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timschochet

Trumpcare- Passed the House and onto the Senate; will it pass there? And what will it finally look like?

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OK, I really appreciated the good discussion we have had on immigration (and by the way, that doesn't have to be finished; we can continue to discuss that as much as everyone wants.) But here I introduce the second topic, Obamacare.

Now this issue has been debated at length and I don't think we need to rehash the good and bad of the existing ACA. Here are my questions:

1. Last night, President Trump stated that he would replace Obamacare with a plan that protects those with pre-existing conditions and makes health care insurance cheaper and more affordable. How can this be accomplished without an individual mandate?

2. Trump's plan, which is basically an adoption of Ryan and Price, would offer tax credits to those who cannot afford insurance. Some conservatives in the senate, particularly Rand Paul and Mike Lee, say they will vote down any such proposal as it amounts to a new subsidy. (According to an interview with Rand Paul I heard yesterday, he seems to think that if a person makes too little to pay taxes currently, he or she would still receive a subsidy under this new plan, but I'm not clear that this is the case.) Do you side with the President and Ryan on this? Or with Rand Paul? 

3. Most importantly, how do you envision the replacement to Obamacare? What should it look like, what would you like to see if you were in charge?

There's plenty more, obviously, but I think this is a good foundation to begin. I should add that, unlike the subject of undocumented immigration, I have no particular bias on this subject. I've been, in the past, both for and against Obamacare as different facts have come to my attention. I'm generally for anything that will improve conditions for the most people without punishing the middle class. 

Edited by timschochet

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Question 1 - the solution, as I've been saying in the numerous other threads here for years, is to simply make the cost of care less, or rationing care.  There is no other way to do it.  Health insurance cost is just a projection of health care costs.  If health care were to cost less (Trump did mention something last night about our extremely high prices on drugs), then health insurance costs would have to fall.  Or we have to ration care.

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10 minutes ago, matttyl said:

Question 1 - the solution, as I've been saying in the numerous other threads here for years, is to simply make the cost of care less, or rationing care.  There is no other way to do it.  Health insurance cost is just a projection of health care costs.  If health care were to cost less (Trump did mention something last night about our extremely high prices on drugs), then health insurance costs would have to fall.  Or we have to ration care.

Are you a Trump supporter? (This is not meant to get you to stop posting- I just wasn't aware if you were.) 

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12 minutes ago, Phase of the Game said:

There is no formal plan to discuss about replacing Obamacare. Nothing has been put out. They are working on it.

That's true, but the President did outline some ideas last night. What would you like to see? 

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Just now, timschochet said:

Are you a Trump supporter? (This is not meant to get you to stop posting- I just wasn't aware if you were.) 

Oh, no I'm not - guess I missed that part, sorry.  That said, and as I'm sure you know I'm not a supporter of the ACA as it's currently constructed either.  I'm for doing things to it to either make is sustainable, or honestly going back to the old system.

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Just now, timschochet said:

That's true, but the President did outline some ideas last night. What would you like to see? 

Something sustainable.  The wheels have come off the individual market in only 3 years.  Wherever we go from here needs to be a situation that will last.

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13 minutes ago, timschochet said:

Why? 

What are people discussing?

The negatives of ACA have been well discussed, more than well discussed.

Trump has nothing in hand and his WH will likely have no role in actually crafting it. So what are we discussing?

IMO if they get rid of the mandate and replace it with any kind of federal support (or not) they simply need to be honest with people about what it will cost them personally and the nation as a whole. That's it. People through Congress and the 2018-20 elections can make decisions after that.

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Cutting costs is an important pillar but nobody has shown any inclination to take on the industry.  Trump talked a good game during his campaign but one week after inauguration, he dropped the effort to allow Medicare negotiate bulk discounts on prescriptions. 

Interstate competition is a good free market platitude but is a drop in the bucket at best.  The industry isn't equipped to expand into new markets even if all the significant regulatory differences are somehow eliminated.   Everybody likes HSAs and they're relatively understandable but they're a bandaid when it comes to the catastrophic conditions that keep Americans up at night.

Trump is right is saying it's complicated but somebody is going to have to build a plan for everyone to take pot shots at.  The ACA makes sense as the starting point but the GOP doesn't want to do that.

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It should just be repealed and go back to the free market. Some people will not be able to afford health insurance. That is unfortunate, but there is no way to pay for it for everyone. Do I wish there was a better way, for sure. But there isn't. The middle class has had costs go up so far that they can't hardly go to the doctor either. When government benefits are such that people are turning down jobs because they get more money and benefits if they don't work, then that is a major problem. 

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14 minutes ago, Ratbone said:

It should just be repealed and go back to the free market. Some people will not be able to afford health insurance.  

By all means...let's make sure we have the following instead:

  • for-profit companies in the health care industry and big pharma continuing to rake it in.
  • yearly increases in our military budget which larger than the next 12 countries combined.
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Just now, urbanhack said:

By all means...let's make sure we have the following instead:

  • for-profit companies in the health care industry and big pharma continuing to rake it in.
  • yearly increases in our military budget which larger than the next 12 countries combined.

They may be raking it in. But most people that had insurance were paying considerably less than they are now. Raising the cost for people who actually pay to provide for people who don't pay is not an answer. The military spending is necessary because we are basically the protector of the world. It also helps with the economy so it has a secondary function. 

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7 minutes ago, Ratbone said:

They may be raking it in. But most people that had insurance were paying considerably less than they are now. Raising the cost for people who actually pay to provide for people who don't pay is not an answer. The military spending is necessary because we are basically the protector of the world. It also helps with the economy so it has a secondary function. 

Doesn't medical spending help the economy too?

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Costs are insane across the board.  I think we've lost sight of that thinking that we just need to keep making sure there is insurance.  It's time to relax worrying about the insurance aspect and start attacking costs.  And that doesn't mean limiting personal injury suits in medical malpractice because that is a fraction of the underlying basis for the cost. 

But I have no idea how to do that with any certainty that I can protect my position.  To me, at this point in time, with the history of the country behind us, it should be clear to anyone with a brain cell that given the resources of this country that there is no reason why we would have to worry about certain people not having medical care available to them.  I have to think that we can come up with a medical treatment and insurance system where all preventative care is covered 100% without any deductible, co pay or co insurance, and every child in this country has full and complete coverage for all medical issues, big and small, until age 13 no matter their socioeconomic condition.

Shouldn't that be a fairly straightforward basis?  The richest most powerful country in the world is going to make sure all of its citizens get their checkups and the like, and all of its children will be completely covered for everything in their youth and primary development years.  Seems to me that it makes sense to have a healthy citizenry to, I don't know, run the country and fight the wars and make new reality TV shows.

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46 minutes ago, matttyl said:

Question 1 - the solution, as I've been saying in the numerous other threads here for years, is to simply make the cost of care less, or rationing care.  There is no other way to do it.  Health insurance cost is just a projection of health care costs.  If health care were to cost less (Trump did mention something last night about our extremely high prices on drugs), then health insurance costs would have to fall.  Or we have to ration care.

What are the viable options for reducing health care costs, that do not require govt.-mandated price-fixing? Would more competition necessarily lead to reduced costs?

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Karl Denninger has some interesting thoughts published online about this, but I'm not sure I agree with all of his assertions.

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2 minutes ago, Yankee23Fan said:

 it should be clear to anyone with a brain cell that given the resources of this country that there is no reason why we would have to worry about certain people not having medical care available to them.  I have to think that we can come up with a medical treatment and insurance system where all preventative care is covered 100% without any deductible, co pay or co insurance, and every child in this country has full and complete coverage for all medical issues, big and small, until age 13 no matter their socioeconomic condition.

It is clear to some/most people. Decidedly not so to a lot though

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5 minutes ago, dickey moe said:

What are the viable options for reducing health care costs, that do not require govt.-mandated price-fixing? Would more competition necessarily lead to reduced costs?

Figure out a way for the people of this country to live healthier lifestyles, and cushion the economic blow of the baby boomers that are in the process of bankrupting everything.

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I also wish for a simpler system. It is so damn frustrating trying to figure out what the hell is covered in the premium and when the deductible is used, and who the hell I can actually go see, etc.

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I think that if other forms of legislation were enacted that dealt with government subsidies and the growing welfare state that most people would have less issue with things like the ACA. But it is just another subsidy being paid for by the middle class.  Some of the legislation could include- drug tests for anyone that gets welfare or any insurance subsidy, not being allowed to vote if you have been on full government assistance for more than a year straight. This is a huge conflict of interest.  There are other areas that costs can be cut and kids that need medical attention can get it. 

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26 minutes ago, Eephus said:

Doesn't medical spending help the economy too?

I am sure it does. But the option of enlisting is a big boon for many young people who would have very bad options otherwise. 

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I think Obamacare accomplished some great things.  We probably all know someone who benefited from it at some point.  I know a number of people that have it.

But Trump is right that Obamacare is collapsing.  

Where he's wrong is in the why.  There is a really, really big problem right now and it's the healthcare system and the out-of-control cost of healthcare.

There's one blogger that I've followed for many years.  He's a little wacky (I think he has Asperger's) and at times rants and raves.  But he's also incredibly smart.  When it comes to healthcare, that's the only drum he's beating right now.  I agree with him.

His thoughts on the speech:  https://market-ticker.org/akcs-www?post=231873

 

 

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17 minutes ago, Ratbone said:

I think that if other forms of legislation were enacted that dealt with government subsidies and the growing welfare state that most people would have less issue with things like the ACA. But it is just another subsidy being paid for by the middle class.  Some of the legislation could include- drug tests for anyone that gets welfare or any insurance subsidy, not being allowed to vote if you have been on full government assistance for more than a year straight. This is a huge conflict of interest.  There are other areas that costs can be cut and kids that need medical attention can get it. 

Disenfranchisement of people on government assistance?  Where did that come from?

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Would anyone care to discuss these age based tax credits?  I'm wondering if this gives an excuse for companies to drop insurance coverage for employees. (I believe that larger employers have to provide insurance under the ACA but let's say that's repealed or we're talking about smaller employers.)

For example, my insurance costs about $8,000 per year through my employer.  Under the tax credits, it looks like people without employer-paid insurance would get about an average of $3,000.  What if my employer decides to drop insurance but pay me $6,000 more.  Mathematically that's a win-win even when (I think) accounting for various tax implications.

Maybe I'm not understanding this correctly.

 

Edited by Juxtatarot

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1 hour ago, matttyl said:

Something sustainable.  The wheels have come off the individual market in only 3 years.  Wherever we go from here needs to be a situation that will last.

Single payer. 

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36 minutes ago, Yankee23Fan said:

Costs are insane across the board.  I think we've lost sight of that thinking that we just need to keep making sure there is insurance.  It's time to relax worrying about the insurance aspect and start attacking costs.  And that doesn't mean limiting personal injury suits in medical malpractice because that is a fraction of the underlying basis for the cost.

Yep, I'm all for a free market except when it comes to the health of our people.

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Just now, Sabertooth said:

Single payer. 

God, I wish.  I really wish we could get into a Medicare for All mindset.

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1 minute ago, Henry Ford said:

God, I wish.  I really wish we could get into a Medicare for All mindset.

Is this where I put my tinfoil hat on and say that single payer is really the only fix to the ACA and healthcare and that Obama and the architects of it knew it and got exactly what they wanted out of the bill?  Because I might be able to argue that.  Because it's a brilliant piece of political long term planning.

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How does this all work with a shortage of doctors. If people aren't going to make a lot of money then taking the time and money to become a Dr won't be the direction they go. A single payer system would make it so that you could almost never get into the Dr in a populated area. Practically it just doesn't work in a capitalist society with the population of the US. 

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3 minutes ago, Yankee23Fan said:

Is this where I put my tinfoil hat on and say that single payer is really the only fix to the ACA and healthcare and that Obama and the architects of it knew it and got exactly what they wanted out of the bill?  Because I might be able to argue that.  Because it's a brilliant piece of political long term planning.

It would have been if Bernie had won.  As it is, it would have to be very long term. 

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10 minutes ago, Eephus said:

Disenfranchisement of people on government assistance?  Where did that come from?

It goes along with the idea that the democracy can only survive until the people realize they can vote themselves benefits from the national budget.  The people vote for the candidate that promises the most stuff. ACA is just another form of this and we will continue to go down this path until those living off the handouts are unable to vote for more handouts. 

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43 minutes ago, dickey moe said:

What are the viable options for reducing health care costs, that do not require govt.-mandated price-fixing? Would more competition necessarily lead to reduced costs?

Competition, in the form of more insurance companies options, isn't the answer. IMO, making costs transparent is the answer. I have no idea how it is considered acceptable for a doctor/hospital to charge an insurance company (who passes the costs down to you anyway) 5-10 times as much for the same treatment than they would charge you paying in cash.

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18 minutes ago, Ratbone said:

How does this all work with a shortage of doctors. If people aren't going to make a lot of money then taking the time and money to become a Dr won't be the direction they go. A single payer system would make it so that you could almost never get into the Dr in a populated area. Practically it just doesn't work in a capitalist society with the population of the US. 

1) Is there really a shortage of doctors?

2) Why aren't they going to make a lot of money in a single payer system? Canada has seen increases in physicians for the past decade and their doctors make on average 340K

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17 minutes ago, sn0mm1s said:

Competition, in the form of more insurance companies options, isn't the answer. IMO, making costs transparent is the answer. I have no idea how it is considered acceptable for a doctor/hospital to charge an insurance company (who passes the costs down to you anyway) 5-10 times as much for the same treatment than they would charge you paying in cash.

Quite the opposite, actually.  Often the insurance price is significantly less than the uninsured price. 

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1 minute ago, the moops said:

1) Is there really a shortage of doctors?

2) Why aren't they going to make a lot of money in a single payer system? Canada has seen increases in physicians for the past decade and their doctors make on average 340K

Yes, there is a Dr. shortage. They may make big money but you can't compare anything these other countries do to the US. Canada's population is smaller than California.  I don't know what their tax rate is or what they spend on defense. I would assume not much since they are next to us. 

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1 hour ago, Yankee23Fan said:

Costs are insane across the board.  I think we've lost sight of that thinking that we just need to keep making sure there is insurance.  It's time to relax worrying about the insurance aspect and start attacking costs.  And that doesn't mean limiting personal injury suits in medal malpractice because that is.  a fraction of the underlying basis for the cost. 

But I have no idea how to do that with any certainty that I can protect my position.  To me, at this point in time, with the history of the country behind us, it should be clear to anyone with a brain cell that given the resources of this country that there is no reason why we would have to worry about certain people not having medical care available to them.  I have to think that we can come up with a medical treatment and insurance system where all preventative care is covered 100% without any deductible, co pay or co insurance, and every child in this country has full and complete coverage for all medical issues, big and small, until age 13 no matter their socioeconomic condition.

Shouldn't that be a fairly straightforward basis?  The richest most powerful country in the world is going to make sure all of its citizens get their checkups and the like, and all of its children will be completely covered for everything in their youth and primary development years.  Seems to me that it makes sense to have a healthy citizenry to, I don't know, run the country and fight the wars and make new reality TV shows.

Exactly.  

It is so ####in frustrating that in the last week we made sure to pump yet more $ into the military that is already overbloated, made sure the private prison system is happy, but yeah, we have 0 interest in educating or keeping healthy the people in our country. 

Our priorities are so out of whack  

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13 minutes ago, Ratbone said:

Yes, there is a Dr. shortage. They may make big money but you can't compare anything these other countries do to the US. Canada's population is smaller than California.  I don't know what their tax rate is or what they spend on defense. I would assume not much since they are next to us. 

Alright. Glad you are on top of this

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7 minutes ago, Henry Ford said:

Quite the opposite, actually.  Often the insurance price is significantly less than the uninsured price. 

I wouldn't say "often" unless you also want to claim the uninsured price is "often" less than the insured price. The point is pricing and costs are neither transparent nor consistent. I don't think you can discuss any sort of cost reform until you can actually quantify what is being charged and to whom and what the net collected amount is by the doctor/hospital.

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44 minutes ago, Ratbone said:

It goes along with the idea that the democracy can only survive until the people realize they can vote themselves benefits from the national budget.  The people vote for the candidate that promises the most stuff. ACA is just another form of this and we will continue to go down this path until those living off the handouts are unable to vote for more handouts. 

Well then, what about government employees including the military?  They can't possibly be trusted to vote except in their self-interest so let's take away their vote too. 

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51 minutes ago, Ratbone said:

How does this all work with a shortage of doctors. If people aren't going to make a lot of money then taking the time and money to become a Dr won't be the direction they go. A single payer system would make it so that you could almost never get into the Dr in a populated area. Practically it just doesn't work in a capitalist society with the population of the US. 

All the smart kids are going to want to get into coal mining now.

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