Obamacare...(new title): GOP DEATH PLAN: Don-Ryan's Express

[Weganator]

The other thing to consider is the geopolitical effects of US hegemony when it comes to the military.

 

We subsidize these nations healthcare systems by 1) allowing single payer nations to negotiate price controls, passing costs onto the US consumer 2) We are the dominant military force in the world and none of these nations need to spend (edit: self sustaining defense) money on their military because they know we will defend them.

 

Most of these nations don't have the economies / tax bases to support a military needed in order to defend themselves because they are both too invested in social programs and have too stagnant of economies to grow / sustain such a force.

 

If it weren't for the petrodollar, this system probably would have already collapsed.

Edited January 14, 2017 by Weganator

[PeterMP]

21 minutes ago, The Sisko said:

Finally, as an atheist I'd beg to differ with your assertion about the move toward secularism causing an increase in people's fear of dying. I know and converse with a lot of atheists on the regular, and though it's anecdotal, the vast majority of atheists and agnostics I know are way more accepting and less fearful of death than religious people. I think once you take away all the cosmic fantastical eternal life, reincarnation stuff and see it as simply part of the cycle of life that has existed for eons, it becomes less of an issue. In fact, the difference in perceptions  and reactions to death between believers and non-believers is often the subject of jokes among us. So, no. Just no to that one. 

 

I'd argue the believers you are referring to are not really believers.  They claim to believe, but don't really.  Certainly, this happened before the secularization of society (people that don't believe claiming they do believe).  Maybe secularization has affected their fear of death or has made the phenomena more wide spread and maybe it hasn't.  I'll concede I don't really know.  It just seems to me there is more open fear of death now.

 

(We're taking this pretty far from the topic.  I'll give you a response, and then let it go.)

Edited January 14, 2017 by PeterMP

[LadySkinsFan]

Sisco, I totally agree with your post. You left out an important factor driving health costs, profit.

 

I put my two kitties to sleep yesterday, they were very sick and I just couldn't do it over the holidays and with all the death and near death last year. It was time to end their suffering.

 

Myself, I have an advanced directive with Do Not Resuscitate orders if what they will do will mean no quality of life. Since I saw first hand the protocol once life support is started (my brother) there's no way I will subject my daughter to make those decisions.

 

I'm atheist too, I have no fear of death.  I do have a fear of "living" in a near or vegetative state, lying in a bed somewhere warehoused.

 

I too believe that, even with all the rhetoric around Paradise, people who believe in religions are most afraid of death because they don't think that they will attain Paradise.

[Mooka]

20 hours ago, No Excuses said:

It's kind of amazing that they aren't being absolutely hammered for not having a plan already. What the **** have they been done doing for the past 7 years when they literally tried to repeal ACA time after time? Wasting tax payer money on pointless posturing?

 

Nah, thats not really fair.

 

The Republicans already passed an alternative health care plan a year ago. Obviously Obama vetoed it.

 

It was Tom Price's plan and i assume the new plan will just be a slight variation of it.

 

Refundable tax credits based on age for private insurance.

18 months concurrent coverage = pre-existing conditions.

High risk pools for the sick that fall through the cracks.

Cross-state insurance

Whole bunch of tort reforms protecting Drs.

Etc.

[LadySkinsFan]

Without Medicare, more elderly people will die because they will have to choose from ****ty insurance plans who will profit from them, and having housing and food.

 

I find that reprehensible.

[Hersh]

Listened to Rand Paul just now on his "plan" to replace Obamacare. He would not answer the question as to whether people on Medicaid in his own state would be able to keep their health insurance. He said that if people want Medicaid expansion in a state that taxes would need to be raised. The other part of his plan to decrease insurance costs is basically getting rid of the requirements of actual health insurance. Essentially insurance would cover a lot less so it won't be expensive. Sounds delightful, no? 

[LadySkinsFan]

Reminds me of Grayson's description of the Republicans plan: 

 

1. Don't get sick.

 

2. If you do get sick, die quickly.

 

That was in 2009. Nothing has changed. For shame.

[TheGoodBits]

1 hour ago, Hersh said:

Listened to Rand Paul just now on his "plan" to replace Obamacare. He would not answer the question as to whether people on Medicaid in his own state would be able to keep their health insurance. He said that if people want Medicaid expansion in a state that taxes would need to be raised. The other part of his plan to decrease insurance costs is basically getting rid of the requirements of actual health insurance. Essentially insurance would cover a lot less so it won't be expensive. Sounds delightful, no? 

 

Paul Ryan's plan is to separate cancer patients (and other terminal illnesses) into high risk pools so insurance is cheap as **** for everyone else. Meanwhile the cancer patients are counting on Republican legislators to properly fund the high risk pools. Right now Ryan's proposal is $25B over ten years. $2.5B per year. From what I have read, and I haven't found any really good studies on it, that $2.5B wouldn't begin to scratch the surface for what would be needed. And the GOP was accusing ACA of having death panels... smh

[LadySkinsFan]

Cancer treatment costs are so high because the drug prices are so high. 

 

You know that the payment that the drug companies get from the insurance companies isn't the MSRP, it's probably heavily discounted, except Medicare because Medicare can't negotiate.. Those people without insurance of some kind pay MSRP if they can afford it, otherwise they do without something essential.

 

I think that Republicans hope enough people die so they don't have to pay out. It's the Republican model of insurance companies MO, take in as much as can be gotten and pay out as little as possible.

[TradeTheBeal!]

32 minutes ago, LadySkinsFan said:

Reminds me of Grayson's description of the Republicans plan: 

 

1. Don't get sick.

 

2. If you do get sick, die quickly.

 

That was in 2009. Nothing has changed. For shame.

 

Also...

 

3.  Don't get old

 

4.  Don't get pregnant

[s0crates]

This happened in Michigan today:

 

 

Edited January 16, 2017 by s0crates

[Larry]

I've had a thought, for a while, here.  

 

It's probably a dumb thought.  But I'm just spitballing, and I figured I'd toss it out and probably get shredded by the crowd here.  

 

My question is how to get insurance coverage for low-income people.  The working poor.  That niche.  

 

And I saw a previous poster, making the claim that the R's proposal is to create special insurance for poor people, that doesn't cover much.  

 

And the thought occurs to me that maybe that's not a completely terrible idea.  

 

The thought was that, Before Obamacare, that person's "health insurance" was, he didn;t have any.  If something minor happened, he was SOL.  If something major happened, he went to the ER, and the ER treated him, sent him a bill for a half a million dollars, the guy said he's bankrupt, and somebody (I confess I don't know who) paid for it or ate the cost.  

 

And then, During Obamacare, the solution for that person was to require him to purchase insurance that probably cost half of his income, but the government subsidized it.  It cost the government a lot of money.  (Although I don't know if it wasn't money that the government was already paying, anyway.)  The guy now "has insurance".  But it's got a big deductible, which he can't pay.  So now the guy's status is that some routine screening things are now free (to him), things beyond that are more than he can afford, and if he gets hit with something really big, then the insurance kicks in.  

 

And the thought that occurred to me was:  Maybe what we need, for that person to have a policy that only covers the little things.  A policy that makes routine screening free, and covers the medium-sized things.  But doesn't cover the major things.  

 

In simplistic terms, maybe a policy that has free basic screening, a deductible of $500-1000, a 10% copay after that, but has a maximum payout of, say, $100K per year.  

 

My uninformed opinion is that a policy like that would be fairly cheap, because the insurance company knows that the maximum they're on the hook for is a relatively small number.  

 

And now the guy's insurance status is that screenings are free (for him), small things still have a deductible.  (And it's still a big deductible, for him.)  Medium things are covered.  And if he gets hit with something big, then he's back to declaring bankruptcy, and somebody else gets stuck with the bill.  (Which isn;t necessarily an attractive option.  But it's what he had, before, anyway.)  

 

I'm not sure, but something like that might be better, for that person than what he had, BO.  The policy doesn't cover huge things.  but he wasn't covered for them before, either.  And now, he is covered for routine screenings (which I think is a goal that's good for society, as a whole.)  And he's got a policy which (hopefully) is relatively affordable, for him, and covers him for medium-sized things.  

 

He doesn't need a policy that covers him for 10 years of AIDS drugs.  He needs something that will cover him for (something that takes a two-day stay in a hospital.)  

 

[bearrock]

For those in between 100-250% of the fed pov guideline, out of pocket maximum is capped at 2250 for individuals  and 4500 for family.  This is even if you have the super high deductible plan, because you get subsidy towards out of pocket medical costs.  Now, the average person probably won't need 10 years of HIV meds, but one bout of cancer and you'll burn through 100k annual coverage in a blink of an eye.  Major injury or surgery too.  Combination of premium subsidy and out of pocket subsidy means people above medicaid but below 250 of the poverty line can get comprehensive coverage for no more than heavily subsidized annual premium (at 250% FPG, it's capped at like 4% of your income) plus a few thousand dollars if something goes wrong.  

 

We could add super low premium limited benefit plan as an alternative, but how much lower is it going to get than 4 percent of your income?  Plus, somebody else is left holding the bag when that limited benefit runs out and you still need more care.  

 

News flash.  ACA is a very very good deal for anyone under 400% of the FPG.  That's under 45k for individuals and 95K for family of 4.  It's a burden for employers with more than 50 employees and those who will continue to have the Cadillac plans.  It's a bad deal for those with annual income over a million.  The funny thing is people's opinion doesn't seem to mesh with their self interest.

 

 

[Hersh]

7 hours ago, Larry said:

I've had a thought, for a while, here.  

 

It's probably a dumb thought.  But I'm just spitballing, and I figured I'd toss it out and probably get shredded by the crowd here.  

 

My question is how to get insurance coverage for low-income people.  The working poor.  That niche.  

 

So this is kinda dumb for a couple reasons.?

First, lots of people get cancer so you are going to have a lot of bankruptcy problems or forcing someone else to eat the cost. This defeats the purpose of having insurance and when it comes to eating the costs, those will be passed on to consumers just like the old system. Plus, Insurance companies will probably say this is how they lose money on the exchanges now. 

Second, it essentially creates two Americas or prolongs the two Americas we have. People with more money can afford better insurance so when a rich person gets cancer they won't become bankrupt and lose their house. 

What you are getting at is the problem we face. How to get comprehensive cover and care to people at the lowest rates possible. This leads to maybe the biggest problem that isn't being discussed in all this is how do we actually control the costs of procedures. 

 

[No Excuses]

Whatever the Republicans come up with, if it flops, the next logical conclusion to me is single payer. I don't see how any politician again will be able to sell to anything else. 

[tshile]

19 minutes ago, No Excuses said:

Whatever the Republicans come up with, if it flops, the next logical conclusion to me is single payer. I don't see how any politician again will be able to sell to anything else. 

If you're going to treat healthcare as a right (providers cannot turn people away simply because they don't have insurance, unless it's for elective stuff, which isn't the issue anyways) then you should treat it like a right (and give it to everyone.)

 

The problem is that "single payer" has been conflated with "socialism" which has been conflated with "evil" so... good luck selling that.

 

By the way - giving it to everyone means giving it to everyone. Not arbitrarily picking some income level above which you no longer get this thing everyone else gets, that we've dubbed a 'right.'

[No Excuses]

2 minutes ago, tshile said:

If you're going to treat healthcare as a right (providers cannot turn people away simply because they don't have insurance, unless it's for elective stuff, which isn't the issue anyways) then you should treat it like a right (and give it to everyone.)

 

The problem is that "single payer" has been conflated with "socialism" which has been conflated with "evil" so... good luck selling that.

 

By the way - giving it to everyone means giving it to everyone. Not arbitrarily picking some income level above which you no longer get this thing everyone else gets, that we've dubbed a 'right.'

 

I don't think the "socialism" label is all that dirty in this country anymore. And I suspect majority of the country, which is liberal, would already be on board. 

 

If and when Democrats sweep into power next like 2008, and our healthcare system is still a mess, I think they will full on go for single payer. 

[tshile]

Just now, No Excuses said:

 

I don't think the "socialism" label is all that dirty in this country anymore.

Well, you and I are on two completely different pages then about the fabric of this country.

 

I agree with you otherwise on the topic. I don't see how anything other than single payer actually addresses the problems here. You can't make something a right then declare the free market (which is a term that's become laughable in and of itself at this point) will provide the solution. It just doesn't work that way. It's either a privilege or it's a right, and that determines how you should treat it.

[Riggo-toni]

One need only look at the disastrous mismanagement of the VA healthcare system to understand the apprehension against a single payer government run system. Also, few people will feel thrilled about paying federal sales taxes on goods and services on top of your local state tax.

Likewise, Trump's proposals for saving healthcare by squeezing the demonized pharmaceutical industry will inevitably lead to a rapid decline in new drug development.

 

Insurance chosen and provided by Employers is a bad system left over from the Great Depression. Replace it with a tax exempt benefits wage which an individual allocates between health insurance, health savings accounts, dental, vision, and retirement. Require catastrophic insurance from all, eliminate state regulations and replace them with a single set of federal guidelines that includes standard universal forms.

You switch jobs - you still have the same insurance because you have chosen it independent of where you work, and your new employer is paying you benefit dollars which you simply continue to direct to the same place. Work 2 part time jobs instead of one full time? Doesn't matter - employers have to pay at least a minimum benefit wage whether you are full or part time, so you can consolidate the benefit dollars from each employer to the same insurer.  Job seekers can haggle with prospective employers for a higher benefit wage just as they do for a regular wage, and since any benefit wages will be exempt from payroll taxes, employers will have some incentives to be more generous with benefit wages than regular pay. 

[TheGreatBuzz]

53 minutes ago, Hersh said:

 

So this is kinda dumb for a couple reasons.?

First, lots of people get cancer so you are going to have a lot of bankruptcy problems or forcing someone else to eat the cost. This defeats the purpose of having insurance and when it comes to eating the costs, those will be passed on to consumers just like the old system. Plus, Insurance companies will probably say this is how they lose money on the exchanges now. 

Second, it essentially creates two Americas or prolongs the two Americas we have. People with more money can afford better insurance so when a rich person gets cancer they won't become bankrupt and lose their house. 

What you are getting at is the problem we face. How to get comprehensive cover and care to people at the lowest rates possible. This leads to maybe the biggest problem that isn't being discussed in all this is how do we actually control the costs of procedures. 

 

I think a conversation we need to have is should it be this way?  I know it's not one we like to talk about and people scream "death panels" but where is the line when it becomes "if you can afford to treat yourself, go for it.  If you can't, sometimes you have to let nature take its course?"  I fully admit my opinion is jaded by watching people in my family attempt to squeeze every extra minute of life out and spending tons of money (via their insurance) for it.  

 

Is is there ever a point where we say two people come down with a aggressive but treatable lung cancer for example and one can afford an insurance plan that cures it and the person that couldn't is made as comfortable as possible and nature takes its course?

[tshile]

8 minutes ago, TheGreatBuzz said:

I think a conversation we need to have is should it be this way? 

I agree with you, and this gets back to whether healthcare is a right or a privilege.

 

Note: I said healthcare, not health insurance.

 

If it's a right, then where does that right end? You could, like ACA does, pick a base level of things everyone gets as a right, and then say everything else is a privilege that you can choose to have if you can afford it. Where does that line get drawn?

 

You can say it's all a privilege, but then you have to give healthcare providers the right to turn someone away simple because they don't have insurance. Even if that means little timmy with the broken arm doesn't get a cast. This is not a popular mindset for obvious reasons.

 

It's not a fun conversation to have because health issues are not directly related to your choices all the time. Some people get the **** end of the genetics stick. Some people have bad luck. So it's hard to say a person shouldn't have their cancer cured because they don't have the income required to have the insurance to pay for it. It also bothers people that they have to pay for other people's poor life style choices.

 

It's impossible to have that conversation. See the fact that birth control was listed in ACA's list of basic requirements and the conversation that followed for an example. As an adult, that whole conversation was embarrassing to watch.

 

[TheGreatBuzz]

@tshile I agree with what you said.  I really wish it is a conversation we could have but agree that we can't.  

 

 

Also, anyone advocating for single payer should have to spend a year in the military health care system first.  That will change your mind.  (At one point, while trying to diagnose what turned out to be a kidney stone, the told me they were pretty sure I had Lou Gherigs disease.)

[tshile]

2 minutes ago, TheGreatBuzz said:

@tshile I agree with what you said.  I really wish it is a conversation we could have but agree that we can't.  

 

 

Also, anyone advocating for single payer should have to spend a year in the military health care system first.  That will change your mind.  (At one point, while trying to diagnose what turned out to be a kidney stone, the told me they were pretty sure I had Lou Gherigs disease.)

 

And I know a guy who has to take opiates every day and possibly have his foot removed because he pulled a ligament playing basketball and the military doctors really screwed up his foot.

 

I'm not really a fan of government running things because they so often screw it up, but I do want to point out there is a difference between health insurance and health care.

 

Military is healthcare. They provide health insurance, which has its own set of problems, but majority of the problems is with the healthcare side of things.

 

Single payer is health insurance. Same doctors, nurses, etc - the government is just negotiating prices and paying for it (with taxpayer dollars.)

 

This has been the biggest issue with ACA and the conversation in general from day 1. The lack of ability to separate health insurance from health care. ACA is not healthcare, it's regulations for health insurance.

 

People still do not get this.

 

You don't go "on obamacare." You get insurance from an insurance provider or you use medicaid/medicare.

[TheGreatBuzz]

Good point.  I guess it depends on which version of "single payer" you expect to see.  I have seen some proposals that many doctors, etc would become government employees and I picture that more like the military healthcare system.  If we go single payer in the sense that everything stays the same put government foots the bill for everything, I see costs skyrocketing.  That's what people do when the government is paying, milk them for everything they can.  

[tshile]

1 minute ago, TheGreatBuzz said:

Good point.  I guess it depends on which version of "single payer" you expect to see.  I have seen some proposals that many doctors, etc would become government employees and I picture that more like the military healthcare system.  If we go single payer in the sense that everything stays the same put government foots the bill for everything, I see costs skyrocketing.  That's what people do when the government is paying, milk them for everything they can.  

 

Well, my understanding is the left's idea of single payer is medicare for all... basically... not having the government take over the healthcare industry and have you see government nurses and government doctors... the only people I've seen suggest that are people on the right throwing boogeymen around to scare people.

 

Now... there's an issue with government reimbursements and how it affects doctors/nurses/organizations, etc. We're seeing that right now with the changes in ACA. But that's different. That will always be a potential problem. The problem is skyrocketing costs of healthcare, fixing that by definition means someone gets less money somewhere...

 

You're right - people milk the government for money. Fraud, waste, abuse of the rules, and the sheer fact that the government is always reactive and never proactive, makes this always a problem with anything the government does. Which is why i'm open to other ideas. But the ideas need to be sound, and they need to address the problem.

 

If you're going to require healthcare professionals to treat people who cannot afford the treatment, then you need to come up with a way to pay for that. The old system created a situation where those bills snowballed out of control because the expense was being passed around and becoming larger. If the government is going to pay for anyone's insurance, then it needs a way to negotiate costs; reading the report on how the same procedure costs drastically different amounts of money from places just blocks away screams there is something really wrong with how things are priced and the government should be able to do something about that...