They F'rd up the "Contract with America" crap in the late 1990s regarding healthcare. Tried to gut rehabilitation services for the greatest generation who had strokes & needed rehab services. Was fun to watch these old WWII men & women cuss some politicians out, however.
OT: AHCA
- Thread starter iceheart08
- Start date
i honestly don't know how it works, i always thought pre-existing means not yet diagnosed / known / no evidence of it yet... didn't know they could say it's been pre-existing for 10 years yada yada...
the obvious answer to the post 26 is you get the option at that time to continue your coverage indefinitely. if these plans were insurer to customer and the employer wasn't in the middle then there could be an option to continue under that same coverage... this is of course a big picture solution that would have infinite details that would need to be gotten right to get implemented.
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Maybe - but that quote has defined the ACA for the people who don't like it. A career politician should have known better. Plus add in the problems with the marketplace and the flaws inherent in the system and you had a mess.
The voluntary thing is a good idea, but I don't know that a lot of states would ever have implemented it - good, bad, or indifferent. You and I both know how that goes with party lines.
Common Core education has the same problem.
Thing is, they will say it was pre-existing but, hopefully, you can get a good doc to change the dx to arthritis or something that looks good to the insurer. The awesome doctors will do that. But, still. The hoops. I mean, some of it is ridiculous. Especially if you've been paying premiums for years & years.
what a disaster in publicity... a wholesale national public education standard was undermined by a 1st grade math problem and the idiot parents who couldn't cope with it.
it would have been slow... illinoise, NY, California, Washington, Connecticut, Hawaii all would have... those states are the home states of lots of influential companies... if the system was bad people would have left those states / companies and the companies would have gone berserk... if it worked, slowly one by one states would have signed up because they would have recognized it was working.
personally i'm a fan of universal single payer for preventative, and HSA / catastrophic insurance for everything else... regardless... cost of care is a bigger problem than cost of coverage, and neither plan is going to do anything to address it.
Can you share the details on that problem? I don't remember it to that level of detail. I do remember a meme or something going around.
And don't get me wrong - I don't know that Common Core is the right way to do things or not. But it was harmed mostly because it was associated with Obama.
I'd leave preventative up to the insurance companies or administrators. The idea of preventative care is that it prevents larger problems down the road. Does having 80% of your members get an exam that costs you $1000, but may prevent 75% of them from needing care that will cost you upwards of $100,000, make sense? Depending on the number of people you are talking about and the exact percentages.
A lot of people hate on insurance companies for covering preventative care - they say it drives up costs needlessly. IMO it is, at worst, a simple business decision.
Except the insurance companies DO fault you for preventative care. And then say it does drive up costs.
so this problem is the "joke"
this is actually more what it is supposed to look like:
now a bunch of parents got upset because they couldn't figure it out and their kids were getting taught to do it differently then they did... lots of sarcastic remarks like "i guess i've been doing it wrong for 35 years"... but it was never intended to replace the old tricks and ways arithmetic was done, it was meant as a supplemental demonstration of the concept that subtraction is the opposite of addition. one of the reasons our students are bad at math is because we only learn the tricks and don't learn the concepts.
There is plenty of stupidity in his plan. I didnt have time to go point by point, but that is one point of extreme stupidity. And if you like stupidity, then you definitely should be more than doubly sold.
**** like this is why conservatives are at war with the GOP establishment. People can talk all they want about how "electable" certain repubs are, but what they do is dishonestly whisper sweet nothings into the base's ear for votes, then do stuff like this once they have power.
I ran out of patience after the 2014 midterm elections. I think a few more people are catching on.
That's a nice emotional pull but you're missing the point. discounted healthcare is not the same thing as insurance
People use the emergency room as a primary provider anyways. I work in EMS. I see it everyday.
The worst is homeowners insurance. You pay and pay and pay but you better not ever have to use it.
I provided you with more facts than Donald Trump has in his entire term. If he convinced you to vote for him, I should definitely have swayed you!
I don't understand. First the ACA was unsustainable. Premiums were already skyrocketing. The system would have failed/collapsed within 3 years. So, now we are moving back to closer to what healthcare was prior to the ACA, except depend coverage is still available to 26, pre-existing condition limitations still can't apply, Heath savings account deferrels increase, new high deductible health plan options are mandated and tax subsidies are provided for older groups of individuals who earn less than 100k or 150k filing jointly. Older participants can be charged up to 5 times more for individual coverage, as opposed to 3 times under the ACA, but this is still better than pre ACA. The biggest advantage is to allow insurers to cross state lines so that they can be more competitive. Also, allowing unrelated groups to band together could significantly reduce health costs for small employers.
I neither support or oppose the new legislation. I'll wait to hold judgement, but I'm not going to say the sky is falling when it's clear that what's being proposed is no worse than what we had before the ACA and appears to be much better.
I really feel sorry for the elderly on a fixed income and the 'poor ' people. This doesn't work without the mandate. Either go all in or all out.
You left out a number of reasons why health care cost are so high in the US. Sure, medical inflation is high, but there are many reasons. Medical malpractice insurance is high and that cost is passed to the consumer, but that's a minor cost compared to other reasons. I agree with you that the ACA would ultimately be a governmental burden, but it hadn't gotten there yet and ultimately that would not directly relate to higher heath costs, but higher taxes. My fear was that the ACA would implode resulting in a single provider and socialzed health care.
So why is healthcare so expensive and why can't we just follow other countries?
First, US mandatory Heath care. No hospital can deny health care for someone who is not insured. They can't turn you away. Have you been in an emergency room lately? You will see tons of people there being treated for a cold ...because it's free at least to a majority of the patients. This cost is transferred to the purchasers of insurance, you and me. However, do you want this to go away. If my son is on a camping trip and is injured, I want him to have immediate care. I don't want him waiting around to ensure his insurance card is valid
Second, medical innovation. Yes, those things that save our lives sometimes. It's those neat MRI machines, those new laser surgery machines, new innovation in cancer treatment, new designer drugs (half the population is on statins now, but no one even knew what they were in the 80s). All these great things that heal us ang give us longer life span that are invented somewhere and a lot of that occurs in the US. Until they become generic these items cost a premium. That's so the med manuf and drug companies can recoup its costs and profi off of its investment. These innovation costs are passed on to the consumer. Unlike most other countries, the us is a leader in medical innovation. One of my biggest fears of socialized medicine is the elimination of medical innovation. Why design a drug that cures cancer if you are not going to make $ off of it or hire scientists who might be able to make a cure for cancer if you don't see a profit in it or why make a better MRI if there is no one willing to pay for it. I for one don't want to see innovation in medicine stagnated at all.
Third, the US social attitude toward healthcare. Suppose you mother or wife is sick. You take her to a hospital and demand the best treatment possible be given to her. Cost is no object. You want the best surgeon, the best and latest equipment and the best treatment. Cost is never an issue for anyone in the USif we need care, regardless of age or socioeconomic status. We demand it, no questions asked. When was the last time you heard someone say, I'm in my 70s and I need cancer treatment but the doctors say my life expectancy is not that king anyway, so it's not worth the couple hundred grad it would otherwise cost. We don't look at health care that way. We spare no expense from the richest to the poorest for even one day of additional life. I like that and, again, it's a concern with socialized medicine, but someone has to pay for it. It's one of the reasons why individuals in countries with socialized medicine buy seperatevor supplemental policies. In effect, the rich get quality care and the poor don't.
My point in all of this is that there is no real easy answer from either a liberal or conservative view. The only way to really change this in an overhauling significant manner is to change the way we citizens view healthcare in the US, and I, for one, am not willing to accept many of those changes. And for those that want to nationalize healthcare, I suggest you think again because you might get what you wish for.
Ranked according to what criteria?
I'm betting the criteria is NOT cost!
ANY socialized system I have ever seen is a way to GUARANTEE both inefficiency AND ineffectiveness, including socialized public education! !!
I'm arguing semantics. What you're describing is not insurance. It's healthcare.
I think there is a misconception that the mandate lowered healthcare costs or made money for the government. Neither is the case. There were 2 mandates, an individual and an employer mandate. The employer excise tax was supposed to partially fund coverage for the individuals who worked for that employer that was not provided coverage. The individual mandate imposed a tax. However, most received coverage. The idea was that coverage costs would go down by putting healthier individuals in a plan. That didn't work because carriers were able to induce many of the individuals to more comprehensive and less costly plans. That left mostly unhealthy in the ACA pans, which caused costs to skyrocket etc.
however, even if you were able to fix the ACA by moving to a single provider and forcing individuals to use that provider (effectively nationalizing healthcare, which is where I believe we were headed) it still does not change the fact that healthcare costs become flat once your group reaches a certain size. Sure elderly people cost more to cover than younger people and that does not change. It's a statistical fact. The mandate did nothing to change that except its intent (that did not work well) was to shift the cost of coverage from the older to the younger. It didn't work well because enough young people didn't get into the plan. There were tiers of coverage, but that's the effect of the mandates.
Another way to look at it is that it's simply a tax on younger healthier citizens. Yes you were mandating coverage and there may be som paternal benefit from that, but the only financial benefit was the tax. This can be just as easily solved by giving a tax rebate to the elderly, which is exactly what the new legislation proposes. You may not be happy with the amount of the rebate or the groups it's given to, but that can all be changed by simply increasing the rebate or expanding the group. It's really not a yes mandate or no mandate issue. It's a yes socialzed medicine or a no socialized medicine issue.
That's just.....completely wrong.
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
Medicare has lower overhead costs than private insurance (politifact rates the claim half true because the person claimed higher costs for private insurance than actual estimates but private still had 5x the admin cost):
http://www.politifact.com/truth-o-m...a-boxer-says-medicare-overhead-far-lower-pri/
So we've eliminated your argument that single payer isn't cost effective - it is in the United States and everywhere else in the world. "Effectiveness" is pretty subjective but the WHO list certainly had us below a lot of people.
I don't think that would work very efficiently. Are you going to have a mandate for preventive care? Are you going to mandate lower rates by the high deductible carrier for citizens that purchase preventive coverage. I don't think there is any way to coordinate those rates or coverage. So, the preventive carrier charges a universal rate and the catastrophic carriers charges rates without taking into effect preventive care. So, the consumer ends up paying double, first the cost of preventive care, and second the cost of not having preventive care.
I've never quite understood the issue with the individual mandate. It ensures there are no freeloaders. Why do republicans dislike that?
I would never consider going without health insurance - at least some sort of catastrophic coverage. Just like I wouldn't drive without auto insurance. Why should people be allowed to go without insurance and pass the burden along to us when something happens?
We should also charge premiums in accordance with controllable risk. If you project to consume 5X the healthcare because you are obese, your premium should be 5X @Ron Munson 's premium. If a smoker will cost 3X, premium should be 3X. This shouldn't apply to unpreventable conditions, just preventable ones.
Tax credits are better than subsidies. It ensures the people receiving relief are at least paying taxes. And I'm not sure why you would want to limit deductions based on income. Higher earners are already contributing significantly more into the tax base, both on a percentage basis and a raw dollars basis. Plus they lose other deductions as their incomes rise. If healthcare is a universal right, make it a universal deduction.
We all just need to pay our fare share.
I would never consider going without health insurance - at least some sort of catastrophic coverage. Just like I wouldn't drive without auto insurance. Why should people be allowed to go without insurance and pass the burden along to us when something happens?
We should also charge premiums in accordance with controllable risk. If you project to consume 5X the healthcare because you are obese, your premium should be 5X @Ron Munson 's premium. If a smoker will cost 3X, premium should be 3X. This shouldn't apply to unpreventable conditions, just preventable ones.
Tax credits are better than subsidies. It ensures the people receiving relief are at least paying taxes. And I'm not sure why you would want to limit deductions based on income. Higher earners are already contributing significantly more into the tax base, both on a percentage basis and a raw dollars basis. Plus they lose other deductions as their incomes rise. If healthcare is a universal right, make it a universal deduction.
We all just need to pay our fare share.
Old people and young people have completely different healthcare needs, so trying to combine them into the same plans should and will fail.
Young people should generally be on high deductible plans. At least once they have a little bit of savings. I've been on one for 6 years and it's great. Low premiums, I can contribute to an HSA, I get a tax deduction for said contribution, I pay as I go for any healthcare I want and I'm covered if **** hits the fan.
Heck, my wife and I had a kid on a high deductible plan last year. I dropped to a $5k deductible from a $10k deductible (back to 10k this year), maxed out the HSA (which means I effectively save $2600 in taxes) and paid a lower premium than a PPO. I basically had a child for under $2k.
People really need to be much smarter about how they consume healthcare. High deductible plans combined with HSAs have to be a major part of the evolution of health insurance.
Now oulds on the other hand... Recurring prescriptions and doctors visits combined with less tax advantages with the HSA due to being past the accumulation income phase. They will need something different.
Hopefully when my generation is old, we will have all responsibly loaded up our HSAs in advance...
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Excellent post. Two things:
1. You are correct in saying "the only way to really change this in an overhauling significant manner is to change the way we citizens view healthcare in the US." I see this at MUSC every day. And I want my family to get the best care possible at whatever cost, but it's going to take a shift to the greater good to lower costs. There is a patient who is 88 and just had a double knee replacement. Probably cost Medicare $30,000, and that's a drop in the bucket compared to other treatments (like chemo). Should we really be replacing knees on 88 year olds? How about knees on patients that are morbidly obese, without making them lose weight first? I think the second scenario is just throwing money away. We are going to HAVE to accept changes, like making the obese man lose weight before replacing his knees if we ever want to lower costs.
2. Your statement about not being able to deny anyone medical care is absolutely false. ERs ARE required by law to treat a patient, but only to stabilize the patient. A hospital is not required to attempt to cure a patient. Do you think Roper takes unfunded patients? No, they get stabilized and sent to MUSC.
You are entirely correct about medical innovation. We pay for drug innovation for the rest of the world. Let me give you an example. Crestor (before going generic) would cost about $250/month for an uninsured patient. That same cost in Greece was $30. Why? Because Greece's NHS determines which statins pharmacies can carry. They tell the drug company "we will pay $25 for 30 tabs" (made up number), and AstraZenica says "well, it costs us $20 per month supply to manufacture, so it's worth selling to Greece to make $5 per month supply." Meanwhile, patients in the US are paying for R&D to develop Crestor because AZ has a patent for 17 years. TL/DR - our drug prices (and ALL healthcare) are more expensive than the rest of the world because we are paying for innovation. How do we lower drug prices without reducing innovation? No freakin' idea.
Here is the problem. In most of those nations the rich still live outside the system and everyone pays taxes for all this. In our country, we'd have to start taxing a lot of people who pay nothing now. That wouldn't fly. Pluse those nations are small compared to the US. Bad to compare. We need a system that doesn't involve government at all. No employee benefits either. A purely private system will the term plans based on actuarial data. It is not complicated but a lot would have to actually think instead of react.
Flaw, you have made some good points. First, you are correct, a single provider will definitely be more effective administratively. Even with government mismanagement, how could it not be. No longer having state insurance requirements and effectively combining hundreds of insurance companies into one. Also, eliminating all the claims burocracy. There would also be better access to individuals. That goes without saying. If everyone is covered, then you automatically have better access.
However, there are where the flaws come into the WHO report. Ratings were determined on 4 categories, two of which are access and administrative efficiency. By definition single payer/socialized healthcare is going to be superior in these categories. No matter what we in the US do to improve healthcare absent universal healthcare, we can never be as efficient or as available. My point is that the rating is flawed (no pun intended) because we can't compete on these categories unless we become a single provider system. That is, we could provide free preventive care to all and build hospitals in every neighborhood, but we'd still fall last on that list. It's like comparing apples and oranges, but with the caveat that apples are always better.
Now if you look at he quality of care category, you will see that the US fared much better - generally in the 3 and 4 range. Certainly there is room for improvement there, but it does not mean a single provider system is better. One of the factors pointed out is that Americans simply have less healthy lifestyles than our European counterparts and this was counted as a negative in healthcare.
So why is our cost for healthcare more? There are a number of reasons. As you pointed out, Our system is less efficient and that can be imprivved on. For example, the current legislation proposes an end to state autonomy over health carriers. However, when compared to a governmental ssystem (like in the U.K. Or Canada), the excess bureaucracy does offset somewhat our private inefficiency. My point is that this is not where the excessive cost comes from. These costs come from our lifestyle, mandatory health services, litigation mentality, medical innovation, and the way we perceive and expect healthcare benefits to be provided (see my earlier post on this), and these issues don't go away by simply implementing a a single provider system. So, implementation of a single provider system will move us up on the WHO list, but it won't solve many of the underlying issues and could (imho would) make them worse.
However, none of that is why we are not going to a single provider system. The real reason is taxes. The U.K. Has the #1 health system in the world by the WHO report. However that does not take into account the separate individual supplementary policies provided to executive level employees and the wealthy. It's basically like paying taxes for public school and sending your kids to private school. This increases care but also alleviates the strain on the system. Again, I see this as a flaw in the report.
The bigger issue is taxes. Every citizen in the U.K.that earns income pays taxes for healthcare. To get an equivalent program in the US we would have to tax every income earner approximately 20% on earnings. However, 45% of our citizens earn under the min poverty level and don't pay taxes. We would either have to start taxing them or move the burden to yhe middle and upper classes. There is no way an administration could increase taxes for this group that's effectively getting free coverage now and is generally living paycheck to paycheck and expect to be re elected. So that amount would have to be paid by others. A conservative estimate is an increase of approximately 25% for every middle an upper income wage earner. So, if you are paying 34% in taxes now, you could be looking at 59% and even higher for Larger income earners. There is a reason why John Lennon wanted to become a US citizen. The other alternative is to tax businesses, which has the effect of stifling the economy, especially small businesses which were made exempt from the mandates under the ACA for this reason.
There are many other reasons our costs will be higher than the UKs. We have a diverse population many of which are located in rural areas. That means more hospitals, doctors, nurses, equipment, etc for fewer people. We also have lifestyle issues and we are generally unhealthily. We have expectations for heathcare that are not going to change. We won't tolerate a Canadian system that might make you wai a month to get an MRI Finally, we are the worlds leader in medical innovation and I don't want to see this go away.
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We would probably still have supplemental private insurance. Our large country makes implementation of single payer more complicated but not more expensive (economies of scale at what not).
Nobody who works pays nothing. Payroll taxes apply to everyone and a healthcare tax would almost certainly be a payroll tax (Medicare already is). The wealthy in our country also pay a lot less in taxes, generally, than they would in other countries. I'm also willing to pay extra in taxes for everyone to have healthcare.
You didn't provide any argument for your totally privatized healthcare proposal. Why is that better? Or is it just "the free market and competition will magically improve things?"
Scotch, I handle a lot of benefits matters for my firm and I've given a number of speechs on ERISA and the ACA, and I don't believe republicans are against the mandate. I believ what they were against was the creation of a huge burocracy for an experiment destined to fail with staggering potential costs. The mandates were really just a tax from the governments perspective that shifted costs to shift from old to young. I guess the other problem is that many had was the belief that we need less gov interference, not more. The subsidies under the ACA were all provided as tax credits and individuals were not eligible for subsidies unless they were applicable tax payers. I believe that one of the budget proposals is to make healthcare cost uniformity deductible. However, I'm sure they are running into issues over who is going to pay for this.
Thanks, on point 2 I was referring to the Emergency Medical Treatment and Active Labor Act which requires Hospitals emergency rooms for any hospital that accept Medicare to provide medical screening services to anyone seeking medical care and prohibits the hospital from discharging the patient if in need of emergency medical treatment unless it's to transfer to another hospital or with the patients authorization. I didn't mention Medicare because so few hospitals don't accept Medicare. Also, I didn't want to get technical as to what I meant by care. I agree that you don't have to cure them, but you have to treat or at least screen them and you can't send them on their way if they are in need of emergency care.
I agree regarding medical innovation. The loss of it is one of the scariest aspects of a single provider system imho. You hear of countries like Norwayand New Zeland that have great healthcare, but don't participate at all in medical innovation. I'd like to compare counties like France and GB over the last decade to see what country is leading the charge in medical innovation.
The one thing I never hear folks talk about with these debates is cost of health insurance companies themselves. Administrative costs from health insurance companies is like 30% of the total cost of health care in the US, up from 19-24% in 1991. The bloated bureaucracy of health insurance jacks up costs throughout the system. They have no incentive to be efficient and no regulation or oversight of their practices (and no--since this is a monopoly, no free market system will reduce these costs, and a switch to a 'free market' system wouldn't change anything unless you had some serious govt intervention to break-up the monopoly).
One in four health care workers is an administrative worker as opposed to a care worker. That sector is up 50%. And does anyone have any better customer service stories from health insurance companies?? Didn't think so...
So, for example, a corporation gets billed 3% by a health insurance company to administer the plans (pay claims). The same work costs less than 1% with big bad govt run Medicare. The govt already does health insurance better than insurance companies. That two percent difference is one of the main reasons your health insurance is so much more expensive than other systems and countries and the care is poor.
Obamacare and Trumpcare don't do anything to curtail the power of health insurance companies. You can't have meaningful reform without upsetting that lobby. Both parties are in their pockets as deep as they will or can go. http://www.nejm.org/doi/full/10.1056/NEJM199105023241805
One in four health care workers is an administrative worker as opposed to a care worker. That sector is up 50%. And does anyone have any better customer service stories from health insurance companies?? Didn't think so...
So, for example, a corporation gets billed 3% by a health insurance company to administer the plans (pay claims). The same work costs less than 1% with big bad govt run Medicare. The govt already does health insurance better than insurance companies. That two percent difference is one of the main reasons your health insurance is so much more expensive than other systems and countries and the care is poor.
Obamacare and Trumpcare don't do anything to curtail the power of health insurance companies. You can't have meaningful reform without upsetting that lobby. Both parties are in their pockets as deep as they will or can go. http://www.nejm.org/doi/full/10.1056/NEJM199105023241805
The first point is not true when compared to the UK. You might have a physician in Britain servicing 400 families. That same physician may be able to service only 100 in Arizona. The same applies to hospitals, medical equipment, nurses, etc.
Your second point is also incorrect. Approximately 45% of our labor force earn under the min poverty level and don't pay taxes. Everyone else would have to cover this group which would account to a 20-25% increase in taxes. And that's still not going to fix many of the underlying issues which cause US heathcare to be so costly and there is a good chance that the quality of care will decrease. It certainly will decrease if we are forced to manage costs in an amount necessary to make it viable/acceptable.
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Conspiracy theorists, can't live with them, can't live with them.
Amazing to me how Medicare is accepted in our country but universal healthcare for everyone else is a polarizing topic.