What is going on with the Obamacare "repeal"?

[Pb]

I quit reading the news to spare my blood pressure a few weeks (and it is wonderful!).  Can someone tell me what is going on with the obamacare repeal?  I saw something had passed the House.  Are the Republicans screwing it up again like the crappy Ryancare or what?  Should I be outraged or hopeful?   

[K Frame]

My assessment?

The Republican party is *expletive deleted*ing things up so badly that they're virtually guaranteeing the Democrats of huge gain in the House and Senate in 18 months.

[makattak]

My assessment?

The Republican party is *expletive deleted*ing things up so badly that they're virtually guaranteeing the Democrats of huge gain in the House and Senate in 18 months.

That fits with my theory that they don't want to be in charge. They are actively sabotaging themselves so they'll lose.

I'm sure the sacrificial lambs will get cushy lobbying jobs.

(I know it sounds like a crazy conspiracy theory, but it makes more sense than what we've seen over the past few years.)

[DittoHead]

The house is hoping blame can be pinned on the senate, either for not fixing their terrible bill, or not passing their wonderful bill depending on what happens over there.

[Ben]

From what I've seen, it's modified Ryancare. I can't quite figure out the differences, other than they seem to be giving some kind of opt-out option for pre-existing conditions, in which states can create their own high risk pool. Something that sounded like a good compromise all other things considered, was that they were giving people a grace period to get standard insurance if they have a pre-existing condition. If they fail to do so after "X" period, they are out of luck and the insurance company can charge them whatever seems fair*. This is why they gave the option for states (likely CA, NY, etc.) to do the pool. It appears there will be quite a few more modifications before it has a chance of passing the senate.

Krauthammer has been bugging me of late, but I think he has hit the nail on the head with his latest opinion that we will have single payer within seven years. He stated that our only choices are really a free market solution or single payer, and because we already started handouts with Obamacare, no one is going to want to step away from the feeding trough. I think he is spot on there. Now that the Pandora's box of freebies has been opened, whether via Obamacare supplements or GOPcare tax credits, too many people will cry about their "rights" being taken away.

I am still sympathetic to pre-existing condition coverage, but have no idea how to viably make that work in a free market system.

On the tangent, whatever I think about the legislation, it's schadenfreude part 2 watching the dems freak out about "millions of deaths". Especially satisfying was listening to Nancy Pelosi talk about "how dare they pass this without knowing what's in it!". She wins the lack of self-awareness award for the century.


*This actually seems like a fair compromise to me, all other things considered. Asking insurance companies to cover people who chose not to have insurance, caught some expensive disease, then said, "Here's $500/mo, cover my million dollars in upcoming medical expenses" is like an uninsured homeowner calling the insurance company the day after their house burned down and saying, "Here's $500. Sign me up for insurance and buy me a new house."

[Monkeyleg]

What I would like would be a return to what we had pre-Obama, but with a couple of changes. You would buy your own health insurance, or get it through your employer (yeah, I know, same thing). You could choose to have a less expensive policy that did not cover pre-existing conditions, or a more expensive policy that did. For those who provably cannot afford health insurance, the government would provide some form of insurance.

I think it's too late for even that, though. People think they're getting something for free, and they won't give it up, even though it's costing them a lot.

[DittoHead]

Insurance plans that cover pre-existing conditions don't really make sense. It's just not how insurance works. Same with routine checkups and stuff, that's not what insurance is about. I think there's just a fundamental misunderstanding about what you should expect from it.

Putting mandates on insurance companies is not a cure for scarcity. Sometimes, it makes things worse. Insurance companies operate by making a very careful study of actuarial information, which allows them to make remarkably accurate predictions about the medical needs of large populations with known demographic characteristics. Nobody knows whether any given 60-year-old man will have a heart attack this year, but stack up 10 million of them, and the pointy-headed actuarial nerds can tell you with a high degree of accuracy how many of them will. But we want insurance to be something different: We want it to be the conqueror of scarcity.

[Ben]

Insurance plans that cover pre-existing conditions don't really make sense. It's just not how insurance works. Same with routine checkups and stuff, that's not what insurance is about. I think there's just a fundamental misunderstanding about what you should expect from it.

Well, except for instance, if a child is born with a condition, it's "pre-existing" but if the parents have insurance, it's covered. If the child then in adulthood gets their own insurance with no lapse, are they really gaming the system, anymore than say some adult who is healthy when originally insured who gets something like cancer, and is covered? That's kind of part of the insurance pool, where the insurance companies bet that their healthy clients will give them the buffer to cover their unhealthy clients. That's part of why the pay actuaries big bucks (given limited government interference in pricing).

Certainly someone who rolls the dice and says "I'm not gonna pay for insurance and just spend my dough on hookers and blow" gets whatever is coming to them and gets no sympathy if while gambling on no insurance, contracts something serious.

Otherwise, again, we have to then look at how to handle pre-existing and serious conditions, because if the insurance company doesn't cover it, eventually the taxpayers will.

As far as annual checkups, I think you'll be hard pressed to find any insurance companies who are against covering annual exams as part of the package. Again, statistics tell them they save money in the long run by promoting that and catching potentially serious issues early.

[DittoHead]

If the child then in adulthood gets their own insurance with no lapse, are they really gaming the system, anymore than say some adult who is healthy when originally insured who gets something like cancer, and is covered?

An insurance policy is good for a specific term. At the end of that term, the policy is adjusted according to what has changed. Insurance is meant to protect against risk in the future, not something that has already happened. The insurance company can choose to cover an existing condition if they really want you as a customer but they need to be able to charge accordingly. Or they can choose to drop you all together if they don't think they can make money off you. Likewise, an individual should be free to not get insurance if they don't think it's going to end up being worth it.

how to handle pre-existing and serious conditions, because if the insurance company doesn't cover it, eventually the taxpayers will.

If that's truly the case, universal healthcare is inevitable and we might as well get going on it.

As far as annual checkups, I think you'll be hard pressed to find any insurance companies who are against covering annual exams as part of the package. Again, statistics tell them they save money in the long run by promoting that and catching potentially serious issues early.

Agreed, much like good driver discounts and all the other new "incentives" car insurance companies offer (I think they have one where they monitor you like big brother now?) they will offer lower premiums/costs to people who do things that will save them money. The government doesn't need to be involved in any way with those though, they certainly don't need to be mandated as included coverage.

[Ben]

If that's truly the case, universal healthcare is inevitable and we might as well get going on it.

Well, and this is the problem. At this point (IMO) we will never get to a free market solution. No one is willing to give up freebies, and right or wrong (I guess you can argue for or against based on freedom, morality, Darwinism, charity, good feelings, or whatever) only a small minority of the country at this point is willing to say, "that's the breaks" if someone contracts a serious condition through no fault of their own. Those people will be treated either via insurance or taxes. They could be handled by private charities given zero government interference, but that's not gonna happen either.

[Ben]

Also, heck, maybe I don't know what a "pre-existing condition" is in the context of the healthcare debate. Certainly if the below counts, then I need to re-evaluate. I've always thought of it as serious and debilitating, but then maybe I no longer know the modern context of those words either.


http://twitchy.com/samj-3930/2017/05/05/damn-ben-shapiro-unleashes-sick-takedown-of-alyssa-milanos-dramatic-pre-existing-condition/

[Monkeyleg]

Well, universal health care will either result in the bankruptcy of this country, or early deaths for thousands and thousands of people every year.

Look at Medicare. I paid about $150,000 total into Social Security in my lifetime, which means I paid about $35,000 into Medicare. Last year my health care costs came to $429,000. I'm sure Medicare paid a lot less than that, but it was still more than the $35K I paid in my lifetime. So far this year my costs for chemo are over $70,000. If I had the stem cell transplant, the MSRP for that is $800,000. Universal health care couldn't afford to cover me. The government would have to let me die, which is what's going to happen anyway. It's just not economically viable.

[Scout26]

An insurance policy is good for a specific term. At the end of that term, the policy is adjusted according to what has changed. Insurance is meant to protect against risk in the future, not something that has already happened. The insurance company can choose to cover an existing condition if they really want you as a customer but they need to be able to charge accordingly. Or they can choose to drop you all together if they don't think they can make money off you. Likewise, an individual should be free to not get insurance if they don't think it's going to end up being worth it.
If that's truly the case, universal healthcare is inevitable and we might as well get going on it.
Agreed, much like good driver discounts and all the other new "incentives" car insurance companies offer (I think they have one where they monitor you like big brother now?) they will offer lower premiums/costs to people who do things that will save them money. The government doesn't need to be involved in any way with those though, they certainly don't need to be mandated as included coverage.

I'll use me as an example of "Pre-existing condition".

For 21 years after I got out of the Army we had United Healthcare as our Health Insurance.  Most the time, it was my ex- that carried the insurance, although there were time when I carried (Airborne Express being a prime example as the rates they charged management were the same as what they charged the Teamsters.) 

21 years.  Now there, were a couple of childbirths, and some sprains and broken bones over that time.  Nothing out of the ordinary that the usual family of four with active kids would expect over that time.   

Until I hit 46 and my health deteriorated.   What you are stating is that United Healthcare was betting that once I got sick, they would only have to pay my medical expenses until I hit policy renewal time, and then they would be free to charge whatever they felt like (knowing that I would be costing them a ton of money) or simply drop me completely.

I contend that their actuaries calculated that x number of adult males would contract a terminal disease and would have to pay their medical expenses for more than just that one (or less) year, until it was time to renew.    Now, my rates have gone up slightly (rate of inflation plus a bit more), but I figure that I'm part of the actuarial calculation as to what they charge all (now) 51 year old males of my race and demographic because they know that I drew the short straw and one of the x number that will come down with a terminal disease and live for more than just that term of insurance. 

Otherwise, there is no point in getting health insurance, if you now that once you get sick, you have until the end of the policy term to either 1) get well, or b) die.   Because unless you are somewhat wealthy, you will now be able to afford health care after that policy term ends.

And that's what insurance is.  They transfer of risk.  I have always made sure I transferred the risk.  I have Car Insurance, Life Insurance, Health Insurance and Disability Insurance.

I made "bets" with USAA (car), Phoenix Life (Life), Mutual of Omaha(life), United Healtcare(Medical), and Mutual of Omaha(Disability).  All of them except USAA have pretty much lost their bets on me.  Although, I'm sure their actuaries accounted for me when they quoted me their rates back when I was healthy, when I bought the policies.

As I've stated before, because we are changing the rules of the game mid-stream, people with pre-existing conditions should be allowed to continue their existing coverage under a new (of the same) policy within xx days of the new rules taking effect.   However, people with pre-existing conditions, who did NOT have coverage before, should now be allowed to buy coverage now. 



Somewhat like my Life Insurance policies.  I have two totaling $650,000.   In both there are Disability Riders, which state in essence, if I am totally and completely disabled (and terminal cancer with End Stage Renal Disease aka,: Kidney Failure; count) then the Insurance Companies pay my premiums.  Which they are.  The cost of those riders were calculated by the actuaries at the time I bought the policies.   They made a bet and lost.

[DittoHead]

What you are stating is that United Healthcare was betting that once I got sick, they would only have to pay my medical expenses until I hit policy renewal time, and then they would be free to charge whatever they felt like (knowing that I would be costing them a ton of money) or simply drop me completely.

Isn't that the case though? That's why insurance companies drop people, or increase their premiums. They might be making calculations for a longer term than the policy, but just because you had a policy with them last year doesn't mean they should be obligated to keep the same rate or do business with you at all this year. They of course have an interest in keeping customers happy, and that means not dropping someone the second they use their insurance but they are doing so only to keep customers and make money. There shouldn't be any mandate that says they have to keep doing business with you.

Otherwise, there is no point in getting health insurance, if you now that once you get sick, you have until the end of the policy term to either 1) get well, or b) die.   Because unless you are somewhat wealthy, you will now be able to afford health care after that policy term ends.

And that's what insurance is.  They transfer of risk.  I have always made sure I transferred the risk.  I have Car Insurance, Life Insurance, Health Insurance and Disability Insurance.

What you're saying essentially is that insurance policies must be open ended and the policy term is meaningless. Regardless of what happens, the insurance company would be locked into those terms as long as you keep paying your premium. That doesn't seem viable.

Insurance & risk are about the future, not things that have already happened.

[HankB]

. . .  So far this year my costs for chemo are over $70,000.  . . .

If you could "follow the money" you'd probably find that only a small fraction of it went to the actual chemo drugs. A larger fraction went to those administering them, and the balance probably went to feed a bloated bureaucracy full of lawyers and administrative pencil pushers of all types, as well as taxes.

Some years back I had some prescription eye drops for allergies . . . I thought they were rather pricey, and after I figured out how much actual medication was in the small vial, and allowing for packaging, it turned out the drug was actually going for around $30,000,000 a gallon. There is NO WAY that was production cost, so most of it was "overhead."

[Pb]

I don't know what is the best way to deliver health care or pay for it, so I'm going with James Madison in the Federalist 45:

"The powers delegated by the proposed Constitution to the federal government, are few and defined. Those which are to remain in the State governments are numerous and indefinite. The former will be exercised principally on external objects, as war, peace, negotiation, and foreign commerce; with which last the power of taxation will, for the most part, be connected. The powers reserved to the several States will extend to all the objects which, in the ordinary course of affairs, concern the lives, liberties, and properties of the people, and the internal order, improvement, and prosperity of the State."

Every state should have their own system.  With fifty different systems, people can move to the place with the system they like best.

[MechAg94]

I don't know what is the best way to deliver health care or pay for it, so I'm going with James Madison in the Federalist 45:

"The powers delegated by the proposed Constitution to the federal government, are few and defined. Those which are to remain in the State governments are numerous and indefinite. The former will be exercised principally on external objects, as war, peace, negotiation, and foreign commerce; with which last the power of taxation will, for the most part, be connected. The powers reserved to the several States will extend to all the objects which, in the ordinary course of affairs, concern the lives, liberties, and properties of the people, and the internal order, improvement, and prosperity of the State."

Every state should have their own system.  With fifty different systems, people can move to the place with the system they like best.

ditto

[Frank Castle]

My opinion

 We are replacing one cluster *expletive deleted*ck of bill for another cluster *expletive deleted*ck of bill. In 4 or 8 years, A new guy will take control and come up with his own cluster *expletive deleted*ck of a bill.

Insurance companies are going to charge whatever the *expletive deleted*ck they want!

No White House health bill is going to change that.

[Perd Hapley]

Insurance companies are going to charge whatever the *expletive deleted*ck they want!

No White House health bill is going to change that.

Obamacare sure changed it.

[RocketMan]

What is going on with the Obamacare repeal?  What Obamacare repeal would that be?
Someone please tell me when there is an Obamacare repeal.  I don't want to miss it.

[Hawkmoon]

And that's what insurance is.  They transfer of risk.  I have always made sure I transferred the risk.  I have Car Insurance, Life Insurance, Health Insurance and Disability Insurance.

I made "bets" with USAA (car), Phoenix Life (Life), Mutual of Omaha(life), United Healtcare(Medical), and Mutual of Omaha(Disability).  All of them except USAA have pretty much lost their bets on me.  Although, I'm sure their actuaries accounted for me when they quoted me their rates back when I was healthy, when I bought the policies.

Insurance isn't so much transfer of risk as it is allocation of risk. Insurance companies aren't in business to lose money. they just spread the risk out across the entire spectrum of their customer base. You are correct -- the possibility of Amy Schumer (and several other) policyholders drawing the short straw is all part of the actuarial calculation. For people like you, who bought in and paid regularly while healthy, the marketplace works. The problem with Obamacare is that the .gov suddenly asked the insurance companies to take on a metric boatload of people with preexisting conditions who had not signed on when they were healthy, and who had not paid for their coverage for any period of time before contracting the aforementioned preexisting condition.

And, now that people with those conditions have coverage, they (understandably) get upset at the thought that they may lose it. I get that -- but this is the problem with the .gov having forced the marketplace to accept risks that said marketplace would never have accepted if it hadn't been a requirement of the legislation.

In reality, the ONLY way out now is for the .gov to nationalize health care. And then the .gov is going to encounter the same problem the insurance companies have always known -- it can be expensive to treat some illnesses and conditions. So nationalization will inevitably lead to triage, long wait times, and "death panels" making decisions on who deserves to get the care they need, and who doesn't.

I saw this first-hand in 2014, through the VA. I was having heart problems. My primary care doctor kept changing my medications, but I was never referred to a cardiologist. I'm old enough that I'm also on Medicare, so I finally went to an outside doctor. That doctor referred me to a cardiologist -- STAT -- and three days later I was in the hospital for open chest surgery. If I had not had the outside option, it's highly probable that I would have died while waiting for the VA to let me see a cardiologist.

[DittoHead]

A few quotes on healthcare from the president:

But ultimately, you know I use the expression, “If you have a bad knee, I would rather have the federal government focus on North Korea than fixing your knee.”

Ok, I guess I don't disagree with that at least.

You’re going to have absolute guaranteed coverage. You’re going to have it if you’re a person going in…don’t forget, this was not supposed to be the way insurance works. Insurance is, you’re 20 years old, you just graduated from college, and you start paying $15 a month for the rest of your life and by the time you’re 70, and you really need it, you’re still paying the same amount and that’s really insurance.

But I believe it’s very important to have this. Because one thing Obamacare did, is it gave that and it was a concept that people hadn’t heard of. And now I don't want to end it. I don’t want to end it for somebody that…first of all I don’t want to end it for the people that already have it. And I don’t want to end it for somebody that hasn’t been buying insurance for all of his life where he has a guarantee that for all of his life he’s been buying the insurance and he can buy it inexpensively when he turns 65 or 70 years old.

Not so sure about that part...

[Pb]

Trump's views on health insurance appear to make no sense at all.   

[dogmush]

Trump's views on health insurance appear to make no sense at all.   

<-----------That's my shocked face. No really.

[lupinus]

Insurance isn't so much transfer of risk as it is allocation of risk. Insurance companies aren't in business to lose money. they just spread the risk out across the entire spectrum of their customer base. You are correct -- the possibility of Amy Schumer (and several other) policyholders drawing the short straw is all part of the actuarial calculation. For people like you, who bought in and paid regularly while healthy, the marketplace works. The problem with Obamacare is that the .gov suddenly asked the insurance companies to take on a metric boatload of people with preexisting conditions who had not signed on when they were healthy, and who had not paid for their coverage for any period of time before contracting the aforementioned preexisting condition.

And, now that people with those conditions have coverage, they (understandably) get upset at the thought that they may lose it. I get that -- but this is the problem with the .gov having forced the marketplace to accept risks that said marketplace would never have accepted if it hadn't been a requirement of the legislation.

In reality, the ONLY way out now is for the .gov to nationalize health care. And then the .gov is going to encounter the same problem the insurance companies have always known -- it can be expensive to treat some illnesses and conditions. So nationalization will inevitably lead to triage, long wait times, and "death panels" making decisions on who deserves to get the care they need, and who doesn't.

I saw this first-hand in 2014, through the VA. I was having heart problems. My primary care doctor kept changing my medications, but I was never referred to a cardiologist. I'm old enough that I'm also on Medicare, so I finally went to an outside doctor. That doctor referred me to a cardiologist -- STAT -- and three days later I was in the hospital for open chest surgery. If I had not had the outside option, it's highly probable that I would have died while waiting for the VA to let me see a cardiologist.

But we won't have single payer. Because then what would the health insurance giants do? And more importantly what would their lobbyists do?

Nah. The problem isn't the insurance companies, it's the rates. So rather than nationalizing the health care and going single payer and paying directly, we'll just go ahead and supercharge the exchange concept. And now we'll all have a schnazy new tax, no health insurance premiums and deductibles, and the kind folks in Washington will pay the insurance companies to cover all the folks in the states they operate in. BCBS can have this patch, and United can have that one, oh and here ya go Aetna...

Single payer would be far to efficient for Washington. The problem isn't just that we have socialists in government, they're also pretty *expletive deleted*ing bad at it.


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