GOP gets its way on ACA, will help the Dems in the end

[Helix]

In other words, RomneyCare required an infusion of federal cash to 'work'. There is not much difference between ths state of CA and the countries of UK or France in population or GDP and CA is larger (in both respects) than Canada. As I said before, it is really more of an issue of border control (citizenship vs. state residency).

i don't see much use for a confusing state to state hodgepodge system. it has been heading in the direction of real universal healthcare for a while now, and we should have done it decades ago, IMO.

 

[jnug]

Judge's rulling is absurd. It will be overturned on appeal. Trump can run his mouth about this one all he wants.

The shame here is that this Judge made his ruling just before the last day for enrollment for this year. Coincidence??? I think not.

 

[ttwtt78640]

i don't see much use for a confusing state to state hodgepodge system. it has been heading in the direction of real universal healthcare for a while now, and we should have done it decades ago, IMO.

One problem would appear to be the US Constitution unless you feel that anything that the federal government chooses to do is, by definition, a federal power. Medicare has essentially flat premiums - that would be far from the case for a UHC system which by most accounts would require quite progressive taxation to fund.

Even if a UHC system could manage get per person annual medical care expenses down from about $10K/person/year to $6K/person/year (a rosy initial SWAG of 40% savings) that would mean a family of 4 would pay about $2K/month to break even - the more folks that would be required to pay less (in UHC taxes?) means that other (most?) folks would be required to pay more.

https://www.cms.gov/Research-Statis...endData/NationalHealthAccountsHistorical.html

 

[ataraxia]

One problem would appear to be the US Constitution unless you feel that anything that the federal government chooses to do is, by definition, a federal power. Medicare has essentially flat premiums - that would be far from the case for a UHC system which by most accounts would require quite progressive taxation to fund.

Even if a UHC system could manage get per person annual medical care expenses down from about $10K/person/year to $6K/person/year (a rosy initial SWAG of 40% savings) that would mean a family of 4 would pay about $2K/month to break even - the more folks that would be required to pay less (in UHC taxes?) means that other (most?) folks would be required to pay more.

So what is your solution? I mean other than just leaving everything to the free market and accepting that many Americans are possibly going to die if they hit hard times, and accepting that as just the price of freedom.

 

[Helix]

One problem would appear to be the US Constitution unless you feel that anything that the federal government chooses to do is, by definition, a federal power. Medicare has essentially flat premiums - that would be far from the case for a UHC system which by most accounts would require quite progressive taxation to fund.

Even if a UHC system could manage get per person annual medical care expenses down from about $10K/person/year to $6K/person/year (a rosy initial SWAG of 40% savings) that would mean a family of 4 would pay about $2K/month to break even - the more folks that would be required to pay less (in UHC taxes?) means that other (most?) folks would be required to pay more.

https://www.cms.gov/Research-Statis...endData/NationalHealthAccountsHistorical.html

general welfare clause. do you consider Social Security and Medicare to be unconstitutional?

 

[ttwtt78640]

So what is your solution? I mean other than just leaving everything to the free market and accepting that many Americans are possibly going to die if they hit hard times, and accepting that as just the price of freedom.

My solution is to offer expanded Medicaid as a public option and to remove EMTALA - expanded Medicaid premiums would be set at 10% of AGI which is (coincidentally?) the point at which medical care expenses become tax deductible. Expanded Medicaid premiums would be due monthly (in advance) or, if paid annually, offer a 10% discount (9% of AGI). To prevent 'opting in' only during periods when folks anticipate needing expensive medical care, expanded Medicaid premiums double (to 20% of AGI) if continuous coverage is not maintained.

 

[ttwtt78640]

general welfare clause. do you consider Social Security and Medicare to be unconstitutional?

Yes. Social Security a bit less so since personal benefits are (largely) based on personal contributions and some can (and do) opt out.

 

[Helix]

Yes. Social Security a bit less so since personal benefits are (largely) based on personal contributions and some can (and do) opt out.

i don't agree that those programs are unconstitutional. real UHC won't be, either.

 

[What if...?]

The people that vote red are unreachable.

The good news is they will suffer the most from their decisions.

You can bet the "its the democrats fault" messaging is already in the can.

 

[What if...?]

That sly Trump! Now he can trade pre-existing conditions for the wall!

"Give me my wall or this baby dies!"

 

[What if...?]

Yep, no premiums, no deductibles and no co-pays. Your "out of pocket" cost is based on your (household?) income, the assessed value of your property and how much you consume in taxable goods/services and has absolutely no bearing on how much medical care that you require (desire?). Medicaid is funded jointly by the federal and state governments and dictates to medical care providers how much they will be paid (totally from public funds) for a providing a given medical treatment.

The major problem that I see with such a Medicaid for all system is that the care providers are then faced with a "take it or leave it" choice - if performing treatment X loses money then they may well stop providing (offering?) that service. Unless 'care for cash' is made illegal then we will soon have a two tiered system where most (must?) use the public rate clinics/hospitals and some will still get top notch care since, even after paying higher taxation, they can afford the best care that money can buy.

I look at it like this - if providing a service (say mowing a lawn) gets the provider of that service paid $20 (totally from public funds) then one must decide if doing that job is a wise thing to do. They may well decide that taking another job (say painting) which pays $30 for the same time and effort is a better occupational choice. I can't see why medical care professionals which must make a significant personal effort to attain the requisite education and skills would continue to pursue that 'trade' if other jobs (requiring the same or less education and skills) paid better.

I've always advocated for insurance as supplement to some.form.of universal care.

Want lattes and a poodle sitter at the doctor's office, get a supplemental insurance policy.

Can't afford to? You get to wait with the rest of us.

But you'll still get treated. And it won't bankrupt you.

 

[What if...?]

Maybe, yet care demand will go up as care provider supply remains the same or goes down. This is what causes the often cited care delay in nations (some with popualtions below that of some US states) with "free" medical care. We were told that ER (the costliest care environment possible) use would go down after PPACA was enacted on the theory that folks would receive more 'preventive' care - that did not happen.

It should be obvious to all that the often touted 'cost savings' are simply going to be achieved by paying the same care providers less for performing the same type of care. Why do you suppose that no US state offers UHC for its resisdents?

Medical profession lobbies, of course.

I would also suggest that if your doctor tells you to lose weight and you make no effort to do so you don't get treated for weight related issues later on.

And maybe a cap on "free" visits to the doctor/emergency room for hypochondriac types. (Sith allowances for those who's condition requires that kind of thing. I've seen too many who go to the doctor for every little could-be thing.

 

[ttwtt78640]

I've always advocated for insurance as supplement to some.form.of universal care.

Want lattes and a poodle sitter at the doctor's office, get a supplemental insurance policy.

Can't afford to? You get to wait with the rest of us.

But you'll still get treated. And it won't bankrupt you.

I favor returning medical care insurance to act like most other forms of insurance - it only pays claims for the rare, unexpected and expensive events and does not pay for routine maintenance costs. Imagine what auto insurance would cost if it covered oil changes, tune-ups, front end alignments and replacement of worn tires. Imagine what homeowners insurance would cost if it covered replacing worn carpeting/appliances and periodic repainting.

Humans are high maintenance animals with normally long lifespans. There is no reason to expect 'society' to pay for the modest costs of treating routine bumps, cuts, sprains, tummy aches, infections and colds. If you need orthopedic surgery or cancer treatment then, and only then, put in an insurance claim. My annual medical maintenance costs are about $350 to $400 which in no way should require insurance to cover.

 

[Greenbeard]

I favor returning medical care insurance to act like most other forms of insurance - it only pays claims for the rare, unexpected and expensive events and does not pay for routine maintenance costs. Imagine what auto insurance would cost if it covered oil changes, tune-ups, front end alignments and replacement of worn tires. Imagine what homeowners insurance would cost if it covered replacing worn carpeting/appliances and periodic repainting.

Humans are high maintenance animals with normally long lifespans. There is no reason to expect 'society' to pay for the modest costs of treating routine bumps, cuts, sprains, tummy aches, infections and colds. If you need orthopedic surgery or cancer treatment then, and only then, put in an insurance claim. My annual medical maintenance costs are about $350 to $400 which in no way should require insurance to cover.

How much do you think insurers spend on "routine" (i.e., primary) care?

 

[iguanaman]

It will be struck down on appeal and the SCOTUS will likely refuse to take the case, since they've already ruled on an identical one already.

Even if it did go to the SCOTUS, Roberts will probably side with the law as before.

This is just an activist judge making a show.

Right. He is probably lookiing for a promotion from Trump.

 

[iguanaman]

I favor returning medical care insurance to act like most other forms of insurance - it only pays claims for the rare, unexpected and expensive events and does not pay for routine maintenance costs. Imagine what auto insurance would cost if it covered oil changes, tune-ups, front end alignments and replacement of worn tires. Imagine what homeowners insurance would cost if it covered replacing worn carpeting/appliances and periodic repainting.

Humans are high maintenance animals with normally long lifespans. There is no reason to expect 'society' to pay for the modest costs of treating routine bumps, cuts, sprains, tummy aches, infections and colds. If you need orthopedic surgery or cancer treatment then, and only then, put in an insurance claim. My annual medical maintenance costs are about $350 to $400 which in no way should require insurance to cover.

The problem with that is that unknown and untreated aliments tend to get worse and cost more to treat than if found early. So it is cost effective to cover regular check-ups.

 

[ttwtt78640]

How much do you think insurers spend on "routine" (i.e., primary) care?

I see quite a bit of insurance used at my primary care clinic. I, being uninsured and paying cash, am the exception and not the rule by far. Until that amount is zero then they are paying too much. How much do you think that insurers spend on replacing worn tires?

 

[Greenbeard]

I see quite a bit of insurance used at my primary care clinic. I, being uninsured and paying cash, am the exception and not the rule by far. Until that amount is zero then they are paying too much. How much do you think that insurers spend on replacing worn tires?

The answer is a bit over 7% on average, which most experts agree is too low, given the importance of primary care.

Primary care is not where premium dollars are going.

 

[What if...?]

I find the entire issue of healthcare economics contradictory, inexplicable, shallow, short-sighted, and strongly prone to making individual institutions and persons either heroes or villains, usually the latter. Honestly, I don't have an answer, at least not one that will satisfy the voter AND the consumer, the same people who hold contradictory positions.

However, a few observations:

The ACA-Obamacare was supposed to solve this, and in its supporters theory should have. Medicare (100 percent government paid medical care) was nearly doubled in the overwhelming majority of the population. Subsidies far above the poverty line were given up to 400 percent of the poverty level - essentially to median income. Family costs were supposed to drop 2500.00 per year. Exchanges were supposed to provide affordable as well as well as comprehensive plans for all - partially paid by increased taxes and charges to employers who did not provide a plan.

So let's be honest, WHO could be left out if this worked as intended (other than the minority that live in states that didn't cover the free increase in Medicaid)?

Yet there is an outbreak of a raging fever for Medicare, likely stemming from a collective feeling that things in at least some respects are lot worse, not better. In 2012 (or so) 85% of people were happy with their insurance. Since then UNSUBSIDIZED premiums and deductibles have become absurdly expensive, provider access pools have shrunk and has been sharply limited, out-of-state coverage ended, many companies no longer offering plans, etc.

In other words, it would seem that the cost of providing more insurance opportunity for the lowest quartile has been at a cost (financial or in consumer choice) to a large portion of the unsubsidized consumer - and they are not happy.

So now that we are experiencing major unintended consequences from the most latest idealistic government bromide we should do it again cause we are guessing that it will work this time?

Hey, what could go wrong?

Republicans could sabotage it as they did the ACA.

It never had a chance to work because too many were working to make it fail.

The mandate was because young healthy people don't think they need healthcare. Until they mangle their leg snowboarding, of course.

 

[What if...?]

Of course, government is rarely said to be related to the problem but is frequently said to be (or have) the solution.

I.like to point to my example as to drug costs.

I have asthma. An inhaler retails for $50 here. $15 copay on my insurance.

And I just went to Mexico and bought 4 of the same inhaler with a Spanish label.

For $13.

So $3.25 in Mexico.

$50 in the US. 15 times as much.

Something clearly isn't right.

 

[ttwtt78640]

The problem with that is that unknown and untreated aliments tend to get worse and cost more to treat than if found early. So it is cost effective to cover regular check-ups.

Nope, it is both wise and effective to require regular check-ups. Your car warranty requires routine maintenance but (generally) does not pay for it - if you don't do that routine maintenance then the warranty will likely not honor their end. Many are told by their doctor to lose weight, exercise more and quit smoking - yet few do that.

 

[ttwtt78640]

I.like to point to my example as to drug costs.

I have asthma. An inhaler retails for $50 here. $15 copay on my insurance.

And I just went to Mexico and bought 4 of the same inhaler with a Spanish label.

For $13.

So $3.25 in Mexico.

$50 in the US. 15 times as much.

Something clearly isn't right.

Yep your inhaler salesman is likely making more profit on that $15 than the inhaler (from Mexico) cost you. You just figured out how to save significant money - yet there is no incentive for the inhaler salesman to do so because most folks simply think that their medical care insurance 'benefit' saved them $35.

 

[JustHanging]

I will vote for Medicare for all. But we need to get all the billionaires out of the loop and the tax money only funds health care. Not billionaires and their penthouses and private jets and multiple homes all over the world. The insurance industry gone. Nobody on the payroll making more than an average government worker. No CEO's, No board of directors getting million dollar bonuses while health care for the needy is being denied do to cost.

There are lots of good systems that can be used as models. Apparently our (Canada) system isn't that great compared to some, but I think it's fantastic. I've always got prompt, no hassle, no worry, service. The ones that are better must be really good.

 

[iguanaman]

Nope, it is both wise and effective to require regular check-ups. Your car warranty requires routine maintenance but (generally) does not pay for it - if you don't do that routine maintenance then the warranty will likely not honor their end. Many are told by their doctor to lose weight, exercise more and quit smoking - yet few do that.

And you want them to have an excuse not to see them in the first place placing more expense on the HC system.

 

[Middle_Ground]

I read the judges ruling. Its actually solid.
I say let it go. I hope its repealed quickly. I hope all that want it gone not understanding what it really is suffer badly.
I hope those that really know what a going on can hold out because this is the fast track for Medicaid and or Medicare for all.
Republicans and their people have been chipping away for years I hope they get everything coming to them.