

I'm amazed at the depth of the misinformation that's been uncovered, and the fact that since the 1970s we've all been unwitting participants in a giant dietary clinical trial.  Time to stop it!
I spent years reading about health and fitness.  And years trying to lose weight/ maintain a healthy weight.  But almost always based on the government recommendations - even had an account at mypyramid.gov.  Thing is, even for an active female in her 30s (back then), 6+ servings of grain was a LOT!

Eventually kept reading, found "Death by Food Pyramid" by Denise Minger, which led me to "What to Eat" by Luise Light.  She was in charge of coming UP with the food pyramid in the 1980s.  Hired a bunch of experts, reviewed all the literature...made her team's recommendations ... and got shot down because of the "don'ts".  She quit in frustration, and the bastardized food pyramid came out a few years later, looking nothing like she'd recommended.  (Hint: 0-2 servings of grain per day, whole grains only, active people and teenagers can probably tolerate more.)

For fun, I went into the government website a few years ago, looked at their current recommendations (still 6 servings of carbs), looked at their recommendations for caloric intake also.  You literally cannot have a caloric intake as low as recommended if you include all those carbs as well as the other recommendations.  I did the math.

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Re: What comes after the ACA?
« Reply #5741 on: October 04, 2019, 08:05:40 AM »
  You literally cannot have a caloric intake as low as recommended if you include all those carbs as well as the other recommendations.  I did the math.

I would love it if you would post your math here.

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Re: What comes after the ACA?
« Reply #5742 on: October 04, 2019, 08:36:33 AM »
There's no food pyramid anymore. It's now a "food plate." From http://www.foodpyramid.com/mypyramid/, though:

** at least 3 ounces of whole grains **
1.5 ounces of brown rice = 300 calories
2 slices of wheatbread = 200 calories

** 2.5 cups of veggies **
1 cup of bell pepper = 31 calories
2 cups of spinach = 14 calories
.5 cup of kale = 15 calories
= 60 calories

** 2 cups of fruit **
1 cup of banana = 135 calories
1 cup of blackberries = 65 calories
= 200 calories

avocado oil for cooking and in salad dressing, 2 tablespoons? = 250 calories

** 3 cups of milk/yogurt/cheese **
1.5 cup of milk = 220 calories
1 cup of yogurt = 250 calories
.5 cup of cheese = 225 calories


That's 1705 calories. Add in some lentils and you're there.


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Re: What comes after the ACA?
« Reply #5743 on: October 04, 2019, 09:52:34 AM »
** 3 cups of milk/yogurt/cheese **
1.5 cup of milk = 220 calories
1 cup of yogurt = 250 calories
.5 cup of cheese = 225 calories
Is cheese really counted equivalent, volume-wise, to milk?  That's an awful lot of cheese if that's how you prefer to take your dairy.

bacchi

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Re: What comes after the ACA?
« Reply #5744 on: October 04, 2019, 10:32:44 AM »
** 3 cups of milk/yogurt/cheese **
1.5 cup of milk = 220 calories
1 cup of yogurt = 250 calories
.5 cup of cheese = 225 calories
Is cheese really counted equivalent, volume-wise, to milk?  That's an awful lot of cheese if that's how you prefer to take your dairy.

Good point.

One of the faults of the Pyramid I guess. I was just throwing in foods to meet the minimums.

mm1970

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Re: What comes after the ACA?
« Reply #5745 on: October 04, 2019, 11:05:40 AM »
  You literally cannot have a caloric intake as low as recommended if you include all those carbs as well as the other recommendations.  I did the math.

I would love it if you would post your math here.

I don't have it anymore, and it came from the "Super Tracker", which was shut down last year.  It would make a recommendation for each food group, and a total calorie recommendation.  But the total calorie recommendation was around 1700-1800, if my memory serves, and the minimum calories when you added everything up came to 1900-2000.

Quote
** at least 3 ounces of whole grains **
1.5 ounces of brown rice = 300 calories
2 slices of wheatbread = 200 calories

Note that the myplate site STILL says "total of 5-6 ounces of grain for women" (yes, at least 3 should be whole grain, but they are still recommending a total grain intake of about 2x that).

bacchi

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Re: What comes after the ACA?
« Reply #5746 on: October 04, 2019, 11:44:21 AM »
Quote
** at least 3 ounces of whole grains **
1.5 ounces of brown rice = 300 calories
2 slices of wheatbread = 200 calories

Note that the myplate site STILL says "total of 5-6 ounces of grain for women" (yes, at least 3 should be whole grain, but they are still recommending a total grain intake of about 2x that).

For women, from http://www.foodpyramid.com/myplate/:

** 5-6 ounces of (whole) grains **
1.5 ounces of brown rice = 300 calories
4 slices of wheat bread = 400 calories
= 700 calories

** 2-2.5 cups of veggies **
1 cup of bell pepper = 31 calories
2 cups of spinach = 14 calories
.5 cup of kale = 15 calories
= 60 calories

** 1.5-2 cups of fruit **
.66 cup of banana (=1 banana) = 90 calories
1 cup of blackberries = 65 calories
= 155 calories

** 3 teaspoons of veggie oil ***
avocado oil for cooking and in salad dressing, 1 tablespoons = 125 calories

** 3 cups of milk/yogurt/cheese **
1 cup of milk = 150 calories
1 cup of yogurt = 250 calories
1.5 ounce of cheese (=1 cup) = 175 calories
= 575

Total = 1615 calories

Leaving precious little for 5 ounces of protein (legumes, nuts, meat, etc.) There's enough calorie room for 1-2 tablespoons (=1-2 equiv. ounces) of peanut butter. :)

However, protein equivalents include milk and yogurt and cheese and whole wheat bread, so it's not quite as bad as it seems.

I'm confident the creators worked it out but only on specific food choices. They might've gone through different foods and kicked out those that didn't fit until they got exactly the right combination. "This works! Publish it!"


As a grainarian+legumarian, I generally eat lentils and beans and skimp on the dairy.
« Last Edit: October 04, 2019, 11:45:55 AM by bacchi »

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Re: What comes after the ACA?
« Reply #5747 on: October 04, 2019, 01:23:44 PM »
For women, from http://www.foodpyramid.com/myplate/:

** 5-6 ounces of (whole) grains **
1.5 ounces of brown rice = 300 calories
4 slices of wheat bread = 400 calories
= 700 calories

From https://www.choosemyplate.gov/eathealthy/grains, they define grain consumption recommendations in terms of "ounce equivalents." They have a table on that page for what that means in terms of common grains. For brown rice, an "ounce equivalent" is a half cup of cooked rice. That's 108 calories per Google. A slice of bread counts as on "ounce equivalent." Also roughly 100 calories. Your woman eating 5-6 "ounce equivalents" from rice and bread would probably be getting 500-600 calories from grains, not 700.


Quote
However, protein equivalents include milk and yogurt and cheese and whole wheat bread, so it's not quite as bad as it seems.

If you eat cheese does that mean it counts as a full serving of both dairy and protein, or does that just mean that you can have an extra serving of cheese in lieu of meat or beans or nuts?

bacchi

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Re: What comes after the ACA?
« Reply #5748 on: October 04, 2019, 02:03:07 PM »
For women, from http://www.foodpyramid.com/myplate/:

** 5-6 ounces of (whole) grains **
1.5 ounces of brown rice = 300 calories
4 slices of wheat bread = 400 calories
= 700 calories

From https://www.choosemyplate.gov/eathealthy/grains, they define grain consumption recommendations in terms of "ounce equivalents." They have a table on that page for what that means in terms of common grains. For brown rice, an "ounce equivalent" is a half cup of cooked rice. That's 108 calories per Google. A slice of bread counts as on "ounce equivalent." Also roughly 100 calories. Your woman eating 5-6 "ounce equivalents" from rice and bread would probably be getting 500-600 calories from grains, not 700.

Thanks for the correction. This pyramid/myplate thing is complicated.

Quote
Quote
However, protein equivalents include milk and yogurt and cheese and whole wheat bread, so it's not quite as bad as it seems.

If you eat cheese does that mean it counts as a full serving of both dairy and protein, or does that just mean that you can have an extra serving of cheese in lieu of meat or beans or nuts?

I've no idea. I'm sure it's on the site somewhere but I'm not dedicated enough to look.

The best thing for American diets might be as simple as: Stop eating (frozen) processed foods. Stop eating fast food. Stop drinking cola.

seattlecyclone

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Re: What comes after the ACA?
« Reply #5749 on: October 04, 2019, 02:08:41 PM »
The best thing for American diets might be as simple as: Stop eating (frozen) processed foods. Stop eating fast food. Stop drinking cola.

I think you've captured much of part 1 of Michael Pollen's "Eat food. Mostly plants. Not too much." That simplicity really resonates with me.

Our understanding of dietary science changes. I remember in the 90s it was all "Fats are bad! Eat lots of grain instead!" Now it's gone a bit far in the other direction "Grains are bad! Eat lots of fat and protein instead!"

Just eat a reasonable amount of real food, most any kind, and you'll probably do okay.