Finally. Good riddance to Obamacare.

[Koldo]

I'm a proponent of free market wholeheartedly but in cases where restrictions and controls need to be in place , I just don't want to see people personally raped through their wallet and have their economic freedom without penalty to choose for themselves taken through the barrel of a gun like Obama did to so many Americans under a veil of lies and deceit, yet further coupled as if it couldn't get any worse, imposed a mandated perpetual debt on everyone that cannot ever be paid in full.

What a way to live your life in what is coined as being, The land of the free.

Straw that broke the camels back that ensured Trump's victory.

What you want just doesn't sound feasible.
You want a considerable reduction in price and to no longer be obligated to purchase it, but you are not offering anything in return.

 

[metis]

What some seem to forget were the conditions prior to the ACA getting passed whereas medical inflation was higher, co-pays skyrocketing, emergency rooms closing, etc. The CBO analysis of what would happen if the ACA was just dissolved is scary-- literally.

 

[Shadow Wolf]

There is another way of dealing with this that is far more sensible and workable, such as issuing very heavy fines and maybe even prison time if an employer hires an undocumented worker. So, why don't the Republicans get something like this passed? Well, guess which party a majority of these large farm owners support?

Now, now, you can't just go in an interfere with business like that. It makes you a Communist and anti-American. You'll disrupt cash flows and bring society to its knees. And it's a reasonable and sensible approach that actually works to reduce incentive to come here when there are fewer jobs, rather than just adding a wall. And, realistically, there are already tunnels going underneath the Mexico/America border. If anything, it gives incentive to the cartels to dig a complex network of tunnels, some that exist for smuggling, and some that serve no other purpose than the use of wealthier Mexicans paying the cartels exorbitant fees for this relatively easier, simpler, and quicker way of sneaking into America.

 

[tytlyf]

What some seem to forget were the conditions prior to the ACA getting passed whereas medical inflation was higher, co-pays skyrocketing, emergency rooms closing, etc. The CBO analysis of what would happen if the ACA was just dissolved is scary-- literally.

Republicans don't care because they're heavily lobbied by the insurance companies trying to keep the status quo ripping people off and not having to cover people with pre-existing conditions. Republicans don't like the ACA because their favorite media tells them it's evil, government run healthcare. People don't fact check in the states, it's a growing problem.

 

[metis]

Republicans don't care because they're heavily lobbied by the insurance companies trying to keep the status quo ripping people off and not having to cover people with pre-existing conditions. Republicans don't like the ACA because their favorite media tells them it's evil, government run healthcare. People don't fact check in the states, it's a growing problem.

Exactly.

And there was a survey released not long ago (by Pew, if my memory is correct) that said that a large minority (I believe it was around 40%) of those who voted from Trump believe that unemployment has gone up and that the stock market has gone down since Obama took office. Gee, I wonder where they get this from?

 

[Shadow Wolf]

What some seem to forget were the conditions prior to the ACA getting passed whereas medical inflation was higher, co-pays skyrocketing, emergency rooms closing, etc. The CBO analysis of what would happen if the ACA was just dissolved is scary-- literally.

If my sister wasn't a physicians assistant who worked for a doctor who had no problem with her calling me in simple anti-biotics without seeing her if I got sick, I don't know what I would have done if a simple illness turned into a serious disease. I did start developing carpel tunnel syndrome then, and just had to deal with it until I eventually did get insurance for it. And having life-long knee problems and my first knee surgery before I was 18, I was a high-risk patient with a pre-existing condition. The ACA isn't perfect and could be better, but realistically what we had before was so much worse. Even the rising costs, something that has been out of control for many many years now, have had some brakes applied to them. And realistically a major issue with the ACA is Republican states aren't cooperating with with, insurance companies aren't cooperating with it, and the public isn't cooperating with it. If everyone would have went along with it, it can be very competitive for insurance companies with the government doing nothing more than setting minimum standards, assisting people with finding insurance plans, and financial assistance to the poor. If the bill wasn't so heavily antagonized, I don't see why it couldn't work at least as well as the Dutch system, which overall is consistently ranked as one of the world's better systems.

 

[metis]

If my sister wasn't a physicians assistant who worked for a doctor who had no problem with her calling me in simple anti-biotics without seeing her if I got sick, I don't know what I would have done if a simple illness turned into a serious disease. I did start developing carpel tunnel syndrome then, and just had to deal with it until I eventually did get insurance for it. And having life-long knee problems and my first knee surgery before I was 18, I was a high-risk patient with a pre-existing condition. The ACA isn't perfect and could be better, but realistically what we had before was so much worse. Even the rising costs, something that has been out of control for many many years now, have had some brakes applied to them. And realistically a major issue with the ACA is Republican states aren't cooperating with with, insurance companies aren't cooperating with it, and the public isn't cooperating with it. If everyone would have went along with it, it can be very competitive for insurance companies with the government doing nothing more than setting minimum standards, assisting people with finding insurance plans, and financial assistance to the poor. If the bill wasn't so heavily antagonized, I don't see why it couldn't work at least as well as the Dutch system, which overall is consistently ranked as one of the world's better systems.

I hear ya, and hopefully you're doing a lot better.

I personally know a woman whose life has been literally saved by the ACA because she and her husband got dropped by their insurance company and she had cancer. She signed up very early, got the needed medications, and now she is cancer free.

 

[Twilight Hue]

What you want just doesn't sound feasible.
You want a considerable reduction in price and to no longer be obligated to purchase it, but you are not offering anything in return.

Not exactly. More like looking at those direct causes that skyrockets health costs rather than elsewhere, like "finding more revenue" that only patches things for a small while.

 

[Twilight Hue]

What some seem to forget were the conditions prior to the ACA getting passed whereas medical inflation was higher, co-pays skyrocketing, emergency rooms closing, etc. The CBO analysis of what would happen if the ACA was just dissolved is scary-- literally.

A lot of it isn't affordability. Its abuse, price gouging etc. It skyrockets for various reasons and none of it I suspect reflects healthcare in terms of what it really is at the core which I suspect is far less than what people pay out right now.

 

[Koldo]

Not exactly. More like looking at those direct causes that skyrockets health costs rather than elsewhere, like "finding more revenue" that only patches things for a small while.

Like the free market and the 'for-profit' outlook ?
Have you heard about 'The Price Ain’t Right?' ?

In the conclusion you can read:

"We also find a large number of observable factors relating to costs and quality are systematically correlated with higher hospital prices. However, hospital market structure stands out as one of the most important factors associated with higher prices, even after controlling for costs and clinical quality. We find that hospitals located in monopoly markets have prices that are about 15.3 percent higher than hospitals located in markets with four or more providers. This result is robust across multiple measures of market structure and is consistent in states where the HCCI data contributors (and/or Blue Cross Blue Shield insurers) have high and low coverage rates."

Considering we already know one of the direct causes, how do you propose that to be dealt with ?

 

[metis]

A lot of it isn't affordability. Its abuse, price gouging etc. It skyrockets for various reasons and none of it I suspect reflects healthcare in terms of what it really is at the core which I suspect is far less than what people pay out right now.

Actually most of it is in regards to overhead because we operate our health-care system on a for-profit basis-- the only one in the world. For example, one thing the ACA did was to limit profit margins from 40% down to 20%. But that's only part of the story since so much money is tied up in advertising. You can't watch a half-hour of tv without being hit with at least one medical advertisement. And then there's the mailers that arrive at your home, the sales pitches to doctor's offices, etc.

The best thing we could have done is to have gone single payer but with built-in competition, much like Germany and Denmark have.

 

[Shadow Wolf]

Actually most of it is in regards to overhead because we operate our health-care system on a for-profit basis-- the only one in the world. For example, one thing the ACA did was to limit profit margins from 40% down to 20%. But that's only part of the story since so much money is tied up in advertising. You can't watch a half-hour of tv without being hit with at least one medical advertisement. And then there's the mailers that arrive at your home, the sales pitches to doctor's offices, etc.

The best thing we could have done is to have gone single payer but with built-in competition, much like Germany and Denmark have.

I seriously wonder if people forgot just how quickly prices were skyrocketing before the ACA. They think they are bad now, at least the ACA tried to throw out a parachute to slow them down, and it has worked to slow it down to less than what it was before. It's still rising out of control, but the facts are it's not rising as fast as it was, and the increases we've been seeing, for the most part, just about everywhere, are not directly related to the ACA but states and insurance companies throwing fits.

 

[metis]

I seriously wonder if people forgot just how quickly prices were skyrocketing before the ACA. They think they are bad now, at least the ACA tried to throw out a parachute to slow them down, and it has worked to slow it down to less than what it was before. It's still rising out of control, but the facts are it's not rising as fast as it was, and the increases we've been seeing, for the most part, just about everywhere, are not directly related to the ACA but states and insurance companies throwing fits.

I can't include the results from this last year because I don't have them, but up to at least that point our rate of medical inflation was roughly half versus the time period from 1997-2007. However, what many have noticed is their co-pays increasing, but that has been a trend that's been going on for at least three decades now.
The system needs some serious fixing, no doubt, but I have a hard time picturing the Republicans doing it because they individually are simply all over the place on this. When they had control of both chambers and the presidency under Bush, they did nothing except to pass Medicare Plan D, which they threw on the budget deficit.

 

[Kirran]

Damn, you guys have some crazy country, I'm serious. Honestly, I have come to the opinion that by the standards of the Western world the USA is regressive on a number of issues, with some deep-rooted societal flaws which are almost unique to it.

This is a manifestation of that - it seems to me to be nothing but a manifestation of a certain societal distrust - the 'Wild West' mentality, maybe? But I do see the USA developing, and I think societies do naturally fix their fault lines over time, although it certainly isn't always quick.

 

[Twilight Hue]

Like the free market and the 'for-profit' outlook ?
Have you heard about 'The Price Ain’t Right?' ?

In the conclusion you can read:

"We also find a large number of observable factors relating to costs and quality are systematically correlated with higher hospital prices. However, hospital market structure stands out as one of the most important factors associated with higher prices, even after controlling for costs and clinical quality. We find that hospitals located in monopoly markets have prices that are about 15.3 percent higher than hospitals located in markets with four or more providers. This result is robust across multiple measures of market structure and is consistent in states where the HCCI data contributors (and/or Blue Cross Blue Shield insurers) have high and low coverage rates."

Considering we already know one of the direct causes, how do you propose that to be dealt with ?

I like co-ops to help pool purchasing power and lower costs and price capping for starters.

Optional payroll deductions that provides an individual pool similar to an annuity that can be used periodically to help defray basic healthcare costs. It would help in curtailing frivolous use of the system.

Oversight by independent groups similar to joint commission that monitors profitibiliy vs costs to ensure a fair and equitable relationship between providers and patients and provides disclosure on where money is going and how it's spent.

Actually most of it is in regards to overhead because we operate our health-care system on a for-profit basis-- the only one in the world. For example, one thing the ACA did was to limit profit margins from 40% down to 20%. But that's only part of the story since so much money is tied up in advertising. You can't watch a half-hour of tv without being hit with at least one medical advertisement. And then there's the mailers that arrive at your home, the sales pitches to doctor's offices, etc.

The best thing we could have done is to have gone single payer but with built-in competition, much like Germany and Denmark have.

If the mandate can be addressed, I'd be more partial to single payer. I think there should be a corporate mandate as opposed to an individual mandate. Imv.

 

[esmith]

every once in awhile we need a little bit of jocularity

 

[metis]

If the mandate can be addressed, I'd be more partial to single payer. I think there should be a corporate mandate as opposed to an individual mandate. Imv.

IMO, the best and simplest way is to handle basic care through the Medicare system but for all ages. The overhead is only a fraction of that with the private insurers.

 

[esmith]

IMO, the best and simplest way is to handle basic care through the Medicare system but for all ages. The overhead is only a fraction of that with the private insurers.

Ok, you like the Medicare program. That means that everyone that would get healthcare via this system would pay a monthly premium (currently $110 parts A&B) without any subsides. This would not be a "family" plan, everyone including children would be responsible for $110 a month. This plan would only pay 80% of what Medicare thinks the procedure should be and there is a $166 (2017) deductible. You are not covered for annual physicals or test, only a "Wellness" visit. If you go to a doctor that does not accept Medicare you are responsible for all charges
So let's take a family of 4, their monthly premium would be $440 and no subsides. Note: this cost does consider amount you pay to the FICA tax. In other words if you were working you would still pay the FICA tax plus direct premiums.

So do you still like the idea?

 

[Koldo]

I like co-ops to help pool purchasing power and lower costs and price capping for starters.

Optional payroll deductions that provides an individual pool similar to an annuity that can be used periodically to help defray basic healthcare costs. It would help in curtailing frivolous use of the system.

Oversight by independent groups similar to joint commission that monitors profitibiliy vs costs to ensure a fair and equitable relationship between providers and patients and provides disclosure on where money is going and how it's spent.

I would like you to clarify how exactly any of this would lead to a considerable reduction in the price paid for healthcare ( compared to the current situation ).

 

[Shadow Wolf]

IMO, the best and simplest way is to handle basic care through the Medicare system but for all ages. The overhead is only a fraction of that with the private insurers.

Honestly, if Pence were to steer Trump in the direction of adopting a national HIP plan, it's actually pretty good insurance, and you pay your monthly bill, and depending on plus or basic, copays and deductibles. On my plan, I have had not a dime for out-of-pocket medical expenses in a couple years since I got on it. But they would have to expand a few things that it covers, and make it easier to get on, because in the days before ACA even if you had need for the insurance that was good enough and could prove your employers insurance wasn't even worth the monthly/weekly cost alone because it covered so little and what you need just wasn't covered (In my case, a torn ligament and cartilage in my knee). Private insurance was also so unreliable and slow to move, this insurance was so fast that I went ahead and got some piercings knowing I was about to meet a surgeon for me knee, having anticipated a lengthy wait for insurance to approve it, but a few days later I was being scheduled for surgery (had to get the piercings redone though).
Pence did hint at HMS, and if a plan is put together that is modeled after Indiana's own HIP, with a few adjustments it could work out very well.