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Repealing the ACA under Trump

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dudeguyy    3,490

I believe the CBO scores proposals based on ten year estimates, correct? I don't know a whole lot about their work but I think that's correct.

 

That analysis assumed repeal without replacement, though. That isn't likely to happen.

 

I did come across this piece this morning as well, though:

 

 

 

The comments come after Trump told The Washington Post this weekend that he is nearly done crafting a plan that has "insurance for everybody" as its goal, although his transition team quickly walked back those remarks Monday.
Lawmakers want to focus on lowering costs, not expanding coverage, which is one of the Democrats' main talking points. They are very wary of discussing how many people would be insured under their plan, aware that many Americans are concerned they'll lose their coverage under a would-be GOP overhaul. Instead, they are emphasizing more people will have access to more affordable policies.

 

It appears his comments are not in step with GOP at all. This may have been more thoughtless posturing from Trump.

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zoogs    6,367

Trump's rhetoric on this issue is turning him into a potential ally for progressives. This is neither an excuse nor an endorsement of him. The methods he's actually likely to pursue to those ends are very dangerous, and I hope that real progressives will be able to see clearly the choice between ideal healthcare and democracy. The former can always be fought for and regained in the normal course of politics. The latter should never be lost.

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Fru    868

To me, health care is such an important and critical issue that I don't care who implements/improves it.

 

If the GOP had proposed something more efficient and better than the ACA then that's phenomenal. But they didn't, and haven't. They're about to strip life saving health care from people. Explain that one to me all you "100% Pro Lifers"

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zoogs    6,367

^^ Yup. To add, what I meant by the democracy thing is Trump's strategy appears to be using the bully pulpit to cow private industry into submission. I don't think that will succeed here in the U.S., but in general this kind of a world can be realized, and that's called fascism.

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BigRedBuster    8,066

I believe the CBO scores proposals based on ten year estimates, correct? I don't know a whole lot about their work but I think that's correct.

 

That analysis assumed repeal without replacement, though. That isn't likely to happen.

 

I did come across this piece this morning as well, though:

 

 

 

The comments come after Trump told The Washington Post this weekend that he is nearly done crafting a plan that has "insurance for everybody" as its goal, although his transition team quickly walked back those remarks Monday.
Lawmakers want to focus on lowering costs, not expanding coverage, which is one of the Democrats' main talking points. They are very wary of discussing how many people would be insured under their plan, aware that many Americans are concerned they'll lose their coverage under a would-be GOP overhaul. Instead, they are emphasizing more people will have access to more affordable policies.

 

It appears his comments are not in step with GOP at all. This may have been more thoughtless posturing from Trump.

This is going to sound like I'm defending Trump which makes me want to throw up.

 

But, dismantling and replacing in pieces is an absolute DUMB idea. You have to go about this with an end frame work that you want to get to. Doing it in pieces is going to result in a huge legislation where the pieces don't work together.

 

Now, if they want to propose and pass a replacement that is best implemented in pieces....then great. But, to pass different parts over the next 4 years is a recipe for failure.

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knapplc    19,301

I believe the CBO scores proposals based on ten year estimates, correct? I don't know a whole lot about their work but I think that's correct.

 

That analysis assumed repeal without replacement, though. That isn't likely to happen.

 

I did come across this piece this morning as well, though:

 

 

 

The comments come after Trump told The Washington Post this weekend that he is nearly done crafting a plan that has "insurance for everybody" as its goal, although his transition team quickly walked back those remarks Monday.
Lawmakers want to focus on lowering costs, not expanding coverage, which is one of the Democrats' main talking points. They are very wary of discussing how many people would be insured under their plan, aware that many Americans are concerned they'll lose their coverage under a would-be GOP overhaul. Instead, they are emphasizing more people will have access to more affordable policies.

 

It appears his comments are not in step with GOP at all. This may have been more thoughtless posturing from Trump.

 

How can they possibly be "in the dark" about a replacement plan when they've had it ready to roll out for the last six years?

 

All we've heard is the Republicans are going to "Repeal and Replace" Obamacare.

 

Don't tell me that was a lie this whole time. If so I'll be shocked. SHOCKED, I SAY!

 

¯\_(ツ)_/¯

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Comfortably Numb    5,061

 

No wonder the House GOP voted to exempt ACA repeal bills from required analysis by the CBO.

I do not like at all how they (Trump) are going about replacing the ACA. I'm not sure any of them have an alternate plan because I sure haven't heard any details other than the horsesh#t of being allowed to purchase across state lines. To be honest it is making me fairly nervous that they repeal and then don't do crap, like they haven't in forever already.

 

But I will say, if premiums are only going to double by 2026, sign me up for that much lower cost trajectory. That is nine years away. I don't know about you guys but my premiums have much more than doubled in the last 9 years. This year alone I saw a 28% increase, last year was about 18%, and the year they implemented the ACA it was about 10% plus the across the board 25% increase.

 

The problem with the ACA has always been that they didn't fix or even begin to address the cost problem. It does need to be severely tweaked or replaced but all these asshats care about is repeal. If they know how to fix it, I sure would like for them to share how. Considering that hasn't happened at all, I will assume they're about to make a much bigger mess of it.

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Comfortably Numb    5,061

Well I guess ask and ye shall receive.

Just saw an ad on TV sponsored by the house republicans asking for us to visit...

www.abetterhealtcareplan.com

 

Pretty disappointed. It links you to a ten second video bragging about how they have a plan and then redirects you back to that site so you can watch the worthless video again. No details. F#@kers.

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dudeguyy    3,490

Just checked out that site. Paid for by something called the American Action Network, whose stated purpose is to promote center right policy. Who knows whose plan they support, but apparently they also work to promote a House GOP majority, so it could be any of those- Ryan's, Price's, etc. I honestly think they're trying to figure how to piece bits and pieces of them all together to form a working whole at this point. They obviously haven't coalesced behind anything.

 

The ACA did decrease premium growth overall, but it didn't work for everyone and it certainly didn't reverse growth. That's going to be difficult save for some very major changes in the dynamics of our healthcare, ones which I would welcome. You're a small business owner, are you not, JJ? I fear you may be in one of those unfortunate groups who did not see a single muc relief form the ACA as others.

 

I worry about the implications of these Republican plans, though. They seemingly want to ditch the pre-existing conditions bit as a cost saving method, in favor of a "non-lapse" policy instead. This would mean they could not deny anyone who maintained continuous coverage, but if you become unemployed and lose your insurance, you becomes eligible for denial. I worry about them tossing out the "No lifetime cap" rule. And from what I've gathered, ALL the GOP plans will, without exception, make it cheaper for young, healthy people and more expensive for older or sicker folks. I'm not cool with shifting the cost burden to the folks who actually need the coverage.

 

We shall see. Have it remain hopeful.

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Comfortably Numb    5,061

Dudeguyy- The only relief I experienced was the first year I changed from our small group company plan to the ACA plan, I was able to get a better plan for only slight increase from what I wouldve had to pay on my other renewal. Our company plan was with Anthem BCBS and I had cut it down to generic only Rx's and it had a little higher deductible, out of pocket etc. The ACA plan I went with Kaiser who had just expanded into our area. The prescription coverage was better and had lower deductible. The next year the premium went up 18% and this year almost 28%. I compared many different available plans and the only better premiums were real sh#t for coverage.

 

I'm not sure if I fall into some unlucky category or not. That doesn't seem likely as I am in the same marketplace as anyone else. Of course I do not have an employer subsidizing any of my cost and I don't get any premium help from the government as I make too much money. So fAR I have been able to deduct the health premiums on my taxes since I am considered self employed.

 

The other benefit (sort of) I got was I discontinued offering a health plan to my employees. Once the ACA came into being, I did not have to be worried or concerned about them being able to acquire coverage so I 86'D it. I absolutely hated the yearly rigamaroll of selecting a plan that fit everyone's needs and it was becoming cost prohibitive because I had to pay a certain minimum percentage of their premiums. So I gave them all a healthy raise and turned them loose to the marketplace or, in some cases, it allowed them to get on a spouses work plan that they were not eligible for when my company had it available.

 

But my experience has been that prior to the ACA premium costs were increasing about 15% per year and after it has averaged about 20%+ per year. Those kind of increases are not and will not be sustainable for many people. Luckily, being the boss of me ;-) I have been able to adjust my pay as needed to cover my insurance increases. Business has been decent or that wouldn't be an option. Our plan covers a family of 4 and the monthly premium is about $1860 now. It's now more than our house payment. $4-$5K yearly cost increases cant be sustainable for a lot of people, can they? The threshold for premium assistance is well below my income and I'm feeling the pinch. Of course we have experienced some unusual healthcare costs as well. Maxed our out of pocket last year, so that sure didn't help. About $32K between premiums and care costs. It has to really suck for people near the threshold.

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knapplc    19,301

The problem with healthcare, that Obamacare didn't remotely fix, is that our health should not be a for-profit business. We need universal healthcare like every other first-world nation. They can repeal and replace Obamacare but all they're going to do is interrupt the healthcare of millions of Americans without fixing the problem.

 

Until that happens, rates are going to go up and Americans are going to continue to go broke paying these outrageous healthcare prices.

 

hCNTbpR.jpg

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QMany    3,006

7 years since the first repeal try, $666M in ads, and still no replacement plans...

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ColoNoCoHusker    396

Knapp - While the rank/order of compensation is probably accurate, the actual numbers in the Medscape Compensation Report are generally regarded as quite inflated. The survey is pretty flawed in determining earnings but rather than fix it, Medscape/WebMD just blame the participants...

 

Dudeguyy - Prior to the ACA, pre-existing conditions were lapsed-based. If you ever had a gap in insurance, anything that occurred at/before that gap fell into not covered. It was total BS and removing that clause is not the financial drain the Repubs are making it out to be. If it was, you would see the insurance companies' leadership at the front of this public discussion. They are not for good reason...

 

JJ - Sorry to hear about your experience. As a small business owner in Colorado for 10+ years now, I have had to deal with the same issues. However, my experience is the exact opposite of yours in terms of cost, premium increases, and quality of coverage. My family has more medical issues than anyone I have ever met. As an employee for others I had stellar insurance. As a business it's been pretty close to that. With the ACA, our costs came down a lot. I will say that Anthem BCBS and Kaiser are probably the two worst providers for small businesses. I have had an insurance broker even before starting my own company. I would strongly urge you to find a good broker as I think it would make a world of difference.

 

It has been my position for years that the main reason for premium increases is simply because the insurance companies can do it. I have experience with claims processing systems and revenue assurance projects for the largest insurance providers. Imo, health insurance cannot be a free & open market; how can it be when it is literally a matter of life & death? It is a monopolistic, collusion based system.

 

The plight of Colorado HealthOp is a great example of how insurance companies work in this country. This health cooperative started post-ACA. It was highly profitable from the outset and provided excellent and affordable coverage. Rather than compete with the cooperative, the three largest insurance providers in the state lobbied the Division of Insurance, Governor, and State Reps to get CHO dropped from the Exchange and delisted. The reason given by the state in deslisting CHO was a $30 million shortfall when the cooperative had over $50 million in cash. It was classic private sector corruption of government policy standards, imo.

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BigRedBuster    8,066

The problem with healthcare, that Obamacare didn't remotely fix, is that our health should not be a for-profit business. We need universal healthcare like every other first-world nation. They can repeal and replace Obamacare but all they're going to do is interrupt the healthcare of millions of Americans without fixing the problem.

 

Until that happens, rates are going to go up and Americans are going to continue to go broke paying these outrageous healthcare prices.

 

hCNTbpR.jpg

 

I honestly don't have a problem with what doctors make. 8+ years of college and 300,000-400,000+ in debt, along with having our health in their hands.....they should be making a lot of money.

 

And....your doctor's salary isn't the biggest problem with the cost of health care. But...it's a convenient boogie man.

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Fru    868

 

The problem with healthcare, that Obamacare didn't remotely fix, is that our health should not be a for-profit business. We need universal healthcare like every other first-world nation. They can repeal and replace Obamacare but all they're going to do is interrupt the healthcare of millions of Americans without fixing the problem.

 

Until that happens, rates are going to go up and Americans are going to continue to go broke paying these outrageous healthcare prices.

 

hCNTbpR.jpg

 

I honestly don't have a problem with what doctors make. 8+ years of college and 300,000-400,000+ in debt, along with having our health in their hands.....they should be making a lot of money.

 

And....your doctor's salary isn't the biggest problem with the cost of health care. But...it's a convenient boogie man.

 

 

So when a doctor gets a bonus from a pharmaceutical company for prescribing needless medication, it doesn't concern or bother you?

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ColoNoCoHusker    396

 

 

The problem with healthcare, that Obamacare didn't remotely fix, is that our health should not be a for-profit business. We need universal healthcare like every other first-world nation. They can repeal and replace Obamacare but all they're going to do is interrupt the healthcare of millions of Americans without fixing the problem.

 

Until that happens, rates are going to go up and Americans are going to continue to go broke paying these outrageous healthcare prices.

 

hCNTbpR.jpg

 

I honestly don't have a problem with what doctors make. 8+ years of college and 300,000-400,000+ in debt, along with having our health in their hands.....they should be making a lot of money.

 

And....your doctor's salary isn't the biggest problem with the cost of health care. But...it's a convenient boogie man.

 

 

So when a doctor gets a bonus from a pharmaceutical company for prescribing needless medication, it doesn't concern or bother you?

 

 

But at least drug reps are no longer allowed to show up unannounced or provide food to clinical practices and staff. Glad our government is cracking down on the high-risk/high-corruption activities...

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BigRedBuster    8,066

 

 

 

The problem with healthcare, that Obamacare didn't remotely fix, is that our health should not be a for-profit business. We need universal healthcare like every other first-world nation. They can repeal and replace Obamacare but all they're going to do is interrupt the healthcare of millions of Americans without fixing the problem.

 

Until that happens, rates are going to go up and Americans are going to continue to go broke paying these outrageous healthcare prices.

 

hCNTbpR.jpg

 

I honestly don't have a problem with what doctors make. 8+ years of college and 300,000-400,000+ in debt, along with having our health in their hands.....they should be making a lot of money.

 

And....your doctor's salary isn't the biggest problem with the cost of health care. But...it's a convenient boogie man.

 

 

So when a doctor gets a bonus from a pharmaceutical company for prescribing needless medication, it doesn't concern or bother you?

 

 

But at least drug reps are no longer allowed to show up unannounced or provide food to clinical practices and staff. Glad our government is cracking down on the high-risk/high-corruption activities...

 

I would assume those figures are their salaries from whatever hospital/clinic they work. That is the part I don't have a problem with.

 

Where in that data does it show how much they make off of pharmaceutical companies giving bonuses?

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zoogs    6,367

Oh. Not to comment on doctor's salaries, I think the important part of that post was the idea that health should be viewed as a public good, and healthcare both a right and a social responsibility, versus purely a profit-driven enterprise. This is less about indignation over those who currently profit and more about the role government ought to play.

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ColoNoCoHusker    396

 

 

 

 

The problem with healthcare, that Obamacare didn't remotely fix, is that our health should not be a for-profit business. We need universal healthcare like every other first-world nation. They can repeal and replace Obamacare but all they're going to do is interrupt the healthcare of millions of Americans without fixing the problem.

 

Until that happens, rates are going to go up and Americans are going to continue to go broke paying these outrageous healthcare prices.

 

hCNTbpR.jpg

 

I honestly don't have a problem with what doctors make. 8+ years of college and 300,000-400,000+ in debt, along with having our health in their hands.....they should be making a lot of money.

 

And....your doctor's salary isn't the biggest problem with the cost of health care. But...it's a convenient boogie man.

 

 

So when a doctor gets a bonus from a pharmaceutical company for prescribing needless medication, it doesn't concern or bother you?

 

 

But at least drug reps are no longer allowed to show up unannounced or provide food to clinical practices and staff. Glad our government is cracking down on the high-risk/high-corruption activities...

 

I would assume those figures are their salaries from whatever hospital/clinic they work. That is the part I don't have a problem with.

 

Where in that data does it show how much they make off of pharmaceutical companies giving bonuses?

 

 

The "earnings" is calculated from self-reported data on questionably structured survey (being nice). Things like pharma/distributor bonuses typically come through the practice so those could be excluded. Also, the survey ignores a lot of direct expenses...

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knapplc    19,301

Yes, I think we're getting side-tracked here. Doctors' salaries are exorbitant, but that's only one small piece of the problem. I suppose I could have chosen a better graph to show rising costs, so that's on me.

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ColoNoCoHusker    396

Yes, I think we're getting side-tracked here. Doctors' salaries are exorbitant, but that's only one small piece of the problem. I suppose I could have chosen a better graph to show rising costs, so that's on me.

 

I apologize if I contributed to derailing the thread....

 

I actually think it was the perfect graph to illustrate the issues around Healthcare. It is easy to say the problem is X or Y. In reality it is complex and a larger number of factors than are apparent on the surface. Understanding a small amount of the complexities allows us to better evaluate the ACA and work towards viable solutions and real improvement...

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NM11046    2,042

 

 

The problem with healthcare, that Obamacare didn't remotely fix, is that our health should not be a for-profit business. We need universal healthcare like every other first-world nation. They can repeal and replace Obamacare but all they're going to do is interrupt the healthcare of millions of Americans without fixing the problem.

 

Until that happens, rates are going to go up and Americans are going to continue to go broke paying these outrageous healthcare prices.

 

hCNTbpR.jpg

 

I honestly don't have a problem with what doctors make. 8+ years of college and 300,000-400,000+ in debt, along with having our health in their hands.....they should be making a lot of money.

 

And....your doctor's salary isn't the biggest problem with the cost of health care. But...it's a convenient boogie man.

 

 

So when a doctor gets a bonus from a pharmaceutical company for prescribing needless medication, it doesn't concern or bother you?

 

It's not happening as much as you think. Most physicians who are affiliated with an institution either have limits in what they can "earn" for consulting/speaking or they're not allowed to do anything with industry.

 

You can verify individuals payments here (as well as state info, hospital info)- if you want to see if your physician is working with industry: https://projects.propublica.org/docdollars/

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RedDenver    1,799

 

So when a doctor gets a bonus from a pharmaceutical company for prescribing needless medication, it doesn't concern or bother you?

It's not happening as much as you think. Most physicians who are affiliated with an institution either have limits in what they can "earn" for consulting/speaking or they're not allowed to do anything with industry.

 

You can verify individuals payments here (as well as state info, hospital info)- if you want to see if your physician is working with industry: https://projects.propublica.org/docdollars/

 

What about doctors that own their own practice? Isn't that quite common? (I honestly don't know.)

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NM11046    2,042

No, not at all common anymore. Most are part of large group practices or formally organized Physician Groups. It helps them negotiate insurance, coverages etc. (mostly insurance and helps to balance risk).

 

There are a handful of what are called "Boutique Physicians" that are on their own, don't take ins (cash only) but it's really really rare and only in markets where that's an option for people.

 

You may have a 70 year old family doc that's still on his own, but I'd be surprised.

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Elf    583

One of the very basic decisions in this deal is,

 

Are you for the mandate that everyone needs and has to have coverage, or do you want to accept that some lives are disposable and refuse medical care to those who can't pay for it? That is the mandate issue in simplistic terms.

I disagree with a government mandate to buy anything, including health insurance. When I was young I was incredibly healthy, only got sick on very rare occasions, so I never bought health insurance. I simply didn't need it. When I was a kid there were 10 people in my family. When things like the flu or a cold virus went around I was always the last one to get it, if I got it at all.

 

Now that I'm older I need the health insurance. I have diabetes, sleep apnea, high blood pressure, high cholesterol, sick sinus syndrome, (I have a pacemaker for that one), daily neuropathy pain, daily light-headedness and I've already had a TIA (minor stroke). My wife has fantastic health insurance through her work. The hospital bill for the pacemaker installation was $114,000 and we didn't have to pay even a single penny. I realize that not everyone has insurance of this quality and I think it's a shame we can't make it so everyone that wants it, gets this same level of care.

 

I had another trip to the ER that resulted in another hospital stay just last week. I can't wait to see the bills roll in on this one, 3 ct scans and 2 ultrasounds plus quite a few other tests, ER visit and transfer by meatwagon to a Kaiser approved hospital.

 

If we didn't have health insurance through my wife's work we wouldn't be able to afford the premiums for me. We tried to get mortgage life insurance on me, just in case... The premiums would have been over $1000 a month and I'm only 54.

 

People like me should be able to get health insurance at a reasonable cost, but we can't and somehow that needs to change. If my wife didn't have health insurance for us, I'd be on the outside looking in.

 

A couple of you might recognize this eatery on E Colfax Ave. I had my stroke outside this place.

post-7147-0-11668500-1484945328_thumb.jpg

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funhusker    751

 

One of the very basic decisions in this deal is,

 

Are you for the mandate that everyone needs and has to have coverage, or do you want to accept that some lives are disposable and refuse medical care to those who can't pay for it? That is the mandate issue in simplistic terms.

I disagree with a government mandate to buy anything, including health insurance. When I was young I was incredibly healthy, only got sick on very rare occasions, so I never bought health insurance. I simply didn't need it. When I was a kid there were 10 people in my family. When things like the flu or a cold virus went around I was always the last one to get it, if I got it at all.

 

Now that I'm older I need the health insurance. I have diabetes, sleep apnea, high blood pressure, high cholesterol, sick sinus syndrome, (I have a pacemaker for that one), daily neuropathy pain, daily light-headedness and I've already had a TIA (minor stroke). My wife has fantastic health insurance through her work. The hospital bill for the pacemaker installation was $114,000 and we didn't have to pay even a single penny. I realize that not everyone has insurance of this quality and I think it's a shame we can't make it so everyone that wants it, gets this same level of care.

 

I had another trip to the ER that resulted in another hospital stay just last week. I can't wait to see the bills roll in on this one, 3 ct scans and 2 ultrasounds plus quite a few other tests, ER visit and transfer by meatwagon to a Kaiser approved hospital.

 

If we didn't have health insurance through my wife's work we wouldn't be able to afford the premiums for me. We tried to get mortgage life insurance on me, just in case... The premiums would have been over $1000 a month and I'm only 54.

 

People like me should be able to get health insurance at a reasonable cost, but we can't and somehow that needs to change. If my wife didn't have health insurance for us, I'd be on the outside looking in.

 

Hope you get to feeling better, Elf.

 

Regarding the bold, that is the goal of the mandate. Insurance is outrageous for older sick people because providers know, without a doubt, they are going to spend a boatload of money. If young healthy people don't buy it (like you said, there is no need for them too) and pay premiums, the providers won't make any money.

 

Without a mandate in some form, people will without a doubt be left on the outside looking in. It sucks!

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Elf    583

Hope you get to feeling better, Elf.

I think I've given up hope on that happening. Ever.

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zoogs    6,367
Speaking only on the topic of the mandate...



When I was young I was incredibly healthy, only got sick on very rare occasions, so I never bought health insurance. I simply didn't need it.



I disagree with this. As far as you knew you were healthy, and fortunately you didn't end up needing it. What if you had suddenly learned otherwise -- or your situation unexpectedly changed? I'm glad it didn't, but what are your options then?

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Elf    583

Speaking only on the topic of the mandate...

 

 

 

When I was young I was incredibly healthy, only got sick on very rare occasions, so I never bought health insurance. I simply didn't need it.

 

I disagree with this. As far as you knew you were healthy, and fortunately you didn't end up needing it. What if you had suddenly learned otherwise -- or your situation unexpectedly changed? I'm glad it didn't, but what are your options then?

 

Then you get a job that offers health insurance as a benefit.

 

If the situation changes rapidly enough that I can't get health insurance in time? Then that's my fault and I'm the only one responsible for the debt and the decision that put me in debt.

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knapplc    19,301

Then you get a job that offers health insurance as a benefit.

 

If the situation changes rapidly enough that I can't get health insurance in time? Then that's my fault and I'm the only one responsible for the debt and the decision that put me in debt.

People get cancer diagnoses out of the clear blue sky. And then what do you do? Just not accept healthcare? Accept it, run debt up into the hundreds of thousands of dollars (two different family members have had cancer costing over two hundred thousand in healthcare), and then either spend the rest of your life in debt? Or you die, and your family is burdened with that debt?

 

What's the solution there? You're OK with going into lifelong debt, not accepting healthcare you can't pay for, or passing that debt along to your kin?

 

Why, when every other first-world nation has figured out how to treat their citizens without them going into debt? Why should America/Americans be uniquely burdened like this?

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Elf    583

 

Then you get a job that offers health insurance as a benefit.

 

If the situation changes rapidly enough that I can't get health insurance in time? Then that's my fault and I'm the only one responsible for the debt and the decision that put me in debt.

People get cancer diagnoses out of the clear blue sky. And then what do you do? Just not accept healthcare? Accept it, run debt up into the hundreds of thousands of dollars (two different family members have had cancer costing over two hundred thousand in healthcare), and then either spend the rest of your life in debt? Or you die, and your family is burdened with that debt?

 

What's the solution there? You're OK with going into lifelong debt, not accepting healthcare you can't pay for, or passing that debt along to your kin?

 

Why, when every other first-world nation has figured out how to treat their citizens without them going into debt? Why should America/Americans be uniquely burdened like this?

 

Funny that you mention cancer. My grandma died from cancer when my dad was 11 years old. My grandpa would hear of a rumor of a new cure for cancer so he'd pack up grandma in the car and take off. He racked up a debt of over $250,000 in the late 40's/early 50's. He was a blacksmith and he still managed to repay every penny.

 

Grandpa believed that you do what it takes to pay your debt as long as its honest work. They just don't make men like grandpa anymore.

 

I'll ask that if things in America aren't to your liking, and you already know where things ARE to your liking, why have you not moved? Its a serious question because it's what I would do.

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Moiraine    5,955

 

 

Then you get a job that offers health insurance as a benefit.

 

If the situation changes rapidly enough that I can't get health insurance in time? Then that's my fault and I'm the only one responsible for the debt and the decision that put me in debt.

People get cancer diagnoses out of the clear blue sky. And then what do you do? Just not accept healthcare? Accept it, run debt up into the hundreds of thousands of dollars (two different family members have had cancer costing over two hundred thousand in healthcare), and then either spend the rest of your life in debt? Or you die, and your family is burdened with that debt?

 

What's the solution there? You're OK with going into lifelong debt, not accepting healthcare you can't pay for, or passing that debt along to your kin?

 

Why, when every other first-world nation has figured out how to treat their citizens without them going into debt? Why should America/Americans be uniquely burdened like this?

Funny that you mention cancer. My grandma died from cancer when my dad was 11 years old. My grandpa would hear of a rumor of a new cure for cancer so he'd pack up grandma in the car and take off. He racked up a debt of over $250,000 in the late 40's/early 50's. He was a blacksmith and he still managed to repay every penny.

 

Grandpa believed that you do what it takes to pay your debt as long as its honest work. They just don't make men like grandpa anymore.

 

I'll ask that if things in America aren't to your liking, and you already know where things ARE to your liking, why have you not moved? Its a serious question because it's what I would do.

 

People who say things like the last paragraph aren't thinking. We want the US to be the best it can be. Why would we pack up and quit? People should just leave when they don't like something, instead of try to fix it? What?

 

If people like your grandpa don't exist here anymore why don't you leave? See how silly this is?

 

And knapp isn't a follower of the dude who wants to "Make America Great Again."

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zoogs    6,367

I want to focus on what funhusker said in response. I absolutely agree that people who need health insurance should be able to afford it. But a big part of that is people who don't obviously need it being required to buy it as well.

 

A young person who gets hit with a crushing cancer diagnosis needs healthcare no less than an older person. These are people in a common boat. A system where nobody buys healthcare until they reach a point where they need it cannot be affordable. It would be like a world where nobody buys auto insurance until they crash their car.

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Comfortably Numb    5,061

JJ - Sorry to hear about your experience. As a small business owner in Colorado for 10+ years now, I have had to deal with the same issues. However, my experience is the exact opposite of yours in terms of cost, premium increases, and quality of coverage. My family has more medical issues than anyone I have ever met. As an employee for others I had stellar insurance. As a business it's been pretty close to that. With the ACA, our costs came down a lot. I will say that Anthem BCBS and Kaiser are probably the two worst providers for small businesses. I have had an insurance broker even before starting my own company. I would strongly urge you to find a good broker as I think it would make a world of difference.

 

It has been my position for years that the main reason for premium increases is simply because the insurance companies can do it. I have experience with claims processing systems and revenue assurance projects for the largest insurance providers. Imo, health insurance cannot be a free & open market; how can it be when it is literally a matter of life & death? It is a monopolistic, collusion based system.

We had a good broker prior to the ACA, and I still consult with them from time to time when I have questions even though I am no longer purchasing anything through them (although I very well may be again soon). We literally looked at every plan available and for the last few years, Anthem BCBS was the best available for our very small group. A lot of the problem was that our group was fairly old (nobody under 40...) with no young pups to help balance it out. And now that I am in the Colo health exchange, I compare every available plan every year and so far, Kaiser has been my best option. I have no idea what they are like in the small group market but they are the best (at least premium wise) for my particular family situation.

 

I would disagree with placing all the blame on insurance companies simply because they could raise premiums at will. All you need to do is look at how much healthcare costs have increased to see that a good portion of those premium increases were well founded. I won't say insurance companies had no hand in it or weren't greedy and bloated but they sure aren't the only ones to blame. Physicians making money extremely out of line with what normal folk earn, drug companies charging outrageous amounts for drugs and the FDA helps protect them doing it, all of the cover your ass testing providers do- necessary because of the prevalence of lawsuits, uninsured care costs being passed on to people who actually have insurance, lots of people who run to the doctor or emergency room every time they get a sniffle, layers and layers of paperwork and bureaucracy in hospitals and insurance companies. There are a bunch of reasons why the costs are out of control. The only one of these that the ACA began to try to address was stipulating that a certain percentage of their expenses had to go directly to patient care rather than layer upon layer of managers etc. But we all know how they get around that kind of "sounds good" bs.

 

I do agree that it cannot be a free and open, for profit, industry. When the only choice you have is spend the money or ignore your health, it can't be.

 

The system is completely f#cked up and broken. Whatever replacement they come up with, they need to maintain a mandate for coverage, continue covering all pre-existing conditions, have no lifetime cap, find a way to get everyone covered and then fix the real problem which is costs and premiums that are ridiculously out of control. It's been that way for a long, long time and it only has gotten worse since the ACA. A good start would be an overhaul of the FDA and their protectionist policies that let drug makers gouge us forever. All of the problems will be fixable if they just figure out a way to rein in costs. The big challenge will be doing that while maintaining accessibility of care.

 

Sorry, I'll stop my rant now before I get really carried away.

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Comfortably Numb    5,061

 

 

Then you get a job that offers health insurance as a benefit.

 

If the situation changes rapidly enough that I can't get health insurance in time? Then that's my fault and I'm the only one responsible for the debt and the decision that put me in debt.

People get cancer diagnoses out of the clear blue sky. And then what do you do? Just not accept healthcare? Accept it, run debt up into the hundreds of thousands of dollars (two different family members have had cancer costing over two hundred thousand in healthcare), and then either spend the rest of your life in debt? Or you die, and your family is burdened with that debt?

 

What's the solution there? You're OK with going into lifelong debt, not accepting healthcare you can't pay for, or passing that debt along to your kin?

 

Why, when every other first-world nation has figured out how to treat their citizens without them going into debt? Why should America/Americans be uniquely burdened like this?

 

Funny that you mention cancer. My grandma died from cancer when my dad was 11 years old. My grandpa would hear of a rumor of a new cure for cancer so he'd pack up grandma in the car and take off. He racked up a debt of over $250,000 in the late 40's/early 50's. He was a blacksmith and he still managed to repay every penny.

 

Grandpa believed that you do what it takes to pay your debt as long as its honest work. They just don't make men like grandpa anymore.

 

I'll ask that if things in America aren't to your liking, and you already know where things ARE to your liking, why have you not moved? Its a serious question because it's what I would do.

 

Sorry Elf, that is pure bullsh#t. People should not have to go broke and work their whole lives to pay off medical care debt. There has to be a better way. What your Grandpa did was noble and to be commended but it shouldn't be required.

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RedDenver    1,799

 

 

 

Then you get a job that offers health insurance as a benefit.

 

If the situation changes rapidly enough that I can't get health insurance in time? Then that's my fault and I'm the only one responsible for the debt and the decision that put me in debt.

People get cancer diagnoses out of the clear blue sky. And then what do you do? Just not accept healthcare? Accept it, run debt up into the hundreds of thousands of dollars (two different family members have had cancer costing over two hundred thousand in healthcare), and then either spend the rest of your life in debt? Or you die, and your family is burdened with that debt?

 

What's the solution there? You're OK with going into lifelong debt, not accepting healthcare you can't pay for, or passing that debt along to your kin?

 

Why, when every other first-world nation has figured out how to treat their citizens without them going into debt? Why should America/Americans be uniquely burdened like this?

 

Funny that you mention cancer. My grandma died from cancer when my dad was 11 years old. My grandpa would hear of a rumor of a new cure for cancer so he'd pack up grandma in the car and take off. He racked up a debt of over $250,000 in the late 40's/early 50's. He was a blacksmith and he still managed to repay every penny.

 

Grandpa believed that you do what it takes to pay your debt as long as its honest work. They just don't make men like grandpa anymore.

 

I'll ask that if things in America aren't to your liking, and you already know where things ARE to your liking, why have you not moved? Its a serious question because it's what I would do.

 

Sorry Elf, that is pure bullsh#t. People should not have to go broke and work their whole lives to pay off medical care debt. There has to be a better way. What your Grandpa did was noble and to be commended but it shouldn't be required.

 

Agreed. And the frustrating part of this is that literally dozens of countries have already solved this problem - for decades now. The US is the richest country in the history of the world, how are we not able to implement a known solution?

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BigRedBuster    8,066

 

 

So when a doctor gets a bonus from a pharmaceutical company for prescribing needless medication, it doesn't concern or bother you?

It's not happening as much as you think. Most physicians who are affiliated with an institution either have limits in what they can "earn" for consulting/speaking or they're not allowed to do anything with industry.

 

You can verify individuals payments here (as well as state info, hospital info)- if you want to see if your physician is working with industry: https://projects.propublica.org/docdollars/

 

What about doctors that own their own practice? Isn't that quite common? (I honestly don't know.)

 

Who cares if they do?

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BigRedBuster    8,066

 

Speaking only on the topic of the mandate...

 

 

When I was young I was incredibly healthy, only got sick on very rare occasions, so I never bought health insurance. I simply didn't need it.

 

I disagree with this. As far as you knew you were healthy, and fortunately you didn't end up needing it. What if you had suddenly learned otherwise -- or your situation unexpectedly changed? I'm glad it didn't, but what are your options then?

 

Then you get a job that offers health insurance as a benefit.

 

If the situation changes rapidly enough that I can't get health insurance in time? Then that's my fault and I'm the only one responsible for the debt and the decision that put me in debt.

 

As an employer that offers full health benefits, this comment is full bullsh#t.

 

So...you only want to work for me until you get terminally ill and I'm the one paying for it.

 

 

 

 

 

 

 

 

 

 

Yes....I've been in this situation before.

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ColoNoCoHusker    396

I am not saying ALL blame goes on the insurance companies. I would say out of all the factors/parties involved, this is the single largest individual contributor that can be changed. Conservatively on the order of 30% of the whole, imo. There is definitely an issue with the actual rising costs of healthcare. However premium increases have outpaced healthcare cost increases for a long time.

We have done a number of projects for the largest healthcare insurance providers the past couple years. One thing we found was for every 1.2% increase in healthcare costs, premiums were raised over 3%. This is on the conservative side. The corollary would be for a car manufacturer to build the sales commission into the vehicle price delivered to the car lot. The car lot then adds sales commission into the price of the vehicle on top their margin after delivery. Once the vehicle is sold, they charge commission a third time on top of the price of the vehicle. However, only the first commission calculation is paid to the sales person. No other industry can double to triple stack cost margins the way healthcare insurance does.

These insurance providers routinely spend hundreds of thousands of dollars to save tens of thousands of dollars or less. One of the largest healthcare providers in this country automatically placed 10% of the incoming claims into research status for revenue deferment. This required several hundred staff to handle the call volume created plus numerous additional people to actually research the claim. Given that most claims were small, this was far from cost effective. We could have implemented a software solution for ~$230k that would have attained better revenue deferment with a cost savings to the company on the order of ~$30mil annually. The client could not get past their internal politics to move on it.

The waste in the largest healthcare insurance companies is brazen at best and criminal at worst. These companies functionally establish the market premium prices. I have never seen the largest healthcare provider raise premiums without the next 20+ companies doing the same, like dominoes.

I could go on with more stories and these examples are the tamest of the bunch. Don't get me wrong, healthcare providers, pharma companies, insured, insurance providers, government, employers, etc all have plenty of blame to share in this. From my perspective though, insurance providers are the least incentivized to improve efficiency and control costs out of all parties involved and it's not even close.

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dudeguyy    3,490

Two things I'd like to touch on quick:

Elf brought up the concept of attaining good private healthcare by finding the right job that will offer it. Unfortunately, as was said, that doesn't work for some folks. Cancer, disability and other expensive chronic conditions can rack up a huge bill in no time, and usually folks with those conditions literally CAN'T work a job for insurance purposes. Those with disabilities may not qualify for Medicare. So for this subset of folks, the private insurance market is entirely out of the picture, as well as some government plans. I personally have a moral problem with just hanging those people out to dry. I know it's not the smartest move fiscally, but I was taught that we should look out for the weakest among us, not cast them aside.

Secondly, unfortunately, Elf, one of the best parts of the ACA were the provisions that put a cap on the amount insurance companies can charge their older, sicker patients. I believe the blanket rule is that they currently can charge older patients no more than 3x the amount they charge younger people. From what I've read, Republicans may be tossing aside those protections with their plans. I don't like hearing that and I hope it doesn't come to fruition.

 

Best of luck with your health, man! I hope you get back to feeling as good as you can.

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dudeguyy    3,490

I am not saying ALL blame goes on the insurance companies. I would say out of all the factors/parties involved, this is the single largest individual contributor that can be changed. Conservatively on the order of 30% of the whole, imo. There is definitely an issue with the actual rising costs of healthcare. However premium increases have outpaced healthcare cost increases for a long time.

 

We have done a number of projects for the largest healthcare insurance providers the past couple years. One thing we found was for every 1.2% increase in healthcare costs, premiums were raised over 3%. This is on the conservative side. The corollary would be for a car manufacturer to build the sales commission into the vehicle price delivered to the car lot. The car lot then adds sales commission into the price of the vehicle on top their margin after delivery. Once the vehicle is sold, they charge commission a third time on top of the price of the vehicle. However, only the first commission calculation is paid to the sales person. No other industry can double to triple stack cost margins the way healthcare insurance does.

 

These insurance providers routinely spend hundreds of thousands of dollars to save tens of thousands of dollars or less. One of the largest healthcare providers in this country automatically placed 10% of the incoming claims into research status for revenue deferment. This required several hundred staff to handle the call volume created plus numerous additional people to actually research the claim. Given that most claims were small, this was far from cost effective. We could have implemented a software solution for ~$230k that would have attained better revenue deferment with a cost savings to the company on the order of ~$30mil annually. The client could not get past their internal politics to move on it.

 

The waste in the largest healthcare insurance companies is brazen at best and criminal at worst. These companies functionally establish the market premium prices. I have never seen the largest healthcare provider raise premiums without the next 20+ companies doing the same, like dominoes.

 

I could go on with more stories and these examples are the tamest of the bunch. Don't get me wrong, healthcare providers, pharma companies, insured, insurance providers, government, employers, etc all have plenty of blame to share in this. From my perspective though, insurance providers are the least incentivized to improve efficiency and control costs out of all parties involved and it's not even close.

 

Having your insight here has been fantastic, Colo. Thanks for bringing your info to the table.

 

This to me illustrates the problem with a strictly free market-based approach. Encouraging competition and consumer choice is great, but there's little there as is to incentivize insurance companies to bring costs down without some level of government intervention, IMO.

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knapplc    19,301

 

 

Then you get a job that offers health insurance as a benefit.

 

If the situation changes rapidly enough that I can't get health insurance in time? Then that's my fault and I'm the only one responsible for the debt and the decision that put me in debt.

People get cancer diagnoses out of the clear blue sky. And then what do you do? Just not accept healthcare? Accept it, run debt up into the hundreds of thousands of dollars (two different family members have had cancer costing over two hundred thousand in healthcare), and then either spend the rest of your life in debt? Or you die, and your family is burdened with that debt?

 

What's the solution there? You're OK with going into lifelong debt, not accepting healthcare you can't pay for, or passing that debt along to your kin?

 

Why, when every other first-world nation has figured out how to treat their citizens without them going into debt? Why should America/Americans be uniquely burdened like this?

 

Funny that you mention cancer. My grandma died from cancer when my dad was 11 years old. My grandpa would hear of a rumor of a new cure for cancer so he'd pack up grandma in the car and take off. He racked up a debt of over $250,000 in the late 40's/early 50's. He was a blacksmith and he still managed to repay every penny.

 

Grandpa believed that you do what it takes to pay your debt as long as its honest work. They just don't make men like grandpa anymore.

 

I'll ask that if things in America aren't to your liking, and you already know where things ARE to your liking, why have you not moved? Its a serious question because it's what I would do.

 

I'll call 100% bullsh#t on a 1950s-era American Blacksmith making enough money to 1) pay off a $250,000 debt starting in the 1950s and 2) doing it while working as a Blacksmith.

 

First, a Blacksmith is a uniquely unusual trade to be engaged in in the 1950s. But they exist today, so let's say he had a tremendously unique niche job. OK.

 

Today, a Blacksmith will make between $30,000 and $75,000. In 1950s money, that's $2,500-$6,300 per year. Presuming your grandpa was an EXCELLENT Blacksmith, let's make him a top earner at $6,300/year, and heck, because we're generous, let's double his salary.

 

So your grandpa, as a 1950s-era Blacksmith par excellence, made $12,600 per year. He had bills, obviously, like food (29% of his expenditures in the 1950s), housing (27%), apparel (11%), and healthcare (5%). We won't even count his expenditures on kids (presuming only one, your dad), travel (for grandma's treatment) entertainment, or anything else. He lived a Spartan life. At $12,600 per year, with those normal expenditures, he would have had about $3,500 per year to apply to that debt.

 

Even presuming no interest on that debt, it would have taken him 71 years to pay it off, again presuming zero other expenditures and no money spent on children or anything like travel, a new couch, a TV - nothing else. We could even give him cost-of-living raises as the years go by and it would still have taken him over 40 years, starting from 1950, to pay that off. If he wasn't the best Blacksmith in the country and didn't make double that salary, we're talking a debt that isn't paid off to this day.

 

Either you're not telling us the whole story, you're not privy to the actual story, or this isn't remotely true.

 

I'll be the first to admit I'm no economist, so if someone wants to fact-check my numbers by all means please do.

 

 

 

Further, what is this nonsensical idea that, if I don't like what's happening in my country, I need to leave?

 

Is that what America is to you? As soon as you don't like it, if you know of a better system somewhere else, you give up your citizenship and move on? I think America is much more than that, personally. I think it's worth fighting for. I think if I don't like something about this country, it's my obligation to roll up my sleeves and work to make it better. Sounds like, according to your story, that's what your grandpa would have done. Maybe they just don't make men like your grandpa anymore in your family.

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RedDenver    1,799

 

 

 

So when a doctor gets a bonus from a pharmaceutical company for prescribing needless medication, it doesn't concern or bother you?

It's not happening as much as you think. Most physicians who are affiliated with an institution either have limits in what they can "earn" for consulting/speaking or they're not allowed to do anything with industry.

 

You can verify individuals payments here (as well as state info, hospital info)- if you want to see if your physician is working with industry: https://projects.propublica.org/docdollars/

 

What about doctors that own their own practice? Isn't that quite common? (I honestly don't know.)

 

Who cares if they do?

 

It would affect the statement I quoted, "Most physicians who are affiliated with an institution either have limits in what they can "earn" for consulting/speaking or they're not allowed to do anything with industry."

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