ACA Running Thread

[CHDeac]

Busy day and i just took a break to look at the web and it looks like Trump has a secret plan to cover everyone, andit is cheaper and less complex.

This guy is some kind of super genius secret wunderkind man-boy!

https://www.washingtonpost.com/blog...t-to-repeal-obamacare/?utm_term=.868bdbc30a01

Exactly. This is hard complicated stuff. Any real reform needs to go beyond insurance reform which the ACA basically was. We need to rethink how we demand care as consumers, how deliver care as providers and how we finance care as payers.

And people aren't going to like the answer. It might mean jumping through more hoops to get coverage for certain things. It might mean paying some docs more and a lots of docs less. It might mean that the latest time released drug wont be covered as its non time released version is. It might mean that you cant see any doctor who want unless you want to pay for it. It also might mean that a catastrophic HSA plan is meaningless to someone making $14,000 / year. It might mean that all benefits shouldn't be tax free and there's such a thing as too rich of benefits. It might mean that a person needs to pay something for a service, as small as a token it may be. It might mean someone, either gov't or insurer or employer, stands at least in part between you and your doctor. It might mean there are a whole lot of things you need to pay for out of pocket. It might mean we wont cover vasectomies, gender reassignment surgery or birth control. It might mean we pay a lot more for soda, cigarettes, steak and booze. It might mean if you dont play by the rules, you cant get health care unlike how it works today.

The ACA made it worse in a lot of ways. I pray these knuckle heads don't make it even worse. Some days I get excited with what I hear. Other days I get depressed.

Ive said it before and I will say it again. We need to lower the # of health care units we consume and pay less per unit. Patients and providers will fight that all the way to the bitter end.

 

[myDeaconmyhand]

You keep saying that but it just simply is not true. There are multiple replacement plans out there. Which one, or combination thereof, that gets picked is still up for debate, but the inauguration hasn't even happened yet.

And your opinion is that the people who consider it a complete failure are wrong; and my opinion, and that of most Americans, is that your opinion is wrong.

As long as health care coverage is provided by a profit driven industry, any form of universal coverage is going to squeeze the middle class. These companies losing money on the exchange are making record profits and spend billions on lobbyists who come up with buzzwords like "death panels" to scare people away from logical end of life coverage.

 

[WFU71]

I was told this evening that Trumpcare will include Medicaid block grants. This would be bad news for states like Virginia that have done a better job of managing their Medicaid costs. It's apparently in the replacement plan that will be presented.

 

[Deacfreak07]

Exactly. This is hard complicated stuff. Any real reform needs to go beyond insurance reform which the ACA basically was. We need to rethink how we demand care as consumers, how deliver care as providers and how we finance care as payers.

And people aren't going to like the answer. It might mean jumping through more hoops to get coverage for certain things. It might mean paying some docs more and a lots of docs less. It might mean that the latest time released drug wont be covered as its non time released version is. It might mean that you cant see any doctor who want unless you want to pay for it. It also might mean that a catastrophic HSA plan is meaningless to someone making $14,000 / year. It might mean that all benefits shouldn't be tax free and there's such a thing as too rich of benefits. It might mean that a person needs to pay something for a service, as small as a token it may be. It might mean someone, either gov't or insurer or employer, stands at least in part between you and your doctor. It might mean there are a whole lot of things you need to pay for out of pocket. It might mean we wont cover vasectomies, gender reassignment surgery or birth control. It might mean we pay a lot more for soda, cigarettes, steak and booze. It might mean if you dont play by the rules, you cant get health care unlike how it works today.

The ACA made it worse in a lot of ways. I pray these knuckle heads don't make it even worse. Some days I get excited with what I hear. Other days I get depressed.

Ive said it before and I will say it again. We need to lower the # of health care units we consume and pay less per unit. Patients and providers will fight that all the way to the bitter end.

Where can I vote for this?

 

[2&2 Slider To Leyritz]

As long as health care coverage is provided by a profit driven industry, any form of universal coverage is going to squeeze the middle class. These companies losing money on the exchange are making record profits and spend billions on lobbyists who come up with buzzwords like "death panels" to scare people away from logical end of life coverage.

If every single word of what you typed is true (and I'm not agreeing or disagreeing with you), then that is simply more evidence of how the ACA sucks and fucked things up even worse than they were. It completely shifted everything out of alignment.

 

[2&2 Slider To Leyritz]

So there ARE replacement options, they just can't decide which one to go with? That doesn't make it any better. Again...8 years they've had to decide and sell to America. If they truly have all these replacement options, how come nobody seems to know what they are?

Plenty of people know what they are, CH has posted links on this thread. You just choose to ignore them because the "THEY HAVE NOTHING TO REPLACE IT WITH AFTER 8 YEARS!!!!!1!!1!!1111!!" battlecry fits your worldview better.

 

[PhDeac]

They've voted over 50 times for repeal without a specific plan to replace.

 

[ThinkingWithMyDeac]

Outside of single payer system a replacement is a complicated task because people like a lot of stuff that was in the ACA. There are two sides to the health insurance problems, side 1 is not enough people with insurance, side 2 insurance is too expensive. The ACA was designed to fix side 1 with a prayer that if all aligned correctly it would start to help side 2. The problem is that when you start mandating coverage of people in a for profit model then rates rise across the board for those that were already in the pool.

 

[Wrangor]

Financially and/or morally?

I don't think the government Has a moral obligation to treat every illness. I think we have a utilitarian duty to treat our society and a moral desire to do it in the best most efficient way possible. That way we have the kind of society that can provide excellent benefits for centuries to come.

In some ways I look at it like my farm. I am not morally obligated to provide them healthcare but I have the desire to see them succeed in life and therefore we offer a comprehensive plan to make sure that it is affordable. We don't cover everything but we do cover a large portion and for about half we cover 100%. Not because I am obligated but because I am interested. But I can't cover health to the point where it causes me to go bankrupt or cover it foolishly and waste a bunch of money because in the end that will cost my employees 10 years from now. I have to be smart now so that I am sustainable.

Our current model isn't sustainable. It is a black hole.


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[Wrangor]

Sure. And that's where a GI individual product fits in. I just value the benefits of employer offered care and think we need to encourage it when appropriate. The ACA didn't do this well.

Could we not have a base government option hat covered everyone minimally but effectively and then put in incentives for companies to offer excellent secondary coverage? This would untie us from the corporate model but at the same time encourage good faith efforts from business to invest in their employees.


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[2&2 Slider To Leyritz]

Outside of single payer system a replacement is a complicated task because people like a lot of stuff that was in the ACA. There are two sides to the health insurance problems, side 1 is not enough people with insurance, side 2 insurance is too expensive. The ACA was designed to fix side 1 with a prayer that if all aligned correctly it would start to help side 2. The problem is that when you start mandating coverage of people in a for profit model then rates rise across the board for those that were already in the pool.

People like about 2 pages worth of things out of the 1 million pages of regulations. That is like saying we should keep [Redacted] because he beat Duke once.

As to the bolded, no shit, that problem was obvious to anyone who gave it more than 3 seconds of thought at any point in time. So why enact something that didn't pass the common sense test from the beginning?

 

[2&2 Slider To Leyritz]

They've voted over 50 times for repeal without a specific plan to replace.

Of course, because they are two different issues and the votes might not align. Back to the perfect [Redacted] analogy, as bad as Wellman is do people fault him for not having a replacement in place before firing [Redacted]? No way, get the shitshow out of there and then figure out what the replacement is. Now for Gaudio that was a legit concern because Gaudio was acceptable on many levels. But when you are at the [Redacted]/Obamacare level of ineptitude, gotta get the disaster out and then deal with the cleanup.

 

[Deacfreak07]

I don't think the government Has a moral obligation to treat every illness. I think we have a utilitarian duty to treat our society and a moral desire to do it in the best most efficient way possible. That way we have the kind of society that can provide excellent benefits for centuries to come.

In some ways I look at it like my farm. I am not morally obligated to provide them healthcare but I have the desire to see them succeed in life and therefore we offer a comprehensive plan to make sure that it is affordable. We don't cover everything but we do cover a large portion and for about half we cover 100%. Not because I am obligated but because I am interested. But I can't cover health to the point where it causes me to go bankrupt or cover it foolishly and waste a bunch of money because in the end that will cost my employees 10 years from now. I have to be smart now so that I am sustainable.

Our current model isn't sustainable. It is a black hole.


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This seems an odd position for a pro lifer to take.

 

[bcobbdeacs]

2&2,
Don't think a coaching search is analogous to 20000000 people having insurance terminated at once(some of whom are no doubt having chemotherapy or Cardiac surgery at the time of discontinuence) without some thought to their lives. No, here you need to step up to the plate and get your best plan together and repeal and pass simultaneously.

 

[2&2 Slider To Leyritz]

2&2,
Don't think a coaching search is analogous to 20000000 people having insurance terminated at once(some of whom are no doubt having chemotherapy or Cardiac surgery at the time of discontinuence) without some thought to their lives. No, here you need to step up to the plate and get your best plan together and repeal and pass simultaneously.

Why? Does repealing Obamacare suddenly make insurance illegal or terminate existing insurance contracts? Of course not.
And regardless, again, they are putting a replacement plan together now that they have the actual ability to repeal. How have you missed that over the last few weeks?

 

[bcobbdeacs]

2&2
Repealing does terminate insurance for people on the govt. subsidy unless they can then foot the full bill themselves, further, as has been repeatedly pointed out you have had 8 years to craft a viable replacement even if it was only done in committee that could have been floated on the first day of the new congress but we are still hearing about the possibility of someone releasing their plan soon with no concrete replacement. Better to have a competent plan that the repubs can then own and do all at once.

 

[WakeandBake]

In my admittedly simple world view, I just cant understand the compulsion of the ownership class to condemn and refuse a single-payer healthcare solution - granted, that mostly they shoulder through higher taxes on themselves - that results in a healthier and more robust labor force and consumer base with more cash in their pockets. Isn't it an investment that they would ultimately financially benefit from in the long run, in the same way my company benefits from providing good health care for its employees? And why wouldn't the working class voters in Michigan, Wisconsin, Ohio, and Pennsylvania also not demand this from the ownership class? And wouldn't ownership also find it attractive to stave off union influence? Doesn't it also simplify the administration process for providers?

Seems to me that single-payer solves a lot of issues for all parties involved. what the fuck is wrong with us? Is protecting tax rates for the top 5% important enough to pass all this shit downhill to us regular folks?

 

[awaken]

How drug companies make healthcare more expensive
http://www.newsobserver.com/news/business/article121135613.html


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[WFU71]

In my admittedly simple world view, I just cant understand the compulsion of the ownership class to condemn and refuse a single-payer healthcare solution - granted, that mostly they shoulder through higher taxes on themselves - that results in a healthier and more robust labor force and consumer base with more cash in their pockets. Isn't it an investment that they would ultimately financially benefit from in the long run, in the same way my company benefits from providing good health care for its employees? And why wouldn't the working class voters in Michigan, Wisconsin, Ohio, and Pennsylvania also not demand this from the ownership class? And wouldn't ownership also find it attractive to stave off union influence? Doesn't it also simplify the administration process for providers?

Seems to me that single-payer solves a lot of issues for all parties involved. what the fuck is wrong with us? Is protecting tax rates for the top 5% important enough to pass all this shit downhill to us regular folks?

It's not that simple, IMO. In my former corner of healthcare (rehab and skilled nursing), private insurance companies did a much better job of watching and questioning the dollars spent than Medicare and Medicaid.

 

[WFU71]

Why? Does repealing Obamacare suddenly make insurance illegal or terminate existing insurance contracts? Of course not.
And regardless, again, they are putting a replacement plan together now that they have the actual ability to repeal. How have you missed that over the last few weeks?

Most of those 20,000,000 people were added through Medicaid expansion, so repealing the ACA without a replacement plan would apparently leave them out in the cold. Their status under a replacement plan that block grants Medicaid is a big question. If the replacement plan uses historical Federal money spent on Medicaid in each state and includes the Medicaid expansion dollars, the non-expansion states (probably all Republican controlled) are screwed. If the plan takes the expansion dollars out, I don't see how the expansion states can afford the added burden.