Thread: Health Insurance / Health Care and you?

nebish - 3/10/2017 at 03:11 PM

I am wondering, what is the single or overbearing issue you have with your insurance or your health care as it stands?

For me it is cost, and the inability to have a competitive environment on cost. If you've ever asked a provider how much your service was going to cost and received a dumbfounded look as a response you know what I mean.

Office visits, medical procedures and prescriptions seem exempt from having to supply a cost quote or estimate on what you are about to have done or buy.

A typical response might be, "well it depends what insurance you have". Why? Why shouldn't the cost for any given service cost 'x' no matter what insurance a person has or doesn't have? Providers charge different amounts for different insurance plans as they get reimbursed a certain % based on said plan. Or certain procedures or exams get reimbursed a set amount by the insurer or government plan...but if you say you are paying cash the price for that service is drastically different than what the provider would otherwise be getting from the insurance provider.

If you are sitting at the doctor's office and you need a prescription, they ask where to send it? Why can't I say, "depends, how much if Village Pharmacy, how much is Rite Aid, how much is it at Walmart?"

The cost for goods and service relationship in medicine and medical care is so detached from the people receiving it.

When you need a repair on your car, or your home. Or considering a large purchase...a car, a major appliance. Or travel, hotels...airfare. In everything else in life we weigh one cost vs another cost and make decisions based on what is important to us in that equation, cheaper isn't always better, sometimes there is a reason to pay more, other times there is not. But in medical care and drugs we go into it completely blind of the costs and as a result providers and facilities do not have any real competition and therefore have no incentive to keep prices down.

Sure maybe the urgent care place is competing with the emergency room. Or maybe one pharmacy is competing against another. Maybe ABC MRI place is competing with the XYZ MRI place. And one out patient facility is competing with a different out patient facility...but patients have no way to analyze the cost of one vs the other and really doctors and medical providers are essentially isolated from competition and having to provide cost estimates.

That is something I would like to change.

Every prescription from your doctor should be able to be shopped at any pharmacy against published prices.

Every service performed or scheduled should be accompanied with an complete estimated cost for the service (including facility charges, individual doctor fees, anesthesiologist, etc).

And there should be one cost for all. Cash, uninsured, cadillac insurance plans, bare bones insurance plans, medicare, whatever, the base charge for anything and everything should be the same. Why charge one person one price for penicillin and then charge somebody else a different amount for the exact same thing?


nebish - 3/10/2017 at 03:25 PM

Here is an interesting story:

quote:
Why Can’t The Market for Medical Care Work Like Cosmetic Surgery?
By Devon Herrick Filed under Health Alerts on June 17, 2013 with 46 comments

Americans see their doctors more than 1 billion times a year ― and spend nearly $300 billion on physician services ― but they rarely discuss the price of a given service with their physicians in advance of receiving treatment. It gets worse. Although only about 10 percent of health care expenditures are spent on physicians’ services, doctors are the gate keepers to virtually all care that is provided to patients ― including MRI scans, lab tests, hospital admissions and surgeries. Yet doctors rarely provide a list of prices for goods and services they provide or discuss the prices of the procedures they order. Patients don’t bother to shop for medical care, and doctors don’t advertise their prices because nearly 90 percent of patients’ tabs are paid with other people’s money.

However, when patients pay their own medical bills, they act like normal consumers ― comparing prices and looking for value. And when patients act like prudent consumers, doctors who want their patronage must respond by competing on prices, convenience and other amenities.

Consider cosmetic surgery, one of the few areas of medicine where consumers pay out of pocket. The inflation-adjusted price of cosmetic medicine actually fell over the past two decades — despite a huge increase in demand and considerable innovation [See Figure]. Since 1992:

The price of medical care has increased an average of 118 percent.
The price of physician services rose by 92 percent.
The inflation rate, for all goods and services, as measured increased by 64 percent.
Yet cosmetic surgery prices only rose only about 30 percent.

HA1-06-17-2013

The price of cosmetic medicine was held in check by a variety of competitive forces: Doctors who perform cosmetic services quote package prices, and generally adjust their fees to stay competitive. The industry is constantly developing new products and services that expand the market and compete with older services. As more cash-paying patients demand procedures, doctors rush to provide them. There are few barriers to entry in cosmetic surgery. Any licensed physician can enter the field.

Entrepreneurial physicians are also on the lookout for new ways to market their services. Consider the ubiquitous deal-of-the-day emails, where Groupon and LivingSocial offer goods and services to subscribers at greatly reduced prices. These daily deal promoters offer numerous medical-related services, including Botox, corrective eye surgery, dental teeth cleaning, teeth whitening, laser hair removal, laser facial resurfacing, cosmetic fillers, spider vein and brown spot removal at highly discounted prices. This defies the conventional wisdom that a doctor would never advertise a bundled cash price — much less extend the offer to hundreds of thousands of random people sight-unseen. Yet the offers land in millions of email inboxes every day, and competition is fierce.

Consider botulism toxin injections, such as Botox and Dysport. According to surveys by the American Society of Plastic Surgeons, the average fee to administer botulism toxin was $369 in 2012, compared to $365 a dozen years earlier in 2000. Groupon and LivingSocial have occasionally offered Botox deals for as little as $99, with $149 quite common.

Another competitive service is laser skin resurfacing, which cost about $2,556 in 1996, according to the American Society of Plastic Surgeons. Physicians began offering less-invasive, fractional laser resurfacing that reduced recovery time. The cost of fractional laser skin resurfacing fell to $1,113 by 2012. Yet, couponing websites have offered numerous laser resurfacing deals for only $299. One Dallas-area Med Spa even offers this service, available with a one-year membership, for as little as $149 — a mere fraction of the cost elsewhere.

Wherever there is price competition, quality competition tends to follow. Take corrective eye surgery. From 1999 (when eye doctors began performing Lasik in volume)HA2-06-17-2013 through 2011, the price of conventional Lasik fell about one-quarter due to intense competition. [See Figure] Eye surgeons who wanted to differentiate themselves from other surgeons, and charge more, began to provide more advanced Custom Wavefront Lasik technology using IntraLase (a laser-created flap). By 2011, the average price per eye for doctors performing Custom Lasik was about what conventional Lasik had been more than a decade earlier; but the quality is far better. Occasionally an eye surgeon will offer a daily deal at half this price.

One criticism skeptics often voice in discussions about fostering patient consumerism is that a patient having a heart attack is not in a position to shop for the cheapest cardiac care from the back of an ambulance taking him to the emergency room. Few people would disagree. But only about $1 out of $20 is spent on patients who enter the health care system through the emergency room door.

Consider the experience of an insured patient whose doctor orders an abdominal CT scan. Receiving this service at a hospital outpatient department could cost the patient (or her health plan) nearly $3,000 depending on whether the patient’s deductible has been met. Yet this same service is available outside the hospital at a medical imaging center for prices that are often 85 percent less. Few health plans provide the tools for enrollees to compare prices and few patients have an incentive to ask about prices.

Doctors and hospitals don’t quote prices and don’t compete on price because most patients are largely insulated from the adverse effects of not making price comparisons and acting like consumers. Both economic studies and common sense confirm that people do not shop carefully and prudently when someone else is picking up the tab. The contrast between cosmetic surgery and other medical services is important. One sector has a competitive marketplace and stable prices. The other does not.

The medical marketplace should work more like the market for cosmetic surgery.
- See more at: http://healthblog.ncpa.org/why-cant-the-market-for-medical-care-work-like-c osmetic-surgery/#sthash.mT0Prw3M.dpuf


heineken515 - 3/10/2017 at 04:42 PM

I get health insurance through my company, always have.

My biggest issue is getting my 24 and 22 year old sons to actually use the insurance I have for them.


nebish - 3/13/2017 at 02:20 AM

quote:
I get health insurance through my company, always have.

My biggest issue is getting my 24 and 22 year old sons to actually use the insurance I have for them. [/quote

In that you mean taking advantage or annual physicals and preventive check-ups? They are listed on your plan?


Sang - 3/13/2017 at 05:11 PM

Same here - my son turns 26 in May, so we are trying to get him to go get a physical while he has my good insurance......


heineken515 - 3/13/2017 at 07:16 PM

quote:
In that you mean taking advantage or annual physicals and preventive check-ups? They are listed on your plan?


Yes they are on my plan and yes getting a healthy young person to get checkups, annuals etc.

And I guess that is the root of one of the problems with Obamacare is it not? Making young, healthy people pay for something they probably don't want or think they need. I could be wrong.


emr - 3/13/2017 at 10:13 PM

quote:
quote:
In that you mean taking advantage or annual physicals and preventive check-ups? They are listed on your plan?


Yes they are on my plan and yes getting a healthy young person to get checkups, annuals etc.

And I guess that is the root of one of the problems with Obamacare is it not? Making young, healthy people pay for something they probably don't want or think they need. I could be wrong.


Ponder this: Medical Insurance can never be free market because in an emergency can be turned away from a hospital/ER. So the bet that I'll never need this is hedged by all of society. Until we as a society will turn away someone who is not financially able to pay the point is moot They will then have their illness treated for free.

My other peeve is that insurance is tied to employment but not for everyone. This limits business growth/expansion and job options for people - as well as career choices. Whomever ends up paying for it (through taxes; personal consumption) this should be unlinked.

My real take is that we should have a basic level of national health care with the option to buy into higher levels of care. And the basic level has to be at a level above Medicaid - because only the hospitals and not the providers get paid enough to survive.

How to fund this? The country needs to decide. But we are the only civilized nation without it - what is happening now is a shell game. This reality needs to be faced


nebish - 3/14/2017 at 02:47 AM

I'm ready for either a national health care system or everyone pays for what you get. Blow this system up. **** insurance companies.


BoytonBrother - 3/14/2017 at 06:07 AM

I would say that we truly do not understand the pros and cons of Obamacare v Trumpcare v The way it was before. How can anyone predict and measure whether it has a positive or negative impact? You have to wonder why we allow ourselves to get worked up over something we can only speculate about.


emr - 3/14/2017 at 12:16 PM

quote:
I would say that we truly do not understand the pros and cons of Obamacare v Trumpcare v The way it was before. How can anyone predict and measure whether it has a positive or negative impact? You have to wonder why we allow ourselves to get worked up over something we can only speculate about.


That is part of what I alluded to. Every "system" creates winners/loser. Those who can obtain insurance at a somewhat reasonable price; those who can't. Who gets subsidized/who doesn't.

In NY State there is only one carrier who will sell PPO insurance to small businesses. When they stop it will be impossible as a small business to obtain "good insurance." At any price. Two years ago I looked into the exchange - it wouldn't allow me to purchase the higher level (Gold/Platinum) plans at any cost. Only bronze HMO

So we all are rolling the dice


OriginalGoober - 3/14/2017 at 01:07 PM



Why are democrats fighting tooth and nail to save a collapsing unsustainable healthcare program. Obamacare in many states has only one single provider. The rest of the insurers bailed out because of skyrocketing costs.

Rather than work with republicans on replacement, they are wanting to save this bloated monument to liberal democratic policy.


MartinD28 - 3/14/2017 at 03:04 PM

quote:


Why are democrats fighting tooth and nail to save a collapsing unsustainable healthcare program. Obamacare in many states has only one single provider. The rest of the insurers bailed out because of skyrocketing costs.

Rather than work with republicans on replacement, they are wanting to save this bloated monument to liberal democratic policy.


FOX talking points. You might want to study a bit more from CBO to get a broader perspective.

Republicans worked well with Obama when he was attempting to pass health care reform? Dems should cave and work on this new trophy of a plan.

Goob - Will you be one of the 24 million projected to lose health insurance? Do you think that reflects favorably on Trumpcare / Ryancare?

[Edited on 3/14/2017 by MartinD28]


IF - 3/14/2017 at 05:48 PM

Watched The Charlie Rose show last night and David Brooks of the New York Times was one of the guests. The conversation focused on Trump in general and also the republicans proposed health care plan. This quote from David Brooks for me sums up the GOP health care plan, “Introduces more risk into people’s lives and takes away social support.”




heineken515 - 3/14/2017 at 06:43 PM


nebish - 3/14/2017 at 07:06 PM

Looking back at how CBO scored ACA then and now.

quote:

https://www.forbes.com/sites/theapothecary/2017/01/02/learning-from-cbos-hi story-of-incorrect-obamacare-projections/3/#30d9eebf6b78

Jan 2, 2017 @ 02:46 PM

Learning From CBO's History Of Incorrect ObamaCare Projections

Brian Blase, Contributor

As Congress readies legislation to repeal and replace the Affordable Care Act (ACA), Congressional Budget Office (CBO) estimates will play an important and respected role as they did in the passage of the law in 2010. We now know that many of CBO’s projections of important aspects of the ACA have significantly differed from actual outcomes. In this piece, I highlight CBO’s key past errors in projecting effects of the ACA. They can largely be grouped into two categories. First, CBO projected that the exchanges would be stable by now with more than twice as many enrollees as they currently have, rather than suffering from severe adverse selection in most states as they now are. Second, CBO projected that the ACA Medicaid expansion would be much smaller and less expensive than it has turned out to be.

These errors were caused by two primary mistakes in CBO’s model and assumptions. First, CBO significantly overestimated the degree to which the individual mandate would induce relatively healthy people with middle class income to buy coverage in the exchanges. Second, CBO failed to anticipate that states would respond to the federal government’s elevated reimbursement rate for the Medicaid expansion by maximizing enrollment and paying insurance companies extremely high payment rates for this population. CBO has not yet explained if or how it has corrected its models for these past mistakes, but it should do so if it wants to improve confidence in its estimates of repeal and replace legislation.

Exchange Enrollment Much Less Than CBO Projected

When the ACA passed in 2010, CBO projected 21 million people would be enrolled in the exchanges in 2016. After the Supreme Court ruled that the Medicaid expansion was optional for states and not compulsory, CBO increased its projection of 2016 exchange enrollment to 22 million as some people who would otherwise have been enrolled in Medicaid in non-expansion states were then expected to enroll in the exchanges instead. Exchanges plans have proved much less attractive than expected as enrollment will average only about 10 million people this year. This means that CBO’s last projection of exchange enrollment before the exchanges opened overshot actual 2016 enrollment by 120 percent.

In a briefing to congressional staff on the effects of repealing the ACA that I attended as a Senate staffer in June 2015, I asked CBO about their then-projection that exchange enrollment would nearly double between 2015 and 2016. They responded that this was largely because of both an increase in awareness of the individual mandate and the increase in the associated tax penalty. In stark contrast to the projections of CBO and others, enrollment barely increased between 2015 and 2016.

CBO’s model has consistently and significantly overestimated the effect of the individual mandate in inducing people to enroll in the exchanges. Since higher income people were supposed to be more affected by the mandate (the penalty increases with income), a less effective than expected mandate means that exchange enrollees are also much poorer than expected. If CBO has not adequately adjusted its model for its mistake about the effectiveness of the mandate, its estimates of bills to repeal and replace the ACA—which will almost certainly eliminate the individual mandate—will continue to incorporate this source of inaccuracy.

Insurers Performance Much Worse Than CBO Projected

In February 2014, one day before a congressional oversight hearing examining the ACA’s risk corridor program, CBO released an estimate that the risk corridor program would net the federal government $8 billion over three years. CBO’s estimate assumed that insurers would be quite profitable selling exchange plans since insurers with “excess” profits contributed to the program while those with “excess” losses received payments from the program.

It turns out that CBO was significantly mistaken about insurer profitability. Insurers have incurred large losses on ACA plans, losses which have grown over time. These losses resulted in a $2.5 billion risk corridor deficit in 2014 and resulted in a $5.8 billion deficit in 2015. The large losses have also driven many insurers from the exchanges.

Reinsurance Program Subsidies Much More Generous Than CBO Projected

Insurers’ losses in 2014 and 2015 would have even been larger if not for receiving larger per enrollee payments through the reinsurance program than expected. The reinsurance program compensated insurers for a large share of the cost of their most expensive enrollees. CBO projected that reinsurance payments lowered premiums by about 10% in 2014. In an April Mercatus study I coauthored, we found that net reinsurance payments equaled about 20% of premiums—double what CBO expected. CBO’s estimates of insurer profitability look even worse since the agency significantly underestimated reinsurance payments as a percentage of premiums.

Medicaid Expansion Enrollment Much Greater Than CBO Projected

Since the exchanges have enrolled so few relative to expectations, the vast majority of the newly insured are enrolled in Medicaid. The figure below shows CBO’s most recent estimate of Medicaid expansion enrollment along with CBO’s 2010, 2014, and 2015 estimates. The figure—as well as the one on spending—adjusts CBO’s previous year estimates for its current assumptions about state adoption of the expansion. (Currently 31 states have adopted the expansion.) This adjustment allows for a better intertemporal comparison because it holds constant CBO’s assumptions about the percentage of the newly eligible Medicaid population residing in expansionary states.



Medicaid expansion enrollment is much higher than CBO expected when the ACA passed in 2010, and it is also significantly higher, particularly in 2017 and beyond, than estimated in both CBO’s 2014 and 2015 reports. Essentially this means that far more people—roughly 50% more—have enrolled in Medicaid in the states that expanded than expected by CBO.

Medicaid Expansion Spending Much Greater Than CBO Projected

In addition to higher-than-expected enrollment, spending per newly eligible Medicaid enrollee is much greater than CBO expected. As I wrote in July when the Obama administration released the 2015 Medicaid actuarial report, government spending on newly eligible enrollees equaled about $6,366 in 2015—an amount 49% higher than CMS’s projection of $4,281 from just one year earlier. In April 2014, CBO projected the Medicaid expansion enrollee average cost would be approximately $4,200 in 2015, a number very close to the erroneous CMS projection.



Both higher-than-expected enrollment and spending per enrollee has resulted in the Medicaid expansion being much more costly than projected. For example, in April 2014, CBO projected that the Medicaid expansion would cost $42 billion in 2015. The actual cost was approximately $68 billion, about 62% higher. The figure below shows CBO’s past projections of federal spending on the Medicaid expansion, again adjusting CBO’s previous year estimates for its current assumptions about state adoption of the expansion.

Medicaid expansion is proving much more expensive than CBO expected, largely because the agency failed to anticipate how states would respond to the elevated reimbursement rate for ACA Medicaid expansion enrollees. Many states have set very high payment rates to insurers for the expansion population with the cost dispersed to federal taxpayers.

More New Medicaid Enrollees Were Already Eligible Than CBO Projected

Recent research suggests that only between 30% and 40% of new Medicaid enrollees in 2014 were made eligible for the program by the ACA. In contrast, CBO’s most recent estimate projected that 13 million people would be added to Medicaid in 2016 because of the ACA—11 million, or 85%, as newly eligible and 2 million, or 15%, as previously eligible. This large discrepancy has significant implications for the proper share of federal and state spending as well as the practical implications of repeal.

Previously eligible but unenrolled Medicaid recipients could generally enroll at any time including at the point of needing medical care, meaning that the practical effect of repeal on coverage loss may be significantly overstated. To put it simply, many of the newly covered Medicaid recipients will remain eligible even if the ACA is repealed without a replacement.

Economic Growth After Obamacare Much Lower Than CBO Projected

In January 2010, CBO projected that growth in real gross domestic product (GDP) would average 3.2% from 2010 to 2016. By way of comparison, the annual GDP growth rate after the first six years of another severe recession (1981-82) averaged 4.6%.

Economic growth after the Great Recession has been anemic by historical standards and relative to expectations. As the figure below shows, annual real GDP has increased just 2.1%, 50% below the average growth rate predicted by CBO and less than half the growth rate during the Reagan recovery. The weak economic recovery has produced lower health care spending, and thus lower health insurance premiums, than would have resulted with a stronger recovery.



Conclusion

Projecting the economic impact of major pieces of legislation is a difficult task with substantial amounts of uncertainty. To its credit, CBO acknowledges this, even as there is a tendency elsewhere to treat CBO estimates as gospel. Since CBO estimates will once again play a prominent role in the coming ACA repeal and replace debate, it is important to appreciate the large degree of uncertainty and to understand CBO’s key mistakes estimating the ACA. In particular, it would be good to know the steps CBO has taken to correct for its two biggest mistakes—overestimating the effect of the individual mandate and failing to anticipate how states would respond to the elevated reimbursement rate for the Medicaid expansion population. CBO should then inform lawmakers how it has adjusted its model and assumptions. And irrespective of CBO’s methodological changes, lawmakers should proceed with full awareness of the limits of CBO’s projection capability.









[Edited on 3/14/2017 by nebish]


nebish - 3/15/2017 at 02:47 AM

As to the 14 million losing healthcare in 2018, CBO says this:

quote:
CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.
https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestima te/americanhealthcareact.pdf



Not sure if CBO quantifies what "most" of 14 million is, but taking that at face value..."most" of the 14 million people losing coverage in 2018 do not want coverage. And then some other smaller group of people compared to "most" would lose it due to rising premiums.


nebish - 3/15/2017 at 03:30 AM

As I think most of us remember, ACA was facing challenges beyond 2016...before the election, even when Hillary was a projected POTUS winner, ACA was going to be facing problems. CBO word alot of their projections compared to "current law", but the current law of ACA was on thin ice, not from Republicans in Congress, but from reality acting like a loosening wrench on the nuts and bolts of the plan.

Sept 2016

quote:
excerpt:

Next year is considered crucial by Obamacare advocates. A number of insurers intend to exit Obamacare marketplaces, and many insurers remaining on those exchanges plan to hike their premium prices more sharply than in past years.

While federal health regulators have noted that more than 80 percent of Obamacare exchange customers get subsidies that can shield them totally or largely from premium price increases, millions of unsubsidized customers have no such protection.

The price hikes, and other factors, have raised concern that 2017 may be the year when efforts to expand coverage to the uninsured hit a wall.
http://www.cnbc.com/2016/09/07/obamacare-pushes-nations-health-uninsured-ra te-to-record-low.html



August 2016:
quote:
excerpt:

It's going to be a lot easier for people to pick an Obamacare plan in 2017, if only because there will be fewer to choose from.

One of the biggest drivers of increased healthcare costs is the lack of competition in some markets. This problem is acutely present for the Affordable Care Act's public insurance exchanges, according to a new study by Avalere Health.




http://www.businessinsider.com/one-of-the-biggest-problems-with-obamacare-i s-only-getting-worse-2016-8



While many will hail adding people to Medicaid coverage, many with that coverage find it hard to get care as they are denied access by providers since they are reimbursed only about 40% of their services under ACA.

January 2015:

quote:
excerpt:

Primary care doctors face pay cut

Family doctors who treat Medicaid patients will see steep drops in payments from the federal government that could make it tougher for millions of low-income people to find care.

Reimbursements from Medicaid will shrink an average of 43 percent starting in January, when the federal government’s temporary raise for primary care doctors is set to expire.

The federal government had raised its reimbursement rates to entice more doctors to accept Medicaid patients under ObamaCare. Patients with Medicaid have been historically known to cost healthcare providers far more than they are repaid for the treatment, causing some doctors to turn away patients.
http://thehill.com/policy/healthcare/228294-obamacares-2015-challenges




May 2015:
quote:
excerpt

Why Some Doctors Won’t Accept Medicaid

When comparing reimbursement rates among health insurance plans, Medicaid is the lowest payer, meaning it’s not a moneymaker for doctors’ offices. Paired with the administrative requirements of accepting public insurance, doctors sometimes just don’t want the hassle.
http://health.usnews.com/health-news/health-insurance/articles/2015/05/26/y ouve-got-medicaid-why-cant-you-see-the-doctor




Now it is certainly fair to take issue with the Republicans and Trump because someone disagrees with the direction they are taking their repeal and replace compared to say the direction Hillary Clinton would've went. Either way, it is undeniable that ACA would've been highly unstable and even ineffective going forward without action.

quote:
http://www.huffingtonpost.com/john-geyman/affordable-care-act-implo_b _12894720.html

THE BLOG 11/10/2016 07:39 am ET | Updated Nov 10, 2016

Affordable Care Act: Imploding And Beyond Repair

By John Geyman

Originally Published by The Hill, Oct, 21, 2016

Our experience with the first six and a half years of the Affordable Care Act already tells us whether it will work.

Despite the law’s goals of containing costs and making health care affordable, it’s proven to be too expensive to be sustainable, overly complex and bureaucratic, and a gift to the private health insurance industry and other corporate stakeholders in the medical-industrial complex.

To be fair, the ACA has brought some kind of coverage to about 20 million Americans, in good part through the expansion of Medicaid in 32 states (including D.C.) and the subsidized exchanges. But its negative results far outweigh its gains, as shown by these data points:

> We still have 29 million uninsured Americans (compared to 48 million at the start), plus tens of millions underinsured.

> Insurance plan deductibles and co-pays have sharply increased, deterring people from seeking necessary care. A brand new market is opening up, “gap insurance,” to cover what is not covered in today’s market - insurance for those who have insurance.

> Narrowed networks under the ACA have forced many millions of patients to change their desired physicians and hospitals.

> The ACA has accelerated a national trend of corporate consolidation of insurers and hospitals, with growing market and political power.

> The ACA’s regulation of health insurers has been lax, leaving insurers many ways to game the system (e.g. by overstating the health risks of their enrollees) in their self-interest.

> Expanding hospital systems, facing less competition, are free to charge much higher prices, by up 40 percent to 50 percent.

> Pharmaceutical drug prices have been sharply increasing, often shockingly so. A one-year course of cancer drugs often exceeds200,000, forcing many patients to choose between bankruptcy and treatment.

> The costs of insurance and health care now exceed25,000 for a family of four covered by an average employer-sponsored PPO plan.

> Overpayments to privatized Medicaid plans are endemic in more than 30 states, often involving unnecessary and duplicative payments.

> The ACA’s accountable care organizations have failed to contain costs and improve quality of care.

> Most of the nonprofit co-ops established under the ACA have failed.

> Sign-ups for ACA coverage on the exchanges have fallen far short of expectations - just 11 million this year compared to 24 million forecasted, with many people unable to afford even subsidized coverage.

> Premium increases of 50 percent or more for 2017 are being reported in a number of states, including Minnesota, while many insurers are exiting their markets.

> Given this dysfunctional reality under the ACA, it’s remarkable that neither major political party has a plan to truly fix the situation.

If elected, Hillary Clinton proposes to bring on the public option (which can’t possibly succeed against the overwhelming market share of a subsidized insurance industry), increase subsidies, add new tax credits for deductibles and co-payments, and lower the age for Medicare eligibility to age 55. These tweaks would not reverse the huge private bureaucracy bent on increasing profits in markets subsidized by taxpayers.

Given the opportunity, Republicans would repeal the ACA with no credible plan for replacement - relying on such long-discredited approaches as consumer-directed health care, health savings accounts, high risk pools, selling insurance across state lines, and giving states more leeway with block grants.

We should have learned by now that segmented risk pools designed for profits by private health insurers will never provide universal access to affordable health care in this country.

Virtually all advanced countries around the world learned this long ago with one or another form of universal health insurance.

Multiple studies have demonstrated that in the U.S. we could save about $500 billion a year by enacting a nonprofit single-payer national health program that streamlines administration. Those savings would be sufficient to guarantee everyone high-quality care, with no cost sharing, on a sustainable basis. The system could also negotiate lower drug prices.

Studies over the past two decades have shown 3 of 5 Americans supporting an improved version of Medicare for all. Support for single payer is also growing among doctors and other health care professionals. Yet the Expanded and Improved Medicare for All Act, H.R. 676 (Rep. John Conyers’ bill), with 62 co-sponsors, sits neglected in a House committee.

Until we recognize that the largest possible risk pool is required to implement universal coverage in the public interest, and that the private health insurance industry is on a death march, we cannot make necessary health care available to all Americans.

Can’t we get to real health care reform on a nonpartisan, win-win basis?

John Geyman, M.D. is the author of The Human Face of ObamaCare: Promises vs. Reality and What Comes Next and How Obamacare is Unsustainable: Why We Need a Single-Payer Solution For All Americans

visit: http://www.johngeymanmd.org


[Edited on 3/15/2017 by nebish]


gina - 3/15/2017 at 11:17 PM

quote:
As to the 14 million losing healthcare in 2018, CBO says this:

quote:
CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.
https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestima te/americanhealthcareact.pdf




Not sure if CBO quantifies what "most" of 14 million is, but taking that at face value..."most" of the 14 million people losing coverage in 2018 do not want coverage. And then some other smaller group of people compared to "most" would lose it due to rising premiums.

If it comes down to it, people can go to the walk in emergency care places. Find a good one with Doctor's who are reasonably knowledgeable and just utilize them. I may need to do that later this year. If it comes to that, I will go in as an informed health care consumer. Most Doctors are just not that knowledgable. I told the internist I was losing my hair and thought it could be a thyroid or endocrine problem, I suggested he check my prolactin levels. He got pissed off and only did regular thyroid tests which showed nothing. He had nothing to offer me, somebody else told me take prenatal vitamins, they fix it if your hair is falling out. All it has in there is folic acid and B vitamins, but in the formulation they have it, it works. Anybody else losing your hair, get some prenatal vitamins and take one per day. Within a week or so, you will probably see improvement.

Yeah that is a minor thing, but it is important. After some of what I have been thru with other things I am mostly just disgusted with the medical profession, though I will say there are still some great Doctors, over the 6 months I met a few of them who are very impressive, and I don't need to offer any suggestions, they know their stuff.






[Edited on 3/15/2017 by gina]


nebish - 3/17/2017 at 03:47 AM

I don't know what the solution for this mess of a system we have. I'm open to a national single payer system, but I also want everyone to have some skin in the game on their health and consequences for certain decisions they make (good or bad). I think really the over riding thing I want is for costs to go down. Not just costs that the individual is exposed to, but net costs that 3rd party payers or anyone are also responsible for. Hospitals with 24 hour ERs having unpredictable inflows and corresponding expenses will always be a challenge and there is a certain level of cost shifting from uninsured and Medicaid patients to everyone else. But outside of an ER billing department, it would certainly seem to me that costs shouldn't be that hard to reign in on just about everything else. We need cost transparency in medicine and health care and I think we need people to care what these costs are to make decisions off of just like we do about everything else in life.

Stories on the Surgery Center of Oklahoma have been out there for a while, but it fits into this thread. They are still functioning today as they were in 2013 when this piece was written.

quote:
Down The Cost Of Health Care By Thousands Of Dollars

Tara Culp-Ressler
Senior Editor at ThinkProgress. Contact me: tculp-ressler@thinkprogress.org
Jul 10, 2013

In Oklahoma City, one surgical center is successfully reducing the price tag for their procedures by thousands of dollars  and encouraging nearby hospitals to follow suit.

What’s the secret?

The two doctors who started the Surgery Center of Oklahoma, Dr. Keith Smith and Dr. Steven Lantier, are committed to charging fair prices, and they founded their hospital with the goal of price transparency. “What we’ve discovered is health care really doesn’t cost that much,” Dr. Smith told KFOR-TV. “What people are being charged for is another matter altogether.”

They have been posting all of their prices online for the past several years, and they charge significantly less than other hospitals in the area.

“When we first started we thought we were about half the price of the hospitals,” Dr. Lantier said. “Then we found out we’re less than half price. Then we find out we’re a sixth to an eighth of what their prices are. I can’t believe the average person can afford health care at these prices.”

After comparing the Surgery Center’s prices with the bills for the same surgical procedures at other Oklahoma City hospitals, KFOR-TV confirmed just how wide that gulf is. For example, a $3,500 breast biopsy at Surgery Center of Oklahoma will cost $16,244 at nearby Mercy Hospital. A hysterectomy jumps from $8,000 at Surgery Center to $37,174 at Integris Baptist Hospital. And the OU Medical Center consistently charges about $15,000 more than what the Surgery Center does for common procedures like open fracture repairs and gall bladder removal.

The two doctors started somewhat of a medical bidding war after they started publicizing their pricing options. People began traveling from out town and even from out of state to take advantage of the much lower bills at the Surgery Center — and other hospitals took notice. At least five other Oklahoma City-area medical facilities started posting their own prices online, and some of them are even beginning to lower their bills as their patients push for price-matching.

“Hospitals are having to match our prices because patients are printing their prices and holding that in one hand and holding a ticket to Oklahoma City in the other hand and asking that hospital to step up,” Dr. Smith pointed out.

There are some caveats accompanying the Surgery Center of Oklahoma’s business model. What works for surgery centers may not necessarily work for larger hospitals, since surgery centers tend to focus on elective procedures that are a bit more predictable than the range of care needed in an emergency department. And, since the federal Medicare program doesn’t currently support this type of online pricing for their beneficiaries, the Surgery Center can’t accept any patients with Medicare or Medicaid plans. Only those with private insurance, or those who lack insurance altogether, may patronize the facility. Some critics say that allows the Surgery Center to cherry-pick the healthiest or highest-income patients.

But on a broader scale, more price transparency in the health care sector is sorely needed. New government data has confirmed that hospital pricing is often completely random, with the most expensive hospital in the country charging about four times more than average for no apparent reason. When it’s not clear what health services cost, doctors are more likely to recommend and patients are more likely to agree to expensive and unnecessary tests and procedures. And most patients can’t easily shop around to make the most informed decisions about where they want to get their care.

Provisions under Obamacare will attempt to spur more transparency in this area to both equip Americans with more information about their health care and convince hospitals to make their prices more competitive. Some private hospitals, like the handful in Oklahoma City, are already taking it upon themselves to get started.

https://thinkprogress.org/how-one-oklahoma-hospital-is-driving-down-the-cos t-of-health-care-by-thousands-of-dollars-f507cdf32111#.hue499l1h


emr - 3/20/2017 at 05:58 PM

Part (but not all) of the ability of the asc to charge less is because they can turn away the uninsured; decide which insurances they choose to participate in; and don't need to stay open 24/7 for Emergencies. Cherry Picking is a very lucrative position for a business to have.


WaitinForRain - 3/20/2017 at 09:15 PM

Cherry picking makes health insurers wadZILLions of dollars. And even if all the different insurance companies would use 1 single standardized form for application and submitting claims it would save MILLIONS.

I work in healthcare. I am not eager to see the return of mass uninsured, there is no reason why hospitals should provide free care for people. Insurance companies make money off of this. They cherry pick and someone else gets burned for the charges.

We need to get away from Damage Control Healthcare and into wellness care, we need single payer, and we need to get rid of obscene CEO salaries and bonuses and $500 bags of saline.

How to Charge $546 for 6 liters of saltwater:

http://www.nytimes.com/2013/08/27/health/exploring-salines-secret-costs.htm l

the drug cartels have nothing over Big Healthcare.


nebish - 3/21/2017 at 01:29 PM

When did the cost for one's medical cost become somebody else's responsibility? I remember when I was a kid people would just talk about hospitalization insurance, but everything else was the individual's responsibility. Seems to me like the health insurance industry in and of itself has led to the cost explosion. The very thing that supposedly allows people to afford medical costs is the exact same thing that is driving up the cost.

Like I said when somebody else is paying, who shops around on price (to the extent you can?). When you are paying out of pocket, don't you shop on price? We saw how much "business" the Surgery Center of Oklahoma got from their "competitors" when they started publishing the rates for their procedures - and we see how much other places were charging.

Surgery Center of Oklahoma doesn't turn away the uninsured, that is if you have a means to pay for it. Sometimes uninsured doesn't have to mean indigent. Everyone makes decisions in their lives, what to spend, where to spend. Why shouldn't people plan, save and budget for their potential medical costs? Don't we do that when our homes and autos need repaired? But for some reason, when it comes to medical costs people don't want to think about it, oh that should be the government's or the insurance companies or somebody else's responsibility. When we have the patient caring about the cost is when we can have cost reductions. Maybe if we could rein the prices in we could get closer to a system where people could afford the costs. Instead we get a place like Surgery Center of Oklahoma charging $3500 for something while somebody else is charging $16,244 for the same thing. Or $8000 instead of $37,174 at another place for the same thing!

ER Hospitals are a different story, I get it whether there are zero people there or 50 people there they are open and staffed and the people and situations they face are unpredictable.

And I guess it is all tied together. I still think overall price transparency should be the goal. Why am I the crazy one when I ask my doctor or whatever facility I am at how much it will cost ahead of time? They shouldn't be incapable of offering a price estimate.

The health insurance and the medical industry in this country is so complicated and confusing, the IV bag story really pisses me off. Just like charging 5 different rates for the same thing for 5 different people. All Washington ever does is just add more and more layers of complexity onto the system, which seems to lead to higher and higher net costs. I think it needs stripped down, exposed and we need to start over on how medicine is administered, billed and paid for in this country.


emr - 3/21/2017 at 02:27 PM

Again re: surgi center of Oklahoma. People can pay if they are uninsured; many people can afford say a Colonoscopy or Arhtroscopy.

But those who are indigent get it for free in an Emergency Basis only at the hospitals. And the $500,000 complicated open heart surgery for the indigent/uninsured never enters into the bottom line at the surgi center.

The $500 saline bills pay for free saline for the uninsured.

The system is nuts; there is no transparency. But unless everyone has insurance and/or hospitals have the right to turn away the indigent none of this can ever get fixed.

I've said it many times here but ALMOST NO ONE CAN AFFORD TO PAY FOR TRULY EXPENSIVE CATASTROPHIC ILLNESSES. PEOPLE WHO "ROLL THE DICE" WITHOUT INSURANCE REALLY AREN'T ROLLING THEM


nebish - 3/21/2017 at 03:39 PM

Hospitals can't turn people away because of something Reagan passed stating that ability to pay can't be considered when somebody comes to the hospital for care.

Is that where costs started ballooning? Something, some event in history had to be the marker for cost escalation that continues today. Growth of employer sponsored plans? Insurance profit greed, when did that really kick in?

I'm just trying to see if there is a line in the sand where people had a certain level of responsibility to pay for most of their normal medical and drug costs, and were able to mostly afford it - to where we are now.

As to rolling the dice...

...if someone has no health insurance, no medicare, no medicaid and goes to ER they do get care and then also get the bills. If they can't pay those bills it get turned over to collection agencies probably for pennies on the dollar then the hospital has to look to recoup those lost charges somewhere else. For the individual, some people might do their best and work out some cost reduction agreement and a payment plan, others will surely just have to fold under the debt they've created and may have to declare bankruptcy to escape the costs their care created. So technically, the uninsured do have something to lose if it comes down the result of having to go bankrupt. So there is some dice rolling involved still, correct?

On the other hand, if one can get on Medicaid then they go to the ER, get care and get no bills and the government pays a % of the bill and the hospital either eats the cost of the balance or shifts the cost to the other payers. Which, I would suspect that hospitals still look to recover the unpaid part of medicaid bills somewhere right? They are shifting those costs to the saline bags just like they are for uninsured no?


Fujirich - 3/21/2017 at 04:34 PM

We're caught in this endless loop of public debate about who pays. Who pays isn't the issue. The costs are the issue, and we never address that.

If medical costs were reduced by 1/4 - still making us one of the most expensive countries for health care - the number of people who could be treated and cared for with the same current dollars would more than cover everyone.

I'm no fan of gov't run single payer for the US. It might work in some places, but I seriously doubt it would here (see the VA). We have un-involved health care consumers because they haven't had to think much about their costs. That's the legacy of group buying, and a big contributing factor to why providers aren't faced with questions about how much something costs. If we stopped the group coverage, health care consumers would pay a lot more attention to costs, forcing providers to be much more visible in their pricing. Unless we stop the cycle of why one person can get charged 5x more than the next due to what insurance they have, this will never be improved.


emr - 3/21/2017 at 04:34 PM

Yes its all cost shifting. Believe it or not physicians (other than Cosmetic Surgeons) for the most part hate self pay patients.. Despite the ease of not dealing with insurance companies there is always the concern of "what if they need further tests and at that point can't pay." And "What if there is a complication and they can't pay." Then you are involved legally and without options.

So since there are so many more medical treatments/tests/options out there than there were in 1960 it is very complicated (even too tough for Trump!!!!) Most insurance plans now make patient's pay increasingly larger portions of their expenses to try to make them price conscious. But doctors/hospitals are still on the line when people stop paying (can't abandon patients in the short term or when sick)

I still think low level universal coverage with options to buy into higher levels the best plan. But we are a spoiled country


Bhawk - 3/21/2017 at 05:38 PM

quote:
Who pays isn't the issue.


It most certainly is in the current state.

quote:
If medical costs were reduced by 1/4


How?

quote:
I'm no fan of gov't run single payer for the US. It might work in some places, but I seriously doubt it would here (see the VA).


What does single payer have to do with the VA? There's a ton of measures in place by both the VA and CMS that prevent them from paying out anything to providers at all.

quote:
That's the legacy of group buying, and a big contributing factor to why providers aren't faced with questions about how much something costs. If we stopped the group coverage, health care consumers would pay a lot more attention to costs, forcing providers to be much more visible in their pricing. Unless we stop the cycle of why one person can get charged 5x more than the next due to what insurance they have, this will never be improved.


This requires the uncoupling of insurance as an employer benefit. Not sure if that's possible after 75 some odd years.


nebish - 3/23/2017 at 01:36 PM

Big day today in the House to see if they can get the votes to pass their bill.

You know, from day #1 years and years ago, I never understood the rallying cry that Republicans made of repealing ACA. ACA is and was problematic, I wasn't for it then, but once it was passed I didn't wake up every day and dream about repealing it.

Then the Republicans had all these years to come up with a replacement, some of which they actually passed bills doing so. But now everyone is scrambling. I guess it is different when you are doing something for show vs doing something that is really going to stick.

It is easy to sit here and pretend to be against everything. Not a fan of insurance run system, not a fan of government-insurance ACA system, I don't think I am a supporter of the Republican repeal and replacement. I see it as all very troubling.

Most of my posts here have talked about costs. I don't want to layer more ways to have people be able to afford bloated costs in our current system. I want to look for ways to lower the root costs so more people can afford what they need and get. Unfortunately I'm not sure any meaningful number of people in Washington see it that way, instead Democrats mostly just want to give more people something for nothing and others...well honestly I don't think the Republicans even know what they want to do.


heineken515 - 3/23/2017 at 04:25 PM

I recall way back when Bill was President, Hillary took on some sort of health care task force and I recall her saying something about looking into health care costs and that would be one of the major points of her efforts.

I thought then that was a smart thing to do.

I can only guess that there are heavily funded, well backed forces attached to keeping this on the back burner.


Bhawk - 3/23/2017 at 06:23 PM

quote:
I recall way back when Bill was President, Hillary took on some sort of health care task force and I recall her saying something about looking into health care costs and that would be one of the major points of her efforts.

I thought then that was a smart thing to do.

I can only guess that there are heavily funded, well backed forces attached to keeping this on the back burner.


The three-tiered model that Obamacare is based on was modeled after Bob Dole's healthcare plan circa the 1996 election, which was concepted by the Heritage Foundation, the most respected conservative think tank there is. Go figger.


Swifty - 3/23/2017 at 07:57 PM

What's confusing about this is that giving people access to different payment systems is considered choice and because there is individual choice this type of exchange is considered market driven. This seems to be the prevalent mentality and it obscures the fact that in respect to the actual service or product we have very little choice.

In order for any health service or product to be paid for by insurance it has to be related to allopathic care. And the primary party that benefits from allopathic care is big pharma because allopathic doctors extensively use the products of big pharma. This is one of the reasons that big pharma lobbies extensively against any health strategy that is non--allopathic, as these systems seldom use the products of big pharma.

In respect to health care we are conceptually trapped in a system governed by two symbiotic monopolies. The costs of big pharma are high because there is no diversity in the delivery of health care. The salaries of allopathic doctors are high because they are the only health providers paid by most insurers.

If you look at most European health care markets there is a lot of diversity in choice about what type of health care to use. And it is this choice that brings down costs. Homeopathic medicine has been around almost as long as allopathic medicine and yoga and acupuncture are ancient in comparison. And these alternative medicines are mostly safe. I say mostly because there is always going to be some allopathic scribe who will tell you that you'll bleed to death if you go to an acupuncturist.

And the alternate care systems work very well for colds, influenza and most kinds of body pain. These are also the ailments that keep people out of work which lowers productivity. There are plenty of reasons to diversify health care but we are slaves to allopathy and big pharma.


BoytonBrother - 3/23/2017 at 08:41 PM

Sad and pathetic that Trump has failed so much so early. Failed executive orders, failed at passing his healthcare reform. Failure! Very bad. Very bad.


2112 - 3/23/2017 at 10:47 PM

quote:
Sad and pathetic that Trump has failed so much so early. Failed executive orders, failed at passing his healthcare reform. Failure! Very bad. Very bad.


Not to mention failing to get Mexico to pay for the wall. Who would have ever guessed that Mexico would have refused? But on the bright side his coal mining friends are now allowed to pollute our rivers and streams, so at least he should be happy about that.


Fujirich - 3/23/2017 at 11:32 PM

quote:
quote:
Who pays isn't the issue.


It most certainly is in the current state.

quote:
If medical costs were reduced by 1/4


How?

quote:
I'm no fan of gov't run single payer for the US. It might work in some places, but I seriously doubt it would here (see the VA).


What does single payer have to do with the VA? There's a ton of measures in place by both the VA and CMS that prevent them from paying out anything to providers at all.

quote:
That's the legacy of group buying, and a big contributing factor to why providers aren't faced with questions about how much something costs. If we stopped the group coverage, health care consumers would pay a lot more attention to costs, forcing providers to be much more visible in their pricing. Unless we stop the cycle of why one person can get charged 5x more than the next due to what insurance they have, this will never be improved.


This requires the uncoupling of insurance as an employer benefit. Not sure if that's possible after 75 some odd years.


1) Shifting around "who pays" has done nothing to improve care, and only a little to improve the number covered (at very high cost). Even with Obamacare, millions remain uncovered. If we remain locked in the "who pays" discussion, that will just continue.

2) "How" is trusting what the free market does when having to survive based on creating satisfied customers. Health care doesn't have to do that today because the purchase and payment part of the equation is so distorted compared to any other product or service. The Swiss system does this without imposing a heavy gov't hand and they're about a 1/3rd less costly than we are.

3) The point about the VA was simply an example of our gov't running a health care program, and its resulting quality. Single payer fans just ignore that mess and think if instituted countrywide, it would be great. No, it would be a nightmare, and the Federal gov't would never function again because they'd be stuck in an endless loop of health care issues. Just look at how much time they now waste on the relatively small issues of how Obamacare works, then multiply that countless times when adding every single decision about running health care for the nation to their burden.

4) The employee benefit of health care doesn't have to change. Employees would just receive funds to purchase their health care as individuals, the way all other insurance is purchased. Gov't benefits would be rearranged the same way. This is the Swiss system. It forces the consumer to be more involved, but benefits from that in terms of lower costs.


gina - 3/24/2017 at 11:36 PM

Some very disturbing predictions today from the NY side IF the Obamacare replacement coverage in it's original form were passed.

http://www.nydailynews.com/news/politics/trump-pulls-plug-obamacare-repeal- vote-gop-support-falters-article-1.3007886

http://www.nydailynews.com/news/politics/cuomo-warns-big-state-tax-hike-oba macare-repeal-plan-passes-article-1.3005853

http://www.nydailynews.com/new-york/gop-obamacare-repeal-saves-rural-new-yo rkers-cash-city-expense-article-1.3004093


NY's Governor Cuomo said:
“Life has options, and the hard reality is that Collins and Faso are leaving New York State with only two unacceptable choices,” Cuomo said. “Either we could pass on the devastating cuts to our hospitals, nursing homes and the 40% of New Yorkers who currently receive Medicaid and health benefits. Or, we would be forced to raise state income taxes — either by increasing taxes on all New Yorkers by 10%, or if Collins and Faso have their way in protecting only the wealthy, on the middle class by 26%.”

The shift would add $2.3 billion to the state budget, bringing the total loss the state is looking at under the House bill to $6.9 billion over the next four years, he said.Cuomo said that under the bill, 2.7 million New Yorkers will lose health coverage while hospitals will see funding cut by $355 million.

Cuomo called it “absurd” to ask the state to cover the costs at the same time the health care bill provides a $150 billion tax cut to the 1% richest Americans and a $54 billion increase in defense spending.

“The thought would be somehow our governor, being as inept as he is, can’t find a single dollar of savings in a $63 billion Medicaid program over the next three years, I mean, give me a break, governor,” Collins said.

Cuomo warned that the cuts would affect those who need help the most, including nursing home payments being slashed by $401 million, home care payments by $360 million, and hospital payments by $355 Million.

REMARKS: Contentious? Oh yes. There seem to be a lot of points where Democrats and Republicans are at odds. The states do not have enough money to run their programs, the insurance companies cannot afford to provide 'affordable' coverage to the many people who need the coverage, and it is NOT just New York. Imagine this scenario nationwide. The Democrats said they would filibuster if the Vote was taken on the American Health Care Act, and Trump realized he was 7 votes short on the Republican side, so he had Ryan pull the bill and the vote was not held. Trump does not want to waste time. If the bill has no way of passing, why waste everybody's time? He will work on other things, if the others do not want to seriously work on the bill. I have not seen the specifics of the bill, but have heard criticisms of it from many sources. Bernie Sanders was able to make health care affordable in Vermont, maybe some of the Reps need to meet with Bernie, and dare I say, even Bill Clinton probably has valuable advice. He is smart, balanced a Nationwide budget, and let the country with a surplus. He knows how to do those things.





[Edited on 3/24/2017 by gina]


Chain - 3/24/2017 at 11:48 PM

Just yesterday Republicans were screaming that the Affordable Care Act would destroy America within practically days.....Now that their turd of a bill went down in flames it's, oh well, f*ck it, let's just move on....Or, they could actually work with the other side and actually work to improve the problems (and there certainly are serious problems associated with the Affordable Care Act) now and moving forward long into the future.

But then again healthcare in this country has been a mess for decades and requires true leadership and compromise and not the partisan rhetoric that seems to be the only thing Washington is good at these days.

Lastly, in typical Trump fashion, if he doesn't get his way he just leaves a mess for someone else to clean up. Where are those amazing negotiating skills, little Donnie? Where is the plan that'll provide better coverage for less and for everyone? What a charade con artist we have in the oval office.


MartinD28 - 3/25/2017 at 12:45 AM

quote:
Just yesterday Republicans were screaming that the Affordable Care Act would destroy America within practically days.....Now that their turd of a bill went down in flames it's, oh well, f*ck it, let's just move on....Or, they could actually work with the other side and actually work to improve the problems (and there certainly are serious problems associated with the Affordable Care Act) now and moving forward long into the future.

But then again healthcare in this country has been a mess for decades and requires true leadership and compromise and not the partisan rhetoric that seems to be the only thing Washington is good at these days.

Lastly, in typical Trump fashion, if he doesn't get his way he just leaves a mess for someone else to clean up. Where are those amazing negotiating skills, little Donnie? Where is the plan that'll provide better coverage for less and for everyone? What a charade con artist we have in the oval office.


The emperor is learning he is not quite the deal maker that he's bragged about being. Instead Trump/ Ryan Care doesn't get off the ground and would be easily compared to the Trump's bankruptcies. They both share about the same amount of success.

The irony is that the GOP attempted to repeal Obamacare what 40, 50, 60 some times, and now that they had the chance to actually do it they failed. It goes to show that 8 years of doing nothing but saying "no" does not translate on how to govern.

Oh well...on to building the wall that the American taxpayers will foot the bill for if it ever gets built. Who will Donnie blame when he FAILS to get Mexico to pay for it as he promised if it does get built?


Chain - 3/25/2017 at 12:07 PM

quote:
quote:
Just yesterday Republicans were screaming that the Affordable Care Act would destroy America within practically days.....Now that their turd of a bill went down in flames it's, oh well, f*ck it, let's just move on....Or, they could actually work with the other side and actually work to improve the problems (and there certainly are serious problems associated with the Affordable Care Act) now and moving forward long into the future.

But then again healthcare in this country has been a mess for decades and requires true leadership and compromise and not the partisan rhetoric that seems to be the only thing Washington is good at these days.

Lastly, in typical Trump fashion, if he doesn't get his way he just leaves a mess for someone else to clean up. Where are those amazing negotiating skills, little Donnie? Where is the plan that'll provide better coverage for less and for everyone? What a charade con artist we have in the oval office.


The emperor is learning he is not quite the deal maker that he's bragged about being. Instead Trump/ Ryan Care doesn't get off the ground and would be easily compared to the Trump's bankruptcies. They both share about the same amount of success.

The irony is that the GOP attempted to repeal Obamacare what 40, 50, 60 some times, and now that they had the chance to actually do it they failed. It goes to show that 8 years of doing nothing but saying "no" does not translate on how to govern.

Oh well...on to building the wall that the American taxpayers will foot the bill for if it ever gets built. Who will Donnie blame when he FAILS to get Mexico to pay for it as he promised if it does get built?


No doubt he'll blame most everything he fails at (and I suspect his list of failures will be long before he's booted out of the White House) on Obama, the Dems, and the courts. Oh, and the left wing media....


BoytonBrother - 3/25/2017 at 04:34 PM

He has the demeanor of someone who doesn't want to be there.


gina - 3/25/2017 at 04:42 PM

Trump doesn't like defeat. He needs to win. Since the Republican side was 7 votes short of passage, they had 20 yes votes, they needed 7 more; he has decided to just walk away from it. When Obamacare 'implodes' as he calls it, he figures everyone will be more cooperative. The subsidies for people buying into the exchange to get insurance were only legislated for one year, so if somebody signed up for Obamacare, they got subsidized for one year, then they might have to pay the full premiums themselves, what then? They can't, they lose insurance, get hit with tax penalties and do not get health care. Many of the insurance companies already realized they cannot afford to provide care under the reimbursement rates for people insured through the exchange, so there is crisis there also.

The act that they put forward as a replacement still left 24 million people without insurance so it did not totally fix the problem. I mentioned the problems the states could face with New York as an example, so the health care crisis will not be just resolving itself.

Trump's next project is Tax Reform. Ohhh boy. This will be an even hotter debate among Congress.

I wonder if Trump will reach the point if he cannot get things done where he just says fuk y'all, see how you like it when things get worse. When they get bad enough then you will work to fix them.

Meanwhile we are on the verge of world war, you just have not heard about it yet.


MartinD28 - 3/25/2017 at 05:23 PM

quote:
Trump doesn't like defeat. He needs to win. Since the Republican side was 7 votes short of passage, they had 20 yes votes, they needed 7 more; he has decided to just walk away from it. When Obamacare 'implodes' as he calls it, he figures everyone will be more cooperative. The subsidies for people buying into the exchange to get insurance were only legislated for one year, so if somebody signed up for Obamacare, they got subsidized for one year, then they might have to pay the full premiums themselves, what then? They can't, they lose insurance, get hit with tax penalties and do not get health care. Many of the insurance companies already realized they cannot afford to provide care under the reimbursement rates for people insured through the exchange, so there is crisis there also.

The act that they put forward as a replacement still left 24 million people without insurance so it did not totally fix the problem. I mentioned the problems the states could face with New York as an example, so the health care crisis will not be just resolving itself.

Trump's next project is Tax Reform. Ohhh boy. This will be an even hotter debate among Congress.

I wonder if Trump will reach the point if he cannot get things done where he just says fuk y'all, see how you like it when things get worse. When they get bad enough then you will work to fix them.

Meanwhile we are on the verge of world war, you just have not heard about it yet.


You say that the emperor doesn't like defeat & needs to win. Newsflash - under his ownership & leadership, he just suffered a MAJOR DEFEAT. Quite frankly, if one listens to his talks and rants, he really never seemed to talk as if he understood much of the policy nor details of the plan. What was in the plan went against much of his campaign rhetoric. In the end & as usual, he blamed the democrats, yet it was his own GOP that trashed this bad piece of legislation.

As ACA needs some enhancements / maintenance, the GOP plan would have destroyed the lives of millions. The GOP had 7 or 8 years to get their act together, and look what happened.

Now he's on to another of his campaign issues. Wait until tax reform when the rich get major relief and the middle class & the poor get leftover crumbs. The policy and details will end up far from his campaign promises. He's not delivering on much of his promises. That's why he's < 40% in favorability ratings and probably heading south.


gondicar - 3/25/2017 at 05:40 PM

The GOP had 7 years to figure out the healthcare thing and it was an epic failure right out of the gate. Trump's comments after yesterday's defeat were classic Donald Trump. No depth, no eloquence, no ownership, no class, no truth, no leadership. No president. With his companies, now is when he usually declares bankruptcy and moves on...the country won't be so lucky, but he still might not be around much longer #russia


Chain - 3/25/2017 at 06:11 PM

quote:
He has the demeanor of someone who doesn't want to be there.


Agree....In fact, right from the moment he was declared the winner it was very obvious that he not only didn't want to be president, but that he knew he was WAY over his head. He had that "deer in the headlights" look on his face.

The guy simply hasn't the intellect, curiosity, demeanor, maturity or passion for governing to be POTUS. It's more and more evident that entering the race was always about getting attention, building his brand, and monetizing that attention. It was never about actually being president.

What I don't understand is why some in the Republican party back this turd of a president despite his obvious ineptness when Pence is far more their conservative stool pigeon and would be their wet dream occupant of the White House if Trump were booted. I think it's this scenario that many within the party are coming to terms with.

While I'm not a fan of Pence and his platform, at least the guy is an adult and somewhat intelligent beyond just marketing, real estate, and bankruptcy law.

[Edited on 3/25/2017 by Chain]


Chain - 3/25/2017 at 08:58 PM

A question for the far brighter folks on this site than I (and there are lots of you here...which is why I hang here....I've learned a lot over the years from many sides to a lot of issues...Thank you all, by the way). If Trump were to be impeached, I can't help but wonder given this was the actual election, not a few years in like Nixon or as I like to call him, "Sweet William Now" Billy Clinton, would Pence also be susceptible to impeachment? What does the actual Constitution dictate?

Especially if he colluded once he was chosen for the ticket, should they prove he did? Assume a felony and thus the first impeachment proceedings against a VP? Or am I wrong, has a VP previously been impeached?

Chime in everyone....Or as Willie Nelson would say, "Let me hear you Micky"



[Edited on 3/25/2017 by Chain]

[Edited on 3/25/2017 by Chain]

[Edited on 3/25/2017 by Chain]

[Edited on 3/25/2017 by Chain]


Sang - 3/25/2017 at 09:49 PM

Spiro Agnew resigned...

Less than a year before Richard M. Nixon’s resignation as president of the United States, Spiro Agnew becomes the first U.S. vice president to resign in disgrace. The same day, he pleaded no contest to a charge of federal income tax evasion in exchange for the dropping of charges of political corruption. He was subsequently fined $10,000, sentenced to three years probation, and disbarred by the Maryland court of appeals.


Chain - 3/25/2017 at 11:41 PM

Ah, I see...Thank you Sang. Now we know the blind devotion to the Idiot in Chief, Little Donnie....Pence might not survive either and thus all hands on deck no matter how nuts the Captain might be.

Could Trump be our Caligula? Seriously?

Actually, Caligula was far brighter than Trump....I retract the question...

[Edited on 3/25/2017 by Chain]


gondicar - 3/25/2017 at 11:51 PM

I do feel sorry for people like this guy who bought into the Trump Train campaign lies and now regret it, but for the life of me I just can't understand how they could have been so badly duped in the first place...these are not dumb people, yet it was so obvious...now we all are paying for it.

https://www.washingtonpost.com/news/morning-mix/wp/2017/03/23/the-trump-tro ubadour-went-to-45-trump-rallies-in-honor-of-his-late-son-now-he-feels-betr ayed/


2112 - 3/26/2017 at 12:40 AM

I have no idea why so many bought into Don the Cons' lies, but Crooked Hillary's emails don't seem to be such a big deal now.


BoytonBrother - 3/26/2017 at 05:23 AM

The Trump supporters weren't duped. They never cared whether he could enact his policies or not. They just admired someone who was willing to be as hostile as he was/is. They just want the hostility - nothing more, nothing less. Accomplishments? not important.


Chain - 3/26/2017 at 07:38 PM

I think many Trump voters probably knew the guy is and has always been a lying con artist. I mean, really, how could anyone not who did the most basic research on him? His past is littered with broken promises, screwing contractors, outright lying, failed business ventures, etc....I think many voters were and are still simply frustrated with Washington and the two party system that is corrupt as hell and simply wanted someone, anyone, to blow it up.

Then of course there's those who believe government should be run like a business, even if their chosen candidate isn't actually very good at running actual businesses despite said candidate portraying himself as being a successful business man. He's a master marketer/shyster who plays the con of being a good business man.


nebish - 3/27/2017 at 01:14 PM

I saw Kathleen Sebelius on Don Lemon I think it was the other night. And Lemon posed her a question, "some people complain that they are forced to pay for things they don't need or want in their insurance policies, as in mental health care, maternity care for a man, etc". Sebelius' response is "those people don't understand how insurance works" (kind of laughing while she is saying it).

With all due respect to Mrs Sebelius, I remember how private health insurance plans worked before ACA when premiums were lower and when many people got the appropriate coverage for their needs (without having ACA mandated provisions in the plan).

I wonder if Mrs Sebelius understands how insurance works? Because choice in what you want to pay for and what you want covered is found in all other forms of major insurance.

Take home insurance. First of all, wide ranging choice of deductibles are available, in either dollar amounts or percentage of home value (and when deductibles go up, the premium goes down - in inverse was true with ACA). Then, you can insure the home for market value or replacement cost; and within this you the homeowner can submit a professional appraisal or quote from a certified home builder to determine the replace cost coverage you want (as in you don't just have to rely upon the insurance company to tell you how much it will take to rebuild your home). You can work to set a customized value for contents, with special provisions for collectables. You can choose different coverage levels of liability coverage. You can purchase earthquake coverage, or special policies for additional high wind/hail or flood/water backup coverage. Mold remediation coverage can be increased. If you have detached building on the property, coverage levels for those buildings can be selected. So many varied choices to customized coverage to suit one's needs or wants with different price points along the way.

Let's look at auto coverage. Again, off the bat, you can choose a deducible that fulfills your objective and the premiums is priced accordingly (higher deductible = lower premium, the way insurance pricing is supposed to work). I can have comprehensive, liability only, or fire & theft only. I can determine what extent of liability coverage I want to pay for. I can select or reject under insured / uninsured motorist coverage. I can pick certain coverage for hail damage or cracked windshield replacement. I can get a premium discount for safe driving record.

There is alot of choice in home and auto policies and alot of opportunity to save in not paying for coverage that one doesn't need or want. It doesn't sound to me like Mrs Sebelius is very familiar with how other insurance works. Thankfully she wasn't in charge of changing the home or auto insurance industry.


gina - 3/27/2017 at 11:14 PM

quote:
The Trump supporters weren't duped. They never cared whether he could enact his policies or not. They just admired someone who was willing to be as hostile as he was/is. They just want the hostility - nothing more, nothing less. Accomplishments? not important.


Not so, he had and has a platform of changes he wants to make, and that is why people voted for him. People want tax reform, and he is on that right now. People want the illegal immigration to be effectively dealt with, it is my understanding bids will be accepted in April for the building of the wall, and construction can begin within 6 months. Trump is a man of action, and he will try his hardest to make America great again. I will concede that the health care proposal needs more work.


emr - 3/28/2017 at 01:14 AM

quote:
I saw Kathleen Sebelius on Don Lemon I think it was the other night. And Lemon posed her a question, "some people complain that they are forced to pay for things they don't need or want in their insurance policies, as in mental health care, maternity care for a man, etc". Sebelius' response is "those people don't understand how insurance works" (kind of laughing while she is saying it).

With all due respect to Mrs Sebelius, I remember how private health insurance plans worked before ACA when premiums were lower and when many people got the appropriate coverage for their needs (without having ACA mandated provisions in the plan).

I wonder if Mrs Sebelius understands how insurance works? Because choice in what you want to pay for and what you want covered is found in all other forms of major insurance.

Take home insurance. First of all, wide ranging choice of deductibles are available, in either dollar amounts or percentage of home value (and when deductibles go up, the premium goes down - in inverse was true with ACA). Then, you can insure the home for market value or replacement cost; and within this you the homeowner can submit a professional appraisal or quote from a certified home builder to determine the replace cost coverage you want (as in you don't just have to rely upon the insurance company to tell you how much it will take to rebuild your home). You can work to set a customized value for contents, with special provisions for collectables. You can choose different coverage levels of liability coverage. You can purchase earthquake coverage, or special policies for additional high wind/hail or flood/water backup coverage. Mold remediation coverage can be increased. If you have detached building on the property, coverage levels for those buildings can be selected. So many varied choices to customized coverage to suit one's needs or wants with different price points along the way.

Let's look at auto coverage. Again, off the bat, you can choose a deducible that fulfills your objective and the premiums is priced accordingly (higher deductible = lower premium, the way insurance pricing is supposed to work). I can have comprehensive, liability only, or fire & theft only. I can determine what extent of liability coverage I want to pay for. I can select or reject under insured / uninsured motorist coverage. I can pick certain coverage for hail damage or cracked windshield replacement. I can get a premium discount for safe driving record.

There is alot of choice in home and auto policies and alot of opportunity to save in not paying for coverage that one doesn't need or want. It doesn't sound to me like Mrs Sebelius is very familiar with how other insurance works. Thankfully she wasn't in charge of changing the home or auto insurance industry.



Not to repeat myself too much (which I've been known to do) but if you elect not to insure your car for replacement value and it is totaled you are not driving away with a new one. If you underinsure your health and show up at the ER at 3:00AM you are going to be treated by the hospital and its physicians for whatever ails you. Yes; it may bankrupt you. But one can't get blood from a stone.

And down to detail. If a Jehovah's witness signs up for insurance that doesn't cover blood transfusions and/or organ transplantation and changes their mind it is malpractice to deny them the service


nebish - 3/28/2017 at 02:15 AM

quote:
quote:
The Trump supporters weren't duped. They never cared whether he could enact his policies or not. They just admired someone who was willing to be as hostile as he was/is. They just want the hostility - nothing more, nothing less. Accomplishments? not important.


Not so, he had and has a platform of changes he wants to make, and that is why people voted for him. People want tax reform, and he is on that right now. People want the illegal immigration to be effectively dealt with, it is my understanding bids will be accepted in April for the building of the wall, and construction can begin within 6 months. Trump is a man of action, and he will try his hardest to make America great again. I will concede that the health care proposal needs more work.


For 8 years the Republicans made it priority #1 to repeal, and sometimes, to repeal and replace "Obamacare". And Donald Trump is the Republican President, the Republicans have a majority in the House of Representatives and have previously passed ACA repeal bills.

I'm not vested in this, but Trump and the Republicans are certainly vested in this...neck deep. 8 years, Eight Years...they told people they would do this, and they - or he - couldn't. "People" may want tax reform and "people" may want immigration reform, those issues strike much closer to my area of interest, but you just can't say 'oh well' and move on now and act like nobody else is watching or cares.

quote:
Not to repeat myself too much (which I've been known to do) but if you elect not to insure your car for replacement value and it is totaled you are not driving away with a new one. If you underinsure your health and show up at the ER at 3:00AM you are going to be treated by the hospital and its physicians for whatever ails you. Yes; it may bankrupt you. But one can't get blood from a stone.

And down to detail. If a Jehovah's witness signs up for insurance that doesn't cover blood transfusions and/or organ transplantation and changes their mind it is malpractice to deny them the service


I don't mind repetitive posts as it shows conviction and consistency and helps remind people who quickly scroll through posts of important points you want to make.

The current health insurance industry in this country is not capable of enacting the kind of changes that a person like Kathleen Sebelus wants to set forth. She says 'we' don't understand how insurance works, well if she was setting the parameters for home owners insurance 'we' would all have hurricane and earthquake coverage on our homes, regardless of location. That is the same thing as requiring me to pay for drug rehab or maternity costs - something I will never use.

People need to have skin in the game, people need to budget and save for their medical costs. Nobody should get a free ride. If you have income of 20k or 200k some portion of that should go towards medical expenses that you incur.

You know really, alot of the people complaining about ACA now are complaining because their deductibles are too high and they can't "use" the insurance, as in they are having to pay for too much.

That is a good thing, people having to be accountable for their costs up to the deductible and make decisions and form habits accordingly. Health insurance should not be an all-expenses-paid vehicle. It should cover events and circumstances that are unforseen and unexpected in our lives.

The problem that I see with the ACA is that if you are searching for an individual policy and make too much money to get a subsidy then you find premiums on $6000 deductible plans too high. I mean, why we have to subsidize up to 400% of federal poverty level points to another underlying problem, the sh:t is too damn expense in the first place. 400%. I think federal poverty level is 12,500, so if you make $50k as an individual you are still eligible for subsidy. Why? A $6000 deductible plan should have relatively low premiums, that essentially is a catastrophic plan and should be billed as such. But no, we have some people paying several hundred dollars per month for that and then still have to pay out of pocket for everything up to that point. I don't know exactly, I think I have an idea, but something after ACA made high deductible plans have the same premium as previous lower deductible plans. And as deductibles rise, premiums should decrease - the inverse was true with ACA. People paid more and got less - atleast some of them.

And then there is that. This is hardily the first time and won't be the last time, but ACA has divided us as so many other things in our history has.

Middle class people buying individual plans not eligible for subsidy assistance are seeing their premiums go up and they get pinched more, while somebody on Medicaid can just walk into the ER and get what they need and walk out with no bills.

Resentment is building from the middle down. Surely we've had resentment from the lower tier of society upwards, and to an extent alot of people resent somebody else for what they have or where they are in life.

But here the example is, work hard, save when you can for your medical expenses and then somebody else in society doesn't have to work and doesn't have to save for their expenses. Medicaid certainly has it's drawbacks, but then again, when you look at it this way it has it's benefits too. When working middle class people would rather have Medicaid then their private plans we have a problem with how this system is constructed.


Sang - 3/28/2017 at 04:02 AM

Why I understand what you are saying, this line from you always bothers me about republicans/conservatives...

"But here the example is, work hard, save when you can for your medical expenses and then somebody else in society doesn't have to work and doesn't have to save for their expenses."

This seems to always be code for 'lazy people' and usually minorities... I hear all the time from a few libertarians that I know that 'I worked hard for my money, why can't they'.... well, maybe they weren't a privileged white person who was able to get a good education and had a network of friends and relatives to help them get a good job.....

It's always "they" that just don't want to work .... and I don't think it's that simple.

I know that's not what you meant...... but if you listen to Paul Ryan and the other republican mouthpieces on the healthcare issue, you wonder if they know how the real world works and how most people struggle to pay just their very basic bills....


nebish - 3/28/2017 at 01:05 PM

I think that something we rarely stop to do or talk about is that there are all different types of people in any group. Not every person in whatever category is the same with the same circumstances or background or feelings.

So ofcourse, there are many people that have been less fortunate in their lives which hasn't been of their own doing. Life's circumstances, or luck as it is, has put them where they are - not that they want to be there, or stay there...it's just the facts of life. They aren't bad in any way. Just like there are many people who through no good special efforts of their own have found themselves in better circumstances, these people aren't better in any way. It is just the way life works.

What I feel related to medical expenses is that everyone needs to have an appreciation and exposure to the costs they are creating through their use of products and services in our health care system.

Even if a medicaid recipient was responsible for say 10% of their billed cost and the government would pick up some larger portion...it doesn't have to be the same % or amount that somebody more financially stable is responsible for, it just has to be some amount that makes people realize and think about their actions and the consequences of choices and different types of services they use. There should not be a total disconnect between the ones receiving the care and the ones paying for the care.


emr - 3/28/2017 at 01:41 PM

Almost all Insurance companies now make the consumer responsible for an increasing amounts of their bill - for just the reason you stated. Charging Medicaid participants even $5 would make them more responsible. A few don't have even that.

I think we all agree that the system is broken; the question is how to fix it. I think the middle class felt a bit thrown under the bus with ACA when it found out it was going to pay the bill for the poor. The definition of rich is akin to the definition of promiscuity (AKA anyone who gets laid more than you do.) Everyone thinks those who make more than they do should pay.


gina - 3/28/2017 at 06:42 PM

A $5 fee to someone living on $7,000 per year is not reasonable. That's what public assistance recipients in New York have who are on assistance only and covered by Medicaid receive. Medicaid is income based. There are working poor people and families, the qualifying income is not much above migrant worker incomes.

The insurance companies need to stop the greed, and their executives do not need triple digit incomes off the backs of the poor and the working class. Just like the oil executives who were getting 300-400% profits back in 2008, I don't even know what it is now, it is wrong.

Here's a novel idea, insurance and housing costs based on a person's income. So if you have almost nothing, you do not pay the same as someone else who has a lot more. Minimum wages need to be indexed to the costs of living in different parts of the country, one size does not fit all.

http://www.universallivingwage.org/

If people earned a LIVING WAGE, they could pay something towards their health care, as things are now, they cannot. Multiple problems, common sense solutions.







[Edited on 3/28/2017 by gina]


Muleman1994 - 4/2/2017 at 02:55 PM

The New York Times reinforces President Trump on ObamaCare being on the brink of collapse.

Obamacare Choices Could Go From One to Zero in Some Areas

https://www.nytimes.com/2017/03/31/upshot/obamacare-choices-could-go-from-o ne-to-zero-in-some-areas.html?_r=1

The NYT agrees with President Trump.
Things are really changing.


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