ACA Running Thread

[dartsndeacs]

I can try to address the rest of you post later, but some of the work you mentioned (assigning value to each category of health services) has been done. The Urban Institute put out a report this month, actually. I pasted a couple of figures below. Of note, things that people claim are "unnecessary" and driving up premiums probably represent smaller sum of the pie than you think (see maternity care).

Replace the Child tax credit with a child tax and have maternity coverage covered by the state. State covered preventative care.

What is most inpatient services, cancers and stuff? Make that covered by the state. Everything else, you're on your own. You wanna buy specialty drugs that got $8k a month, knock yourself out.

Healthcare. Solved.

 

[Louis Gossett Jr]

I'm of the notion that penalties should be tied directly to your health. Like premiums severely staggered by health goals that you can obtain. Like don't have an end of life care directive premium is ten times what it normally is.

 

[tiltdeac]

I'm of the notion that penalties should be tied directly to your health. Like premiums severely staggered by health goals that you can obtain. Like don't have an end of life care directive premium is ten times what it normally is.

I was actually surprised that we don't seem to be outliers in end of life spending as a percentage of total health expenditures compared to other countries. LINK

Medical spending in the last twelve months of life accounted for approximately 8–11 percent of aggregate medical spending in most countries, with the United States spending the least (8.5 percent) and Taiwan the most (11.2 percent) (Exhibit 3). There was no strong association between this percentage and the type of health care system in a given country. Medical spending in the last three calendar years of life accounted for approximately twice the percentage of aggregate medical spending as spending in the last twelve months of life did, ranging from 16.7 percent in the United States to 24.5 percent in Taiwan.

 

[Louis Gossett Jr]

Yeah that seems to indicate end of life needs to extend beyond what is considered immediate end of life. I guess it's not that surprising that as your body wants to die globally the response is to spend as much as possible to prevent it from happening.

 

[CHDeac]

Yeah that seems to indicate end of life needs to extend beyond what is considered immediate end of life. I guess it's not that surprising that as your body wants to die globally the response is to spend as much as possible to prevent it from happening.

Being the cynic I am, in a FFS Medicare world, not a lot of incentives to prevent ineffective end of life planning. I for one am a fan of death panels.

 

[CHDeac]

Legitimate question from a place of pure ignorance: what would be wrong with a "menu" style setup? Basically, assign a yearly value to each category of health services (ambulance and emergency, women's health, men's health, radiology, etc.), then divide by 12 to get the monthly premium. You can add whatever protections you want in your health insurance, but they have that set value, so you know how much you are paying, and you don't have to get a plan with coverage you don't need.

Wouldn't that be actual freedom in the marketplace? I am genuinely curious as to if this is even feasible. I'm sure there are many issues with it, but I am no health care expert, just having a thought.

Adverse selection. People will buy what they need which will drive up the cost.

It drives me nuts when the 60 year old couple bitches that Obamacare mandates contraceptives and maternity that "they dont need" while nit mandates substance abuse coverage for a new born. The whole idea of insurance is you spread the costs.

Edit: That chart really makes my point. Good find.

 

[WFU71]

A sobering prediction:
http://www.providermagazine.com/news/Pages/2017/0717/Senate-Draft-ACA-Replacement-Bill-a-Big-Job-Loser,-Says-Report.aspx

"A brief spurt in employment would add 753,000 more jobs in 2018, but employment would then deteriorate sharply,” the report said. “By 2026, 1.45 million fewer jobs would exist, compared to levels under the current law. Every state except Hawaii would have fewer jobs and a weaker economy.”

Hardest hit would be employment in health care, with a projected 919,000 fewer health jobs. Across the spectrum of potential economic decline, the states that expanded the Medicaid program under the ACA would be especially hard hit.

“Our estimates are based on changes in federal funding gained or lost to states, consumers, and businesses. The BCRA significantly reduces federal funding for Medicaid. It lowers federal match funding for the District of Columbia and 31 states that expanded Medicaid, encouraging them to discontinue their expansions,” the report said.

 

[jhmd2000]

I'm of the notion that penalties should be tied directly to your health. Like premiums severely staggered by health goals that you can obtain. Like don't have an end of life care directive premium is ten times what it normally is.

To be clear for my Democrat friends, this refers to one's own life.

 

[Deacsfan27]

To be clear for my Democrat friends, this refers to one's own life.

Remember, not smug and elitist. Just liberals.

 

[avalon]

adorable.

 

[dartsndeacs]

A sobering prediction:
http://www.providermagazine.com/news/Pages/2017/0717/Senate-Draft-ACA-Replacement-Bill-a-Big-Job-Loser,-Says-Report.aspx

"A brief spurt in employment would add 753,000 more jobs in 2018, but employment would then deteriorate sharply,” the report said. “By 2026, 1.45 million fewer jobs would exist, compared to levels under the current law. Every state except Hawaii would have fewer jobs and a weaker economy.”

Hardest hit would be employment in health care, with a projected 919,000 fewer health jobs. Across the spectrum of potential economic decline, the states that expanded the Medicaid program under the ACA would be especially hard hit.

“Our estimates are based on changes in federal funding gained or lost to states, consumers, and businesses. The BCRA significantly reduces federal funding for Medicaid. It lowers federal match funding for the District of Columbia and 31 states that expanded Medicaid, encouraging them to discontinue their expansions,” the report said.

"Hardest hit is healthcare jobs" Seems like that's normal and what needs to happen to me? If out of control healthcare costs are a problem, excess jobs in the healthcare market are likely a cause.

 

[Deacsfan27]

I'll give it to the Pubs---they know the company line even when it's a huge detriment to the American people. They stick to their guns.

 

[Deacsfan27]

"Hardest hit is healthcare jobs" Seems like that's normal and what needs to happen to me? If out of control healthcare costs are a problem, excess jobs in the healthcare market are likely a cause.

If you think that the jobs are "excessive" and causing the majority of the higher bills for patients. I am under the impression that it is insurers and medical providers who are simply jacking up prices for revenue, not to pay for an excess of healthcare workers.

 

[dartsndeacs]

I happen to like the Cruz plan. If we're going to cover those with pre-existing conditions, that should be through the state, not affecting all premiums equally. Now it could be a disaster in execution, but is a better overall idea than just relying on getting a larger healthier pool. Clearly the tax penalty of Obamacare or the republican plan of allowing insurers to charge higher premiums if you were previously uninsured for a period are bad plans/not working to get the healthy into the pool.

 

[dartsndeacs]

If you think that the jobs are "excessive" and causing the majority of the higher bills for patients. I am under the impression that it is insurers and medical providers who are simply jacking up prices for revenue, not to pay for an excess of healthcare workers.

well didn't someone earlier say that insurer's profits are capped by law? I certainly recall discussing that in practice, the insurers profits per their publicly disclosed 10-ks weren't that outrageous (was like 6%)

 

[jhmd2000]

I'll give it to the Pubs---they know the company line even when it's a huge detriment to the American people. They stick to their guns.

It's a shame that the American people don't know what's good for them. Fortunately for us, you're here.

 

[Louis Gossett Jr]

All it does is bring everything back to where you were before Obamacare without just saying bye to Obamacare. If you don't mandate what needs to be covered and allow shitty plans to be offered that count as being covered you end up with lots of people choosing that plan because hey look it's cheap now, then going to the doctors anyways because you will get sick and it will cost a lot to you and to others that subsidize your inability to pay.

 

[dartsndeacs]

All it does is bring everything back to where you were before Obamacare without just saying bye to Obamacare. If you don't mandate what needs to be covered and allow shitty plans to be offered that count as being covered you end up with lots of people choosing that plan because hey look it's cheap now, then going to the doctors anyways because you will get sick and it will cost a lot to you and to others that subsidize your inability to pay.

Does it keep the employer mandates in place? If so, this doesn't seem accurate.

 

[Deacsfan27]

It's a shame that the American people don't know what's good for them. Fortunately for us, you're here.

Well in this case I am relying on the the Congressional Budget Office and their score of the bill since they most assuredly know more than I do.

 

[dartsndeacs]

Well in this case I am relying on the the Congressional Budget Office and their score of the bill since they most assuredly know more than I do.

Seems they did a bang up job scoring Obamacare