Henry Ford
Footballguy
I believe he's suggesting that voting for someone who can give you a pay raise is a conflict of interests similar to voting for someone who can provide you with free stuff, but maybe I'm wrong.
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Trumpcare- Passed the House and onto the Senate; will it pass there? And what will it finally look like? (3 Viewers)
- Thread starter timschochet
- Start date
I assumed he was but I know he is smart enough to see that one is a job that you work at and risk your life in. The other is sitting on your bottom waiting for money to be sent each month. There is really no comparison.
adonis
Footballguy
From what I hear Trump/Republican plans is largely:
- Tax credits for insurance for folks based on age, not income (rich folks get same as poor)
- Block grants to states for medicaid spending that's not tied to inflation
- HIgh risk pools to cover folks with pre-existing conditions (woefully underfunded based on estimated - somewhere around 1/100th or less the total estimated cost of these risk pools)
- HSA's to help with the cost of medical coverage/expenses
There are huge flaws with most aspects of this plan, if you can call it that. Basically at the current time the republicans don't have a coherent, fleshed out plan that can be subject to analysis, despite years of claims to the contrary and actions to repeal obamacare without a replacement.
The republican focus at this point isn't on coverage, it's about saving money and making the program look less like an entitlement than as allowing folks to pay for their own stuff. Any program like that is destined to fail to cover anywhere near the numbers covered now, due to the lengths one has to go to to achieve cost savings.
- Tax credits for insurance for folks based on age, not income (rich folks get same as poor)
- Block grants to states for medicaid spending that's not tied to inflation
- HIgh risk pools to cover folks with pre-existing conditions (woefully underfunded based on estimated - somewhere around 1/100th or less the total estimated cost of these risk pools)
- HSA's to help with the cost of medical coverage/expenses
There are huge flaws with most aspects of this plan, if you can call it that. Basically at the current time the republicans don't have a coherent, fleshed out plan that can be subject to analysis, despite years of claims to the contrary and actions to repeal obamacare without a replacement.
The republican focus at this point isn't on coverage, it's about saving money and making the program look less like an entitlement than as allowing folks to pay for their own stuff. Any program like that is destined to fail to cover anywhere near the numbers covered now, due to the lengths one has to go to to achieve cost savings.
KarmaPolice
Footballguy
KarmaPolice
Footballguy
There are a lot of assumptions in this statement about people who need help that is not going to help any healthy debate. There is a wide spectrum of people who are in these various programs.
Eephus
Footballguy
It was a reductio ad absurdum counter to your ridiculous and undemocratic idea of taking the vote away from people receiving government assistance. It really has nothing to do with the question of healthcare unless your plan is to make citizens choose between voting rights and medicine.
Henry Ford
Footballguy
Eephus
Footballguy
Henry Ford
Footballguy
I think we can all agree that changing the rules on who's allowed to vote should probably be off the table, regardless of whether people vote for or against their best interests.
shader
Footballguy
I don't think the problem is with Democrats or Republicans. The problem is that healthcare costs are expanding at an unsustainable rate, so any "plan" is going to implode eventually.
Henry Ford
Footballguy
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shader
Footballguy
It's detonating pension plans and it's going to detonate the budget of the federal gov't as well. It's unsustainable. Obamacare could have been the best idea in history, but it won't work when hospitals are fleecing you for simple visits to the ER.
BowieMercs
Footballguy
If Obama had to do it all over, I think he would swing for the fences. He got ObamaCare passed with ZERO GOP support. So he probably could have gotten anything he wanted shoved through, including single payer.
I'm not buying into the repeal noise. Once an "entitlement" is in place, it never goes away. The govt loves spending our money. Wasn't the income tax was supposed to be temporary ?
I'm not buying into the repeal noise. Once an "entitlement" is in place, it never goes away. The govt loves spending our money. Wasn't the income tax was supposed to be temporary ?
timschochet
Footballguy
Can you be more specific? What in your view does coming down on the side of the people mean, in real terms?
the moops
Footballguy
Good chance he would have lost a lot of spineless democratic support. Republicans aren't the only ones in the pockets of healthcare
MikeIke
Footballguy
It means the insurance companies being willing to take a little less profit in exchange for more more people getting access to health care.
This is my biggest problem with how our system works nowadays - companies squeezing every nickel and to hell with the customers, employees, and the public. I feel like a company has a civic duty to help the country by helping individuals. When the average consumer has more money, everyone wins.
I also realize that this will never happen. The only people that matter are the ones with money.
ETA : I feel the same way about the company I work for. Record profits for 9 straight quarters, however annual salary increases for non-executives are capped at 3%. That's
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Ramblin Wreck
Footballguy
BowieMercs
Footballguy
Realistically speaking, pre-existing conditions, chronic illnesses etc need to go into a govt backed high risk pool if we don't move to a single payer system.
Want to see a large scale single payer system? Look at the Veteran's Administration Hospitals. Not sure what the answer is, but I guarantee it's not simple.
Want to see a large scale single payer system? Look at the Veteran's Administration Hospitals. Not sure what the answer is, but I guarantee it's not simple.
Henry Ford
Footballguy
BowieMercs
Footballguy
Dickies
Footballguy
How so? We are the richest country in the world, yet the only major industrialized nation that doesn't. Why are our costs so much higher than other countries. Even drugs that are developed here cost us more than other countries.
We can afford to purchase a bigger military than the rest of the world combined, but we can't afford basic healthcare. I don't buy it.
Dickies
Footballguy
I disagree with your shortage of doctors assessment, and this isn't something I have given a great amount of thought to, but what if we paid qualified candidates a salary to go to medical school?
IMHO healthcare should be like the school system. Provide basic service to the public free of charge (obviously paid for via taxes) and allow private health insurance for people who wish to see a private doctor or have some procedure/service that is not provided under the public system.
Dickies
Footballguy
But are they really negotiating the rate? The whole thing comes across as totally corrupt in my opinion. I posted in the ACA thread that when I took my 1-month old twins in for their checkup they each saw the doctor for 10 minutes and each got their first vaccines. There was a mix-up with COBRA and the doctor thought I was uninsured. I got a bill for $500 per kid for the office visit and $2,500 per vaccine for a total of $6,000. Obviously the insurance didn't pay this amount, but I felt like the healthcare provider just pulled a number out of thin air. If a vaccine cost them $2,500 you can bet your ### they wouldn't be blowing me up on my phone every year to get my shot.
The insurance companies just pass whatever the costs are onto us, but it adds a veil of secrecy to the whole process. I don't think they have the greatest incentive to lower the costs
Henry Ford
Footballguy
They absolutely have incentive to lower the cost - the lower the cost the more different things you have to pay for out of your deductible before they pay a penny and the less they spend on care.
But exactly - you got a bill for $6,000 from the provider, no doubt your insurer actually paid $2,000-3,000, and even if you had to pay that out of pocket for deductible, you'd be getting a $3,000-4,000 benefit out of having insurance. Which is huge.
Pop Tart
Footballguy
Blinders dude, take them off. We've definitely been doing it wrong. It's not like the world wants our quality healthcare nor use of our military. Everyone else is better....
Here is an article about it- http://www.foxbusiness.com/features/2016/04/20/why-u-s-doctor-shortage-is-getting-worse.html Granted it is Fox so that will mean it isn't true. SO here is a 2nd article that can be interpreted a few ways.- http://www.pbs.org/newshour/rundown/u-s-really-facing-serious-doctor-shortage/
I do like your idea though of paid medical school or some incentive.
dickey moe
Fingerpicker
Completely agree. Part of the problem is that government involvement in health care (e.g. subsidies, credits, Medicare/Medicaid reimbursements and price-fixing) has resulted in lack of cost transparency.
dickey moe
Fingerpicker
dickey moe
Fingerpicker
Henry Ford
Footballguy
dickey moe
Fingerpicker
Eephus
Footballguy
Lack of transparency in medical expenses would be a problem with or without government involvement. Regulation, insurance and litigation don't explain the cost differences for common medications and procedures in this country vs. others. Everybody has an anecdote about price gouging. I don't believe it's gotten progressively worse since the ACA; it's been ridiculous much longer than that.
Candidate Trump talked about tackling costs but President Trump has made no moves toward action. Just about my best case scenario for his presidency is for Trump to take a populist turn on this issue, tweet about the drug companies and make very very good deals with the industry.
matttyl
Footballguy
Price transparency would be huge.
Little story to explain what I mean - I became a father a little over a year and a half ago. I've also been a life/health insurance broker for over a decade (so both pre-ACA and currently, but that doesn't matter for this story). When my wife first went to the hospital to deliver, they got her all comfortable and such - and I went downstairs to the billing office to give them all of her insurance information and such. I handed the billing lady a copy of her health ID card (it was with Blue Cross and Blue Shield). She took the info on the card and looked it up in her system to verify that the coverage was still in force, which it was. I then asked her a direct question, full well knowing she wouldn't give me an answer - "assuming no complications, what will the cost of this delivery be here?" She looked at me like I had three heads - "I have no idea." I said, "well, you will charge that carrier something for your services, can you tell me what that's going to be?" Nothing.
For big procedures, it won't matter as you'll just hit the max OOP on your policy so you wouldn't care between a $100k surgery and a $500k surgery - it will be the same $6k max OOP to you regardless - but for many services, maybe you'd want to do a little price shopping, but you can't see any of the prices.
matttyl
Footballguy
Very, very true (with participating providers, of course). This is so often overlooked and not understood by my clients.
Grace Under Pressure
Footballguy
Great example, and especially the bolded mindset. There isn't even one consideration being given by the human beings involved in this transaction as to the cost. This is a basic child birth. Something that happens millions of times per year, literally. Mind boggling, really.
shader
Footballguy
This is the big problem with healthcare. It's illegal in other industries.
Can you imagine going to get your brakes done and they say "eh well we're not really sure until we get in there", and then they charge you $899.00? But the next time it's $1,899? You'd have a fit and threaten to sue. But when the medical industry does it, we just accept it and move on.
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shader
Footballguy
The question in terms of healthcare is simple. When does it all go belly-up and why?
There's no way that healthcare costs can continue to go up like they are. First of all, people cant' afford the health insurance as it's skyrocketing. They also can't afford the actual healthcare, as I'd bet most people have ridiculously high deductibles.
It will hit a point where people throw their hands up and quit. Either they quit on health insurance, or they quit on their doctors bills.
Hospitals have ever-expanding budgets, ridiculously expensive IT infrastructure and equipment, high-paid doctors (3rd highest paid in the world I think?)...They work like corporations. In fact, most of them are. Most hospitals are run by big corporations who are 100% about profits. So what happens when their budgets get strained (as they do)?
I worked at one of these big corporations once in the IT dept. I watched the IT dept make a 100 million dollar mistake because they didn't do any testing. When that happens, who pays? When a hospital system gets hacked and decides to spend an enormous amount of money to bolster their security, who pays? When doctors and nurses and staff want pay raises, who pays? In a hospital system, the source of income is clear. It's sick and dying people.
When a massive business is built around taking care of sick and dying people, the only way to increase the costs (unless you want to get really nefarious and imagine that they are trying to keep people sick, which I don't believe) is by raising the costs.
So it's a cycle that feeds on itself and eventually the whole thing will implode and the detonation will be truly awful. The bad part? What happens if these major companies go bust? I suppose the federal government will have to step in again.
There's no way that healthcare costs can continue to go up like they are. First of all, people cant' afford the health insurance as it's skyrocketing. They also can't afford the actual healthcare, as I'd bet most people have ridiculously high deductibles.
It will hit a point where people throw their hands up and quit. Either they quit on health insurance, or they quit on their doctors bills.
Hospitals have ever-expanding budgets, ridiculously expensive IT infrastructure and equipment, high-paid doctors (3rd highest paid in the world I think?)...They work like corporations. In fact, most of them are. Most hospitals are run by big corporations who are 100% about profits. So what happens when their budgets get strained (as they do)?
I worked at one of these big corporations once in the IT dept. I watched the IT dept make a 100 million dollar mistake because they didn't do any testing. When that happens, who pays? When a hospital system gets hacked and decides to spend an enormous amount of money to bolster their security, who pays? When doctors and nurses and staff want pay raises, who pays? In a hospital system, the source of income is clear. It's sick and dying people.
When a massive business is built around taking care of sick and dying people, the only way to increase the costs (unless you want to get really nefarious and imagine that they are trying to keep people sick, which I don't believe) is by raising the costs.
So it's a cycle that feeds on itself and eventually the whole thing will implode and the detonation will be truly awful. The bad part? What happens if these major companies go bust? I suppose the federal government will have to step in again.
matttyl
Footballguy
And even if the costs were transparent (which they aren't), how are they justified? To end my little example story above - my son was 5 weeks early (it apparently runs in my family) so he was pretty underweight (5 pounds, 5 ounces). He wasn't as bad off as I was when I was born 4 weeks early, though, thank God. The hospital wanted to keep him a few days to be sure he was going to be ok and to try to put some weight on him. Completely understandable - and he had wonderful care for 6 days in the nursery (not accredited to be called a NICU at the time, but same idea). 24 hour nurses, state of the art equipment....blah blah. The all in bill for this (which includes the actual delivery and wife's 2 nights afterwards), roughly $40k (the vast majority paid by insurance).
That may sound ridiculous - but just over 2 years ago a family member of mine had an accident. They fell off a horse when the horse spooked, and the horse reared back and stepped on their head, crushing part of their skull over their left eye. An emergency helicopter ride to get them to the hospital ~40 miles away - roughly $35k. 17 nights in the ICU, I believe was roughly $25-30k per day. A few surgeries (numerous plates implanted into face, forehead, skull) and follow ups....all in hit 7 figures. Yup, over a mill. Crazy costs.
That may sound ridiculous - but just over 2 years ago a family member of mine had an accident. They fell off a horse when the horse spooked, and the horse reared back and stepped on their head, crushing part of their skull over their left eye. An emergency helicopter ride to get them to the hospital ~40 miles away - roughly $35k. 17 nights in the ICU, I believe was roughly $25-30k per day. A few surgeries (numerous plates implanted into face, forehead, skull) and follow ups....all in hit 7 figures. Yup, over a mill. Crazy costs.
matttyl
Footballguy
We've hit that point - at least in the Obamacare/ACA individual markets. There are fewer people enrolled this year than there were last year. That's what happens when the average prices there went up by 25.6% last year. So the unhealthy stay in because it's still a good deal for them, but the healthy leave not seeing any value in it.
As for folks quitting on doctor bills - that's been happening for years, and still is. Medical expenses has been the top reason for personal bankruptcy for a long time I believe.
The Commish
Footballguy
And his party would have rejected him. They rejected the notion of a public option (which is a significant compromise to single payer) and he didn't seem to fight all that much for the public option. We think he'd have had more success with something even more liberal? I doubt it.BowieMercs said:
adonis
Footballguy
I think the thought at the time was to make it a moderate compromise to get Republican support, so more elements of some things he thought conservatives/republicans would support were put in there. Had he known that despite it being largely a rehash of many republican ideas, the republicans would be 100% opposed to whatever he put out there that would accomplish the same goals, he might have started off more liberal in terms of a solution.
One of the biggest critiques he had starting out, in terms of negotiating with the Republicans, was that he started at a position of compromise rather than taking an initial hard-line on his side and fighting to get to the middle. No need to argue whether this was accurate or not, but it was a pretty common complaint about the early years of his presidency...ACA included.
The Commish
Footballguy
This makes zero sense given what happened. The GOP was exactly NONE of the equation. His own party didn't have the appetite for a public option, which again, was a significant compromise to single payer. This has nothing to do with the cooperation he might/might not get from the GOP. It's about the cooperation he'd get from his own party. And it was crystal clear that the GOP was going to be 100% in opposition to him...they said that...blatantly.
adonis
Footballguy
There's considerable uncertainty about the future of the ACA. It has received few modifications/improvements. The republicans ran on a platform of repealing it entirely, right in the middle of the season for renewals. The health plans aren't sure what's going to happen...there's just a ton of uncertainty out there right now.matttyl said:
But the number of uninsured folks who now have insurance is still significantly higher than before the law was passed. There are definitely problems with it...but either you try to fix the problems with the system, and improve things, or you end up dropping a lot of folks off of insurance plans and likely not doing much about costs either.
The Republicans have had 8 years, or more, to come up with a good solution. Year after year, we hear that they have it...it's ready, they're ready to repeal obamacare and put in their solution. It'll save money, it's responsible...but year after year, promise after promise they fail to materialize.
I'm not here to play partisan politics, but to me that shows me that coming up with a conservative solution to this issue is incredibly challenging and republicans have known this all along. It's easier to just oppose someone doing something than it is to put up your own idea that you say is better and receive pushback for that. If you think about it, with the 50+ votes to repeal obamacare on the books, and no republican plan that we can point to and analyze, it's a pretty sad state of affairs imo for those who simply criticize without putting up a plan that improves things.
We'll see though...they're gonna have to put something up and the details I posted earlier are leaks from the plans floating around washington...and while they don't comprise an entire solution, they do represent the leading thoughts as far as I've heard.
adonis
Footballguy
https://www.theatlantic.com/politics/archive/2015/07/the-real-story-of-obamacares-birth/397742/
I mean, it's not worth re-litigating how the ACA came about. I'm not even trying to argue with whether it was a good law or not. But most of this stuff is pretty public knowledge and most folks are told a different story about the origins of the ACA than what actually happened.
It does seem likely, more likely at least, that if the Obama administration was negotiating for this healthcare option in a way that did not rely on working with Republicans, that at the very least there would have been included a public insurance option...but instead, they stuck with what's mostly a market solution of healthcare insurances, along with medicaid expansion. This was done to try at the very least to elicit some cooperation from republicans. It didn't work. But it's hard to convince me that if they had realized how opposed the republicans would've been very early on, that the wouldn't have started out with a more liberal baseline.
matttyl
Footballguy
I'm not sure you can say that, concerning the individual market that is. The vast majority of the "newly insured" are covered via Medicaid. Go look up the numbers - Medicaid enrollment has grown by nearly 20m people since 4th quarter 2013. The individual market is only slightly larger that it was pre-ACA.....and getting smaller.
adonis
Footballguy
I think that's an interesting point.
Why do you think it is that commercial markets seem like they've had a saturation of policies while the non-commercial market growth has been huge?
I'll float one idea in that I think a big portion of folks who can afford insurance were already paying for insurance before the ACA. There may have been a smaller segment of folks who couldn't get it due to pre-existing conditions who might be eligible now, and also a lot of folks under 26 would ride under their parent's plan and not have to get their own for quite some time.
However, a ton of the folks who couldn't otherwise afford insurance have been taken on in the form of Medicaid/Medicare, and given subsidies for commercial insurance. It would be interesting to get a breakdown of this data by experts...
The Commish
Footballguy
Right...this is what I am refuting and replacing with what happened. Your second paragraph says exactly what I said when it came to the GOP. The reality is, Obama's original proposal had a public option in it. That was axed in the Senate before it even got to the GOP in the House because the Senate deemed the public option a non-starter politically.
So this:
is demonstrably incorrect. It was in his original plan and the Senate told him "no". Ben Nelson (D) specifically as well as Joe Lieberman (technically an "independent")
matttyl
Footballguy
It's pretty readily available.
Anyway my point is that there were 55m enrolled in Medicaid in 2013, today there are 74.2m enrolled (well, as of December 2016). That's about 19m more people.
Yes, some folks were previously either excluded or priced out of the individual market and no longer are - but with the spike in prices for individual policies that followed to allow that, many previously insured folks are now priced out (not everyone is eligible for subsidies). While the numbers are a bit all over the place, I personally think that about 11-12m people had individual coverage pre-ACA, possibly a wee bit more. Today that number is higher, but only to about 14-15m after the big price increases last year. These "20 million new insured" aren't covered via private policies - the vast majority were simply put on Medicaid.
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