Armed Polite Society
Main Forums => Politics => Topic started by: Scout26 on October 14, 2017, 12:45:51 AM
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First we have the Executive Order:
https://www.newyorker.com/news/amy-davidson-sorkin/donald-trumps-terrible-executive-order-on-health-care
Where the knickers of the New Yorker are such a bunch that they had to break out the thesaurus to get enough synonyms for "Terrible".
Then we have the cut-off of the "illegal" subsidies.
http://www.foxnews.com/politics/2017/10/13/democratic-ags-sue-trump-over-obamacare-subsidy-cutoff.html
From the New Yorker story:
Trump claimed that he had no choice but to defund the subsidies because paying them went against the will of Congress. This is the argument in a lawsuit, instigated by House Republicans, that is making its way through the federal courts. Basically, those Republicans argue that, although the plain language of the A.C.A. describes and authorizes the payment of subsidies, Congress should be allowed to vote on actually releasing the money every year. In effect, Congress promised the money when it passed the A.C.A., but now it wants the right to hold that money hostage on a regular basis. The case relies on a highly technical reading of the legislative fine print; nevertheless, the congressional challengers won a round in the lower courts, though that had been stayed pending an appeal—one that, on Thursday, the Trump Administration apparently decided to drop. (Attorney General Jeff Sessions had earlier said that he agreed with the House Republicans.) More than that, it is, at best, a technical ambiguity that any congressional majority interested in something other than utter chaos in the insurance markets could easily fix. Such a majority does not exist right now.
Sure sucks when the law, as written, doesn't agree with your feelings. IIRC, authorizations for expenditures have to be approved year-by-year as prior Congresses can't bind the hands of future Congresses via expenditures. Which is why there is (supposed to be) an annual budget process and budget.
So if Congress won't repeal Obamacare, Trump is bound and determined to keep his promise and push it over a cliff so it can die screaming in a fire.
While I don't like the dictatorial elements, they do appear to be constitutional means and methods to subvert the ACA via its flaws. It's not like he's re-writting entire sections to help out his donors and others. The onus is still on Congress to act to repeal and replace Obamacare. Since the USSC ruled that Obamacare is a "tax", perhaps when Congress gets to work on Tax reform, they are repeal Obamacare at the same time. Given what Trump has done, there will not be any insurers left in any of the marketplaces or counties to offer insurance.
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I would love to see the "group insurance" mandate turned into a federal requirement that states can't overrule. I tried to get Costco insurance a few years ago, but it wasn't available in CA. As of now, AFAIK, it's not available to individuals at all in any state. Hopefully the EO will allow big outfits like them, Walmart, the NRA, etc. to offer affordable individual plans with choices (like not paying for maternity coverage if you're a male).
I always said that if Obamacare was really serious and cared about affordability, they would have allowed for things like people who leave an employer be allowed to remain on that employer's group plan (on their own dime), and allow for organizations to form ubiquitous group plans. Of course that would lower prices too much, keep middle income people out of Obamacare, and not provide money to cover subsidies for the people who get free insurance. Even Bill Clinton said that was an abomination that directly targeted middle income earners.
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I always said that if Obamacare was really serious and cared about affordability, they would have allowed for things like people who leave an employer be allowed to remain on that employer's group plan (on their own dime), ...
You mean like COBRA?
There's nothing even remotely affordable about paying the full price for your former employer's group plan. Been there, done that.
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You mean like COBRA?
There's nothing even remotely affordable about paying the full price for your former employer's group plan. Been there, done that.
COBRA includes a surcharge.
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COBRA includes a surcharge.
I didn't know that. [Nobody ever tells me anything.]
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COBRA includes a surcharge.
It's not a "Surcharge". It's you have to pay you share of the cost AND what share your employer had been paying as part of your benefit package. So instead of say you paying 50% and your employer paying 50%, you now get to pay 100%.
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It's not a "Surcharge". It's you have to pay you share of the cost AND what share your employer had been paying as part of your benefit package. So instead of say you paying 50% and your employer paying 50%, you now get to pay 100%.
No, I know that - mentioned it in the OP. :)
There is also an additional surcharge since you're no longer a member of the group.
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I was able to get on a group plan this year because I'm on the board of directors (not an employee) of a local institution. I pay the full cost for myself and the wife. High deductible HSA qualified plan cost us $1528 per month which is better than the 1730 it was going to cost us.
1 month health insurance premium should not cost more than our mortgage (with no taxes or insurance in escrow btw). And this is no dive joint- 4 BR, 3 full bath, heated garage, all on 40 acres with outbuildings.
We are hearing forecast of 20% premium increases for 2018.
Trump can burn down Obamacare, the insurance companies, drug companies, and the big hospital systems for all I care.
I love where I live but the cost of health insurance is making it increasingly difficult to stay self employed and stay here.
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We are hearing forecast of 20% premium increases for 2018.
I'm up 48% for 2018, and it's the absolute cheapest plan available in my area. I'm also HDHP and HSA. If I made $40K or less per year, it would be $1/month on the CA Obamacare. Since I made more last year, I get to pay for all those people getting their health insurance for $1.
It looks like whatever Trump is doing is going to take possibly a year to implement, so it appears I have to suck up that 48%. My once a year visit to the doctor for a physical and blood work is going to cost me $8000 for the one appointment.
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Without the Insurance subsidy payments, it's going to fall apart fairly quickly. Insurance companies will bail if they are bleeding money. They won't wait until next year.
Also, I'm half tempted to setup my own group (John Browning Aficionados??) work with a Insurance company and offer my members ($5 per year) group plans as outlined in the Trump EO.
There are plenty of entities (Kiwanis, Rotary, Elks, American Legion, VFW, etc) that could be all over this. Same with Churches/religious groups.
It would not only increase their membership numbers, but it would be full circle (almost) to the "Mutual Aid" societies of the turn of the century.
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I was able to get on a group plan this year because I'm on the board of directors (not an employee) of a local institution. I pay the full cost for myself and the wife. High deductible HSA qualified plan cost us $1528 per month which is better than the 1730 it was going to cost us.
1 month health insurance premium should not cost more than our mortgage (with no taxes or insurance in escrow btw). And this is no dive joint- 4 BR, 3 full bath, heated garage, all on 40 acres with outbuildings.
We are hearing forecast of 20% premium increases for 2018.
Trump can burn down Obamacare, the insurance companies, drug companies, and the big hospital systems for all I care.
I love where I live but the cost of health insurance is making it increasingly difficult to stay self employed and stay here.
My problem with that sort of cost is that after a couple years of putting that money in the bank, you would have pretty good medical emergency fund of your own. Subsidizing other people's medical costs sucks.
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My problem with that sort of cost is that after a couple years of putting that money in the bank, you would have pretty good medical emergency fund of your own. Subsidizing other people's medical costs sucks.
For regular stuff, and even moderate medical expenses, yeah, banking money can be fiscally smarter (hence HSAs). You get hit with cancer (or a bus) though, and then not so much.
Hence why I hope they bring some type of catastrophic care insurance back. Hopefully with some different options. While I would take catastrophic care given my current health, at my age, I'd like just a little more than catastrophic, where I'm only out "X" dollars, and the insurance will cover at least up to a couple of million.
Other than it having me covered for pregnancy and other nonsense, I'd be fine with my current HDHP bronze plan for covering major medical (and not covering, as my dad likes to say, "every fart in my belly"). However given what it is, it seems it would be more reasonable in the $200/mo range. Not the $460/mo I'm paying now, and absolutely not the nearly $700/mo they're going to hit me with in 2018.
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I want my plan back that i had before the ACA became law. But the insurance companies are never going to let that happen. So now I am in debt up to my eyes and can't even affairs to go to the doctor.
Yeah it is so much better now.
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I want my plan back that i had before the ACA became law. But the insurance companies are never going to let that happen. So now I am in debt up to my eyes and can't even affairs to go to the doctor.
Yeah it is so much better now.
Sorry Jim, but according to the Obamacare fanclub, you are fake news. In the era of Obamacare, it is impossible for anyone to have to pay anything for health care. Anyone who says they're not covered or whose insurance and medical expenses have gone up instead of down is simply a liar.
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I want my plan back that i had before the ACA became law. But the insurance companies are never going to let that happen. So now I am in debt up to my eyes and can't even affairs to go to the doctor.
Exactly. I'm pretty sure I cracked another tooth, and the offer from the ex fiance who's now on disability to "sort of shack up"* so our combined incomes will qualify me for the community dental clinic down the road from her is starting to look really tempting.
*I have about as much interest in living with her more than a few days at a time as I do in paying the neighbor $20 to wipe off some pliers with a vodka soaked rag, yank the tooth and mold a replacement from JB Weld. On the other hand, every time I do the math, it looks more like the way to go until Trump can get some things done.
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This is one of several good videos from Reason that highlight doctors going insurance-free. (https://youtu.be/6-Vqjo2S1us)
An interesting thing that I learned from this one was that if you subscribe to a direct primary care practice you are disqualified from having a health savings account. Therefore you cannot use an HSA to pay your DPC.
But DPC docs are lobbying Congress to change that. But that seems like something that Trump could just change with an EO. And it certainly the sort of thing he would do. Unless there are downsides to that that I'm not seeing.
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This is one of several good videos from Reason that highlight doctors going insurance-free. (https://youtu.be/6-Vqjo2S1us)
An interesting thing that I learned from this one was that if you subscribe to a direct primary care practice you are disqualified from having a health savings account. Therefore you cannot use an HSA to pay your DPC.
But DPC docs are lobbying Congress to change that. But that seems like something that Trump could just change with an EO. And it certainly the sort of thing he would do. Unless there are downsides to that that I'm not seeing.
Personally, I'm all for an all-open HSA account. Annual contribution limit of something like $5k + healthcare costs not already claimed within the last three years. IE If you spend $15k in healthcare over 3 years, you can deposit a total of $30k into the account, leaving you with $15k + interest.
Add rules that allow you to transfer funds in an HSA to HSAs for your spouse and children, if you chose to. So somebody's kid might go to college with $60k in their HSA, which should cover medical expenses for darn close to life. Have some reasonable restrictions.
One that you can even deposit into using post-tax money and deduct later if your employer doesn't want to play.
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Health insurance...... if you are not on an employer's plan, you probably pay a lot more than you're comfortable paying. The only people who like Obama Care (ACA) are the people that get it for next to nothing. This has to change, but a law will not all of a sudden make poorer people be able to afford health insurance unless it is subsidized. The future is single payer unfortunately. Everything else just chips around the edges.
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Health insurance...... if you are not on an employer's plan, you probably pay a lot more than you're comfortable paying. The only people who like Obama Care (ACA) are the people that get it for next to nothing. This has to change, but a law will not all of a sudden make poorer people be able to afford health insurance unless it is subsidized. The future is single payer unfortunately. Everything else just chips around the edges.
Actually, I'd like to alter this just a smidgen - from affording health insurance to affording health coverage. It doesn't matter if health insurance is $50/year if it doesn't cover anything and people are still going bankrupt from healthcare costs from any illness.
People don't need healthcare insurance. They need to be able to seek care for an illness or injury without going bankrupt, and insurance should be for evening costs out - like with other insurances. You spend $600/year on house insurance, for example, to render a possible total loss from a fire down to a predictable $100/year as part of your umbrella home insurance policy.
And, because it is a critical life need, people will see the doctor no matter what. They'll just declare bankruptcy later, which raises the prices we all pay. Plus, the bankruptcy procedure is inefficient, so it's better to figure out a different way.
we don''t need single payer. I say that we raise eligibility for medicare though. The subsidies are to wean people off of a 100% coverage plan like medicare, to avoid that being a cliff - "We can't earn $1k more, we'd lose $18k in health benefits!"
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The subsidies are to wean people off of a 100% coverage plan like medicare, to avoid that being a cliff - "We can't earn $1k more, we'd lose $18k in health benefits!"
This is one of the major problems with Obamacare, which even Bill Clinton said is "crazy". Someone who makes $50K/yr ends up making less than someone who earns $40K/yr, because they have to pay that full insurance amount while the $40K person who qualifies for the subsidy gets insurance for practically free.
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The disconnect i see on both sides of the ACA argument is that having insurance and being able to afford to go to the doctor are two completely different things.
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The disconnect i see on both sides of the ACA argument is that having insurance and being able to afford to go to the doctor are two completely different things.
Much like having a right to health care, and being able to afford health care are two different things. The right to have arms, and the ability to afford them, and so on...
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The disconnect i see on both sides of the ACA argument is that having insurance and being able to afford to go to the doctor are two completely different things.
Yep. Which is my entire point. If going to the doctor is $40, well, the vast majority of people in the US can scrounge up $40.
What gets me is that, in many cases, the standard copay for seeing a doctor - turns out to be as high, or higher, than what a doctor who doesn't deal with insurance charges for a standard visit.
That's how much they're screwing us - they've inflated the price of a standard visit something around 100%. Everything else follows from that, I think.
Another thing that Obama did is make it so there's a maximum percentage insurance companies can use for administration and profit. Problem with that? Remember government cost plus contracts? It places a perverse incentive on insurance companies to pay more for medical care - because then that percentage can be stretched further.
In most areas, there isn't enough competitors to stop this either.
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Yep. Which is my entire point. If going to the doctor is $40, well, the vast majority of people in the US can scrounge up $40.
What gets me is that, in many cases, the standard copay for seeing a doctor - turns out to be as high, or higher, than what a doctor who doesn't deal with insurance charges for a standard visit.
That's how much they're screwing us - they've inflated the price of a standard visit something around 100%. Everything else follows from that, I think.
In the systems I have worked at, the typical co-pay (depending on the insurance plan) is $ 15-20. If you don't have insurance and you are paying cash, you will likely be paying $ 150-225, depending on the specialty and complexity of the visit. Usually around 70% of that charge goes to overhead, and the provider gets the remainder.
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Another thing that Obama did is make it so there's a maximum percentage insurance companies can use for administration and profit. Problem with that? Remember government cost plus contracts? It places a perverse incentive on insurance companies to pay more for medical care - because then that percentage can be stretched further.
If only we could apply that to government.
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If only we could apply that to government.
Uh? In what aspect do we NOT? The government gets a cost+ amount of your income for "administration" stuff. It signs out cost+ contracts all the time.
And, as I just pointed out, this sucks as a system.
In the systems I have worked at, the typical co-pay (depending on the insurance plan) is $ 15-20. If you don't have insurance and you are paying cash, you will likely be paying $ 150-225, depending on the specialty and complexity of the visit. Usually around 70% of that charge goes to overhead, and the provider gets the remainder.
The system I was looking at was a regular GP visit, with a $40 copay. For paying cash, shopping around a bit to get the best deal(which you don't do when insurance is paying), especially providers that have jettisoned ALL insurance dealings.
Then consider - 70% of the charge going to overhead. $150 * .3 = $45 going to the doctor.
I'm not saying that overhead can be eliminated, but 70%, really?
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Uh? In what aspect do we NOT? The government gets a cost+ amount of your income for "administration" stuff. It signs out cost+ contracts all the time.
And, as I just pointed out, this sucks as a system.
The system I was looking at was a regular GP visit, with a $40 copay. For paying cash, shopping around a bit to get the best deal(which you don't do when insurance is paying), especially providers that have jettisoned ALL insurance dealings.
Then consider - 70% of the charge going to overhead. $150 * .3 = $45 going to the doctor.
I'm not saying that overhead can be eliminated, but 70%, really?
70% for overhead is probably what the govt is doing with our taxes though that might be optimistic.
The overhead is why I think going to basically a cash for services straight free market system would be cheaper for everyone, doctors and patients. I doubt it would ever happen. There is always an outlier or other excuse. In trying to "cover" everyone, we end up preventing people from getting basic health care.
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70% for overhead is probably what the govt is doing with our taxes though that might be optimistic.
The overhead is why I think going to basically a cash for services straight free market system would be cheaper for everyone, doctors and patients. I doubt it would ever happen. There is always an outlier or other excuse. In trying to "cover" everyone, we end up preventing people from getting basic health care.
Chronic or serious illness is the "outlier or other excuse". These are quite common, statistically speaking. Car accidents, heart attacks, etc.
Which could be resolved with catastrophic health insurance coverage, but that would violate the 'cash for services straight free market system' thing mentioned.
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Chronic or serious illness is the "outlier or other excuse". These are quite common, statistically speaking. Car accidents, heart attacks, etc.
Which could be resolved with catastrophic health insurance coverage, but that would violate the 'cash for services straight free market system' thing mentioned.
Not if government butted out. The free market would figure out the best balance.
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Uh? In what aspect do we NOT? The government gets a cost+ amount of your income for "administration" stuff. It signs out cost+ contracts all the time.
And, as I just pointed out, this sucks as a system.
The system I was looking at was a regular GP visit, with a $40 copay. For paying cash, shopping around a bit to get the best deal(which you don't do when insurance is paying), especially providers that have jettisoned ALL insurance dealings.
Then consider - 70% of the charge going to overhead. $150 * .3 = $45 going to the doctor.
I'm not saying that overhead can be eliminated, but 70%, really?
Overhead really depends on your specialty, location and practice setting. The national average is around 60% or so, as per the MGMA. The more staff and the more expensive the location, the higher the overhead. Overhead typically includes the fixed costs such as rent, staff salaries and benefits, taxes, insurance, medical supplies/equipment and the like. It is entirely feasible, and happens every darn day, that we lose money on patient visits because Medicare/Medicaid/private insurance does not cover the fixed costs of the overhead to see that patient. Especially in primary care, we may end up making about $ 30 or less in 'profit' for a typical office visit paid by many of the insurance plans. This is why we now expect the typical primary care provider to see 20-25 patients per day. Volume is the only way to survive. The 'good' thing about the ACA is that at least the patients have some degree of insurance so we can get some degree of reimbursement, as opposed to writing it all off to bad debt. See all the especially rural hospitals who have shut down entirely or had to close the ER because of this. Not enough actual revenue coming in to pay the bills.
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Overhead really depends on your specialty, location and practice setting. The national average is around 60% or so, as per the MGMA. The more staff and the more expensive the location, the higher the overhead. Overhead typically includes the fixed costs such as rent, staff salaries and benefits, taxes, insurance, medical supplies/equipment and the like. It is entirely feasible, and happens every darn day, that we lose money on patient visits because Medicare/Medicaid/private insurance does not cover the fixed costs of the overhead to see that patient. Especially in primary care, we may end up making about $ 30 or less in 'profit' for a typical office visit paid by many of the insurance plans. This is why we now expect the typical primary care provider to see 20-25 patients per day. Volume is the only way to survive.
Hmm... interesting.
It is starting to sound like house calls by doctors might be far more cost effective. Less of the "go to the doctor and get sick from the sick people at the doctor" as well.
I wonder if making 10 house calls per day would be provide significantly more profit than 20 per day in an office.
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http://www.latimes.com/business/technology/la-me-doctor-house-calls-20160320-story.html
Here is an interesting story about house calls. You could make money at it if you charged a standard office visit fee but accepted cash only at the time of service and were in a busy area with a steady stream of visits. No insurance and no billing hassles. You can have a lot of unpaid downtime however, with travel to/from the patients and times when there are no patients to see.
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Essentially there is no simple solution to healthcare. Socialized healthcare comes with bureaucracy, long wait times, etc. Free market healthcare doesn't handle chronic or ueber expensive stuff well. American healthcare grabs the worst of both worlds, and subsidizes the entire world's pharmacological development. Oddly, virtually no one thanks us for developing life saving cheap drugs.
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Perhaps of interest, I saw my cardiologist today. I had to go to a different location, and deal with a completely different staff and office setup. It's a multi-doctor practice that was formerly associated with a large-ish hospital in another city. Now the doctors from my doc's practice have joined into an even larger group practice that's affiliated with the larger-ish hospital in the nearby city. I asked him why the change.
His answer was that the other hospital "fired" them. When I first saw him, it was a private practice with no affiliation. Just a few months after I first became their patient, the practice was acquired by the hospital in the other city. Apparently, the doctors wasted too much time doctoring, and that hospital didn't think they were producing enough profit. So they cut them loose.
I guess by rolling into a larger group practice they can continue to practice decent doctoring and realize efficiencies of scale by having more doctors share the staff. Dunno -- time will tell.
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A popular complaint of the left is that Trump is "sabotaging Obamacare." I hope they keep saying that. Yeah, keep spreading the word that Trump is following through on a major campaign promise. Enjoy your 8 years.
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A popular complaint of the left is that Trump is "sabotaging Obamacare." I hope they keep saying that. Yeah, keep spreading the word that Trump is following through on a major campaign promise. Enjoy your 8 years.
I'm not sure that would work out the way you're thinking. If people lose their healthcare because of it, they'll be pissed.
Essentially there is no simple solution to healthcare. Socialized healthcare comes with bureaucracy, long wait times, etc. Free market healthcare doesn't handle chronic or ueber expensive stuff well. American healthcare grabs the worst of both worlds, and subsidizes the entire world's pharmacological development. Oddly, virtually no one thanks us for developing life saving cheap drugs.
I agree with you 100% on the worst of both worlds. Note, long wait times are not actually guaranteed - a lot of european countries have waiting times that average out to the same as the USA. You know, an x-ray might be slower, but sonograms faster, type stuff.
The US has effectively single payer coverage for two of the most expensive conditions out there - Dialysis and Transplants. I propose something along these lines:
1. Universal HSP eligibility
2. Most people pay for most of their healthcare via the HSP.
3. Insurance covers the range between, oh, $6k and $1M. The $6k can be increased if the HSP is suitably funded.
4. Uncle Sam picks up past $1M, because how many people get that much healthcare and aren't dying or disabled? This provides stability to the insurance companies.
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I'm not sure that would work out the way you're thinking. If people lose their healthcare because of it, they'll be pissed.
That's not what I meant. He said he'd repeal Obamacare. "Sabotaging Obamacare" sounds a lot like repealing it.
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Perhaps of interest, I saw my cardiologist today. I had to go to a different location, and deal with a completely different staff and office setup. It's a multi-doctor practice that was formerly associated with a large-ish hospital in another city. Now the doctors from my doc's practice have joined into an even larger group practice that's affiliated with the larger-ish hospital in the nearby city. I asked him why the change.
His answer was that the other hospital "fired" them. When I first saw him, it was a private practice with no affiliation. Just a few months after I first became their patient, the practice was acquired by the hospital in the other city. Apparently, the doctors wasted too much time doctoring, and that hospital didn't think they were producing enough profit. So they cut them loose.
I guess by rolling into a larger group practice they can continue to practice decent doctoring and realize efficiencies of scale by having more doctors share the staff. Dunno -- time will tell.
My guess is that the cardiology group did not meet expectations for patients admitted to, and procedures performed at, the hospital that owned them. So from that standpoint, the group was not producing a profit for the hospital.
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That's not what I meant. He said he'd repeal Obamacare. "Sabotaging Obamacare" sounds a lot like repealing it.
BUT BUT BUT BUT... HE MIGHT BE BLAMED FOR OBAMACARE FAILING!@!!!!@!@
<wrings hangs> <wipes cold sweat off of brow>
/spineless GOP crapweasels off
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The most reasonable health care system I have read about is Singapore's system. It combines a mandatory heath savings account contribution (6.5–9.0%) for citizens with gov subsidies for hospital care based on income. The largest subsidy available for lower income folks is 80%- so everyone must pay at least of 20% of their bill in cash, with richer people paying a lot more.
The mandatory HSA can be used to pay for private insurance or for paying health care bills.
I have no idea how this system would work in the USA.
https://en.wikipedia.org/wiki/Healthcare_in_Singapore
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Uh? In what aspect do we NOT? The government gets a cost+ amount of your income for "administration" stuff. It signs out cost+ contracts all the time.
I guess I wasn't clear. What I meant was, make it so there's a maximum percentage insurance companies government can use for administration and profit on ANY program or service. Government is horrible at getting the best bang for our bucks with duplication of administrative services, fraud, waste, abuse, affirmative action bidding, pork barrel projects, etc.
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I'm not sure that would work out the way you're thinking. If people lose their healthcare because of it, they'll be pissed.
It's not "losing Healthcare", it they'll be pissed if they have to pay for their own.
Insurance (was) just that. It was to cover you if something catastrophic happened. You break your arm or leg or get a serious illness. Not "I have the sniffles, someone else pay for my doctor/office visit." I said on many occasions, I remember watching my mother write a check for $25 or $50 or some such amount after dragging me to the doctor because that cough wouldn't go away or a fever wouldn't come down. That came out of pocket. When I broke my arm(s) and leg(s), they took me to the ER and that was covered by insurance.
People don't understand what insurance is.
Allstate doesn't cover you taking your car in for an oil change. State Farm doesn't cover needing new tires. USAA doesn't pay when you need to replace your brakes. But all pay (if you have insurance) to get your car repaired AFTER an accident, if you had their insurance BEFORE the accident.
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American healthcare grabs the worst of both worlds, and subsidizes the entire world's pharmacological development. Oddly, virtually no one thanks us for developing life saving cheap drugs.
That is a huge part of the problem. It sucks that we American consumers are the ones stuck paying the lion's share of the R&D costs.
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That's not what I meant. He said he'd repeal Obamacare. "Sabotaging Obamacare" sounds a lot like repealing it.
I think most who cared enough about healthcare for it to be a point wanted "repeal and replace". I have very little skin in the game and I want it replaced more than repealed. Hell, I'd settle for some laws just fixing the major problems.
The republicans haven't come up with a viable replacement yet, and I think that is why it hasn't been successfully repealed.
Meanwhile, people have to live in the system, so it's like throwing sand in the engine of your only car because you wanted a better car. Making the existing car worse, without providing the new one, isn't helping the person.
I guess I wasn't clear. What I meant was, make it so there's a maximum percentage insurance companies government can use for administration and profit on ANY program or service. Government is horrible at getting the best bang for our bucks with duplication of administrative services, fraud, waste, abuse, affirmative action bidding, pork barrel projects, etc.
I just got done telling you that that was a bad idea because it simply encourages larger spending to match the desired overhead(and profit), didn't I?
I'd prefer to just actually empower the OMB to fight fraud, waste, and abuse.
It's not "losing Healthcare", it they'll be pissed if they have to pay for their own.
At our costs, why wouldn't they be pissed? It's cheaper to fly to the Bahamas and take a vacation for a couple weeks to get a hip replacement than it is to get it done at home, and that's including the flights and expense of the vacation!
And in many cases, with our increased costs, it becomes a case of if you are lower income, you can't afford it period. As in the recommended treatment exceeds your income entirely. Should we let such people die from lack of treatment? Become disabled? In continuous pain? Etc...
In many cases, their medical condition amounts to a moderate disability that limits their ability to work(not prevents, limits), and being marked as disabled and going on medicaid is difficult and can take years.
Insurance (was) just that.
As a note, I agree with you. I only call it "insurance" because that is what people recognize. Often I'll call them "healthcare plans". Because they're not insurance.
Allstate doesn't cover you taking your car in for an oil change. State Farm doesn't cover needing new tires. USAA doesn't pay when you need to replace your brakes. But all pay (if you have insurance) to get your car repaired AFTER an accident, if you had their insurance BEFORE the accident.
A better analogy might be windshield replacements. Some insurance companies pay for them because it is a "Safety issue", some don't. Most wave the deductible and pay for having small cracks repaired completely.
The idea is that paying for the preventive service is cheaper than paying for the treatment later.
And it doesn't help that the insurance companies have arranged to be the "cheaper" method of getting various forms of healthcare, so doing it alone will often get you higher prices even if you are paying cash.
There are also problems. If it worked more like car insurance, my father wouldn't have to maintain coverage during his cancer treatment - the insurance he had when it was discovered would have to pay for all treatment for that cancer.
If the insurance companies want to have their cake about pre-existing conditions, they should have to eat all of it - that means that if you had insurance when the condition was discovered/developed, then that insurance has to pay for it.
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I think most who cared enough about healthcare for it to be a point wanted "repeal and replace". I have very little skin in the game and I want it replaced more than repealed. Hell, I'd settle for some laws just fixing the major problems.
The republicans haven't come up with a viable replacement yet, and I think that is why it hasn't been successfully repealed.
Meanwhile, people have to live in the system, so it's like throwing sand in the engine of your only car because you wanted a better car. Making the existing car worse, without providing the new one, isn't helping the person.
You're talking about policy. I was talking about the way his opponents are framing it. Two very different issues.
They're saying he's bringing down Obamacare. He was elected to bring down Obamacare. When you're not looking at the actual policies (and plenty don't), "sabotaging Obamacare" sounds good to a lot of people. Again, I'm just talking about the sound of the words, not the policy, or its effects.
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At our costs, why wouldn't they be pissed? It's cheaper to fly to the Bahamas and take a vacation for a couple weeks to get a hip replacement than it is to get it done at home, and that's including the flights and expense of the vacation!
And in many cases, with our increased costs, it becomes a case of if you are lower income, you can't afford it period. As in the recommended treatment exceeds your income entirely. Should we let such people die from lack of treatment? Become disabled? In continuous pain? Etc...
In many cases, their medical condition amounts to a moderate disability that limits their ability to work(not prevents, limits), and being marked as disabled and going on medicaid is difficult and can take years.
A new hip is covered by insurance, as it should be. And for something like that you could and should be able to shop around (unless it's an Emergency, then you take what you can get.)
And for the truly poor (not the Obamacare 400% of poverty level "poor")*, in the past the Mutual Aid Societies, Charitable Groups, Hospitals, and Doctors all helped to cover the truly poor. I see no reason why they can't do that now.
As a note, I agree with you. I only call it "insurance" because that is what people recognize. Often I'll call them "healthcare plans". Because they're not insurance.
A better analogy might be windshield replacements. Some insurance companies pay for them because it is a "Safety issue", some don't. Most wave the deductible and pay for having small cracks repaired completely.
The idea is that paying for the preventive service is cheaper than paying for the treatment later.
And it doesn't help that the insurance companies have arranged to be the "cheaper" method of getting various forms of healthcare, so doing it alone will often get you higher prices even if you are paying cash.
There are also problems. If it worked more like car insurance, my father wouldn't have to maintain coverage during his cancer treatment - the insurance he had when it was discovered would have to pay for all treatment for that cancer.
If the insurance companies want to have their cake about pre-existing conditions, they should have to eat all of it - that means that if you had insurance when the condition was discovered/developed, then that insurance has to pay for it.
We need to call things what they truly are. "Healthcare" is what you and your doctors and other professionals do to make you well again. "Insurance" is to transfer risk, a thing providing protection against a possible eventuality. "Welfare" is getting someone else to pay for your problem(s).
If you father only needed one cancer treatment, then I'd agree with you. But since that car keeps crashing into a tree several times a week or so, then you need insurance for each one of those. (I know, BTDTGTTS.) The insurance will pay for that, but what about something else going wrong ?? If he had a heart attack, but had stopped paying for the insurance, then you are fine with that not being covered ??
And look at the deductibles/max out of pocket for O-care. It's designed to NOT be used by the people paying for it, but TO be used that people that aren't. Seriously, if you deductible is $10,000, you going avoid going to the doctor/hospital as best you can, but if your deductible is NOTHING, then you're going to Doctor or ER every chance you get. Since it's FREE !!!
*- don't even get me started on a lot of the folks that are "Poor" under Obamacare, yet have brand new tattoos, piercings, the latest iPhones, and nicer, new cars then I drive. All the while "chilling" in their Section 8 housing, watching the latest flatscreen TV, waiting for their EBT card to recharge with more food stamp and welfare money. :mad: :mad: :mad: :mad: :mad: :mad: :mad:
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http://news.trust.org/item/20171020050722-gq4hu
The nursing shortage will get worse as the baby boomers retire and there are not enough slots in the nursing schools due to lack of faculty. This may well lead to hospitals closing wards, closing to new admits or cancelling surgeries. The answer is not necessarily as easy as 'raise wages' when the hospital revenue is dropping.
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I think most who cared enough about healthcare for it to be a point wanted "repeal and replace". I have very little skin in the game and I want it replaced more than repealed. Hell, I'd settle for some laws just fixing the major problems.
You haven't been paying attention. Every attempt, ever, to fix a problem, by the .gov passing a law, has created more problems then they have solved. The Law of Unintended Consequences....
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You haven't been paying attention. Every attempt, ever, to fix a problem, by the .gov passing a law, has created more problems then they have solved. The Law of Unintended Consequences....
Are you being sarcastic here? You provide no proof that this is the case.
A new hip is covered by insurance, as it should be. And for something like that you could and should be able to shop around (unless it's an Emergency, then you take what you can get.)
Why? Isn't a new hip normally routine maintenance due to aging?
But I agree on shopping around except for when they do studies and hospitals aren't able to give quotes within an order of magnitude of what they expect the final bill to be.
And for the truly poor (not the Obamacare 400% of poverty level "poor")*, in the past the Mutual Aid Societies, Charitable Groups, Hospitals, and Doctors all helped to cover the truly poor. I see no reason why they can't do that now.
400% is where the subsidies end. If you're a family of 4 making $90k, you're not getting much of a subsidy. That said, I'd consider changing that 'tuning', more than a knock on the program.
We need to call things what they truly are. "Healthcare" is what you and your doctors and other professionals do to make you well again. "Insurance" is to transfer risk, a thing providing protection against a possible eventuality. "Welfare" is getting someone else to pay for your problem(s).
That's why I used "healthcare plan". It isn't insurance, and it isn't healthcare. It's a plan for getting healthcare. It's not an ideal term. I'd welcome a better one, I just can't think of one at the moment.
If you father only needed one cancer treatment, then I'd agree with you. But since that car keeps crashing into a tree several times a week or so, then you need insurance for each one of those. (I know, BTDTGTTS.) The insurance will pay for that, but what about something else going wrong ?? If he had a heart attack, but had stopped paying for the insurance, then you are fine with that not being covered ??
I wouldn't be "fine" with it, he is my father, after all, but I'd be more mad at Dad than the insurance companies.
And look at the deductibles/max out of pocket for O-care. It's designed to NOT be used by the people paying for it, but TO be used that people that aren't. Seriously, if you deductible is $10,000, you going avoid going to the doctor/hospital as best you can, but if your deductible is NOTHING, then you're going to Doctor or ER every chance you get. Since it's FREE !!!
Have you actually studied Obamacare? Because zero deductible isn't a thing in those plans. What do you mean by "not used by people paying for it, used by those who aren't"? Because they all end up in the same plans, just with varying amounts of the premium covered by the government.
And even in countries with no deductibles, they don't find that Doctor/ER visits become too common. Visiting the doctor is a pain for most people, and a marginally high deductible won't deter the hypochondriacs anyways, and those with better things to do will go elsewhere anyways.
*- don't even get me started on a lot of the folks that are "Poor" under Obamacare, yet have brand new tattoos, piercings, the latest iPhones, and nicer, new cars then I drive. All the while "chilling" in their Section 8 housing, watching the latest flatscreen TV, waiting for their EBT card to recharge with more food stamp and welfare money.
I think you have issues in that the people you are assuming are "poor" are actually employed and doing other things. Either that or they're committing fraud.
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Why? Isn't a new hip normally routine maintenance due to aging?
A fair number of joint replacements are due to abuse in the form of obesity. You can't exceed the weight rating by a significant margin and expect it to last as long as if used properly. (Though I'm fairly certain these aren't included in the ~20% of American healthcare spending for obesity related issues.)
Had a friend who needed a knee replacement, but the doc told her it wouldn't last if she didn't get and stay well under 300lbs. So she got a wheelchair instead.
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Had a friend who needed a knee replacement, but the doc told her it wouldn't last if she didn't get and stay well under 300lbs. So she got a wheelchair instead.
I see a lot of that around here. As much as the leftists on the coast irritated me, most of them took care of themselves. There's a lot of fat people around here. I swear every fifth license plate is handicapped, and every time I go to Costco or Walmart, there's at least a dozen people all tooling around in motorized carts - most all of them very overweight.
I see the same thing in my own family. My sister can barely walk, and most all of it is due to her being fat. If she lost 100 lbs, it would make all the difference, but she prefers to take pain meds and sit on her ass watching TV all day. Hilariously, she always complains that she can't run this or that errand because of her back or feet or whatever, and gets my 90 year old dad (AKA the enabler) to do it, then everytime he goes to her house he sees a ton of sweets and a freezer full of ice cream, which somehow she was able to walk into the store to buy.
To tie into the health care, as we have discussed many times around here, if more doctors cut down on prescriptions as an easy out for both them and the patient, and pushed exercise / physical therapy, there would be a lot fewer disabled license plates on the road.
Certainly there are cases that simply can't be fixed and require some pain medication for quality of life, but I suspect they are a very small number in the population of handicapped placards, disability benefits, and motorized carts at the Walmart. Especially when you see how young some of these people are.
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^^^I take care of those patients, and the enthusiasm for beginning and continuing exercise or PT is very low. We can recommend and make referrals, but it is up to the patient to carry out the plan.
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^^^I take care of those patients, and the enthusiasm for beginning and continuing exercise or PT is very low. We can recommend and make referrals, but it is up to the patient to carry out the plan.
Yeah, sorry - poor writing on my part. I was by no means laying all the blame on the health care industry. It's a two way street.
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^^^I take care of those patients, and the enthusiasm for beginning and continuing exercise or PT is very low. We can recommend and make referrals, but it is up to the patient to carry out the plan.
We could quit referring them to "Pain Management" clinics. If your back and/or joints hurt because you're fat, take 800mg of Motrin and go for a run. Or live in pain, I don't care but nothing that's not over the counter for you.
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A lot of the obese chronic pain patients that we see are that way because they sustained some sort of injury, typically a back injury, and that limited their mobility and ability to exercise, and the obesity followed and that limited their mobility and ability to exercise even more. In our chronic pain committee meeting just yesterday, we were reviewing a patient case who was injured in a motorcycle accident (a car ran a stop sign and hit him from the right). He sustained major orthopedic and soft tissue trauma and had many surgeries. And I was thinking that could be me, on my motorcycle or bicycle.
Obesity, like chronic pain, is another one of those conditions that modern medicine still cannot fix particularly well. We are probably all waiting for the day of an inexpensive pill with minimal side effects that would cause us to painlessly lose 20% of our body weight. We are not there yet.