The Democrats' new game plan

[makattak]

The democrats plan is the same as before. Push left, harder left, and vigorously resist any movement away from left.

And call it "compromise" when they get less movement to the left than they wanted.

[MechAg94]

And call it "compromise" when they get less movement to the left than they wanted.

Avoid any actual grass roots movements.  Instead seek to set up bot proxies on social media sites and fake mass support in order to drive opinion in the direction those with the money want to go.

[KD5NRH]

and then we had to clean any and everything that was exposed to that kid by basically dumping it in bleach for several hours.

Name one inanimate object in a hospital that shouldn't get exactly that treatment daily.

I know they the existing copay scheme is so that there are no barriers to emergency care, but there's already a law about that (EMTALA). The copay tier system is just the first line of things that need to be reworked.

EMTALA needs a rework too; if you have nothing that could reasonably be considered a symptom of a serious problem, you get discharged directly to a work camp until your bill is paid.  I don't mind the guy showing up to find out he just pulled a muscle badly rather than spraining or breaking his ankle, but the ones who rush in with a problem they've had for 3 days already are clearly not an emergency.

[HankB]

Health insurance should be more like car insurance in the sense that you are only using it to protect against financially catastrophic expenses. 

Considering how high the deductibles are for most ACA plans, there's a strong element of that in place now.

[Scout26]

 And once you are covered, as long as you maintain some type of coverage, you can't be denied.    

Ok, so much for that free market idea  

I didn't say that you have to have insurance.  I think it's a very free market solution.  If you don't want to pay for insurance (remember insurance is simply a way to manage risk), then you don't have to.  However, you assume the risk that if you get sick or hurt, you may or may not be able to get insurance later.   Personal choice, personal responsibility.

Oh, and you'd have to pay for your own healthcare...

[DittoHead]

I didn't say that you have to have insurance.  I think it's a very free market solution.  If you don't want to pay for insurance (remember insurance is simply a way to manage risk), then you don't have to.  However, you assume the risk that if you get sick or hurt, you may or may not be able to get insurance later.   Personal choice, personal responsibility.

Oh, and you'd have to pay for your own healthcare...

Forcing companies to cover pre-existing conditions is incompatible with a free market solution. And unless you force them, they aren't going to (for good reason).

Saying that "you can't be denied" if you maintain coverage doesn't work either. Are they allowed to increase prices if your health changes and you become higher risk? If not then you're adding price controls into the mix. If they can increase prices according to risk then they won't need to ever officially deny coverage, just make absurdly unaffordable.

[MechAg94]

Forcing companies to cover pre-existing conditions is incompatible with a free market solution. And unless you force them, they aren't going to (for good reason).

Saying that if you maintain coverage "you can't be denied" if you maintain coverage doesn't work either. Are they allowed to increase prices if your health changes and you become higher risk? If not then you're adding price controls into the mix. If they can increase prices according to risk then they won't need to ever officially deny coverage, just make absurdly unaffordable.

The easiest solution might be they have to pay out a lump sum if they choose to drop you once you are diagnosed with a costly condition. 

However, for someone like my nephew who will be taking insulin shots the rest of his life, I don't see that cost as insurance anyway. 

[DittoHead]

The easiest solution might be they have to pay out a lump sum if they choose to drop you once you are diagnosed with a costly condition. 

Says who?
Maybe I'm misunderstanding but this sounds like more government regulation. Which is the problem in the first place, right?

Covering preventative care, covering pre-existing conditions, no payout caps, guaranteed coverage - these are all things consumers seem to want, so in theory insurance companies will offer them but they sure as hell aren't gonna be cheap. If the government says they have to offer them then we're right back to obamacare.

[Monkeyleg]

I think I've mentioned in other threads that my care last year came to $429,000. Medicare more than likely didn't even pay $100,000. Still, what insurance company could afford to take me as a policy holder? It's likely I'll rack up those kind of numbers this year or next. They have no options except to have high premiums, deductibles, or both, or to amortize the cost of people like me across their entire customer base. (This is all obvious to all obvious to everyone here).

I can't think of a way to cover existing conditions without raising the premiums somewhere.

I was lucky, and had some foresight, in 2015 when I signed on for my Medicare supplemental insurance. Most people go with the $70 supplement, but I paid for the most expensive ($180) per month plan that paid every last cent, as I knew I would be having surgery in January. As it turns out, that was a better decision than I ever could have imagined.

The only route that's fair is to have those who have pre-existing conditions either pay extra for them, or not have them treated. That's where I am now. I can't afford a bone marrow transplant, so I just get whatever time I get.

[wmenorr67]

Covering preventative care, covering pre-existing conditions, no payout caps, guaranteed coverage - these are all things consumers seem to want, so in theory insurance companies will offer them but they sure as hell aren't gonna be cheap. If the government says they have to offer them then we're right back to obamacare.

Let it be offered but not mandatory that you have to have it.  Kind of like options on a new vehicle, sure you can have 21" rims but they are going to add $1000 per to the cost.

[MechAg94]

I think I've mentioned in other threads that my care last year came to $429,000. Medicare more than likely didn't even pay $100,000. Still, what insurance company could afford to take me as a policy holder? It's likely I'll rack up those kind of numbers this year or next. They have no options except to have high premiums, deductibles, or both, or to amortize the cost of people like me across their entire customer base. (This is all obvious to all obvious to everyone here).

I can't think of a way to cover existing conditions without raising the premiums somewhere.

I was lucky, and had some foresight, in 2015 when I signed on for my Medicare supplemental insurance. Most people go with the $70 supplement, but I paid for the most expensive ($180) per month plan that paid every last cent, as I knew I would be having surgery in January. As it turns out, that was a better decision than I ever could have imagined.

The only route that's fair is to have those who have pre-existing conditions either pay extra for them, or not have them treated. That's where I am now. I can't afford a bone marrow transplant, so I just get whatever time I get.

I am not opposed to some sort of govt system to assist people like you.  I just don't know how to set it up so it doesn't turn into a massive fraud scheme.  

My only solution is something managed and funded at the local level where there is a fixed budget and the people deciding who gets help are close enough to know who the people are and verify things.  There would still be fraud, but if it was state or locally funded, it might be easier control.  I have come across a lot of otherwise honest people who stop caring how much money they spend when they think it is Big FedGov paying.

[MechAg94]

Says who?
Maybe I'm misunderstanding but this sounds like more government regulation. Which is the problem in the first place, right?

Covering preventative care, covering pre-existing conditions, no payout caps, guaranteed coverage - these are all things consumers seem to want, so in theory insurance companies will offer them but they sure as hell aren't gonna be cheap. If the government says they have to offer them then we're right back to obamacare.

What I was thinking of are contract clauses to pay out if the purchaser is diagnosed with something chronic.  Either pay for the care or pay a lump sum to back out of the coverage.  Something similar to life insurance might be the answer.

There is an optional catastrophic health care adder to my work insurance that pays a lump sum if I am diagnosed with one of a list of illnesses like cancer.  IMO, that is similar though maybe not the same as what I am thinking of.  

That doesn't help someone who already has a medical condition.

[Regolith]

Not a gag order in the least. The paradigm of advertising prescription drugs directly to the public is bullshit. At one time it wasn't permitted, and the drug companies got along just fine.

Friend of mine is a doctor and has had countless experiences of patients coming in and asking about the new drug for their condition and getting both pissed off and argumentative when she tells them that it's either not approved for their particular condition, it's likely to be a worse treatment for their condition than the old standby that they're on, it's not covered by their insurance so they'll have to pay HUGE costs out of pocket, or it's not going to work and play well with the other drugs that they're on (or a combination of all of the above).

In one case a patient demanded to be put on some new drug.

"I can't do that."

Why not?

"Because if you combine it with drug X, which you've been taking for over 20 years for X, your risk of suffering a massive stroke goes from not likely because your BP is well controlled to  the certainty of being dead with blood gushing out your eyes and ears."

It wasn't that bad, and she obviously didn't say that, but in the MD's opinion it was not a good choice for her patient.

We pay doctors to design the best treatment protocols for our particular health needs. Is that fool proof? No, but in my opinion it's one hell of a lot more foolproof than depending on an actor in a TV commercial for your treatment regime.

Can you point out for me where in the constitution the government is permitted to stop anyone saying anything, so long as it isn't fraudulent? I seem to have missed that section in the First Amendment.

[K Frame]

Oh please, don't even try that claptrap.

Even the framers didn't consider every right to be absolute, and this is hardly an issue of free speech in the first place.

[Perd Hapley]

Oh please, don't even try that claptrap.

Even the framers didn't consider every right to be absolute, and this is hardly an issue of free speech in the first place.

Why do you say that?

[Northwoods]

Forcing companies to cover pre-existing conditions is incompatible with a free market solution. And unless you force them, they aren't going to (for good reason).

Saying that "you can't be denied" if you maintain coverage doesn't work either. Are they allowed to increase prices if your health changes and you become higher risk? If not then you're adding price controls into the mix. If they can increase prices according to risk then they won't need to ever officially deny coverage, just make absurdly unaffordable.

Insurance is a tool to spread risk.  Monkeyleg can't possibly afford to pay for $429k (for 1 year's worth of many years of treatment) for cancer expenses.  I can't afford to pay for the likely costs coming over the next 40+ years due to getting Parkinson's at the ripe age of 38.  By buying insurance (in my case through my employer since FDR set us up with that stupid-ass paradigm) I'm buying into a pool that is meant to cover those huge expenses.  Same for Monkeyleg.  It should be illegal for insurance companies to drop us like a hot potato just because we happened to wind up in the high expense part of the population.  And if we lose our insurance for reasons out of our control (e.g. the carrier just up and leaves our state, employer lays us off, etc) why should we be left out in the cold unable to afford necessary care just because someone else made a decision that forced us to get different coverage?

A free market is a good thing, but the abuse of those who've paid in faithfully for years/decades shouldn't be allowed.  A free market is not a license to take advantage of those in bad situations. 

[Regolith]

Oh please, don't even try that claptrap.

Even the framers didn't consider every right to be absolute, and this is hardly an issue of free speech in the first place.

Bullshit. You don't just get to say "Not every right is absolute!" every time the restriction YOU happen to want doesn't pass the smell test; you might as well pull out the "fire in a crowded theater" canard. You need a hell of a lot of a better reason than that.  And "patients might bother their doctor about medications they don't need" isn't really up to muster, especially since it wouldn't stop it anyway, unless you plan on stopping people about talking about whatever medications they're taking to other people as well (I've heard many people tell their friends to ask their doctor about X medication because it happened to work for them, regardless of whether or not they're even suffering the same disorder).

Also, how the hell ISN'T it an issue of freedom of speech? You're talking about stopping people from conveying information because you don't like a potential outcome of people possessing that information. Sounds like a freedom of speech issue to me.

[Firethorn]

I don't know the exact numbers as far as the health costs/benefits... but I do know that it's been repeatedly shown that preventative care is several magnitudes cheaper than emergency care.

For example, I know that my middle child's last "well child" ("free" yearly visit) cost my insurance about $500 - but that included all of his school shots.

Indeed.  That's why many insurances offer various preventative services for free - because it'd cost them more in the long run if somebody does without the preventative.  Consider it a 'price' for them offering you cheaper health insurance.

[DittoHead]

Insurance is a tool to spread risk. 

Yes but once you have a pre-existing condition it's no longer just a risk. That would be like having your new car insurance cover an accident that you got in before they started covering you. Why would they do that? Why would anyone sign up for insurance until AFTER they need it?

It should be illegal for insurance companies to drop us like a hot potato just because we happened to wind up in the high expense part of the population. 

If you have some sort of agreement with them that says as long you keep paying they have to keep covering you, then sure they shouldn't be able to get out of it. But that's not how most insurance plans work - it's a year to year basis and they'll cover you for that year and reassess your risk after that year. If you want some sort of guaranteed coverage for life from an insurance company you'd better get that in writing and it's not gonna be cheap.

And if we lose our insurance for reasons out of our control (e.g. the carrier just up and leaves our state, employer lays us off, etc) why should we be left out in the cold unable to afford necessary care just because someone else made a decision that forced us to get different coverage?

Lots of things happen to people that are out of their control, it's their personal responsibility to adapt to those situations as best they can.

A free market is a good thing, but the abuse of those who've paid in faithfully for years/decades shouldn't be allowed.  A free market is not a license to take advantage of those in bad situations.

People buying insurance need to understand what they are paying for. The insurance company is under no obligation to continue doing business with someone just because they did so in the past even if it was for many years/decades. I will grant that the paperwork explaining coverage is very confusing but that doesn't absolve people from their responsibility.