Budget Fight: Why Don't The Gop De-Fund Medicare / Social Security?

[Larry]

I'm sure you are correct to one degree or another. But I challenge anyone to show me a ranking where we are anywhere near number 1.

Well, I'm remembering somebody on ES posting a study that didn't have the problems of people dying young, from unnatural causes, skewing the life expectancy rankings, by looking at the life expectancy only of people who've made it to 65. I only vaguely remember what the guy posted, and I remember that we still weren't #1. But I think we were top 10. Maybe top 5.

 

And all of this is side tracking my point which is the foolishness of insisting government not be involved in anything because of some insane ideology.

 

Oh, I think if you look at the Republican's reactions to Obamacare, and contrast it to their reactions to W's Medicare expansion, it's glaringly obvious that the GOP doesn't have a problem with government paying private companies for health care.  They just have a problem with a Democrat getting credit for it. 

[Wrong Direction]

 But you are willing to shut down the government, do untold harm to the economy, science, education, health care, and our very society based upon your insane beliefs.

 

I don't think the ACA is all bad (I'm 50/50 on it), but this line of thinking is broken. If I could shut down the government for 1 month and fix a major problem with the future of this country, I'd do it. Now, people disagree on just how bad the ACA is, but if you do think it's the worst thing for this country's future (over years and decades), it's perfectly rational to try to stop it in the short run.

[Wrong Direction]

Why does the republican party support medicare/medicaid and social security? 

I'm nitpicking, but they do because there are lobbyists in every single district who make serious and important changes impossible and incompatible with long tenures in Washington.

 

allow them to switch companies at will. Hopefully, promoting transparency and competition.

I'm about 99.9% certain that you'll be able to change plans annually, but not more frequently unless there's significant hardship and you can get a waiver.

 

Shop, explore, and I know that puts a lot of pressure on individuals.  But with research comes benefit, and you can now find a plan that just suits what you need.  If you're not a smoker, and healthy eating, you can get something that just fits what you need at the time...basics & hospitalization in case of emergency.  Single females with no children have been able to get just "basic female care" for years, but now that'll be offered across state lines where you may be able to find a very similar benefit package at a price you can afford, without taking a subsidy.

Sounds great. Of course, this isn't what the ACA does. It's what the R's want though. The ACA has community rating and many mandates which means that everyone's paying for everything. Again, it's debatable about whether this is good or bad, but your post is the opposite of what ObamaCare does.

[chipwhich]

Sounds like you have taken your time and done serious research. Thank you for your insight. I'm sure that people like me who have worked their ass off their entire lives but cant get coverage due to pre existing conditions will not be any better off or more productive to society with health insurance.

 

Well that's a more reasonable post than your rants.

 

I am for people having health insurance, unfortunately the plan that we are getting isn't a good one.  Sure it *might* save your family from financial ruin if something extreme happens, what it WILL do for you is having you paying a premium and a lot of money out of pocket for coverage.

Enjoy going to the exchanges and figuring out which insurances are worth a ****.  I hope your family physicians choose to participate.

 

Now back to topic.

[Wrong Direction]

I think premiums will come in ok for people. The problems will be 1) access to doctors and hospitals and 2) deductibles.

 

The first problem will result in some people going to hospitals which are not in network and thus not covered by the insurance plan. The second will be the biggest popularity problem, IMO. People will look at lower premiums and be happy until they realize that first dollar coverage doesn't start until after they're billed a few thousand dollars because most plans are high-deductible plans.

 

Ironically, this is something conservatives should like. Over time, these HDHPs will help hold down costs.

[chipwhich]

I think premiums will come in ok for people. The problems will be 1) access to doctors and hospitals and 2) deductibles.

 

The first problem will result in some people going to hospitals which are not in network and thus not covered by the insurance plan. The second will be the biggest popularity problem, IMO. People will look at lower premiums and be happy until they realize that first dollar coverage doesn't start until after they're billed a few thousand dollars because most plans are high-deductible plans.

 

I offer all of my employees high deductible health insurance like what I will assume most people could afford from the exchanges.  In my case, I pay my employees deductibles.

For someone with pre existing conditions, on prescription medications, and frequent medical care, they might wonder why they actually pay for the insurance when they see how much they pay out of pocket.  And those deductibles are rising.  For the last 2 years I held a family policy deductible at $2500, this year I had to bump it to $4000 because insurance is skyrocketing because I have to pay to set up these exchanges.

[Larry]

I had this mental image, a day or so ago.

About getting Google to set up an exchange.

I mean, it seems to me that what were talking about is a web page. You enter your zip code, age, maybe some other things. And it comes back with a list of links to insurance companies, and prices.

Maybe you click on an insurance company, and a Google map pops up, shows you doctors near you, colored red or green for whether they take that insurer.

My fantasy had some blue state, say California, paying Google to set up their exchange for them. And then, Google went ahead and set up exchanges for the states where the GOP has announced that they're going to boycott, too. Thus giving people in, say, Florida, choices, too.

I would think that Google would LOVE that job. (Although it also occurs to me that part of the reason they'd love it, is the ability to collect health information about everybody who uses it).

[Wrong Direction]

Oh, I think if you look at the Republican's reactions to Obamacare, and contrast it to their reactions to W's Medicare expansion, it's glaringly obvious that the GOP doesn't have a problem with government paying private companies for health care.  They just have a problem with a Democrat getting credit for it. 

 

I'd take it a step further. R's would design a plan similar to the ACA if they had the power. The differences would be 1) less or no federal mandates, 2) more ability to tailor coverage to the individual (e.g., picking from a menu as opposed to one size fits all), 3) easier portability across state lines, 4) totally different financing structure, particularly the elimination of the idiotic 50 employee economy killer (which D's would love to get rid of too, but our parties can't work together), 5) block grants for sick people and 6) tort reform.

 

There are other changes I'm sure, however, it's definitely not the fact that this is a plan where insurance companies compete that R's are opposing. The alternative is Medicare, which is beholden to politicians who won't fix things until it's too late.

 

This is what R's want, and it's why I argue that the ACA is far from the end of the world. I think this bill could be changed over time to become very good, actually. It's just not there yet.

I offer all of my employees high deductible health insurance like what I will assume most people could afford from the exchanges.  In my case, I pay my employees deductibles.

For someone with pre existing conditions, on prescription medications, and frequent medical care, they might wonder why they actually pay for the insurance when they see how much they pay out of pocket.  And those deductibles are rising.  For the last 2 years I held a family policy deductible at $2500, this year I had to bump it to $4000 because insurance is skyrocketing because I have to pay to set up these exchanges.

 

Right. A lot of us are used to something much closer to first dollar coverage. For low/middle income people, they might get really upset when they see these out of pocket costs.

 

And those who go into Medicaid will likely also be disappointed with access, though their financial exposure will be next to nothing, so they'll probably be relatively happy.

[chipwhich]

I had this mental image, a day or so ago.

About getting Google to set up an exchange.

I mean, it seems to me that what were talking about is a web page. You enter your zip code, age, maybe some other things. And it comes back with a list of links to insurance companies, and prices.

Maybe you click on an insurance company, and a Google map pops up, shows you doctors near you, colored red or green for whether they take that insurer.

My fantasy had some blue state, say California, paying Google to set up their exchange for them. And then, Google went ahead and set up exchanges for the states where the GOP has announced that they're going to boycott, too. Thus giving people in, say, Florida, choices, too.

I would think that Google would LOVE that job. (Although it also occurs to me that part of the reason they'd love it, is the ability to collect health information about everybody who uses it).

 

We have had that for years.  You can get some GREAT pricing on health insurance, the problem is you are really just buying insurance on the GREAT deals and not coverage.

I think there is confusion amongst people wanting insurance -vs- coverage.  That's a BIG difference.

 

Sites like this have been around for years.

 

http://www.ehealthinsurance.com/?allid=Mic17851&sid=eeW9T8WUL|3321443432&omni_medium=cpc&utm_source=bing&utm_medium=cpc&utm_term=Health%20Insurance&utm_campaign=ehealth0406+core

[Wrong Direction]

I had this mental image, a day or so ago.

About getting Google to set up an exchange.

I mean, it seems to me that what were talking about is a web page. You enter your zip code, age, maybe some other things. And it comes back with a list of links to insurance companies, and prices.

Maybe you click on an insurance company, and a Google map pops up, shows you doctors near you, colored red or green for whether they take that insurer.

My fantasy had some blue state, say California, paying Google to set up their exchange for them. And then, Google went ahead and set up exchanges for the states where the GOP has announced that they're going to boycott, too. Thus giving people in, say, Florida, choices, too.

I would think that Google would LOVE that job. (Although it also occurs to me that part of the reason they'd love it, is the ability to collect health information about everybody who uses it).

 

An exchange is a regulatory structure for contracting. What you're describing is a website. R's did this with Part D, with great success, and these websites are being set up as part of the exchanges now too.

[Larry]

Oh, I'm absolutely certain that the R's have been saying for years that their plan for how to fix health care is to have one state (whichever state most favors the insurance companies) setting the rules for all 50 states, AND making it so that, if you can PROVE that your insurance company criminally ****ed you, they can't be punished.

I think that both ideas would absolutely **** the people, in the cause of corporate profits. (You may have gotten that impression, from the way I described the Republican proposals).

(I agree with your assertion that any R plan would have similarities to Obama. See Mittcare.)

We have had that for years. You can get some GREAT pricing on health insurance, the problem is you are really just buying insurance on the GREAT deals and not coverage.

I think there is confusion amongst people wanting insurance -vs- coverage. That's a BIG difference.

Sites like this have been around for years.

http://www.ehealthinsurance.com/?allid=Mic17851&sid=eeW9T8WUL|3321443432&omni_medium=cpc&utm_source=bing&utm_medium=cpc&utm_term=Health%20Insurance&utm_campaign=ehealth0406+core

But I thought that part of the rules for the exchanges was that, for a plan to be listed, then it has to meet certain federal guidelines. Thus hopefully meaning that people comparison shopping will be making more of an "apples to apples" comparison.

[chipwhich]

But I thought that part of the rules for the exchanges was that, for a plan to be listed, then it has to meet certain federal guidelines. Thus hopefully meaning that people comparison shopping will be making more of an "apples to apples" comparison.

 

Sorry, you are correct it will.  And there are regulations to control what people pay "out of pocket".  Out of pocket being above and beyond what they pay premium wise.

[Wrong Direction]

Oh, I'm absolutely certain that the R's have been saying for years that their plan for how to fix health care is to have one state (whichever state most favors the insurance companies) setting the rules for all 50 states, AND making it so that, if you can PROVE that your insurance company criminally ****ed you, they can't be punished.

I think that both ideas would absolutely **** the people, in the cause of corporate profits. (You may have gotten that impression, from the way I described the Republican proposals).

(I agree with your assertion that any R plan would have similarities to Obama. See Mittcare.)

 

 

Yeah, I'm familiar with your take on that. I disagree. With transparency (common website, more of a menu of options) and subsidies/grants for the sick and poor, I think you could easily meet the needs of people. Either way, there's plenty of middle ground that reasonable people could find, IMO. Hell, I believe in some mandates too. 

[chipwhich]

Yeah, I'm familiar with your take on that. I disagree. With transparency (common website, more of a menu of options) and subsidies/grants for the sick and poor, I think you could easily meet the needs of people. Either way, there's plenty of middle ground that reasonable people could find, IMO. Hell, I believe in some mandates too. 

 

Obamacare that is getting rolled out is what it is.  I hope when I decide to retire, should I need to use Obamacare, it will be there for me, but more importantly functional and a good service.

Every year my benefit broker lays out a spreadsheet of 5-7 health insurers for me to consider for my company (I have to renew and get repriced every year).  My broker provides me with an extensive side by side look to include deductible costs, premium costs, copays, costs for hospital visits, emergency room visits, prescription drug coverage, etc.  That gives me a big picture to compare all the companies at face value.  What it doesn't actually show is the level of service each vendor provides and the amount of doctors that participate with each vendor.  I can ALWAYS get deals on insurance for my company, but not the DOCTORS or the SERVICE my employees (and my wife and I) want.

 

I hope Obamacare works out and everyone thinks it's great and saves money.  I suspect people will be in for a real eye opener.

[Wrong Direction]

Obamacare that is getting rolled out is what it is.  I hope when I decide to retire, should I need to use Obamacare, it will be there for me, but more importantly functional and a good service.

Every year my benefit broker lays out a spreadsheet of 5-7 health insurers for me to consider for my company (I have to renew and get repriced every year).  My broker provides me with an extensive side by side look to include deductible costs, premium costs, copays, costs for hospital visits, emergency room visits, prescription drug coverage, etc.  That gives me a big picture to compare all the companies at face value.  What it doesn't actually show is the level of service each vendor provides and the amount of doctors that participate with each vendor.  I can ALWAYS get deals on insurance for my company, but not the DOCTORS or the SERVICE my employees (and my wife and I) want.

 

I hope Obamacare works out and everyone thinks it's great and saves money.  I suspect people will be in for a real eye opener.

For exchange plans, people will be able to see doctors [in the network] in advance. I'm actually surprised your broker can't provide that now.

 

ObamaCare will probably cause people like yourself to really consider dropping coverage for employees and put everyone into the exchange. Many would argue that's one of the main goals...to end employer sponsored insurance. That would be good for a lot of folks. As owner, you could consider to stop paying brokers all those fees and just set a pool of money aside to pay out of pocket costs for employees who enroll in the exchange. Might be less overhead and less costly for your business, while still allowing employees to have insurance.

 

I doubt you want to do this stuff, but it's the type of decision that small and large business owners will be faced with over the coming years. 

 

[As an aside, I'm not sure how the ACA handles arrangements like I just proposed. They might consider that income, and thus it would lower any subsidies an enrollee would be eligible for. This is how bureaucracy works.]

[chipwhich]

For exchange plans, people will be able to see doctors in advance. I'm actually surprised your broker can't provide that now.

 

I can see doctors, but unfortunately I am picking for 80 employees, it's a big effort.

Insurance isn't insurance isn't insurance.  The exchanges wont be able to explain that.  In MD, my CareFirst Blue Cross Blue Shield is superior to any other broker.  Carefirst has more doctors, better coverage, than any other plan in MD, but they also became more expensive than everyone else.  My buddy who has a similar company switched to Coventry to save money, while still appearing to provide the same benefits.  He and his employees have been very disappointed.

[Mad Mike]

Well, I'm remembering somebody on ES posting a study that didn't have the problems of people dying young, from unnatural causes, skewing the life expectancy rankings, by looking at the life expectancy only of people who've made it to 65. I only vaguely remember what the guy posted, and I remember that we still weren't #1. But I think we were top 10. Maybe top 5.

 

Here's your where your contrarian view comes from: An Ill-Conceived Health-Care Ranking - WSJ.com

Not exactly an unbiased source of intellectual enlightenment. And even they admit...

 

 the U.S. is lagging its peers in some major barometers of public health. For instance, the U.S. slipped from 18th to 24th in male life expectancy from 2000 to 2009, according to the United Nations, and from 28th to 35th in female life expectancy. Its rankings in preventing male and female under-5 mortality also fell, and placed in the 30s.

And for the record. NO. Points were NOT given for government health care vs private. 

Lets try this one....

 

The Most Efficient Health Care Systems In The World (INFOGRAPHICS)

 

 

Or how about this one among developed western nations...

U.S. Ranks Last Among Seven Countries on Health System Performance Based on Measures of Quality, Efficiency, Access, Equity, and Healthy Lives - The Commonwealth Fund

 

Or this one...

New Health Rankings: Of 17 Nations, U.S. Is Dead Last - Grace Rubenstein - The Atlantic

[chipwhich]

MadMike, while your stats may be correct, that doesn't mean the affordable care act will fix anything.

I think therein lies the rub.

The US has a lot more working against them than most countries, obesity, mcdonalds on every corner, over medication, and lawyers.

 

As I posted, I hope it works out, I just don't see the current plan doing much but providing insurance and not coverage.

[Mad Mike]

Well that's a more reasonable post than your rants.

 

I am for people having health insurance, unfortunately the plan that we are getting isn't a good one.  Sure it *might* save your family from financial ruin if something extreme happens, what it WILL do for you is having you paying a premium and a lot of money out of pocket for coverage.

Enjoy going to the exchanges and figuring out which insurances are worth a ****.  I hope your family physicians choose to participate.

 

Now back to topic.

 

Ignoring your attempted cheep shot.... 

 

As opposed trying to figure out which insurance companies that wont offer me coverage are worth a **** now?

[twa]

when the reality you can't get the same level of care and access(to both specialists and facilities) becomes clearer

 

Lower Health Insurance Premiums to Come at Cost of Fewer Choices

http://www.nytimes.com/2013/09/23/health/lower-health-insurance-premiums-to-come-at-cost-of-fewer-choices.html?pagewanted=all&_r=1&

 

Some consumer advocates and health care providers are increasingly concerned. Decades of experience withMedicaid, the program for low-income people, show that having an insurance card does not guarantee access to specialists or other providers.

Consumers should be prepared for “much tighter, narrower networks” of doctors and hospitals, said Adam M. Linker, a health policy analyst at the North Carolina Justice Center, a statewide advocacy group.

“That can be positive for consumers if it holds down premiums and drives people to higher-quality providers,” Mr. Linker said. “But there is also a risk because, under some health plans, consumers can end up with astronomical costs if they go to providers outside the network.”

Insurers say that with a smaller array of doctors and hospitals, they can offer lower-cost policies and have more control over the quality of health care providers. They also say that having insurance with a limited network of providers is better than having no coverage at all.

[chipwhich]

Ignoring your attempted cheep shot.... 

 

As opposed trying to figure out which insurance companies that wont offer me coverage are worth a **** now?

 

What good is *INSURANCE* if you can't get *COVERAGE*?

 

I don't know what you pay now without insurance, but you might not get much more than you get now but with higher financial output.

 

[Mad Mike]

What good is *INSURANCE* if you can't get *COVERAGE*?

 

I don't know what you pay now without insurance, but you might not get much more than you get now but with higher financial output.

 

No. I wont.

[chipwhich]

No. I wont.

 

I hope you win the battle, and the war.

Good luck my friend.

 

A year from now you can give us updates.

[Larry]

I can see doctors, but unfortunately I am picking for 80 employees, it's a big effort.

Insurance isn't insurance isn't insurance.  The exchanges wont be able to explain that.  In MD, my CareFirst Blue Cross Blue Shield is superior to any other broker.  Carefirst has more doctors, better coverage, than any other plan in MD, but they also became more expensive than everyone else.  My buddy who has a similar company switched to Coventry to save money, while still appearing to provide the same benefits.  He and his employees have been very disappointed.

Agree that that will likely continue to be a problem. (But one which, I will point out, can't be blamed on Obamacare. Although it may encourage it.)

No doubt the exchanges, with their "one stop shopping" approach, will encourage ensurers to compete very heavily on price. (Since price is no doubt what the most consumers will base their decisions on.) I have no doubt that we'll see insurers fighting to offer just barely enough coverage to meet the exchange minimums, and anything else to make their plans look attractive, based on price and nothing else.

But the only way to avoid that, is to have the person doing the choosing spend a great deal of time, studting plans in detail, and to make a decision tailored for the individual patient. No doubt regulation can HELP. (By eliminating as many corner-cutting as possible.)

But this is a predictable result of competition.

[Wrong Direction]

For what it's worth, plans are already rated on many measures of quality and those ratings are likely to be placed on these same website for comparison purposes. So, in addition to seeing what's covered, consumers can see how plans are rated across many categories, such as customer service.

 

This isn't in place because of the ACA, but it'll help the comparisons. In Medicare Advantage, plans are financially incented to receive 4 or 5 stars (out of 5) on ratings. It's a big financial incentive too.